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1. Operative vs Nonoperative Treatment of Acute Unstable Chest Wall Injuries

Author

Niloofar, Dehghan, Aaron, Nauth, Emil, Schemitsch, Milena, Vicente, Richard, Jenkinson, Hans, Kreder, Michael, McKee, and Kim, Madden

Subjects
Male, Adult, Aged, 80 and over, Adolescent, Rib Fractures, Thoracic Injuries, Middle Aged, Length of Stay, Respiration, Artificial, Young Adult, Treatment Outcome, Humans, Surgery, Prospective Studies, Thoracic Wall, Aged
Abstract

ImportanceUnstable chest wall injuries have high rates of mortality and morbidity. In the last decade, multiple studies have reported improved outcomes with operative compared with nonoperative treatment. However, to date, an adequately powered, randomized clinical trial to support operative treatment has been lacking.ObjectiveTo compare outcomes of surgical treatment of acute unstable chest wall injuries with nonsurgical management.Design, Setting, and ParticipantsThis was a multicenter, prospective, randomized clinical trial conducted from October 10, 2011, to October 2, 2019, across 15 sites in Canada and the US. Inclusion criteria were patients between the ages of 16 to 85 years with displaced rib fractures with a flail chest or non–flail chest injuries with severe chest wall deformity. Exclusion criteria included patients with significant other injuries that would otherwise require prolonged mechanical ventilation, those medically unfit for surgery, or those who were randomly assigned to study groups after 72 hours of injury. Data were analyzed from March 20, 2019, to March 5, 2021.InterventionsPatients were randomized 1:1 to receive operative treatment with plate and screws or nonoperative treatment.Main Outcomes and MeasuresThe primary outcome was ventilator-free days (VFDs) in the first 28 days after injury. Secondary outcomes included mortality, length of hospital stay, intensive care unit stay, and rates of complications (pneumonia, ventilator-associated pneumonia, sepsis, tracheostomy).ResultsA total of 207 patients were included in the analysis (operative group: 108 patients [52.2%]; mean [SD] age, 52.9 [13.5] years; 81 male [75%]; nonoperative group: 99 patients [47.8%]; mean [SD] age, 53.2 [14.3] years; 75 male [76%]). Mean (SD) VFDs were 22.7 (7.5) days for the operative group and 20.6 (9.7) days for the nonoperative group (mean difference, 2.1 days; 95% CI, −0.3 to 4.5 days; P = .09). Mortality was significantly higher in the nonoperative group (6 [6%]) than in the operative group (0%; P = .01). Rates of complications and length of stay were similar between groups. Subgroup analysis of patients who were mechanically ventilated at the time of randomization demonstrated a mean difference of 2.8 (95% CI, 0.1-5.5) VFDs in favor of operative treatment.Conclusions and RelevanceThe findings of this randomized clinical trial suggest that operative treatment of patients with unstable chest wall injuries has modest benefit compared with nonoperative treatment. However, the potential advantage was primarily noted in the subgroup of patients who were ventilated at the time of randomization. No benefit to operative treatment was found in patients who were not ventilated.Trial RegistrationClinicalTrials.gov Identifier: NCT01367951

Published
2022

2. Fracture fixation in the operative management of hip fractures (FAITH): an international, multicentre, randomised controlled trial

