Orientador: Lais Helena Navarro e Lima / Resumo: Justificativa e objetivos: a população mundial está envelhecendo, implicando em aumento na incidência de doenças musculoesqueléticas com necessidade cirúrgica. Lesões geriátricas típicas acomentem quadril, joelho e coluna. Procedimentos cirúrgicos nesta população são de alto risco de morbimortalidade e há falta de dados nacionais sobre esses desfechos. O objetivo primário deste estudo foi descrever e analisar os eventos adversos associados ao tratamento cirúrgico para correção de fratura de fêmur, para coxartrose, para doenças da coluna vertebral e para artroplastia total de joelho, com particular atenção para taxas e causas específicas de mortalidade. Métodos: foi realizado estudo prospectivo, observacional, para avaliar as complicações perioperatórias em pacientes submetidos à cirurgia para correção de doenças de quadril, joelho e coluna. Os pacientes foram avaliados segundo questionário pré-operatório e realizado acompanhamento durante o primeiro ano de pós-operatório com dados do prontuário eletrônico e contatos telefônicos. Na análise descritiva, as variáveis foram expressas em média±desvio padrão e em porcentagens, ou em medianas e quartis. O teste de Mann-Whitney foi aplicado para a análise estatística, pois as variáveis não apresentaram distribuição normal. Foi realizada regressão logística para as variáveis categóricas e contínuas, expressando razão de chances de óbito. A sobrevida foi avaliada pelo modelo de Kaplan-Meier. As análises estatísticas foram realizadas po... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Background: surgery for musculoskeletal conditions is among of the fastest growing groups of surgical procedures across the world. Patients undergoing these surgical procedures are at high risk of postoperative complications. At present, however, we lack robust data on postoperative outcomes for the most frequent performed musculoskeletal surgical procedures in Brazil. Accordingly, we aimed to describe and analyze adverse events associated with musculoskeletal surgical procedures, with focus on cause-specific mortality. Methods: we propose a prospective observational clinical trial using data from a preoperative questionnaire and from the electronic medical records of the Clinics Hospital of Botucatu Medical School, Botucatu, Sao Paulo, Brazil. Patients admitted to the hospital for surgical procedures performed for hip fracture, and for hip, knee, and spinal surgeries were enrolled in the study. Measures of health care use associated with the principal surgical procedure included length of hospital stay, readmission to hospital, and mortality. Postoperative complications were evaluated at moments within the first postoperative year (one week, one month, four months, and one year after surgery). Variables were expressed as mean ± standard deviation and percentages or median and quartis for the descriptive analysis. Mann-Whitney test was applied when variables did not present with a normal distribution. Survival curves were assessed by the Kaplan- Meier model. Results: through ... (Complete abstract click electronic access below) / Doutor

Orientador: Lais Helena Navarro e Lima / Resumo: Justificativa e objetivos: a população mundial está vivendo mais, incorrendo em aumento da incidência de doenças musculoesqueléticas com necessidade cirúrgica, sendo que fratura de fêmur (FF) e coxartrose (CXT) são lesões geriátricas típicas. Procedimentos cirúrgicos nessa população são de alto risco de morbimortalidade e há falta de dados nacionais sobre esses desfechos. O objetivo deste estudo foi analisar os eventos adversos intra e pós-operatórios precoces em pacientes submetidos ao tratamento cirúrgico para correção de FF e para CXT e sua associação com a mortalidade em um ano de seguimento pós-operatório. Métodos: foi realizado estudo prospectivo, observacional para avaliar as complicações perioperatórias em pacientes submetidos à cirurgia para correção de FF e tratamento de CXT. Os pacientes foram avaliados em todo o período perioperatório e acompanhados durante um ano. Os testes de t de Student e qui-quadrado foram aplicados para a análise estatística para verificar as relações de dependência. A análise de sobrevivência foi realizada pelo modelo de Kaplan-Meier e pela regressão univariada e multivariada de Cox. Resultados: foram arrolados 235 pacientes candidatos a participar do estudo. Contudo 27 pacientes foram excluídos por diferentes razões. Entre os 208 pacientes inclusos, 42 foram submetidos ao tratamento cirúrgico de CXT; 166, à cirurgia para correção de FF. Houve predomínio de pacientes do sexo feminino no grupo que foi submetido à cirurgia para correção de FF... