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"open fracture"

Shobhit V Minhas, Louis W Catalano
PURPOSE: To establish and compare the incidence of 30-day postoperative infection in surgically managed open and closed metacarpal and phalangeal fractures, and to determine whether open fractures treated urgently had a lower incidence of postoperative infection. METHODS: We conducted a retrospective analysis of patient demographics, comorbidities, and 30-day infection rates of patients undergoing operative fixation of metacarpal, proximal, or middle phalanx fractures from 2008 to 2015 using the American College of Surgeons' National Surgical Quality Improvement Program database...
June 13, 2018: Journal of Hand Surgery
Andrew E Federer, Joshua S Murphy, James H Calandruccio, Dennis P Devito, Scott H Kozin, Greg S Slappey, Gary M Lourie
OBJECTIVES: To describe a midshaft forearm fracture pattern that places the ulnar nerve at risk in the pediatric population and provide seven clinical case examples describing the injury pattern and treatment methods. DESIGN: Retrospective observational case series, review of literature, cadaver dissection, and treatment recommendations. SETTING: Multi-institutional, Southeast United States PATIENTS:: Seven pediatric patients (5 male, 2 female) with mean age of 8...
June 4, 2018: Journal of Orthopaedic Trauma
Matthew L Costa, Juul Achten, Julie Bruce, Elizabeth Tutton, Stavros Petrou, Sarah E Lamb, Nick R Parsons
Importance: Open fractures of the lower limb occur when a broken bone penetrates the skin. There can be major complications from these fractures, which can be life-changing. Objectives: To assess the disability, rate of deep infection, and quality of life in patients with severe open fracture of the lower limb treated with negative pressure wound therapy (NPWT) vs standard wound management after the first surgical debridement of the wound. Design, Setting, and Participants: Multicenter randomized trial performed in the UK Major Trauma Network, recruiting 460 patients aged 16 years or older with a severe open fracture of the lower limb from July 2012 through December 2015...
June 12, 2018: JAMA: the Journal of the American Medical Association
Anuj Agrawal
BACKGROUND: The Orthopaedic Trauma Association (OTA) classification scheme for open fractures has improved precision, validity and reliability over the modified Gustilo classification system. However, it needs to be modified into a simple and practical classification system to gain widespread acceptance and application. MATERIAL AND METHODS: We devised a new "unified" classification of open fractures based on the Gustilo and OTA classification systems...
June 4, 2018: Injury
Rafael Valadares Oliveira, Luciano Passos Cruz, Marcos Almeida Matos
Objective: The aim of this study is to analyze the accuracy of the two classification systems for open fractures most commonly used in current medical practice, Gustilo and Tscherne, as predictors of infection. Methods: A retrospective observational study was performed, including 121 patients suffering from open fracture of the appendicular skeleton treated at an emergency hospital. The fractures were classified according to Gustilo and Tscherne systems during the initial treatment, and ratings were subsequently confirmed or rectified during hospitalization...
May 2018: Revista Brasileira de Ortopedia
Chase H Foster, Michael Karsy, Michael R Jensen, Jian Guan, Ilyas Eli, Mark A Mahan
BACKGROUND: Peripheral nerve injuries (PNIs) of the lower extremities have been assessed in small cohort studies; however, the actual incidence, national trends, comorbidities, and cost of care in lower extremity PNI are not defined. Lack of sufficient data limits discussion on national policies, payors, and other aspects fundamental to the delivery of care in the US. OBJECTIVE: To establish estimates of lower extremity PNIs incidence, associated diagnoses, and cost in the US using a comprehensive database with a minimum of a decade of data...
June 8, 2018: Neurosurgery
K O Opara, I C Nwagbara
Background: : The management of soft-tissue defects following surgery for chronic osteomyelitis of the tibia is challenging. It often requires complex reconstructive procedures, especially when the distal third of the tibia is involved. We present a relatively simple method of addressing these defects. Aim: : This study aims to report our experience with the use of the sural Island musculo fasciocutaneous flap in the management of osteomyelitis of the tibia. Materials and Methods: : Consecutive patients with osteomyelitis of the tibia requiring soft-tissue cover were managed using the sural Island musculo fasciocutaneous flap, and the outcome was analyzed...