Author

Aaron Nauth, Aaron T. Creek, Abby Zellar, Abdel-Rahman Lawendy, Adam Dowrick, Ajay Gupta, Akhil Dadi, Albert van Kampen, Albert Yee, Alexander C. de Vries, Alexander de Mol van Otterloo, Alisha Garibaldi, Allen Liew, Allison W. McIntyre, Amal Shankar Prasad, Amanda W. Romero, Amar Rangan, Amber Oatt, Amir Sanghavi, Amy L. Foley, Anders Karlsten, Andrea Dolenc, Andrew Bucknill, Andrew Chia, Andrew Evans, Andrew Gong, Andrew H. Schmidt, Andrew J. Marcantonio, Andrew Jennings, Angela Ward, Angshuman Khanna, Anil Rai, Anke B. Smits, Annamarie D. Horan, Anne Christine Brekke, Annette Flynn, Aravin Duraikannan, Are Stødle, Arie B. van Vugt, Arlene Luther, Arthur W. Zurcher, Arvind Jain, Asgeir Amundsen, Ash Moaveni, Ashley Carr, Ateet Sharma, Austin D. Hill, Axel Trommer, B. Sachidananda Rai, Barbara Hileman, Bart Schreurs, Bart Verhoeven, Benjamin B. Barden, Bernhard Flatøy, Berry I. Cleffken, Berthe Bøe, Bertrand Perey, Birgit C. Hanusch, Brad Weening, Bram Fioole, Bram Rijbroek, Brett D. Crist, Brett Halliday, Brett Peterson, Brian Mullis, C. Glen Richardson, Callum Clark, Carlos A. Sagebien, Carmen C. van der Pol, Carol Bowler, Catherine A. Humphrey, Catherine Coady, Cees L. Koppert, Chad Coles, Chadi Tannoury, Charles J. DePaolo, Chris Gayton, Chris Herriott, Christina Reeves, Christina Tieszer, Christine Dobb, Christopher G. Anderson, Claire Sage, Claudine Cuento, Clifford B. Jones, Coks H.R. Bosman, Colleen Linehan, Cor P. van der Hart, Corey Henderson, Courtland G. Lewis, Craig A. Davis, Craig Donohue, Cyril Mauffrey, D.C. Sundaresh, Dana J. Farrell, Daniel B. Whelan, Daniel Horwitz, Daniel Stinner, Darius Viskontas, Darren M. Roffey, David Alexander, David E. Karges, David Hak, David Johnston, David Love, David M. Wright, David P. Zamorano, David R. Goetz, David Sanders, David Stephen, David Yen, Davide Bardana, Davy J Olakkengil, Deanna Lawson, Deborah Maddock, Debra L. Sietsema, Deeba Pourmand, Dennis Den Hartog, Derek Donegan, Diane Heels-Ansdell, Diane Nam, Dominic Inman, Dory Boyer, Doug Li, Douglas Gibula, Dustin M. Price, Dylan J. Watson, E. Mark Hammerberg, Edward T.C.H. Tan, Eelco J.R. de Graaf, Elise Berg Vesterhus, Elizabeth Roper, Elton Edwards, Emil H. Schemitsch, Eric R. Hammacher, Eric R. Henderson, Erica Whatley, Erick T. Torres, Erik G.J. Vermeulen, Erin Finn, Esther M.M. Van Lieshout, Eugene K. Wai, Evan R. Bannister, Evelyn Kile, Evert B.M. Theunissen, Ewan D. Ritchie, Farah Khan, Farhad Moola, Fiona Howells, Frank de Nies, Frank H.W.M. van der Heijden, Frank R.A.J. de Meulemeester, Frede Frihagen, Fredrik Nilsen, G. Ben Schmidt, G.H. Robert Albers, Garland K. Gudger, Garth Johnson, Gary Gruen, Gary Zohman, Gaurav Sharma, Gavin Wood, Geert W.M. Tetteroo, Geir Hjorthaug, Geir Jomaas, Geoff Donald, Geoffrey Ryan Rieser, Gerald Reardon, Gerard P. Slobogean, Gert R Roukema, Gijs A. Visser, Gilbert Moatshe, Gillian Horner, Glynis Rose, Gordon Guyatt, Graham Chuter, Greg Etherington, Gregory J. Della Rocca, Guri Ekås, Gwendolyn Dobbin, H. Michael Lemke, Hamish Curry, Han Boxma, Hannah Gissel, Hans Kreder, Hans Kuiken, Hans L.F. Brom, Hans-Christoph Pape, Harm M van der Vis, Harvinder Bedi, Heather A. Vallier, Heather Brien, Heather Silva, Heike Newman, Helena Viveiros, Henk van der Hoeven, Henry Ahn, Herman Johal, Herman Rijna, Heyn Stockmann, Hong A. Josaputra, Hope Carlisle, Igor van der Brand, Imro Dawson, Ivan Tarkin, Ivan Wong, J. Andrew Parr, J. Andrew Trenholm, J. Carel Goslings, J. David Amirault, J. Scott Broderick, Jaap P. Snellen, Jacco A.C. Zijl, Jaimo Ahn, James Ficke, James Irrgang, James Powell, James R. Ringler, James Shaer, James T. Monica, Jan Biert, Jan Bosma, Jan Egil Brattgjerd, Jan Paul M. Frölke, Jan Wille, Janakiraman Rajakumar, Jane E. Walker, Janell K. Baker, Janos P. Ertl, Jean Paul P.M. de Vries, Jean W.M. Gardeniers, Jedediah May, Jeff Yach, Jennifer T. Hidy, Jerald R. Westberg, Jeremy A. Hall, Jeroen van Mulken, Jessica Cooper McBeth, Jochem Hoogendoorn, Jodi M. Hoffman, Joe Joseph Cherian, John A. Tanksley, John Clarke-Jenssen, John D. Adams, John Esterhai, John F. Tilzey, John Murnaghan, John P. Ketz, John S. Garfi, John Schwappach, John T. Gorczyca, John Wyrick, Jonas Rydinge, Jonathan L. Foret, Jonathan M. Gross, Jonathan P. Keeve, Joost Meijer, Joris J.G. Scheepers, Joseph Baele, Joseph O'Neil, Joseph R. Cass, Joseph R. Hsu, Jules Dumais, Julia Lee, Julie A. Switzer, Julie Agel, Justin E. Richards, Justin W. Langan, Kahn Turckan, Kaili Pecorella, Kamal Rai, Kamran Aurang, Karl Shively, Karlijn van Wessem, Karyn Moon, Kate Eke, Katie Erwin, Katrine Milner, Kees Jan Ponsen, Kelli Mills, Kelly Apostle, Kelly Johnston, Kelly Trask, Kent Strohecker, Kenya Stringfellow, Kevin K. Kruse, Kevin Tetsworth, Khalis Mitchell, Kieran Browner, Kim Hemlock, Kimberly Carcary, Knut Jørgen Haug, Krista Noble, Kristin Robbins, Krystal Payton, Kyle J. Jeray, L. Joseph Rubino, Lauren A. Nastoff, Lauren C. Leffler, Laurents P.S. Stassen, Lawrence K. O'Malley, Lawrence M. Specht, Lehana Thabane, Leo M.G. Geeraedts, Leslie E. Shell, Linda K. Anderson, Linda S. Eickhoff, Lindsey Lyle, Lindsey Pilling, Lisa Buckingham, Lisa K. Cannada, Lisa M. Wild, Liz Dulaney-Cripe, Lodewijk M.S.J. Poelhekke, Lonneke Govaert, Lu Ton, Lucksy Kottam, Luke P.H. Leenen, Lydia Clipper, Lyle T. Jackson, Lynne Hampton, Maarten C. de Waal Malefijt, Maarten P. Simons, Maarten van der Elst, Maarten W.G.A. Bronkhorst, Mahesh Bhatia, Marc Swiontkowski, Margaret J. Lobo, Marilyn Swinton, Marinis Pirpiris, Marius Molund, Mark Gichuru, Mark Glazebrook, Mark Harrison, Mark Jenkins, Mark MacLeod, Mark R. de Vries, Mark S. Butler, Markku Nousiainen, Martijne van 't Riet, Martin C. Tynan, Martin Campo, Martin G. Eversdijk, Martin J. Heetveld, Martin Richardson, Mary Breslin, Mary Fan, Matt Edison, Matthew Napierala, Matthias Knobe, Matthias Russ, Mauri Zomar, Maurits de Brauw, Max Esser, Meghan Hurley, Melissa E. Peters, Melissa Lorenzo, Mengnai Li, Michael Archdeacon, Michael Biddulph, Michael Charlton, Michael D. McDonald, Michael D. McKee, Michael Dunbar, Michael E. Torchia, Michael Gross, Michael Hewitt, Michael Holt, Michael J. Prayson, Michael J.R. Edwards, Michael L. Beckish, Michael L. Brennan, Michael P. Dohm, Michael S.H. Kain, Michelle Vogt, Michelle Yu, Michiel H.J. Verhofstad, Michiel J.M. Segers, Michiel P.C. Siroen, Mike Reed, Milena R. Vicente, Milko M.M. Bruijninckx, Mittal Trivedi, Mohit Bhandari, Molly M. Moore, Monica Kunz, Morten Smedsrud, Naveen Palla, Neeraj Jain, Nico J.M. Out, Nicole Simunovic, Niels W.L. Schep, Oliver Müller, Onno R. Guicherit, Oscar J.F. Van Waes, Otis Wang, Pascal G. Doornebosch, Patricia Seuffert, Patrick J. Hesketh, Patrick Weinrauch, Paul Duffy, Paul Keller, Paul M. Lafferty, Paul Pincus, Paul Tornetta, Paul Zalzal, Paula McKay, Peter A. Cole, Peter D. de Rooij, Peter Hull, Peter M.N.Y.M. Go, Peter Patka, Peter Siska, Peter Weingarten, Philip Kregor, Philip Stahel, Philip Stull, Philippe Wittich, Piet A.R. de Rijcke, Pim Oprel, PJ Devereaux, Qi Zhou, R. Lee Murphy, Rachel Alosky, Rachel Clarkson, Raely Moon, Rajanikanth Logishetty, Rajesh Nanda, Raymond J. Sullivan, Rebecca G. Snider, Richard E. Buckley, Richard Iorio, Richard J Farrugia, Richard Jenkinson, Richard Laughlin, Richard P.R. Groenendijk, Richard W. Gurich, Ripley Worman, Rob Silvis, Robert Haverlag, Robert J. Teasdall, Robert Korley, Robert McCormack, Robert Probe, Robert V. Cantu, Roger B. Huff, Rogier K.J. Simmermacher, Rolf Peters, Roman Pfeifer, Ronald Liem, Ronald N. Wessel, Ronald Verhagen, Ronald Vuylsteke, Ross Leighton, Ross McKercher, Rudolf W. Poolman, Russell Miller, Ryan Bicknell, Ryan Finnan, Ryan M. Khan, Samir Mehta, Sandy Vang, Sanjay Singh, Sanjeev Anand, Sarah A. Anderson, Sarah A. Dawson, Scott B. Marston, Scott E. Porter, Scott T. Watson, Sebastiaan Festen, Shane Lieberman, Shannon Puloski, Shea A. Bielby, Sheila Sprague, Shelley Hess, Shelley MacDonald, Simone Evans, Sofia Bzovsky, Sondre Hasselund, Sophie Lewis, Stein Ugland, Stephanie Caminiti, Stephanie L. Tanner, Stephanie M. Zielinski, Stephanie Shepard, Stephen A. Sems, Stephen D. Walter, Stephen Doig, Stephen H. Finley, Stephen Kates, Stephen Lindenbaum, Stephen P. Kingwell, Steve Csongvay, Steve Papp, Steven E. Buijk, Steven J. Rhemrev, Steven M. Hollenbeck, Steven M. van Gaalen, Steven Yang, Stuart Weinerman, null Subash, Sue Lambert, Susan Liew, Sven A.G. Meylaerts, Taco J. Blokhuis, Tammo S. de Vries Reilingh, Tarjei Lona, Taryn Scott, Teresa K. Swenson, Terrence J. Endres, Terry Axelrod, Teun van Egmond, Thomas B. Pace, Thomas Kibsgård, Thomas M. Schaller, Thuan V. Ly, Timothy J. Miller, Timothy Weber, Toan Le, Todd M. Oliver, Tom M. Karsten, Tor Borch, Tor Magne Hoseth, Tor Nicolaisen, Torben Ianssen, Tori Rutherford, Tracy Nanney, Trevor Gervais, Trevor Stone, Tyson Schrickel, Tyson Scrabeck, Utsav Ganguly, V. Naumetz, Valda Frizzell, Veronica Wadey, Vicki Jones, Victoria Avram, Vimlesh Mishra, Vineet Yadav, Vinod Arora, Vivek Tyagi, Vivian Borsella, W. Jaap Willems, W.H. Hoffman, Wade T. Gofton, Wesley G. Lackey, Wesley Ghent, William Obremskey, William Oxner, William W. Cross, Yvonne M. Murtha, Zoe Murdoch, and Surgery