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Background: The world population is aging, incurring an increase in the incidence of musculoskeletal diseases with surgical necessity. Femur fracture and coxarthrosis are typical geriatric lesions. Surgical procedures in this population are at high risk of morbidity and mortality, and there is a lack of national data on these outcomes. The objective of this study was to describe and analyze early intraoperative and postoperative adverse events in patients undergoing surgical treatment for femoral fracture and for coxarthrosis and its association with mortality in one year of postoperative follow-up. Methods: A prospective, observational study was conducted to evaluate perioperative complications in patients undergoing to surgery for treatment of femur fracture and coxarthrosis. The patients were evaluated throughout the perioperative period and followed up for one year. Student's t-test and chi-square test were applied to the statistical analysis to verify the dependency ratios. Survival analysis was performed using the Kaplan-Meier model and Cox's univariate and multivariate regression. Results: 235 patients were enrolled in the study. However, 27 patients were excluded for different reasons. Among the 208 patients included, 42 underwent surgical treatment of coxarthrosis, 166 to surgery for femoral fracture. There was a predominance of female patients in the group that underwent surgery for femur fracture, while in the group of patients who underwent surgery for correction ... (Complete abstract click electronic access below) / Doutor

Submitted by Fabio Caetano Oliveira Leme (fabio.leme@hotmail.com) on 2018-10-10T02:40:34Z No. of bitstreams: 1 TESE ATELIÊ_2out (1).pdf: 1086669 bytes, checksum: a97e594b7be9b6a9762f9990c060effa (MD5) / Approved for entry into archive by ROSANGELA APARECIDA LOBO null (rosangelalobo@btu.unesp.br) on 2018-10-11T13:34:09Z (GMT) No. of bitstreams: 1 leme_fco_me_bot.pdf: 1086669 bytes, checksum: a97e594b7be9b6a9762f9990c060effa (MD5) / Made available in DSpace on 2018-10-11T13:34:09Z (GMT). No. of bitstreams: 1 leme_fco_me_bot.pdf: 1086669 bytes, checksum: a97e594b7be9b6a9762f9990c060effa (MD5) Previous issue date: 2018-08-27 / Justificativa e objetivos: a população mundial está vivendo mais, incorrendo em aumento da incidência de doenças musculoesqueléticas com necessidade cirúrgica, sendo que fratura de fêmur (FF) e coxartrose (CXT) são lesões geriátricas típicas. Procedimentos cirúrgicos nessa população são de alto risco de morbimortalidade e há falta de dados nacionais sobre esses desfechos. O objetivo deste estudo foi analisar os eventos adversos intra e pós-operatórios precoces em pacientes submetidos ao tratamento cirúrgico para correção de FF e para CXT e sua associação com a mortalidade em um ano de seguimento pós-operatório. Métodos: foi realizado estudo prospectivo, observacional para avaliar as complicações perioperatórias em pacientes submetidos à cirurgia para correção de FF e tratamento de CXT. Os pacientes foram avaliados em todo o período perioperatório e acompanhados durante um ano. Os testes de t de Student e qui-quadrado foram aplicados para a análise estatística para verificar as relações de dependência. A análise de sobrevivência foi realizada pelo modelo de Kaplan-Meier e pela regressão univariada e multivariada de Cox. Resultados: foram arrolados 235 pacientes candidatos a participar do estudo. Contudo 27 pacientes foram excluídos por diferentes razões. Entre os 208 pacientes inclusos, 42 foram submetidos ao tratamento cirúrgico de CXT; 166, à cirurgia para correção de FF. Houve predomínio de pacientes do sexo feminino no grupo que foi submetido à cirurgia para correção de FF, enquanto, no grupo de pacientes que foram submetidos à cirurgia para correção de CXT, a predominância foi do sexo masculino. Com relação à classificação do estado físico, a grande maioria dos pacientes submetidos à cirurgia para correção de CXT apresentou-se classificada com ASA I e II, enquanto 53% dos pacientes submetidos à cirurgia para correção de FF apresentaram-se classificados como ASA III e IV. Os pacientes com FF apresentaram idade média de 73,8±12,5 anos, intervalo médio entre a fratura e a cirurgia de 8,1±8,5 dias, e entre a internação e a cirurgia de 4,7±4,8 dias. Os pacientes submetidos ao tratamento para CXT apresentaram idade de 67,2±7,9 anos. Hipotensão destacou-se por ser o evento mais frequente no período intraoperatório. As complicações pós-operatórias mais frequentes foram distúrbio hidroeletrolítico, alteração cognitiva, reinternação, infecção do trato urinário, pneumonia e reabordagem