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https://www.readbyqxmd.com/read/29678204/are-large-clinical-trials-in-orthopaedic-trauma-justified
#1
Sheila Sprague, Paul Tornetta, Gerard P Slobogean, Nathan N O'Hara, Paula McKay, Brad Petrisor, Kyle J Jeray, Emil H Schemitsch, David Sanders, Mohit Bhandari
BACKGROUND: The objective of this analysis is to evaluate the necessity of large clinical trials using FLOW trial data. METHODS: The FLOW pilot study and definitive trial were factorial trials evaluating the effect of different irrigation solutions and pressures on re-operation. To explore treatment effects over time, we analyzed data from the pilot and definitive trial in increments of 250 patients until the final sample size of 2447 patients was reached. At each increment we calculated the relative risk (RR) and associated 95% confidence interval (CI) for the treatment effect, and compared the results that would have been reported at the smaller enrolments with those seen in the final, adequately powered study...
April 20, 2018: BMC Musculoskeletal Disorders
https://www.readbyqxmd.com/read/29657482/functional-and-radiological-outcome-in-management-of-compound-tibia-diaphyseal-fracture-with-ao-monolateral-fixator-versus-limb-reconstruction-system
#2
Hitesh J Mangukiya, Neetin P Mahajan, Eknath D Pawar, Aakash Mane, Jitsen Manna
Introduction: Tibia being the most common fractured long bone represents 36.7% of all long bone fractures in adults with open fracture comprises 23.5% of all tibial shaft fracture. The lack of the muscular covering over anteromedial aspect of the tibia and poor blood supply predispose open tibial fractures to a 10-20 fold increased risk of developing infection than open fracture in any other anatomical areas and a nonunion rate as high as 28% has been reported in the literature. Methods: We did a prospective study at our institute from 2014-2016 comprising 40 patients with compound tibia diaphyseal fracture managed with AO monolateral external fixator (Group 1) (n = 20) and Limb reconstruction system (Group 2) (n = 20) as primary and definitive tool...
March 2018: Journal of Orthopaedics
https://www.readbyqxmd.com/read/29649850/-diagnostic-and-treatment-strategies-in-morel-lavallee-lesions-in-the-spinal-column-and-pelvis
#3
Christopher A Becker, Christian Kammerlander, Axel Greiner, Fabian Sommer, Christoph Linhart, Wolfgang Böcker, Bianka Rubenbauer, Simon Weidert
BACKGROUND: The Morel-Lavallée lesion is one of the concomitant soft tissue lesions of pelvic fractures. Its role in spine fractures and its treatment in combination with osteosynthesis of pelvic or spine fractures have not yet been determined. The aim of this study was to analyse the best diagnostic and treatment options of both spine and pelvic fractures combined with Morel-Lavallée lesions (MLL). METHODS: An analysis of the literature was performed via PubMed and Medline...
April 12, 2018: Zeitschrift Für Orthopädie und Unfallchirurgie
https://www.readbyqxmd.com/read/29644283/plating-of-an-isolated-fracture-of-shaft-of-ulna-under-local-anaesthesia-and-periosteal-nerve-block
#4
Amir Adham Ahmad, Mohammad Arshad Ikram
Isolated fractures of shaft of ulna are common. Plate fixation with anatomic reduction is thought to produce the best functional results in closed or open fractures. Surgery can be done under general and various types of regional anaesthesia. We report a case of fracture shaft of ulna treated by plating under a combination of WALANT (wide awake, local anaesthesia, no tourniquet) using tumescent anaesthesia and periosteal nerve block as a day care procedure.
December 2017: Trauma Case Reports
https://www.readbyqxmd.com/read/29629594/a-qualitative-study-of-patient-experience-of-an-open-fracture-of-the-lower-limb-during-acute-care
#5
E Tutton, J Achten, S E Lamb, K Willett, M L Costa
Aims The aim of this study was to explore the patients' experience of recovery from open fracture of the lower limb in acute care. Patients and Methods A purposeful sample of 20 participants with a mean age of 40 years (20 to 82) (16 males, four females) were interviewed a mean of 12 days (five to 35) after their first surgical intervention took place between July 2012 and July 2013 in two National Health Service (NHS) trusts in England, United Kingdom. The qualitative interviews drew on phenomenology and analysis identified codes, which were drawn together into categories and themes...
April 1, 2018: Bone & Joint Journal
https://www.readbyqxmd.com/read/29608532/wound-surface-area-as-a-risk-factor-for-flap-complications-among-patients-with-open-fractures
#6
Phelan Shea, Nathan N O'Hara, Sheila A Sprague, Mohit Bhandari, Brad A Petrisor, Kyle J Jeray, Min Zhan, Gerard P Slobogean, Raymond A Pensy
BACKGROUND: Soft tissue complications often dictate the success of limb salvage and the overall outcome of open fractures. Based on prior work at our institution, we hypothesize that wounds greater than 200cm are associated with a greater likelihood of both flap-related reoperation and wound complications among patients requiring soft tissue reconstruction with a rotational flap or free tissue transfer. METHODS: We performed a secondary analysis of FLOW trial data that included all patients who received a rotational or free tissue flap transfer for an open fracture...