Subjects
Male, Bone Screws, Avascular necrosis, Kaplan-Meier Estimate, law.invention, Fracture Fixation, Internal, 0302 clinical medicine, Randomized controlled trial, Femur Head Necrosis, law, Fracture Fixation, Fracture fixation, Medicine and Health Sciences, 80 and over, Single-Blind Method, 030212 general & internal medicine, Non-U.S. Gov't, Aged, 80 and over, Fracture Healing, 030222 orthopedics, Hip fracture, Research Support, Non-U.S. Gov't, Hazard ratio, General Medicine, Equipment Design, Femur Head Necrosis/etiology, 3. Good health, Pulmonary embolism, Multicenter Study, Treatment Outcome, Randomized Controlled Trial, Fracture Fixation, Internal/adverse effects, Female, Reoperation, musculoskeletal diseases, medicine.medical_specialty, Femoral Neck Fractures/surgery, Internal/adverse effects, Bone healing, Research Support, N.I.H, 03 medical and health sciences, Research Support, N.I.H., Extramural, medicine, Journal Article, Humans, Adverse effect, Aged, business.industry, Extramural, medicine.disease, Femoral Neck Fractures, Surgery, Reconstructive and regenerative medicine Radboud Institute for Health Sciences [Radboudumc 10], Reoperation/statistics & numerical data, Quality of Life, business
Abstract