cirúrgica. Nenhum paciente submetido à artroplastia de quadril morreu. Para os pacientes submetidos à correção de FF, a taxa de mortalidade foi de 25,3%. Dentre as causas esclarecidas, a mais comum foi sepse. As complicações pós-operatórias que mostraram relação com aumento da taxa de mortalidade foram idade, intervalo entre internação e cirurgia, distúrbio hidroeletrolítico, insuficiência respiratória, necessidade de intubação orotraqueal, reinternação hospitalar, arritmia e a soma da quantidade de complicações. Na análise multivariada, o modelo estatístico final apresentou as variáveis idade e DHE como as complicações que, conjuntamente, exerceram efeito sobre o aumento da mortalidade no período de 365 dias. Conclusões: as cirurgias para correção de CXT na população estudada relacionou-se com baixa incidência de complicações pós-operatórias e não ocorreram óbitos relacionados a esse procedimento. A taxa de mortalidade encontrada na população de FF, no primeiro ano de seguimento, foi de 25,3%. Idade avançada e distúrbio hidroeletrolítico pós-operatório foram fatores preditores de mortalidade no primeiro ano após cirurgia para pacientes idosos submetidos à correção de FF. / Background: The world population is aging, incurring an increase in the incidence of musculoskeletal diseases with surgical necessity. Femur fracture and coxarthrosis are typical geriatric lesions. Surgical procedures in this population are at high risk of morbidity and mortality, and there is a lack of national data on these outcomes. The objective of this study was to describe and analyze early intraoperative and postoperative adverse events in patients undergoing surgical treatment for femoral fracture and for coxarthrosis and its association with mortality in one year of postoperative follow-up. Methods: A prospective, observational study was conducted to evaluate perioperative complications in patients undergoing to surgery for treatment of femur fracture and coxarthrosis. The patients were evaluated throughout the perioperative period and followed up for one year. Student's t-test and chi-square test were applied to the statistical analysis to verify the dependency ratios. Survival analysis was performed using the Kaplan-Meier model and Cox's univariate and multivariate regression. Results: 235 patients were enrolled in the study. However, 27 patients were excluded for different reasons. Among the 208 patients included, 42 underwent surgical treatment of coxarthrosis, 166 to surgery for femoral fracture. There was a predominance of female patients in the group that underwent surgery for femur fracture, while in the group of patients who underwent surgery for correction of coxarthrosis, the predominance was male. Regarding the classification of the physical condition, the great majority of patients under going surgery for correction of coxarthrosis were classified as ASA I and II, while 53% of patients submitted to surgery for femur fracture were classified as ASA III and IV. Patients with a femoral fracture had a mean age of 73.8 ± 12.5 years, mean interval between fracture and surgery of 8.1 ± 8.5 days, and between hospitalization and surgery of 4.7 ± 4.8 days. Patients submitted to treatment for coxarthrosis presented age of 67.2 ± 7.9 years. Hypotension was noted as the most frequent event in the intraoperative period. The most frequent postoperative complications were hydroeletrolytic disorder, cognitive alteration, rehospitalization, urinary tract infection, pneumonia, need for re- operatorion. No patient undergoing treatment for coxarthrosis died. For patients submitted to femur fracture surgery, the mortality rate was 25.3%. Among the clarified causes of death, the most common was sepsis. The complications that were found to be related to increased mortality were age, interval between hospitalization and surgery, hydroelectrolytic disorder, respiratory failure, need for orotracheal intubation, rehospitalization, arrhythmia, and the sum of the number of complications. After the Multivariate Cox Regression, the final statistical model presented the variables age and hydroelectrolytic diturb as the complications that, all together, had an effect on the increase in mortality in the period of 365 days. Conclusions: surgery to treat coxarthrosis was associated with a low incidence of postoperative complications and there were no deaths related to this procedure. The mortality rate found in the femure fracture population in the first year of follow-up was 25.3%. Advanced age and postoperative hydroelectrolytic disturbance were predictors of mortality in the first year after surgery for elderly patients submitted to femoral fracture correction.