March 21, 2018: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/29598844/effect-of-bmi-on-outcomes-of-surgical-treatment-for-tibial-plateau-fractures-a-comparative-retrospective-case-series-study
#7
Yaşar Mahsut Dinçel, Ali Öner, Yavuz Arikan, Sever Çaglar, Raşit Özcafer, Mehmet Akif Güleç
PURPOSE: Tibia plateau fracture (TPF) treatment aims at achieving a stable, aligned, mobile, painless knee and preventing post-traumatic osteoarthritis. To achieve this goal, surgeons consider criteria such as patients' characteristics, severity, risk of complications, fracture displacement/depression, degree of soft tissue injury. However, body mass index (BMI) is not considered as a risk factor in literature. Our study was conducted to find out any possible correlation between BMI and functional scores or radiological score separately...
March 2, 2018: Chinese Journal of Traumatology, Zhonghua Chuang Shang za Zhi
https://www.readbyqxmd.com/read/29590411/wartime-soft-tissue-coverage-techniques-for-the-deployed-surgeon
#8
Vilas Saldanha, Nathan Tiedeken, Brandon Godfrey, Nichole Ingalls
Background: Since the start of the conflict in the Middle East in 2001, military orthopedic surgeons have faced complex orthopedic injuries including high-energy soft tissue wounds, traumatic amputations, and open fractures. Although orthopedic surgeons are well trained in the management of osseous injuries, the treatment of soft tissue injuries can be technically challenging and unfamiliar. Early washout, debridement of devitalized tissue, external fixation of bony injuries, and antibiotic therapy remain the foundation of early wound management...
March 26, 2018: Military Medicine
https://www.readbyqxmd.com/read/29588023/managing-soft-tissues-in-severe-lower-limb-trauma-in-an-ageing-population
#9
Timothy M Noblet, Philippa C Jackson, Patrick Foster, David Martin Taylor, Paul J Harwood, Jay D Wiper
PURPOSE: With an ageing population, the incidence of trauma in those aged over 65 years is increasing. Strategies for dealing with these patients must be developed. At present the standard management of open tibial fractures in the UK is described by the BOAST4 guidelines (from the British Orthopaedic Association and British Association of Plastic & Aesthetic Surgeons). It is not clear to what extent these are appropriate for older patients. We describe our experience of managing elderly patients presenting with open tibial fractures...
March 13, 2018: Injury
https://www.readbyqxmd.com/read/29576644/complex-tibial-plateau-fractures-treated-by-hybrid-external-fixation-system-a-correlation-of-followup-computed-tomography-derived-quality-of-reduction-with-clinical-results
#10
Konstantinos Kateros, Spyridon P Galanakos, Georgios Kyriakopoulos, Stamatios A Papadakis, George A Macheras
Background: Tibial plateau fractures are common due to high energy injuries. The principles of treatment include respect for the soft tissues, restoring the congruity of the articular surface and reduction of the anatomic alignment of the lower limb to enable early movement of the knee joint. There are various surgical fixation methods that can achieve these principles of treatment. Recognition of the particular fracture pattern is important, as this guides the surgical approach required in order to adequately stabilize the fracture...
March 2018: Indian Journal of Orthopaedics
https://www.readbyqxmd.com/read/29570590/osteoarticular-infections-following-open-or-penetrating-trauma-in-children-in-the-post-community-acquired-methicillin-resistant-staphylococcus-aureus-era-the-impact-of-enterobacter-cloacae
#11
J Chase McNeil, Jesus G Vallejo, Kristina G Hulten, Sheldon L Kaplan
BACKGROUND: Most cases of pediatric osteoarticular infections (OAI) are hematogenous in nature and caused by Staphylococcus aureus. OAI in children can also occur through direct inoculation of microorganisms secondary to penetrating or open trauma. No studies in the US have evaluated the microbiology or outcomes of trauma-related OAI (TROAI) in children in the era of community-acquired MRSA (CA-MRSA). METHODS: Cases were identified from the inpatient infectious diseases consultation database at Texas Children's Hospital from Jan 2011-Dec 2016...
March 21, 2018: Pediatric Infectious Disease Journal
https://www.readbyqxmd.com/read/29564079/complications-after-operative-treatment-of-femoral-shaft-fractures-in-childhood-and-adolescence
#12
Christiane Kruppa, Gabriele Wiechert, Thomas A Schildhauer, Marcel Dudda
Purpose of the study was to retrospectively analyze the complication rates after operatively treated femoral shaft fractures in childhood and adolescence. Retrospective evaluation of 42 children with operatively treated femoral shaft fractures between 2000 and 2014. Fractures were classified as 27 A type, 12 B type and 3 C type fractures according the OTA/AO classification. 8 (19.05%) fractures were open. Age averaged 10.2 years (3-16). Fracture treatment was recorded as temporary or definitive external fixation, ESIN, plate fixation or IMN...