© 2017 Elsevier Ltd Background Reoperation rates are high after surgery for hip fractures. We investigated the effect of a sliding hip screw versus cancellous screws on the risk of reoperation and other key outcomes. Methods For this international, multicentre, allocation concealed randomised controlled trial, we enrolled patients aged 50 years or older with a low-energy hip fracture requiring fracture fixation from 81 clinical centres in eight countries. Patients were assigned by minimisation with a centralised computer system to receive a single large-diameter screw with a side-plate (sliding hip screw) or the present standard of care, multiple small-diameter cancellous screws. Surgeons and patients were not blinded but the data analyst, while doing the analyses, remained blinded to treatment groups. The primary outcome was hip reoperation within 24 months after initial surgery to promote fracture healing, relieve pain, treat infection, or improve function. Analyses followed the intention-to-treat principle. This study was registered with ClinicalTrials.gov, number NCT00761813. Findings Between March 3, 2008, and March 31, 2014, we randomly assigned 1108 patients to receive a sliding hip screw (n=557) or cancellous screws (n=551). Reoperations within 24 months did not differ by type of surgical fixation in those included in the primary analysis: 107 (20%) of 542 patients in the sliding hip screw group versus 117 (22%) of 537 patients in the cancellous screws group (hazard ratio [HR] 0·83, 95% CI 0·63–1·09; p=0·18). Avascular necrosis was more common in the sliding hip screw group than in the cancellous screws group (50 patients [9%] vs 28 patients [5%]; HR 1·91, 1·06–3·44; p=0·0319). However, no significant difference was found between the number of medically related adverse events between groups (p=0·82; appendix); these events included pulmonary embolism (two patients [

Published
2017

3. Finding Evidence: Evidence-Based Practice

Author

Hans Kreder and Richard Martinoff

Subjects
Internet, medicine.medical_specialty, Medical education, Evidence-based practice, Electronic Mail, business.industry, Point-of-Care Systems, Best practice, Alternative medicine, MEDLINE, Information Storage and Retrieval, Hand surgery, Databases, Bibliographic, Electronic mail, Dilemma, Evidence-Based Practice, medicine, Humans, Orthopedics and Sports Medicine, Surgery, The Internet, business
Abstract

Best practice treatment decisions require the integration of external information, internal information, and patient factors. This article provides a tested methodology for formulating a structured question from a clinical dilemma and then transforming that question into a query appropriate for searching online evidence-based resources. Listed are some of the preeminent online databases for searching for evidence pertinent to clinicians specializing in hand surgery. Also discussed are various online methods for continuously delivering pertinent evidence to the clinician as it becomes available. The conclusion is a practical example of a literature search as it applies to a problem commonly encountered in surgical care of the upper extremity.

Published
2009

4. Reliability, Validity, and Responsiveness of the Western Ontario and McMaster Universities Osteoarthritis Index for Elderly Patients with a Femoral Neck Fracture