Submitted by TALITA DE ALMEIDA BARBOSA null (talita_ab1@hotmail.com) on 2018-02-26T18:11:42Z No. of bitstreams: 1 Talita de Almeida Barbosa (doutorado) apos a defesa - biblioteca.pdf: 976358 bytes, checksum: 33b6e1dbd788795aab2bd2d965f7254c (MD5) / Approved for entry into archive by ROSANGELA APARECIDA LOBO null (rosangelalobo@btu.unesp.br) on 2018-02-27T13:20:11Z (GMT) No. of bitstreams: 1 barbosa_ta_dr_bot.pdf: 976358 bytes, checksum: 33b6e1dbd788795aab2bd2d965f7254c (MD5) / Made available in DSpace on 2018-02-27T13:20:11Z (GMT). No. of bitstreams: 1 barbosa_ta_dr_bot.pdf: 976358 bytes, checksum: 33b6e1dbd788795aab2bd2d965f7254c (MD5) Previous issue date: 2018-02-06 / Justificativa e objetivos: a população mundial está envelhecendo, implicando em aumento na incidência de doenças musculoesqueléticas com necessidade cirúrgica. Lesões geriátricas típicas acomentem quadril, joelho e coluna. Procedimentos cirúrgicos nesta população são de alto risco de morbimortalidade e há falta de dados nacionais sobre esses desfechos. O objetivo primário deste estudo foi descrever e analisar os eventos adversos associados ao tratamento cirúrgico para correção de fratura de fêmur, para coxartrose, para doenças da coluna vertebral e para artroplastia total de joelho, com particular atenção para taxas e causas específicas de mortalidade. Métodos: foi realizado estudo prospectivo, observacional, para avaliar as complicações perioperatórias em pacientes submetidos à cirurgia para correção de doenças de quadril, joelho e coluna. Os pacientes foram avaliados segundo questionário pré-operatório e realizado acompanhamento durante o primeiro ano de pós-operatório com dados do prontuário eletrônico e contatos telefônicos. Na análise descritiva, as variáveis foram expressas em média±desvio padrão e em porcentagens, ou em medianas e quartis. O teste de Mann-Whitney foi aplicado para a análise estatística, pois as variáveis não apresentaram distribuição normal. Foi realizada regressão logística para as variáveis categóricas e contínuas, expressando razão de chances de óbito. A sobrevida foi avaliada pelo modelo de Kaplan-Meier. As análises estatísticas foram realizadas por meio do software IBM SPSS STATISTICS V.21. Resultados: foram arrolados 400 pacientes candidatos a participar do estudo. Contudo, 38 pacientes foram excluídos por diferentes razões. Entre os 362 pacientes incluídos, 54 foram submetidos ao tratamento cirúrgico de coxartrose, 210 à cirurgia para correção de fratura de fêmur (FF), 10 à artroplastia total de joelho (ATJ) e 88 foram submetidos à cirurgia de coluna. A maioria dos pacientes submetidos à ATJ eram do sexo feminino (80,0%), apresentaram média de idade de 69,0±9,9 anos, 90% foram classificados como ASA I ou II e 60% são hipertensos. Em relação às complicações pós-operatórias, um paciente apresentou distúrbio hidroeletrolítico, lesão renal aguda (LRA) e pneumonia e outro apresentou depressão no acompanhamento de um ano de pós-operatório. Não houve óbito durante o seguimento. Dos pacientes submetidos à cirurgia de coluna, 52,3% eram do sexo masculino. A média de idade foi de 62,5±10,3 anos e 79,5% eram ASA III ou IV. Em relação às comorbidades prévias à cirurgia, 45,5% eram hipertensos e 25% diabéticos. A complicação pós-operatória mais frequente neste grupo foi distúrbio hidroeletrolítico (25,0%). A taxa de mortalidade foi de 13,6% em 1 ano, tendo com principal causa de óbito infecção seguida de choque séptico (41,7%). Pacientes submetidos à cirurgia de coluna que apresentaram ASA ≥ III cursaram com menor sobrevida em um ano. Metade dos pacientes submetidos à cirurgia para coxartrose eram do sexo feminino. A média de idade foi de 66,3 ± 8,3 anos e 88,9% eram ASA I ou II. Em relação às comorbidades prévias à cirurgia, 64,9% hipertensos, 22,2% hipotireoideos e 14,8% diabéticos. As complicações pósoperatórias mais frequentes foram depressão (5,6%), distúrbio hidroeletrolítico (5,6%) e pneumonia (5,6%). Nenhum paciente faleceu no seguimento de um ano. Em relação à cirurgia para correção de FF, 73,3% dos pacientes eram do sexo feminino. A média de idade foi de 75,2 ± 12,5 anos, 50,5% dos pacientes eram ASA III ou IV. Em relação às comorbidades, 42,4% eram hipertensos e 17,6% eram diabéticos. As complicações pós-operatórias mais frequentes neste grupo foram alterações eletrolíticas (18,6%), alterações cognitivas (12,4%), pneumonia (10,5%) e infecção do trato urinário (10,0%). Sessenta indivíduos do grupo de pacientes submetidos à cirurgia para correção de FF foram a óbito (taxa de mortalidade = 28,6%), tendo como causa principal a infecção seguida de choque séptico (31,7%). Pacientes submetidos à cirurgia para tratamento de FF que apresentaram idade ≥ 78 anos, ASA ≥ III, delirium hipoativo pré-operatório, alteração cognitiva pós-operatória, distúrbio hidroeletrolítico pós-operatório e LRA pós-operatória cursaram com menor sobrevida em um ano. Após análise de regressão logística, obteve-se que, com o aumento de cada ano na idade, há aumento correspondente de 4,1% da razão de chanches de óbito nos pacientes com FF. Pacientes com FF classificados como ASA III ou IV apresentaram razão de chances de óbito aumentada em 2,0 vezes quando comparados aos ASA I ou II. A presença de delirium hipoativo no pré-operatório aumentou em dezoito vezes a razão de chances de óbito nestes