June 2018: Nigerian Journal of Clinical Practice
Iulia Tevanov, Dan Mircea Enescu, Madalina Carp, Andrei Dusca, Alin Ladaru, Alexandru Ulici
Open fractures of the leg with large loss of tissue require extensive reconstructive methods that can injure the donor area. The use of negative pressure wound therapy (NPWT) may minimise the impact of these reconstructive methods because of its capacity to create granulation tissue that will form a wound bed for the skin graft, thus reducing the volume of soft tissue defect and saving the donor region. This case study describes the effectiveness of NPWT in the treatment and reconstruction of an open fracture of the leg, with massive loss of soft tissue, associated with elastic intramedullary nailing in a 10-year-old female patient, who was a victim of a car accident...
June 1, 2018: Journal of Wound Care
David R Tribble, Louis R Lewandowski, Benjamin K Potter, Joseph L Petfield, Daniel J Stinner, Anuradha Ganesan, Margot Krauss, Clinton K Murray
OBJECTIVES: We assessed osteomyelitis risk factors in U.S. military personnel with combat-related open tibia fractures (2003-2009). METHODS: Patients with open tibia fractures who met diagnostic criteria of osteomyelitis were identified as cases using Military Health System data and verified through medical record review. Controls were patients with open tibia fractures who did not meet osteomyelitis criteria. Gustilo-Andersen (GA) fracture classification scheme was modified to include transtibial amputations (TTAs) as the most severe level...
May 24, 2018: Journal of Orthopaedic Trauma
Florent Femy, Arnaud Follin, Philippe Juvin, Anne-Laure Feral-Pierssens
OBJECTIVE: On 13 November 2015, Paris was the target of multiple terrorist attacks responsible for a massive influx of casualties in emergency departments (EDs). Because of the activation of a local crisis plan and the arrival of extra staff, our capacities increased markedly. Our aim was to analyze whether our center, in this challenging context, efficiently managed this massive influx of patients. PATIENTS AND METHODS: We carried out a monocentric retrospective study...
June 5, 2018: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
Nikolas H Kazmers, Christopher H Judson, Angela P Presson, Yizhe Xu, Andrew R Tyser
PURPOSE: Distal radius fracture open reduction and internal fixation (ORIF) represents a considerable cost burden to the health care system. We aimed to elucidate demographic-, injury-, and treatment-specific factors influencing surgical encounter costs for distal radius ORIF. METHODS: We retrospectively reviewed adult patients treated with isolated distal radius ORIF between November 2014 and October 2016 at a single tertiary academic medical center. Using our institution's information technology value tools-which allow for comprehensive payment and cost data collection and analysis on an item-level basis-we determined relative costs (RC) for each factor potentially influencing total direct costs (TDC) for distal radius ORIF using univariate and multivariable gamma regression analyses...
May 31, 2018: Journal of Hand Surgery
Davor Mijatović, Sanda Smuđ Orehovec, Tomislav Đapić, Vilena Vrbanović Mijatović, Marko Mance
The challenges of managing Gustilo IIIB tibial fractures (ie, high energy trauma with a contaminated wound >10 cm in length, severe comminution ["crumbling"] or segmental fractures, and periosteal stripping) in children are unique in part because no clear guidelines exist and the injuries may cause short-term and long-term complications. Repeated wound debridement and secondary reconstruction are required in approximately 20% of these cases in both adults and children. A 13-year-old girl presented with severe polytrauma including an open Gustilo type IIIB fracture of the left lower leg...
May 2018: Ostomy/wound Management
Qihang Ge, Chunyou Wan, Yabei Liu, Xu Ji, Jihai Ma, Haikun Cao, Wei Yong, Zhao Liu, Ningning Zhang
Objective: To investigate the effect of axial stress stimulation on tibial and fibular open fractures healing after Taylor space stent fixation. Methods: The data of 45 cases with tibial and fibular open fractures treated by Taylor space stent fixation who meet the selection criteria between January 2015 and June 2016 were retrospectively analysed. The patients were divided into trial group (23 cases) and control group (22 cases) according to whether the axial stress stimulation was performed after operation...
August 1, 2017: Chinese Journal of Reparative and Reconstructive Surgery
Jun Zhang, Weizhong Yin, Yongmin Qiu, Yanguo Shen, Shifeng Cao, Jian Wang
Objective: To analyze the effectiveness of flexible internal fixation with locking plate for distal femoral fractures. Methods: Between January 2015 and June 2016, 21 cases of distal femoral fractures were treated. There were 5 males and 16 females with an average age of 62 years (range, 32-88 years). Injury was caused by falling in 14 cases, by traffic accident in 5 cases, and by falling from height in 2 cases. The fractures located at the left side in 13 cases and the right side in 8 cases...