Author

Paul T.P.W. Burgers, Rudolf W Poolman, Theodorus MJ Van Bakel, Wim E Tuinebreijer, Stephanie M Zielinski, Mohit Bhandari, Peter Patka, Esther MM Van Lieshout, P J Devereaux, Gordon H Guyatt, Thomas A Einhorn, Lehana Thabane, Emil H Schemitsch, Kenneth J Koval, Frede Frihagen, Kevin Tetsworth, Ernesto Guerra-Farfan, Stephen D Walter, Sheila Sprague, Marilyn Swinton, Taryn Scott, Paula McKay, Kim Madden, Diane Heels-Ansdell, Lisa Buckingham, Aravin Duraikannan, Heather Silva, Martin J Heetveld, Robert D Zura, Victoria Avram, Ajay Manjoo, Dale Williams, John Antoniou, Tim Ramsay, Earl R Bogoch, Andrew Trenholm, Stephen Lyman, Madhu Mazumdar, Kevin J Bozic, Mark Luborsky, Stuart Goodman, Susan Muray, Rob Korley, Richard Buckley, Paul Duffy, Shannon Puloski, Kimberly Carcary, Melissa Lorenzo, Michael D McKee, Jeremy A Hall, Aaron Nauth, Daniel Whelan, Timothy R Daniels, James P Waddell, Henry Ahn, Milena R Vicente, Jennifer T Hidy, Melanie T MacNevin, Hans Kreder, Terry Axelrod, Richard Jenkinson, Markku Nousiainen, David Stephen, Veronica Wadey, Monica Kunz, Katrine Milner, Ria Cagaanan, Melanie MacNevin, Peter J O’Brien, Piotr A Blachut, Henry M Broekhuyse, Pierre Guy, Kelly A Lefaivre, Gerard P Slobogean, Raman Johal, Irene Leung, Chad Coles, Ross Leighton, C. Glen Richardson, Michael Biddulph, Michael Gross, Michael Dunbar, J. David Amirault, David Alexander, Catherine Coady, Mark Glazebrook, David Johnston, William Oxner, Gerald Reardon, Ivan Wong, Kelly Trask, Shelley MacDonald, Andrew Furey, Craig Stone, Minnie Parsons, Trevor Stone, Mauri Zomar, Robert McCormack, Kelly Apostle, Dory Boyer, Farhad Moola, Bertrand Perey, Darius Viskontas, Karyn Moon, Raely Moon, Yves Laflamme, Benoit Benoit, Pierre Ranger, Michel Malo, Julio Fernandes, Karine Tardif, Julie Fournier, Pascal André Vendittoli, Vincent Massé, Alain G Roy, Martin Lavigne, Daniel Lusignan, Craig Davis, Philip Stull, Stewart Weinerman, Peter Weingarten, Steven Lindenbaum, Michael Hewitt, Rebecca Danielwicz, Janell Baker, Michael Mont, Donald E Delanois, Bhaveen Kapadia, Kimona Issa, Marylou Mullen, Andrew Sems, Barb Foreman, Javad Parvizi, Tiffany Morrison, Courtland Lewis, Stephanie Caminiti, Paul Tornetta, William R Creevy, Michelle J Lespasio, Hope Carlisle, Andrew Marcantonio, Michael Kain, Lawrence Specht, John Tilzey, John Garfi, Samir Mehta, John L Esterhai, Jaimo Ahn, Derek Donegan, Annamarie Horan, Kelly McGinnis, James Roberson, Thomas Bradbury, Greg Erens, Kyle Webb, Brian Mullis, Karl Shively, Andrew Parr, Janos Ertl, Ripley Worman, Mark Webster, Judd Cummings, Valda Frizzell, Molly Moore, Clifford B Jones, James R Ringler, Debra L Sietsema, Jane E Walker, Enes Kanlic, Amr Abdelgawad, Juan Shunia, Charles DePaolo, Susan Sutherland, Rachel Alosky, Robert Zura, Maria Manson, Gregg Strathy, Kathleen Peter, Paul Johnson, Meaghan Morton, James Shaer, Tyson Schrickel, Barbara Hileman, Marina Hanes, Elisha Chance, E. Matthew Heinrich, David Dodgin, Michele LaBadie, David Zamorano, Martin Tynan, Ran Schwarzkopf, John A Scolaro, Ranjan Gupta, Samuel Bederman, Nitin Bhatia, Bang Hoang, Douglas Kiester, Neil Jones, Gregory Rafijah, Damon Alavekios, Jason Lee, Akshay Mehta, Steven Schroder, Tom Chao, Vincent Colin, Phuc (Phil) Dang, Stephen Keun Heng, Gregory Lopez, Samuel Galle, Sohrab Pahlavan, Duy L Phan, Minal Tapadia, Christopher Bui, Nickul Jain, Tyler Moore, Nathan Moroski, Deeba Pourmand, Erik N Kubiak, Jeremy Gililland, David Rothberg, Christopher Peters, Christopher Pelt, Ami R Stuart, Kirby Corbey, Franklin D Shuler, James Day, Tigran Garabekyan, Felix Cheung, Ali Oliashirazi, Jonathon Salava, Linda Morgan, Timothy Wilson-Byrne, Mary Beth Cordle, Leon H.G.J. Elmans, Joost A.A.M. van den Hout, Adrianus JP Joosten, Ad FA van Beurden, Stefan BT Bolder, Denise Eygendaal, Adrianus F.C.M. Moonen, Rutger CI van Geenen, Eric A Hoebink, Robert Wagenmakers, Wouter van Helden, Hans-Peter W van Jonbergen, Herbert Roerdink, Joost M Reuver, Alexander FW Barnaart, Elvira R Flikweert, Rover Krips, J. Bernard Mullers, Hans Schüller, Mark LM Falke, Frans J Kurek, Adrianus CH Slingerland, Jan P van Dijk, Wouter H van Helden, Hugo W Bolhuis, Pieter HJ Bullens, Mike Hogervorst, Karin E de Kroon, Rob H Jansen, Ferry Steenstra, Eric EJ Raven, W. Peter J Fontijne, Saskia C Wiersma, Bastiaan Boetes, Edgar JT ten Holder, Huub JL van der Heide, Jochem Nagels, Enrike H.M.J. van der Linden-van der Zwaag, Stefan B Keizer, Jan-Willem A Swen, Peter HC den Hollander, Bregje JW Thomassen, Willem Jan Kleyn Molekamp, Frank R.A.J. de Meulemeester, Arthur EB Kleipool, Robert Haverlag, Maarten P Simons, Eduard L.A.R. Mutsaerts, Rob Kooijman, Roelf R Postema, René J.T.M. Bleker, Harald IH Lampe, Lein Schuman, John Cheung, Frank van Bommel, W. Paul Winia, Daniel Haverkamp, Harm van der Vis, Peter A Nolte, Michel PJ van den Bekerom, Tjitte de Jong, Arthur van Noort, Diederik A Vergroesen, Bernard G Schutte, Harm M van der Vis, Lijkele Beimers, Jasper de Vries, Arthur W Zurcher, G.H. Rob Albers, Maarten Rademakers, Stefan Breugem, Ibo van der Haven, Pieter Jan Damen, Gythe H Bulstra, Martin M Campo, Mathijs P Somford, Daniël Haverkamp, Susan Liew, Harvinder Bedi, Ashley Carr, Andrew Chia, Steve Csongvay, Craig Donohue, Stephen Doig, Elton Edwards, Max Esser, Richard Freeman, Andrew Gong, Doug Li, Russell Miller, Lu Ton, Otis Wang, Ian Young, Adam Dowrick, Zoe Murdoch, Claire Sage, Richard Page, David Bainbridge, Richard Angliss, Ben Miller, Andrew Thomson, Graeme Brown, Simon Williams, Kevin Eng, David Bowyer, John Skelley, Chatar Goyal, Sally Beattie, Enrique Guerado, Encarnacion Cruz, Juan Ramon Cano, Miguel Angel Froufe, Lluis Marull Serra, Samer Al-dirra, Cristina Martinez, Francisco José Tarazona Santabalbina, Jordi Teixidor Serra, Jordi Tomas Hernandez, Marc Aguilar Garcia, Vicente Molero Garcia, Sergi Barrera, Miriam Garrido, Lars Nordsletten, John Clarke-Jenssen, Geir Hjorthaug, Anne Christine Brekke, Elise Berg Vesterhus, Ingunn Skaugrud, Pradeep Tripathi, Sandesh Katiyar, Preksha Shukla, Marc Swiontkowski, Gordon Guyatt, Kyle Jeray, Stephen Walter, Helena Viveiros, Victoria Truong, Kaitlin Koo, Qi Zhou, Deborah Maddock, Nicole Simunovic, Julie Agel, Amar Rangan, Birgit C Hanusch, Lucksy Kottam, Rachel Clarkson, Gregory J Della Rocca, Gerard Slobogean, Jeffrey Katz, Brenda Gillespie, Gail A Greendale, Curtis Hartman, Craig Rubin, James Waddell, H. Michael Lemke, Amber Oatt, Richard E Buckley, Robert