pacientes, assim como a presença de distúrbio hidroeletrolítico pós-operatório aumentou em 8,4 vezes a razão de chances de óbito. Conclusões: as cirurgias de quadril, joelho e coluna na população estudada relacionaram-se com alta prevalência de complicações pósoperatórias. Não houve óbitos relacionados à cirurgia de ATJ ou ao tratamento de coxartrose. As complicações perioperatórias mais frequentes em todos os grupos foram os distúrbios hidroeletrolíticos. A taxa de mortalidade encontrada na população de FF no primeiro ano de seguimento foi de 28,6%, enquanto a taxa de mortalidade nos pacientes submetidos à cirurgia de coluna foi de 13,6%. Pacientes submetidos à cirurgia de coluna classificados como ASA ≥ III apresentaram menor sobrevida em um ano. Idade avançada, ASA ≥ III, delirium hipoativo pré-operatório, alteração cognitiva pós-operatória, distúrbio hidroeletrolítico pós-operatório e LRA pós-operatória foram preditores de menor taxa de sobrevida em um ano no pós-operatório de pacientes submetidos à cirurgia para correção de FF. O aumento de cada ano na idade, pacientes classificados como ASA III ou IV, a presença de delirium hipoativo no período pré-operatório e a presença de distúrbio hidroeletrolítico pós-operatório aumentaram a razão de chances de óbito para os pacientes submetidos à cirurgia para correção de FF. / Background: surgery for musculoskeletal conditions is among of the fastest growing groups of surgical procedures across the world. Patients undergoing these surgical procedures are at high risk of postoperative complications. At present, however, we lack robust data on postoperative outcomes for the most frequent performed musculoskeletal surgical procedures in Brazil. Accordingly, we aimed to describe and analyze adverse events associated with musculoskeletal surgical procedures, with focus on cause-specific mortality. Methods: we propose a prospective observational clinical trial using data from a preoperative questionnaire and from the electronic medical records of the Clinics Hospital of Botucatu Medical School, Botucatu, Sao Paulo, Brazil. Patients admitted to the hospital for surgical procedures performed for hip fracture, and for hip, knee, and spinal surgeries were enrolled in the study. Measures of health care use associated with the principal surgical procedure included length of hospital stay, readmission to hospital, and mortality. Postoperative complications were evaluated at moments within the first postoperative year (one week, one month, four months, and one year after surgery). Variables were expressed as mean ± standard deviation and percentages or median and quartis for the descriptive analysis. Mann-Whitney test was applied when variables did not present with a normal distribution. Survival curves were assessed by the Kaplan- Meier model. Results: through the electronic medical record system, 400 patients were enrolled to participate in the study (97 of spine, 10 of total knee joint arthroplasty (TKA), 54 of coxarthrosis and 239 of femoral fracture (FF). However, 9 individuals of the spine were excluded from the study due to preoperative death (1) and conservative treatment (8), and 29 patients from FF were excluded from preoperative death (17), non-surgical conservative treatment (1), they underwent pelvic fracture correction surgery (5), they did not accept to participate in the study (4) or the surgery was performed in another service (2). Among the 362 patients, 54 were submitted to surgical treatment of coxarthrosis, 210 to surgery for correction of femoral fracture (FF), 10 to total knee arthroplasty due to arthrosis in the joint (TKA) and 88 underwent spinal surgery. The majority of patients submitted to TKA were female (80.0%). Mean age of 69.0 ± 9.9 years, 90.0% are ASA I or II, 60.0% are hypertensive. 1 patient presented hydroelectrolytic disturbance, acute renal injury (AKI) anda pneumonia and 1 presented depression at 1-year post-operative follow-up. There was no death during the follow-up. Of the patients in the spine, 52.3% were male. The mean age was 62.5 ± 10.3 years, 79.5% were ASA III or IV. 45.5% hypertensive, 25.0% diabetic. The most frequent postoperative complication was hydroelectrolytic disturbance (25.0%). The mortality rate was 13.6% at 1 year, with the main cause of death being infection followed by septic shock (41.7%). Patients submitted to spine surgery who presented ASA ≥ III had a shorter survival in one year. Half of the patients undergoing surgery for coxarthrosis were female. The mean age was 66.3 ± 8.3 years, 88.9% ASA I or II, 64.9% hypertensive, 22.2% hypothyroid, 14.8% diabetic. The most frequent postoperative complications were depression (5.6%), hydroelectrolytic disturbance (5.6%), and pneumonia (5.6%). No patient died in 1 year. 73.3% of the patients submitted to FF correction surgery were female. The mean age was 75.2 ± 12.5 years, 50.5% ASA III or IV, 42.4% hypertensive and 17.6% diabetic. The most frequent postoperative complications in FF patients were electrolytic alterations (18.6), cognitive alterations (12.4%), pneumonia (10.5%) and urinary tract infection (10.0%). Sixty patients from the group of patients submitted to FF correction surgery were submitted to death (mortality rate = 28.6%). The main causes were undetermined (40.0%) and infection followed by septic shock (31.7%). Patients