Subtalar joint is a complex joint in hindfoot formed by the talus superiorly and the calcaneus and navicular inferiorly.Subtalar dislocations are high-mechanism injuries,which are caused by simultaneous dislocation of...Subtalar joint is a complex joint in hindfoot formed by the talus superiorly and the calcaneus and navicular inferiorly.Subtalar dislocations are high-mechanism injuries,which are caused by simultaneous dislocation of both talonavicular and talocalcaneal joints,without major fracture of the talus.They are usually classified as medial(most common),lateral,anterior and posterior dislocations,based on the position of foot in relation to talus and the indirect forces that have been applied to cause this significant injury.They are usually diagnosed by X rays,but computed tomography and magnetic resonance imaging can be used to identify associated intra-articular fractures and peri-talar soft tissue injuries respectively.Majority being closed injuries,can be managed in ED by closed reduction and cast immobilisation,but if they are open,have poor outcomes.Complications that ensue open dislocations are post-traumatic arthritis,instability and avascular necrosis.展开更多
BACKGROUND The United Kingdom has an aging population with nearly 1 in 5 being over the age of 65,and over 0.5 million over the age of 90.The treatment of acute fractures of the lower limb in the nonagenarian cohort o...BACKGROUND The United Kingdom has an aging population with nearly 1 in 5 being over the age of 65,and over 0.5 million over the age of 90.The treatment of acute fractures of the lower limb in the nonagenarian cohort of patients poses a technical challenge to orthopaedic surgeons.AIM To report the fracture incidence,survival outcomes of treating acute non-hip lower limb fractures in nonagenarians in Major Trauma Centre.METHODS Thirty Lower limb long bone fractures in patients of age from 90 to 99 years were identified during 12-mo at a Level 1 trauma centre from a computerized database.A retrospective evaluation performed for fracture incidence,treatment,length of hospital duration and mortality at 30-d,1-year and 2-year.RESULTS Thirty fractures(28 patients)were identified,twenty-four fractures were treated with surgery(mean age 93 years SD±2.59)and 6 managed conservatively(mean age 94 years SD±2.07).The mean length of the hospital stay was 18.2 d for both groups.The 30-d,1-year and 2-year mortality risks were 1/23,6/23 and 9/23(4%,26%and 39%)in the surgery group and 0/5,1/5 and 2/5(0%,20%and 40%)in the conservative group,with no evidence for a difference between the two groups at any time point.CONCLUSION Nonagenarians in the surgical group had similar length of hospital stay and mortality risks as those treated conservatively.Patients with fewer comorbidities and admitted from their own home were offered surgery.展开更多
Objectives:Multiple treatments are described in the literature for the treatment of chronic Eustachian tube dysfunction but high-level quality evidence seems missing to support these treatments.This systematic review ...Objectives:Multiple treatments are described in the literature for the treatment of chronic Eustachian tube dysfunction but high-level quality evidence seems missing to support these treatments.This systematic review aimed to determine and compare the safety and efficacy of Laser Eustachian tuboplasty and Microdebrider Eustachian tuboplasty as a treatment for long-term Eustachian tube dysfunction.Data sources:A total of 12 electronic databases were searched up to April 2018 for published and unpublished literature in the English language.References of included studies were checked.Methods:A systematic review was undertaken.Outcomes assessed were:primary outcomes-subjective improvement in symptoms(ETDQ-7),audiometric improvement of hearing,improvement of negative middle ear pressure noticed in tympanometry,objective improvement of tympanic membrane retraction.Secondary outcomes were-the ability to auto-insufflate Eustachian tube i.e.Valsalva manoeuvre,improved quality of life,passive tubal opening,tubomanometry,swallowing test,reduction in mucosal inflammation of Eustachian tube orifice in the nose,complications from the procedure,the need for further procedures.Results are reported in a narrative synthesis as a meta-analysis was not possible due to heterogeneous data.Results:Three studies were included.All included studies were small-scale case series(13-38 par-ticipants).Studies were conducted outside the UK.Subjective and objective improvement of Eustachian tube function was reported in all studies.But all included studies were at high risk of bias and subject to multiple limitations.No major complications were reported in either study.Conclusions:Based on current evidence,it is not possible to recommend the clinical use of either of these two interventions i.e.Laser or Microdebrider Eustachian tuboplasty.Lack of controlled studies was identified as a gap in the evidence.Future research should be directed toward designing randomised controlled trials.These trials should use strict standard methodology and reporting criteria.Future trials should make use of consensus statement document about Eustachian tube dysfunction definition,diagnostic methods,and outcome assessment criteria to design clinical trials.展开更多
文摘Subtalar joint is a complex joint in hindfoot formed by the talus superiorly and the calcaneus and navicular inferiorly.Subtalar dislocations are high-mechanism injuries,which are caused by simultaneous dislocation of both talonavicular and talocalcaneal joints,without major fracture of the talus.They are usually classified as medial(most common),lateral,anterior and posterior dislocations,based on the position of foot in relation to talus and the indirect forces that have been applied to cause this significant injury.They are usually diagnosed by X rays,but computed tomography and magnetic resonance imaging can be used to identify associated intra-articular fractures and peri-talar soft tissue injuries respectively.Majority being closed injuries,can be managed in ED by closed reduction and cast immobilisation,but if they are open,have poor outcomes.Complications that ensue open dislocations are post-traumatic arthritis,instability and avascular necrosis.