Korley, Kelly Johnston, James Powell, David Sanders, Abdel Lawendy, Christina Tieszer, John Murnaghan, Diane Nam, Albert Yee, Daniel B Whelan, Lisa M Wild, Ryan M Khan, Cathy Coady, David Amirault, Glen Richardson, Gwen Dobbin, Ryan Bicknell, Jeff Yach, Davide Bardana, Gavin Wood, Mark Harrison, David Yen, Sue Lambert, Fiona Howells, Angela Ward, Paul Zalzal, Heather Brien, V Naumetz, Brad Weening, Eugene K Wai, Steve Papp, Wade T Gofton, Stephen P Kingwell, Garth Johnson, Joseph O’Neil, Darren M Roffey, Vivian Borsella, Todd M Oliver, Vicki Jones, Terrence J Endres, Samuel G Agnew, Kyle J Jeray, J. Scott Broderick, David R Goetz, Thomas B Pace, Thomas M Schaller, Scott E Porter, Stephanie L Tanner, Rebecca G Snider, Lauren A Nastoff, Shea A Bielby, Julie A Switzer, Peter A Cole, Sarah A Anderson, Paul M Lafferty, Mengnai Li, Thuan V Ly, Scott B Marston, Amy L Foley, Sandy Vang, David M Wright, Andrew J Marcantonio, Michael SH Kain, Richard Iorio, Lawrence M Specht, John F Tilzey, Margaret J Lobo, John S Garfi, Heather A Vallier, Andrea Dolenc, Chalitha Robinson, Michael J Prayson, Richard Laughlin, L. Joseph Rubino, Jedediah May, Geoffrey Ryan Rieser, Liz Dulaney-Cripe, Chris Gayton, John T Gorczyca, Jonathan M Gross, Catherine A Humphrey, Stephen Kates, Krista Noble, Allison W McIntyre, Kaili Pecorella, Craig A Davis, Stephen Lindenbaum, John Schwappach, Janell K Baker, Tori Rutherford, Heike Newman, Shane Lieberman, Erin Finn, Kristin Robbins, Meghan Hurley, Lindsey Lyle, Khalis Mitchell, Kieran Browner, Erica Whatley, Krystal Payton, Christina Reeves, Lisa K Cannada, David Karges, Leslie Hill, John Esterhai, Annamarie D Horan, Christine A Kaminski, Brynn N Kowalski, Jonathan P Keeve, Christopher G Anderson, Michael D McDonald, Jodi M Hoffman, Ivan Tarkin, Peter Siska, Gary Gruen, Andrew Evans, Dana J Farrell, James Irrgang, Arlene Luther, William W Cross, Joseph R Cass, Stephen A Sems, Michael E Torchia, Tyson Scrabeck, Mark Jenkins, Jules Dumais, Amanda W Romero, Carlos A Sagebien, Mark S Butler, James T Monica, Patricia Seuffert, Joseph R Hsu, James Ficke, Michael Charlton, Matthew Napierala, Mary Fan, Chadi Tannoury, Michael Archdeacon, Ryan Finnan, Toan Le, John Wyrick, Shelley Hess, Michael L Brennan, Robert Probe, Evelyn Kile, Kelli Mills, Lydia Clipper, Michelle Yu, Katie Erwin, Daniel Horwitz, Kent Strohecker, Teresa K Swenson, Andrew H Schmidt, Jerald R Westberg, Kamran Aurang, Gary Zohman, Brett Peterson, Roger B Huff, Joseph Baele, Timothy Weber, Matt Edison, Jessica McBeth, Janos P Ertl, J. Andrew Parr, Molly M Moore, Erin Tobias, Emily Thomas, Charles J DePaolo, Leslie E Shell, Lynne Hampton, Stephanie Shepard, Tracy Nanney, Claudine Cuento, Robert V Cantu, Eric R Henderson, Linda S Eickhoff, E. Mark Hammerberg, Philip Stahel, David Hak, Cyril Mauffrey, Douglas Gibula, Hannah Gissel, Corey Henderson, David P Zamorano, Martin C Tynan, Deanna Lawson, Brett D Crist, Yvonne M Murtha, Linda K Anderson, Colleen Linehan, Lindsey Pilling, Courtland G Lewis, Raymond J Sullivan, Elizabeth Roper, William Obremskey, Philip Kregor, Justin E Richards, Kenya Stringfellow, Michael P Dohm, Abby Zellar, Michiel JM Segers, Jacco AC Zijl, Bart Verhoeven, Anke B Smits, Jean Paul PM de Vries, Bram Fioole, Henk van der Hoeven, Evert BM Theunissen, Tammo S de Vries Reilingh, Lonneke Govaert, Philippe Wittich, Maurits de Brauw, Jan Wille, Peter M.N.Y.M. Go, Ewan D Ritchie, Ronald N Wessel, Eric R Hammacher, Gijs A Visser, Heyn Stockmann, Rob Silvis, Jaap P Snellen, Bram Rijbroek, Joris JG Scheepers, Erik GJ Vermeulen, Michiel PC Siroen, Ronald Vuylsteke, Hans LF Brom, Herman Rijna, Piet AR de Rijcke, Cees L Koppert, Steven E Buijk, Richard PR Groenendijk, Imro Dawson, Geert WM Tetteroo, Milko MM Bruijninckx, Pascal G Doornebosch, Eelco JR de Graaf, Maarten van der Elst, Carmen C van der Pol, Martijne van’t Riet, Tom M Karsten, Mark R de Vries, Laurents PS Stassen, Niels WL Schep, G Ben Schmidt, W H Hoffman, Frank H.W.M. van der Heijden, W. Jaap Willems, Cor P van der Hart, Kahn Turckan, Sebastiaan Festen, Frank de Nies, Nico JM Out, Jan Bosma, Albert van Kampen, Jan Biert, Arie B van Vugt, Michael JR Edwards, Taco J Blokhuis, Jan Paul M Frölke, Leo MG Geeraedts, Jean WM Gardeniers, Edward T.C.H. Tan, Lodewijk M.S.J. Poelhekke, Maarten C de Waal Malefijt, Bart Schreurs, Gert R Roukema, Hong A Josaputra, Paul Keller, Peter D de Rooij, Hans Kuiken, Han Boxma, Berry I Cleffken, Ronald Liem, Steven J Rhemrev, Coks HR Bosman, Alexander de Mol van Otterloo, Jochem Hoogendoorn, Alexander C de Vries, Sven AG Meylaerts, Michiel HJ Verhofstad, Joost Meijer, Teun van Egmond, Igor van der Brand, Martin G Eversdijk, Rolf Peters, Dennis Den Hartog, Oscar JF Van Waes, Pim Oprel, Martin Campo, Ronald Verhagen, G.H. Robert Albers, Rogier KJ Simmermacher, Jeroen van Mulken, Karlijn van Wessem, Steven M van Gaalen, Luke PH Leenen, Maarten W.G.A. Bronkhorst, Onno R Guicherit, J. Carel Goslings, Kees Jan Ponsen, Mahesh Bhatia, Vinod Arora, Vivek Tyagi, Ajay Gupta, Neeraj Jain, Farah Khan, Ateet Sharma, Amir Sanghavi, Mittal Trivedi, Anil Rai, null Subash, Kamal Rai, Vineet Yadav, Sanjay Singh, Amal Shankar Prasad, Vimlesh Mishra, D C Sundaresh, Angshuman Khanna, Joe Joseph Cherian, Davy J Olakkengil, Gaurav Sharma, Akhil Dadi, Naveen Palla, Utsav Ganguly, B. Sachidananda Rai, Janakiraman Rajakumar, Peter Hull, Sophie Lewis, Simone Evans, Rajesh Nanda, Rajanikanth Logishetty, Sanjeev Anand, Carol Bowler, Andrew Jennings, Graham Chuter, Glynis Rose, Gillian Horner, Callum Clark, Kate Eke, Mike Reed, Chris Herriott, Christine Dobb, Hamish Curry, Greg Etherington, Arvind Jain, Ash Moaveni, Matthias Russ, Geoff Donald, Patrick Weinrauch, Paul Pincus, Steven Yang, Brett Halliday, Trevor Gervais, Michael Holt, Annette Flynn, Marinis Pirpiris, David Love, Andrew Bucknill, Richard J Farrugia, Torben Ianssen, Asgeir Amundsen, Jan Egil Brattgjerd, Tor Borch, Berthe Bøe, Bernhard Flatøy, Sondre Hasselund, Knut Jørgen Haug, Kim Hemlock, Tor Magne Hoseth, Geir Jomaas, Thomas Kibsgård, Tarjei Lona, Gilbert Moatshe, Oliver Müller, Marius Molund, Tor Nicolaisen, Fredrik Nilsen, Jonas Rydinge, Morten Smedsrud, Are Stødle, Axel Trommer, Stein Ugland, Anders Karlsten, Guri Ekås, Hans-Christoph Pape, Matthias Knobe, Roman Pfeifer, Orthopedic Surgery and Sports Medicine, Graduate School, Other departments, Surgery, Other Research, Amsterdam Movement Sciences, Cardiothoracic Surgery, and Emergency Medicine

