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Arthroplasty for Acute Hip Fractures, Early Results

تبديل مفصل الورك في كسور عنق الفخذ الحادّة نتائج قريبة المدى

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 Publication date 2000
  fields Medicine
and research's language is العربية
 Created by Shamra Editor




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THA as a primary management for acute fractures around the hip should generally be reserved to a very selected few patients where the general condition, life expectancy, age, bone quality, pathological changes, type of injury... Primary THA for acute fractures around the hip done with proper patient selection under the proper condition, and requirements can result in good clinical results with excellent short-term survival of the prosthesis.


Artificial intelligence review:
Research summary
تتناول هذه الدراسة موضوع تبديل مفصل الورك كإجراء بدئي لعلاج كسور عنق الفخذ الحادة، وتستعرض النتائج القريبة المدى لهذا الإجراء. يوضح الباحث الدكتور هيثم غنام أن هذا النوع من العمليات يجب أن يُجرى لمرضى مختارين بعناية، مع مراعاة عوامل مثل عمر المريض، الحالة العامة، بنية العظم، ومدى الحياة المتوقعة. تشير النتائج إلى أن تبديل مفصل الورك يمكن أن يؤدي إلى نتائج سريرية جيدة إذا تم تحت الظروف المناسبة ومع توفر الإمكانيات التأهيلية. تم إجراء الدراسة على 31 مريضًا، وكانت النتائج مشجعة حيث أظهرت تحسنًا في النشاط والفعالية لدى معظم المرضى. كما تم استعراض بعض المضاعفات المحتملة مثل خلع المفصل والتهاب الوريد الخثري.
Critical review
تعتبر هذه الدراسة مهمة في مجال جراحة العظام، حيث تقدم بيانات قيمة حول فعالية تبديل مفصل الورك في علاج كسور عنق الفخذ الحادة. ومع ذلك، هناك بعض النقاط التي يمكن تحسينها. أولاً، كان من الأفضل تضمين مجموعة مقارنة من المرضى الذين تم علاجهم بطرق أخرى لتقديم مقارنة أكثر شمولية. ثانيًا، الدراسة تركز بشكل كبير على النتائج القريبة المدى، وكان من المفيد تضمين نتائج طويلة المدى لتقديم صورة أكثر اكتمالاً عن فعالية هذا الإجراء. أخيرًا، كان من الممكن تقديم تفاصيل أكثر حول المعايير الدقيقة لاختيار المرضى لإجراء هذه العمليات.
Questions related to the research
  1. ما هي العوامل التي يجب مراعاتها عند اختيار المرضى لإجراء تبديل مفصل الورك؟

    يجب مراعاة عمر المريض، الحالة العامة، بنية العظم، مدى الحياة المتوقعة، والتغييرات المرضية الموجودة في المفصل قبل الإصابة.

  2. ما هي النتائج القريبة المدى لتبديل مفصل الورك حسب الدراسة؟

    النتائج القريبة المدى كانت مشجعة، حيث أظهرت تحسنًا في النشاط والفعالية لدى معظم المرضى، مع نسبة عالية من النتائج الممتازة والجيدة.

  3. ما هي المضاعفات المحتملة لتبديل مفصل الورك؟

    تشمل المضاعفات المحتملة خلع المفصل، التهاب الوريد الخثري، والصمة الرئوية.

  4. ما هي الفوائد الرئيسية لتبديل مفصل الورك مقارنة بطرق العلاج الأخرى؟

    الفوائد تشمل السماح بالحركة المبكرة، تقليل الحاجة لإعادة العمل الجراحي، وتجنب المضاعفات مثل النخرة الجافة وعدم الاندمال.


References used
Bochner RM, Pellicci PM, Lyden JP: Bipolar hemiarthroplasty fracture of the femoral neck., J Bone Joint Surg 70- A: 1001, 1988
Carnesale PG, Anderson LD: Primary prosthetic replacement for femoral neck fractures, Arch Surg 110: 27, 1975
Delamarter R, Moreland JR: Treatment of acute femoral neck fractures with total hip arthroplasty, Clin O rthop 218: 68, 1987
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Background& Objective: The acetabular bone deficiency secondary to acetabular fractures presents a complex clinical problem and a big challenge to the orthopedic surgeons due to the technical difficulties related to this deficiency, considering tha t significant number of patients treated either surgically or without surgery will require T.H.A in the future. The purpose of our study was to determine the outcome of T.H.R performed in patients with a history of acetabular fracture. Materials & Methods: We performed T.H.R in 21 patients with previous acetabular fractures in Al-Assad Hospital between2004-2009prespectively, these cases were divided into 3 groups: -first group formed of 7 patients were treated conservatively. Second group formed of 9 patients did an open reduction and internal fixation by screws and plates. -Third group formed of 5 elderly patients with fresh acetabular fractures and were treated primarily by a total prosthesis with use a reinforcement Muller ring . For the clinical evaluation of our cases we used the modified Harris Hip Score Scale and for the radiological evaluation we used the Delee and Charnley scale system . Results: Our overage Harris Hip Score was 83.(80 for the first group, 86 for the second group, and 83 for the third group). -No complications were encountered intraoperative, in the early postoperative period one case developed superficial wound infection and treated by repeated dressing and antibiotic, there was one case of D.V.T on the 4th day treated by rest and anticoagulant, and one case developed loosening of acetabular component 8 months after T.H.A and underwent to revision. Conclusion: T.H.R in acetabular fractures despite the difficulties faced during the procedure is a safe and effective way to salvage the hip when secondary osteoarthritis develops, open reduction and internal fixation of acetabular fractures may have benefits even if it fails to prevent posttraumatic arthritis .Furthermore the clinical results of T.H.R after surgical treatment of acetabular fractures are better than it after conservative treatment of these fractures. Reinforcement ring is an ideal solution when the decision of T.H.R is taken as a primary treatment of acetabular fractures depending on the indications described by Joly.
The study included 25 patients were followed up for two years joined together. The number of females ranged from 18 patients percentage of 72%, the number of males ranged 7 patients by 28%. The incidence of these fractures in women more than men by 3 /1, especially in the seventh and eighth decades where we note in this Study, a good results in females. Muscular weakness occur after surgery due to lack of use, and muscular weakness continue for a period of two years after the surgery, which suggests the use of exercise for a long time . There is a noticeable improvement in two years after the surgery for intracapsul femoral neck fractures within the portfolio in terms of clinical and functional findings, in addition to the improvement in activities of daily routine (functional) for the patient compared to the same segment of the patients one year after surgery. The early treatment and movement as possible to strengthen the muscles of the lower limbs and improve the adjacent joint movement, the absence of lesions associated , the period of hospitalization least for so, technique of surgery, medical care and physical activities encourage are the most important facturs that have helped to warning and predictable, then we get agood results as we wont.
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