Israel Medical Association Journal

Background: Balneotherapy is an established treatment modality for musculoskeletal disease. However, few studies have examined the efficacy of spa therapy in elderly patients with degenerative spine and joint diseases.

Objectives: To assess the effects of balneotherapy on chronic musculoskeletal pain, functional capacity, and quality of life in elderly patients with osteoarthritis of the knee or chronic low back pain.

Methods: A total of 81 patients enrolled and the results of 76 were analyzed. Subjects underwent a 1 day course of 30 minute daily baths in mineral water. Changes were evaluated in the following parameters:  pain intensity, functional capacity, quality of life, use of non-steroidal anti-inflammatory or analgesic drugs, subjective disease severity perceived by the patients, investigator-rated disease severity, and severity of pain perceived by the patients.

Results: Compared to baseline, all monitored parameters were significantly improved by balneotherapy in both investigated groups. Moreover, the favorable effect was prolonged for 3 months after treatment.

Conclusions: This study showed that balneotherapy is an effective treatment modality for elderly patients with osteoarthritis of the knee or with chronic low back pain, and its benefits last for at least 3 months after treatment.
 

Objectives: To report our experience in the treatment of pelvic fractures.

Methods: Between October 1998 and September 2001, 78 patients with pelvic fractures were admitted to our hospital. The age range of the 56 male and 22 female patients was 16–92 (mean 42 years). The cause of injury was road accident in 52 patients, fall from a height in 15, a simple fall in 9, and gunshot wounds in 2 patients. The Glascow Coma Scale score on arrival at the hospital was 3–15 (average 12). Twenty-five patients (32%) were admitted to the intensive care unit, 38 (48%) to the orthopedic department, 5 (6.4%) to neurosurgery and the remainder to a surgical department.

Results: Twenty-six patients (33.3%) received blood transfusion in the first 24 hours. Of the 25 patients (32%) with associated head trauma, 6 had intracranial bleeding; 29 patients (37%) had associated chest trauma, 28 (35.9%) had associated abdominal trauma, 16 (20.5%) had vertebral fractures and 40 (51.2%) had associated limb fractures. Pelvic angiography was performed in 5 patients (6.4%), and computed tomography-angiography of the cervical arteries and chest was performed in 1 and 5 patients respectively. Overall, a CT scan was performed in 56 patients (71.8%), of whom 25 (32%) had a pelvic CT on admission. Injury Severity Score was 4–66 (median 20). Laparotomy was performed in 14 patients (18%), spinal fusion in 5 (6.4%), limb surgery in 16 (20.5%), cranial surgery in 4 (5.02%), pelvic surgery in 10 (12.8%), chest surgery in 3 (3.85%), and facial surgery in 2 patients (2.56%). Seven patients (9%) died during the course of treatment.

Conclusion: Pelvic fracture carries a high morbidity rate. Associated chest, abdomen and limb injuries are often encountered. A multidisciplinary approach is needed to improve survival and outcome in patients with pelvic fractures.