Fractures of femur proximal extremity(FFPE)are the most common fragility fractures requiring hospitalization,with a high risk of mortality,low independence in the activities of daily living and severe consequences on ...Fractures of femur proximal extremity(FFPE)are the most common fragility fractures requiring hospitalization,with a high risk of mortality,low independence in the activities of daily living and severe consequences on healthrelated quality of life.Timing for surgery has a key role in the management of elderly patients with FFPE as recommended by the Australian and New Zealand guidelines and the National Institute for Health and Care Excellence guidelines.Early surgery(within 48 h from hospital admission)allows significant benefits in terms of lower rates of postoperative complications and risk of death and can provide better functional outcomes.Therefore,time for surgery could be considered as a comorbidity marker.The choice between conservative or surgical approach surprisingly seems to be still not strongly supported by available literature,but it seems that both 30 d and 1 year risk of mortality is higher with the conservative treatment rather than with surgery.In light of these considerations,the optimization of FFPE management care is mandatory to improve functional outcomes and to reduce sanitary costs.Albeit it is widely accepted that transdisciplinary approach to patients suffering from FFPE is mandatory to optimize both short-term and long-term outcomes,the feasibility of a comprehensive approach in clinical practice is still a challenge.In particular,the large variability of figures involved could be considered both a resource and an additional disadvantage taking into account the difficulty to coordinate multidisciplinary approach covering care in all settings.Therefore,the aim of the present article was to summarize current evidence supporting transdisciplinary management of patients with FFPE,highlighting the benefits,feasibility and limitations of this approach.展开更多
Few studies report the possible correlation pain-paratendon microvascularity during the painful phase of the chronic Achilles tendinopathy and the efficacy of the radial shock wave therapy re-spect to other therapies....Few studies report the possible correlation pain-paratendon microvascularity during the painful phase of the chronic Achilles tendinopathy and the efficacy of the radial shock wave therapy re-spect to other therapies. The aim of the present longitudinal, controlled study is to demonstrate the variation of the tendon micro vascularization in athletes affected by Achilles tendinopathy and the efficacy and safety of the radial extracorporeal shock wave therapy. Twelve elite runners with Achilles tendinopathy were compared with 12 healthy amateurs, both treated by radial extracorporeal shock wave therapy in 3 sessions (1/every 3 days). VAS scale was used for pain evaluation at one and six months after treatment and a Color and Power Doppler echography was performed to observe the paratendon microvascularity before the beginning of the treatment and at one and six months after. One month after the beginning of the treatment, it was observed a decrease of the hypervascularity in all 12 subjects with tendinopathy and no variation in the control group participants. Clinically, 80% of patients referred pain relief and they were able to return to sports activity. The decrease of the paratendon microvascularity confirms the correlation between the disappearance of the pain and the normalization of the vascularity in the athletes. Moreover, radial extracorporeal shock wave therapy consented a quickly pain relief and returned to the sport. These results confirmed the efficacy and safety of this physical therapy that it could be considered a good therapeutic choice in the treatment of the chronic Achilles tendinopathy.展开更多
文摘Fractures of femur proximal extremity(FFPE)are the most common fragility fractures requiring hospitalization,with a high risk of mortality,low independence in the activities of daily living and severe consequences on healthrelated quality of life.Timing for surgery has a key role in the management of elderly patients with FFPE as recommended by the Australian and New Zealand guidelines and the National Institute for Health and Care Excellence guidelines.Early surgery(within 48 h from hospital admission)allows significant benefits in terms of lower rates of postoperative complications and risk of death and can provide better functional outcomes.Therefore,time for surgery could be considered as a comorbidity marker.The choice between conservative or surgical approach surprisingly seems to be still not strongly supported by available literature,but it seems that both 30 d and 1 year risk of mortality is higher with the conservative treatment rather than with surgery.In light of these considerations,the optimization of FFPE management care is mandatory to improve functional outcomes and to reduce sanitary costs.Albeit it is widely accepted that transdisciplinary approach to patients suffering from FFPE is mandatory to optimize both short-term and long-term outcomes,the feasibility of a comprehensive approach in clinical practice is still a challenge.In particular,the large variability of figures involved could be considered both a resource and an additional disadvantage taking into account the difficulty to coordinate multidisciplinary approach covering care in all settings.Therefore,the aim of the present article was to summarize current evidence supporting transdisciplinary management of patients with FFPE,highlighting the benefits,feasibility and limitations of this approach.
文摘Few studies report the possible correlation pain-paratendon microvascularity during the painful phase of the chronic Achilles tendinopathy and the efficacy of the radial shock wave therapy re-spect to other therapies. The aim of the present longitudinal, controlled study is to demonstrate the variation of the tendon micro vascularization in athletes affected by Achilles tendinopathy and the efficacy and safety of the radial extracorporeal shock wave therapy. Twelve elite runners with Achilles tendinopathy were compared with 12 healthy amateurs, both treated by radial extracorporeal shock wave therapy in 3 sessions (1/every 3 days). VAS scale was used for pain evaluation at one and six months after treatment and a Color and Power Doppler echography was performed to observe the paratendon microvascularity before the beginning of the treatment and at one and six months after. One month after the beginning of the treatment, it was observed a decrease of the hypervascularity in all 12 subjects with tendinopathy and no variation in the control group participants. Clinically, 80% of patients referred pain relief and they were able to return to sports activity. The decrease of the paratendon microvascularity confirms the correlation between the disappearance of the pain and the normalization of the vascularity in the athletes. Moreover, radial extracorporeal shock wave therapy consented a quickly pain relief and returned to the sport. These results confirmed the efficacy and safety of this physical therapy that it could be considered a good therapeutic choice in the treatment of the chronic Achilles tendinopathy.
