Biomedical subjects

Y Dynan

Publications and source records attributed to Y Dynan.

4 recordsLinked to original sources

PubMed2000

Mobilisation strategies after hip fracture surgery in adults.

BACKGROUND: Post-operative care programmes after hip fracture surgery include strategies for mobilisation, such as early weight bearing, gait retraining and other physical therapy interventions. OBJECTIVES: To evaluate the effects of different mobilisation strategies and programmes after hip fracture surgery. SEARCH STRATEGY: The Cochrane Musculoskeletal Injuries Group trials register, Medline, and reference lists of relevant articles were searched. Date of the most recent search: August 1999. SELECTION CRITERIA: All randomised or quasi-randomised trials comparing different mobilisation strategies/programmes after hip fracture surgery. DATA COLLECTION AND ANALYSIS: All reviewers independently assessed trial quality, using a ten item scale, and extracted data. Wherever appropriate and possible, the data are presented graphically. MAIN RESULTS: Each of the four included trials evaluated a different intervention. All had poor and / or poorly reported trial methodology. One trial of 100 patients compared twice daily with once daily physiotherapy. Only limited outcome data were available for checking the claims in the trial report that there was no demonstrable difference in recovery of the two patient groups at nine weeks follow-up. A treadmill gait retraining programme was compared with a conventional gait retraining programme in one trial of 40 patients. More patients in the treadmill group had recovered their pre-fracture level of mobility by the time of hospital discharge, which tended to happen earlier than for the control group. Neither of these differences were statistically significant. One trial of 24 patients compared neuromuscular stimulation of the quadriceps muscle with placebo stimulation. No data were available to test the claims that neuromuscular stimulation improved the recovery of mobility, assessed up to 13 weeks. One trial involving 273 patients with a displaced intracapsular fracture treated by internal fixation compared weight bearing at two weeks after surgery with delayed weight bearing at 12 weeks after surgery. From the limited data available, there were no statistically significant differences between the two methods of treatment for the outcomes of non-union, mortality and overall unfavourable outcome at one year (42/141 versus 50/132; relative risk = 0.79, 95%confidence interval = 0.56 to 1.10). REVIEWER'S CONCLUSIONS: There is insufficient evidence from randomised trials to determine the effects of more frequent physiotherapy, treadmill gait retraining, or neuromuscular stimulation after hip fracture surgery. There is also insufficient evidence to determine the effects of early weight bearing after the internal fixation of an intracapsular proximal femoral fracture.

Adult↗

PubMed2000

Surgical approaches and ancillary techniques for internal fixation of intracapsular proximal femoral fractures.

BACKGROUND: In fixation of intracapsular hip fractures, different implants, surgical approaches and ancillary manoeuvres have been employed to improve the reduction, and the stability of the reconstruction, in an attempt to reduce the frequency of non-union and aseptic necrosis of the femoral head. OBJECTIVES: To compare alternative surgical approaches and ancillary techniques in internal fixation of intracapsular hip fractures which have been subjected to randomised trials in elderly people. SEARCH STRATEGY: The Cochrane Musculoskeletal Injuries Group trials register, Medline, and reference lists of relevant articles were searched. Date of the most recent search: June 1998. SELECTION CRITERIA: All randomised and quasi-randomised trials investigating operative technique for the treatment of intracapsular hip fractures. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality, by use of a ten-item checklist, and extracted data. MAIN RESULTS: One study of 94 patients studied the effect of impaction of the fracture at the time of surgery. The only outcome measure was bone scintimetry. There was no difference in scintimetry for the 29 undisplaced fractures but in displaced fractures treated with impaction the scintimetry appearances were significantly reduced implying a reduction of blood flow to the femoral head. One study of 220 patients compared the results of fractures treated with compression against those without compression. Results for 156 patients at one year showed a tendency to a lower incidence of non-union for those fractures treated without compression. One study of 49 patients noted a tendency to a reduced mortality for closed reduction of the fracture as opposed to open reduction. Non-union of the fracture was more common after closed reduction. REVIEWER'S CONCLUSIONS: Insufficient evidence exists from randomised trials to confirm the benefits of open or closed reduction or for intra-operative impaction or compression of an intracapsular fracture treated by internal fixation.

Aged↗

PubMed2000

Wound irrigation: a simple, reproducible device.

It is well established that copious saline irrigation is essential to good wound toilet with low rates of contamination. We present a simple and inexpensive method of wound irrigation that is ideal for use in both casualty and theatre situations.

Equipment Design↗

PubMed1998

Is Pauwels classification still valid?

Intracapsular proximal femoral fracture may be classified using the Pauwels classification, which relates to the shearing angle of the fracture surface. It implies that the greater the Pauwels angle, the higher will be the non-union rate. The Pauwels angle was studied in a series of 335 patients and related to the eventual radiological outcome. It was found that neither the Pauwels angle nor the classification had any predictive value for the incidence of non-union. A literature review of previous studies of the Pauwels angle indicated similar results. The continued use of the Pauwels classification in determining if the femoral head should be preserved or replaced is unsound.

Femoral Neck Fractures↗