Subjects
Male, medicine.medical_specialty, WOMAC, Abstracting and Indexing, Osteoarthritis, Cronbach's alpha, Surveys and Questionnaires, medicine, Humans, Orthopedics and Sports Medicine, Clinical significance, Femoral neck, Aged, 80 and over, Ontario, business.industry, Reproducibility of Results, Construct validity, General Medicine, medicine.disease, RELIABILITY VALIDITY, Femoral Neck Fractures, Reconstructive and regenerative medicine Radboud Institute for Health Sciences [Radboudumc 10], Clinical trial, Reconstructive and regenerative medicine Radboud Institute for Molecular Life Sciences [Radboudumc 10], medicine.anatomical_structure, Physical therapy, Female, Surgery, business
Abstract

Item does not contain fulltext BACKGROUND: The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) has been extensively evaluated in groups of patients with osteoarthritis, yet not in patients with a femoral neck fracture. This study aimed to determine the reliability, construct validity, and responsiveness of the WOMAC compared with the Short Form-12 (SF-12) and the EuroQol 5D (EQ-5D) questionnaires for the assessment of elderly patients with a femoral neck fracture. METHODS: Reliability was tested by assessing the Cronbach alpha. Construct validity was determined with the Pearson correlation coefficient. Change scores were calculated from ten weeks to twelve months of follow-up. Standardized response means and floor and ceiling effects were determined. Analyses were performed to compare the results for patients less than eighty years old with those for patients eighty years of age or older. RESULTS: The mean WOMAC total score was 89 points before the fracture in the younger patients and increased from 70 points at ten weeks to 81 points at two years postoperatively. In the older age group, these scores were 86, 75, and 78 points. The mean WOMAC pain scores before the fracture and at ten weeks and two years postoperatively were 92, 76, and 87 points, respectively, in the younger age group and 92, 84, and 93 points in the older age group. Function scores were 89, 68, and 79 points for the younger age group and 84, 71, and 73 points for the older age group. The Cronbach alpha for pain, stiffness, function, and the total scale ranged from 0.83 to 0.98 for the younger age group and from 0.79 to 0.97 for the older age group. Construct validity was good, with 82% and 79% of predefined hypotheses confirmed in the younger and older age groups, respectively. Responsiveness was moderate. No floor effects were found. Moderate to large ceiling effects were found for pain and stiffness scales at ten weeks and twelve months in younger patients (18% to 36%) and in the older age group (38% to 53%). CONCLUSIONS: The WOMAC showed good reliability, construct validity, and responsiveness in both age groups of elderly patients with a femoral neck fracture who had been physically and mentally fit before the fracture. The instrument is suitable for use in future clinical studies in these populations. CLINICAL RELEVANCE: The results are based on two clinical trials. The questionnaires used concern pure, clinically relevant issues (ability to walk, climb stairs, etc.). Moreover, the results can be used for future research comparing clinical outcomes (or treatments) for populations with a femoral neck fracture.

Published
2015

5. Increased surgeon experience with rheumatoid arthritis reduces the risk of complications following total joint arthroplasty

Author

Bheeshma, Ravi, Ruth, Croxford, Peter C, Austin, Simon, Hollands, J Michael, Paterson, Earl, Bogoch, Hans, Kreder, and Gillian A, Hawker

Subjects
Arthritis, Rheumatoid, Male, Risk, Postoperative Complications, Treatment Outcome, Arthroplasty, Replacement, Hip, Humans, Female, Clinical Competence, Middle Aged, Arthroplasty, Replacement, Knee, Aged
Abstract