文摘BACKGROUND The United Kingdom has an aging population with nearly 1 in 5 being over the age of 65,and over 0.5 million over the age of 90.The treatment of acute fractures of the lower limb in the nonagenarian cohort of patients poses a technical challenge to orthopaedic surgeons.AIM To report the fracture incidence,survival outcomes of treating acute non-hip lower limb fractures in nonagenarians in Major Trauma Centre.METHODS Thirty Lower limb long bone fractures in patients of age from 90 to 99 years were identified during 12-mo at a Level 1 trauma centre from a computerized database.A retrospective evaluation performed for fracture incidence,treatment,length of hospital duration and mortality at 30-d,1-year and 2-year.RESULTS Thirty fractures(28 patients)were identified,twenty-four fractures were treated with surgery(mean age 93 years SD±2.59)and 6 managed conservatively(mean age 94 years SD±2.07).The mean length of the hospital stay was 18.2 d for both groups.The 30-d,1-year and 2-year mortality risks were 1/23,6/23 and 9/23(4%,26%and 39%)in the surgery group and 0/5,1/5 and 2/5(0%,20%and 40%)in the conservative group,with no evidence for a difference between the two groups at any time point.CONCLUSION Nonagenarians in the surgical group had similar length of hospital stay and mortality risks as those treated conservatively.Patients with fewer comorbidities and admitted from their own home were offered surgery.
文摘Objectives:Multiple treatments are described in the literature for the treatment of chronic Eustachian tube dysfunction but high-level quality evidence seems missing to support these treatments.This systematic review aimed to determine and compare the safety and efficacy of Laser Eustachian tuboplasty and Microdebrider Eustachian tuboplasty as a treatment for long-term Eustachian tube dysfunction.Data sources:A total of 12 electronic databases were searched up to April 2018 for published and unpublished literature in the English language.References of included studies were checked.Methods:A systematic review was undertaken.Outcomes assessed were:primary outcomes-subjective improvement in symptoms(ETDQ-7),audiometric improvement of hearing,improvement of negative middle ear pressure noticed in tympanometry,objective improvement of tympanic membrane retraction.Secondary outcomes were-the ability to auto-insufflate Eustachian tube i.e.Valsalva manoeuvre,improved quality of life,passive tubal opening,tubomanometry,swallowing test,reduction in mucosal inflammation of Eustachian tube orifice in the nose,complications from the procedure,the need for further procedures.Results are reported in a narrative synthesis as a meta-analysis was not possible due to heterogeneous data.Results:Three studies were included.All included studies were small-scale case series(13-38 par-ticipants).Studies were conducted outside the UK.Subjective and objective improvement of Eustachian tube function was reported in all studies.But all included studies were at high risk of bias and subject to multiple limitations.No major complications were reported in either study.Conclusions:Based on current evidence,it is not possible to recommend the clinical use of either of these two interventions i.e.Laser or Microdebrider Eustachian tuboplasty.Lack of controlled studies was identified as a gap in the evidence.Future research should be directed toward designing randomised controlled trials.These trials should use strict standard methodology and reporting criteria.Future trials should make use of consensus statement document about Eustachian tube dysfunction definition,diagnostic methods,and outcome assessment criteria to design clinical trials.