with ASA ≥ III, aged ≥ 78 years, with preoperative hypoactive delirium, with postoperative cognitive alteration, with postoperative hydroelectrolytic disturbance and acute postoperative renal injury were found to be the lowest survival rate in one year of patients undergoing FF. After performing a logistic regression analysis with the data of the patient’s submitted to surgical treatment for FF correction, it was obtained that with the increase of each year in age, there is a corresponding increase of 4.1% of the death rate ratio. Patients classified as ASA III or IV presents the odds ratio for death increased by 2.0 times when compared to ASA I or II. The presence of hypoactive delirium preoperatively increases the odds ratio of death by eighteen times. The presence of a postoperative hydroelectrolytic disorder increases the odds of death by 8.4 times. Conclusions: the hip, knee and spine surgeries in the study population were related to a high prevalence of postoperative complications. There were no deaths related to TKA or to treatment of coxarthrosis. The most frequent perioperative complications in all groups were hydroelectrolytic disorders. The mortality rate found in the FF population in the first year of follow-up was 28.6%, while the mortality rate in patients undergoing spinal surgery was 13.6%. Advanced age, ASA ≥ III, preoperative hypoactive delirium, postoperative cognitive alteration, postoperative hydroelectrolytic disturbance and acute postoperative renal injury were predictors of lower postoperative survival rate of FF. The increase of each year in age, patients classified as ASA III or IV, the presence of hypoactive delirium in the preoperative period and the presence of hydroelectrolytic postoperative disorder increase the odds ratio of death for patients undergoing surgery for correction of FF.

Bei der internen, extramedullären Osteosynthese des distalen Femurs, auf die sich diese Arbeit fokussiert, haben sich in den letzten Jahren interessante Entwicklungen vollzogen. Ausgehend von unzufriedenstellenden Komplikationsraten wurden neue Wege in der Versorgung dieser schwierigen Frakturen gesucht. Osteosynthesematerialien, Repositionstechniken, die Technik der Implantatplatzierung und die Implantate selbst, bei denen die Entwicklung zu winkelstabilen Systemen gegangen ist, haben sich grundlegend geändert. Die vorliegende Arbeit analysiert in einer retrospektiven Studie distale Femurfrakturen, die zwischen dem 1.1.1995 und 31.9.2000 entweder mit einem Fixateur interne (LISS) oder mit der konventionellen Plattenosteosynthese versorgt wurden. In die Studie konnten 51 Patienten mit 54 distalen Femurfrakturen eingeschlossen werden. Die Infektionsrate war in der LISS-Gruppe (0% versus 11,1%) nichtsignifikant geringer, die Rate der verzögerten Frakturheilungen war nichtsignifikant höher. Die einzige verzögerte Frakturheilung (LISS-Gruppe), die einer sekundären chirurgischen Intervention bedurfte, wurde bei einer Patientin mit einem großen Knochendefekt gesehen, der ohne primäre Spongiosaplastik therapiert worden war. Pseudarthrosen traten in beiden Gruppen nicht auf. Die Rate des Materialversagens unterschied sich nicht signifikant. Beim LISS kam es nicht, wie bei den konventionellen Implantaten zu sekundären Repositionsverlusten, es wurden aber im Anfang der klinischen Einführung proximale Schraubenausrisse aufgrund einer Fehlplatzierung gesehen. Es konnte gezeigt werden, dass es durch die Verwendung des LISS und die indirekten Repositionstechniken zu keiner Zunahme der Achsfehlstellungen oder der Operationszeit kam. Die funktionellen Einzelergebnisse und die Punktzahl der erhobenen Scores (Neer-Score und Lysholm-Score) unterschieden sich nicht signifikant. / Internal, extramedullary osteosynthesis of distal femoral fractures which are focussed on in this study has been influenced by interesting developments in recent years. Driven by unsatisfying complication rates new fracture treatments have been looked for. Osteosynthesis materials, reduction techniques, techniques of implant placement and implants themselves - where development went to angular stable systems - have changed decisively. This study analyzes in a retrospective setting distal femoral fractures which were treated between 1.1.1995 and 31.9.2000 either with an internal fixator (LISS) or with conventional plate osteosynthesis. In this study 51 patients with 54 distal femoral fractures could be included. The Infection rate was non significantly lower in the LISS group (0% versus 11,1%), the rate of delayed union was non significantly higher. The only delayed union in the LISS group which needed secondary surgical intervention was seen in a patient with considerate bone loss which was not treated by primary bone grafting. Non-unions were not seen in either group. The rate of implant failure did not differ significantly. In the LISS group no secondary loss of reduction (like in the group with conventional plate osteosyntesis) was seen but proximal screw pull out due to malplacement was reported in the beginning of clinical introduction. It could be demonstrated the LISS and indirect reduction leading not to a higher rate of malalignement nor to prolonged theatre times. Functional results and the point score of the Neer Score and the Lysholm Score showed no significant difference.