To determine the relationship between surgeon experience with, and complications following, total joint arthroplasty (TJA) in patients with rheumatoid arthritis (RA).Using administrative data, we assembled a cohort of patients with RA who had undergone at least 1 elective primary hip or knee replacement procedure between 2002 and 2009. Cox proportional hazards, censored on death and accounting for clustering of patients within surgeons, were used to determine the relationship between overall and "RA-specific" surgeon TJA volume and the occurrence of a composite "complication" outcome (revision, infection, dislocation, or periprosthetic fracture within 2 years of the initial TJA), controlling for potential confounders (patient age, sex, comorbidity, and disease severity).We identified 4,762 patients with RA who were eligible for TJAs (1,515 total hip arthroplasties and 3,247 total knee arthroplasties). Among these patients, 152 (3.2%) experienced a surgical complication within 2 years of the procedure. After controlling for patient and hospital factors, greater surgeon TJA volume in patients with RA (RA TJA), but not overall TJA volume (all TJA), was associated with a reduced risk of complications (for surgeon RA TJA volume per 10 cases, adjusted hazard ratio [HR] 0.81, 95% confidence interval [95% CI] 0.71-0.93, P = 0.002; for surgeon all TJA volume, adjusted HR 0.98, 95% CI 0.97-1.00, P = 0.09).In a cohort of patients with RA who underwent hip or knee TJA, increased surgeon experience performing TJA in patients with RA, irrespective of their overall TJA experience and hospital factors, was associated with a decreased risk of surgical complications. These findings have potential implications for surgeon training and the referral practices of rheumatologists.

Published
2013

6. Increased risk of complications following total joint arthroplasty in patients with rheumatoid arthritis

Author

Bheeshma, Ravi, Ruth, Croxford, Simon, Hollands, J Michael, Paterson, Earl, Bogoch, Hans, Kreder, and Gillian A, Hawker

Subjects
Male, Knee Dislocation, Arthroplasty, Replacement, Hip, Middle Aged, Sensitivity and Specificity, Article, Arthritis, Rheumatoid, Postoperative Complications, Risk Factors, Hip Dislocation, Humans, Surgical Wound Infection, Female, Arthroplasty, Replacement, Knee, Algorithms, Aged, Retrospective Studies
Abstract

Most of the evidence regarding complications following total hip arthroplasty (THA) and total knee arthroplasty (TKA) are based on patients with osteoarthritis (OA); less is known about outcomes in rheumatoid arthritis (RA). Using a validated algorithm for identifying patients with RA, we undertook this study to compare the rates of complications among THA and TKA recipients between those with RA and those without RA.In patients who underwent a first primary elective THA or TKA between 2002 and 2009, those with RA were identified using a validated algorithm: a hospitalization with a diagnosis code for RA or 3 physician billing claims with a diagnosis code for RA, with at least 1 claim by a specialist (rheumatologist, orthopedic surgeon, or internist) in a 2-year period. Recipients with diagnostic codes suggesting an inflammatory arthritis, but not meeting RA criteria, were classified as having inflammatory arthritis. All remaining patients were deemed to have OA. Cox proportional hazards models, censored on death, were used to determine the relationship between the type of arthritis and the occurrence of specific complications, adjusting for potential confounders (age, sex, comorbidity, and provider volume).We identified 43,997 eligible THA recipients (3% with RA) and 71,793 eligible TKA recipients (4% with RA). Total joint arthroplasty recipients with RA had higher age and sex-standardized rates of dislocation following THA (2.45%, compared with 1.21% for recipients with OA) and higher age and sex-standardized rates of infection following TKA (1.26%, compared with 0.84% for recipients with OA). Controlling for potential confounders, recipients with RA remained at increased risk of dislocation within 2 years of THA (adjusted hazard ratio [HR] 1.91, P = 0.001) and remained at increased risk of infection within 2 years of TKA (adjusted HR 1.47, P = 0.03) relative to recipients with OA.Patients with RA are at higher risk of dislocation following THA and are at higher risk of infection following TKA relative to those with OA. Further research is warranted to elucidate explanations for these findings, including the roles of medication profile, implant choice, postoperative antibiotic protocol, and method of rehabilitation following joint replacement.

Published
2013

7. Residents' quality of life during an orthopedic trauma rotation: a multicentre prospective observational study

Author

Ali, Zahrai, Mohit, Bhandari, Amit, Varma, William R, Rennie, Hans, Kreder, David, Stephen, Michael D, McKee, James P, Waddell, and Emil H, Schemitsch

Subjects
Adult, Orthopedics, Career Choice, Traumatology, Quality of Life, Health Status Indicators, Humans, Internship and Residency, Original Article, Prospective Studies, Stress, Psychological
Abstract

Fewer orthopedic surgery trainees are choosing careers in trauma. The impact of stressors on health-related quality of life has not been evaluated among orthopedic surgical residents. The current study aimed to determine predictors of unsatisfactory resident quality of life during trauma rotations.This was a prospective observational study in which we chose orthopedic trauma rotations within 2 training programs at 3 level 1 trauma centres. A sample of 15 orthopedic surgery residents participated in the study. The main outcome measure was the 36-Item Short-Form Health Survey taken at baseline, 2 and 6 months into the rotation. Residents ranked level of stress for 15 work-related and 13 individual problems on 5-point Likert scales.The residents ranged from training years 1 through 5, and their mean age was 31 (standard deviation [SD] 2.8) years. Fear of error decreased at 6 months, compared with baseline (p = 0.007). Lack of time for family decreased as a problem at 2 and 6 months, compared with baseline (p = 0.025). Baseline Physical Component Summary scores were above population norms (p = 0.007). At 2 months, scores for the concept role limitations (physical) decreased significantly (p = 0.019), compared with the baseline. Mean Physical Component Summary scores declined from 57.59 (SD 3.51) at baseline to 53.68 (SD 6.50) at 2 months (p = 0.015) and 53.94 (SD 3.52) at 6 months (p = 0.008). At 2 months, mean general health scores significantly decreased, compared with baseline (p = 0.022). Social functioning scores at 6 months were decreased from population norms (p = 0.02). More resident social time was spent with medical people exclusively at 6 months, compared with baseline (p0.02).Trauma rotations affect residents' emotional well-being. Training programs should equip residents with coping strategies to improve quality of life during trauma rotations.

Published
2008

8. Commentary

Author

Hans Kreder

Subjects
Orthopedics and Sports Medicine, Surgery, General Medicine
Published
2013

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