January 1, 2018: Chinese Journal of Reparative and Reconstructive Surgery
Jialei Chen, Zhaokui Yan, Gang Zhong, Yue Fang
Objective: To discuss the efficacy of skin stretcher applied for repair of postoperative skin and soft tissue defects in tibial fractures. Methods: Between April 2016 and March 2017, 15 cases with skin and soft tissue defects after tibial fractures fixation were treated with the skin stretcher. There were 11 males and 4 females with an age of 24-59 years (mean, 37.5 years). The causes of injury included traffic accident in 7 cases, bruise in 3 cases, falling from height in 3 cases, and falling in 2 cases; without nerve and vascular injury in all patients...
May 1, 2018: Chinese Journal of Reparative and Reconstructive Surgery
Bo Shi, Gang Liu, Lin Li, Shitian Tang, Jun Wang, Mingrui Xie, Xiaoyu Dai, Jianyong He, Yun Zhang, Yi Tang, Jianbo Xianyu, Dong Wang, Mei He, Weiyun Xu, Zhongjin Song, Ying Ma, Fuguo Huang, Yueming Song
Objective: To summarize the injury characteristics and therapeutic strategy of patients injured in "8·8" Jiuzhaigou earthquake. Methods: The clinical data of 48 patients injured in "8·8" Jiuzhaigou earthquake who were admitted to Mianyang Central Hospital were analyzed retrospectively. There were 25 males and 23 females with an average age of 36 years (range, 5-87 years). The average interval from injury to admission was 30 hours (range, 3-53 hours)...
March 1, 2018: Chinese Journal of Reparative and Reconstructive Surgery
Casey Bartow-McKenney, Geoffrey D Hannigan, Joseph Horwinski, Patrick Hesketh, Annamarie D Horan, Samir Mehta, Elizabeth A Grice
Open fractures are characterized by disruption of the skin and soft tissue, which allows for microbial contamination and colonization. Preventing infection-related complications of open fractures and other acute wounds remains an evolving challenge due to an incomplete understanding of how microbial colonization and contamination influence healing and outcomes. Culture-independent molecular methods are now widely used to study human-associated microbial communities without introducing culture biases. Using such approaches, the objectives of this study were to 1) define the long-term temporal microbial community dynamics of open fracture wounds and 2) examine microbial community dynamics with respect to clinical and demographic factors...
May 26, 2018: Wound Repair and Regeneration
Min Wu, Jianzhong Guan, Yuzhou Xiao, Zhaodong Wang, Xiaotian Chen, Zhi Zhao, Kuankuan Zhang, Jun Zhu
Objective: To evaluate the effectiveness of three-dimensional (3-D) printing assisting minimally invasive for intraarticular calcaneal fractures with percutaneous poking reduction and cannulate screw fixation. Methods: A retrospective analysis was performed of the 19 patients (19 feet) with intraarticular calcaneal fracture who had been treated between March 2015 and May 2016. There were 13 males and 6 females with an average age of 38.2 years (range, 24-73 years)...
November 1, 2017: Chinese Journal of Reparative and Reconstructive Surgery
Yao Lu, Rungong Yang, Jialiang Zhu, Lin Yang, Yuzhe Bai, Rigeleng Se, Yaoqi Ying
Objective: To explore the effectiveness of plasma-mediated bipolar radiofrequency ablation debridement (Coblation debridement) in treatment with retention of internal fixation for early postoperative infection of fractures of extremities. Methods: Between January 2012 and May 2015, 16 patients (12 males and 4 females) with early postoperative infection of internal fixation for extremity fracture were treated, with an average age of 41.6 years (range, 19-61 years)...
November 1, 2017: Chinese Journal of Reparative and Reconstructive Surgery
Chunyong Chen, Junjian Ye, Yun Xie, Zhangxiong Lin, Qiyang Xie, Yaoyu Qiu, Gui Wu, Fasheng Wang
Objective: To estimate the outcome of cerclage followed by a figure-of-eight tension band with a single titanium wire for the treatment of patellar fracture. Methods: A retrospective analysis was made on the clinical data of 46 patients with patellar fractures treated between June 2012 and November 2014. There were 30 males and 16 females, aged 20-86 years (mean, 54 years). The fracture causes included falling in 27 cases, traffic accident in 16 cases, and knock in 3 cases...
July 1, 2017: Chinese Journal of Reparative and Reconstructive Surgery
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