Made available in DSpace on 2016-04-27T18:47:08Z (GMT). No. of bitstreams: 1 Ana Elisa Sena Klein da Rosa.pdf: 1325679 bytes, checksum: ff0ceea43091284f2a08c54cdfbf60d9 (MD5) Previous issue date: 2012-02-03 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The relationship of the body in old age is very particular to each individual. Norbert Elias (2001) discussed the difficulty that our own body, so full of freshness and often pleasant sensations, can be slow, tired and clumsy. We cannot imagine it, and basically we do not want it. The fall followed by femoral fracture causes huge strangeness, an image in which the elder cannot identify himself, resulting in a disconnection between the image of the unconscious of the body and the image that the mirror gives him back. The objective of this study was to delineate the socio-demographic profile of 40 elders (31 females and 9 males) with femur fracture in surgical indication for pre operative phase, attended by the Service of Orthopedics of the Hospital of the State Public Servant of São Paulo (HSPESP). It is a cross-sectional observational study, and the data were collected through visits to files of medical records and semi-structured interviews, during the period of October 2010 to February 2011. All statistical analyzes were performed by SPSS for Windows, version 15.0. The age of the subjects studied ranged from 62 to 97 years old, with an average age equal to 78.9 years old, 77.5% were female, and 72.5% cared by a family caregiver. A factor of extreme relevance was that 97.5% of the subjects use more than 3 concomitant medicines daily. These and many others facts were raised with the intention of cross factors that reflect in the trial of human ageing. For the Gerontology, old age is to be understood by different looks. The social, cultural and subjective aspects permeate and intertwine in old age. With this study was possible to notice that a public health policy is necessary for that the rate of falls can be reduced by taking actions which are intended to give the elderly a better self-awareness of his body, and identify situations that can be harmful in relation to increase the risk of falls / A percepção sobre o corpo na velhice é muito particular para cada ser. A esse respeito, Norbert Elias (2001) discorre sobre a dificuldade sentida pelas pessoas quando seus corpos, tão cheios de frescor e muitas vezes de sensações agradáveis, passam a ficar vagarosos, cansados e desajeitados. Não se pode imaginar tal mudança e, no fundo, não se quer. Nesse sentido, a queda acompanhada de fratura femoral causa enorme estranheza, pois há uma imagem com a qual o idoso não se identifica, ocorrendo uma desconexão entre a imagem do inconsciente do corpo e a imagem que o espelho devolve-lhe. O objetivo deste estudo foi traçar o perfil sociodemográfico de 40 idosos (31 do sexo feminino e nove do sexo masculino) com fratura de fêmur, em indicação de tratamento cirúrgico em fase pré-operatória, atendidos pelo Serviço de Ortopedia do Hospital do Servidor Público Estadual de São Paulo. Trata-se de um estudo observacional de corte transversal, com coleta de dados através de visita a arquivos de prontuários médicos e entrevistas semiestruturadas, no período de outubro de 2010 a fevereiro de 2011. Todas as análises estatísticas foram feitas pelo Software Statistical Package for the Social Sciences para Windows, na versão 15.0. A idade dos sujeitos estudados variou de 62 a 97 anos, com média de idade de 78,9 anos, prevalecendo 77,5% do sexo feminino, e 72,5% dos idosos eram cuidados por um cuidador familiar. Um fator de extrema relevância foi que 97,5% dos sujeitos faziam uso de mais de três medicamentos concomitantes diariamente. Esses e muitos outros dados foram levantados com o intuito de cruzar fatores que incidem no processo de envelhecimento humano, pois, para a Gerontologia, a velhice deve ser entendida sob diferentes olhares, uma vez que os aspectos sociais, culturais e subjetivos permeiam e se entrelaçam na velhice. Com este estudo, foi possível notar que uma política de saúde pública faz-se necessária, com o desenvolvimento de ações que tenham como finalidade proporcionar ao idoso um melhor autoconhecimento de seu corpo, assim como identificar situações que possam lhe ser prejudiciais em relação ao maior risco de quedas, para que o índice de quedas possa ser reduzido

<p>The overall aim of this thesis was to evaluate the outcome when treating children for displaced femoral fractures with external fixation.</p><p>In a consecutive and prospective study during the period 1993-2000, 96 children aged 3-15 years with 98 displaced femoral fractures were treated with external fixation and early mobilisation. The mean age was 8.1 years, the mean hospital stay was 8.7 days and the mean treatment time was 61 days. All fractures healed. Minor complications included pin tract infections (18%), clinical insignificant malunions, heterotopic ossification and two re-reductions. Major complications (6%) included two re-fractures after significant trauma and three plastic deformations after premature fixator removal leading to an osteotomy.</p><p>Radiological evaluation was performed up to one year for the whole group and for a subgroup up to two years. The evaluation showed that malunions were few and prone to remodelling almost completely. Although the fractures were fixated without shortening, as recommended earlier, the overgrowth was far less than expected.</p><p>Isokinetic muscle strength was measured in both hamstrings and quadriceps in 31 of the patients and compared with 31 matched children without previous injury to the legs. Early mobilisation seems to prevent residual muscle weakness previously shown after treatment with traction or cast for femoral fractures in children.</p><p>A cost analysis was performed, comparing three different treatment modalities of femoral shaft fractures: traction in hospital, traction in hospital/at home and external fixation. The analysis included both total medical costs and costs for the care provider. The most important factors were days spent at the hospital and the sick leave for the care provider. Treatment that can minimise these factors will contribute strongly to a lowering of health care costs.</p><p>Conclusion: External fixation of displaced femoral fractures in children can be used as standard treatment in children aged 3-15 years. The treatment provides satisfactory results with a low rate of major complications. Early mobilisation seems to prevent residual muscle weakness. The treatment reduce the number of days in hospital and the number of days of sick leave for the care provider and contributes strongly to lowering health care costs.</p>

The overall aim of this thesis was to evaluate the outcome when treating children for displaced femoral fractures with external fixation. In a consecutive and prospective study during the period 1993-2000, 96 children aged 3-15 years with 98 displaced femoral fractures were treated with external fixation and early mobilisation. The mean age was 8.1 years, the mean hospital stay was 8.7 days and the mean treatment time was 61 days. All fractures healed. Minor complications included pin tract infections (18%), clinical insignificant malunions, heterotopic ossification and two re-reductions. Major complications (6%) included two re-fractures after significant trauma and three plastic deformations after premature fixator removal leading to an osteotomy. Radiological evaluation was performed up to one year for the whole group and for a subgroup up to two years. The evaluation showed that malunions were few and prone to remodelling almost completely. Although the fractures were fixated without shortening, as recommended earlier, the overgrowth was far less than expected. Isokinetic muscle strength was measured in both hamstrings and quadriceps in 31 of the patients and compared with 31 matched children without previous injury to the legs. Early mobilisation seems to prevent residual muscle weakness previously shown after treatment with traction or cast for femoral fractures in children. A cost analysis was performed, comparing three different treatment modalities of femoral shaft fractures: traction in hospital, traction in hospital/at home and external fixation. The analysis included both total medical costs and costs for the care provider. The most important factors were days spent at the hospital and the sick leave for the care provider. Treatment that can minimise these factors will contribute strongly to a lowering of health care costs. Conclusion: External fixation of displaced femoral fractures in children can be used as standard treatment in children aged 3-15 years. The treatment provides satisfactory results with a low rate of major complications. Early mobilisation seems to prevent residual muscle weakness. The treatment reduce the number of days in hospital and the number of days of sick leave for the care provider and contributes strongly to lowering health care costs.

Diss. (sammanfattning) Linköping : Linköpings universitet, 2007. / Härtill 4 uppsatser.

Diss. (sammanfattning) Linköping : Linköpings universitet, 2007. / Härtill 4 uppsatser.