December 14, 2017: Orthopedic Reviews
https://www.readbyqxmd.com/read/29558373/antibiotic-prophylaxis-with-cefuroxime-influence-of-duration-on-infection-rate-with-staphylococcus-aureus-in-a-contaminated-open-fracture-model
#13
Jan Puetzler, Willem-Jan Metsemakers, Daniel Arens, Stephan Zeiter, Richard Kuehl, Michael J Raschke, Robert Geoff Richards, Thomas Fintan Moriarty
OBJECTIVES: The optimal duration of perioperative antibiotic prophylaxis (PAP) for open fractures remains controversial because of heterogeneous or unclear guidelines and highly variable prophylactic regimens in clinical practice. We aimed at testing different PAP durations under controlled conditions in a contaminated rabbit fracture model. METHODS: A complete humeral osteotomy in 18 rabbits was fixed with a 7-hole locking compression plate and inoculated with Staphylococcus aureus...
April 2018: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/29557939/orthopaedic-watercraft-injuries-characterization-of-mechanisms-fractures-and-complications-in-216-injuries
#14
Joseph Christensen, Sean Spence, David Watson, Anjan Shah, Benjamin Maxson, Anthony Infante, Roy Sanders, Hassan R Mir
OBJECTIVE: To review the orthopaedic injuries from watercraft treated surgically at our institution and report the mechanisms, fractures, and complications encountered. DESIGN: Retrospective case series. SETTING: Level I trauma center. PATIENTS/PARTICIPANTS: There were 216 fractures from watercraft in 146 patients. Average age was 33 years (range 4-78 years), there were 68% males (99/146), and 16% of the injuries occurred in children...
April 2018: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/29555530/negative-pressure-wound-therapy-versus-conventional-wound-dressings-in-treatment-of-open-fractures-a-systematic-review-and-meta-analysis
#15
REVIEW
Xi Liu, Hui Zhang, Shiqiang Cen, Fuguo Huang
BACKGROUND: Though several systematic reviews concerned have been published, controversy still exists. The current systematic review was designed to clarify the detailed advantages and disadvantages of the negative pressure wound therapy (NPWT) in treatment of open fractures in comparison with the conventional wound dressings. METHODS: A systematic search was performed in Pubmed, Cochrane Library, Embase, and Google Scholar for the published relevant clinical studies...
March 16, 2018: International Journal of Surgery
https://www.readbyqxmd.com/read/29555119/the-principles-and-practice-of-open-fracture-care-2018
#16
Amna Diwan, Kyle R Eberlin, Raymond Malcolm Smith
The principles of open fracture management are to manage the overall injury and specifically prevent primary contamination becoming frank infection. The surgical management of these complex injuries includes debridement & lavage of the open wound with combined bony and soft tissue reconstruction. Good results depend on early high quality definitive surgery usually with early stable internal fixation and associated soft tissue repair. While all elements of the surgical principles are very important and depend on each other for overall success the most critical element appears to be achieving very early healthy soft tissue cover...
February 21, 2018: Chinese Journal of Traumatology, Zhonghua Chuang Shang za Zhi
https://www.readbyqxmd.com/read/29547428/global-surgery-system-strengthening-it-is-all-about-the-right-metrics
#17
David A Watters, Glenn D Guest, Viliami Tangi, Mark G Shrime, John G Meara
Progress in achieving "universal access to safe, affordable surgery, and anesthesia care when needed" is dependent on consensus not only about the key messages but also on what metrics should be used to set goals and measure progress. The Lancet Commission on Global Surgery not only achieved consensus on key messages but also recommended 6 key metrics to inform national surgical plans and monitor scale-up toward 2030. These metrics measure access to surgery, as well as its timeliness, safety, and affordability: (1) Two-hour access to the 3 Bellwether procedures (cesarean delivery, emergency laparotomy, and management of an open fracture); (2) Surgeon, Anesthetist, and Obstetrician workforce >20/100,000; (3) Surgical volume of 5000 procedures/100,000; (4) Reporting of perioperative mortality rate; and (5 and 6) Risk rates of catastrophic expenditure and impoverishment when requiring surgery...
April 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29545992/outcomes-and-risk-factors-for-polymicrobial-posttraumatic-osteomyelitis
#18
Luciana Souza Jorge, Patrícia Silva Fucuta, Maria Gabriele L Oliveira, Marcelo Arruda Nakazone, Juliana Arruda de Matos, Alceu Gomes Chueire, Mauro José Costa Salles
Background: We hypothesized that polymicrobial posttraumatic osteomyelitis (PTO) may be associated with worse outcomes when compared to monomicrobial PTO. We therefore attempted to show the outcomes and predisposing factors associated with polymicrobial PTO. Methods: A single-center case-control study was carried out from 2007 to 2012. The outcome variables analyzed were: the need for additional surgical and antibiotic treatments, rates of amputation, and mortality associated with the infection. Univariate and multivariable analyses using multiple logistic regression were performed to identify risk factors associated with polymicrobial PTO, and p < 0...
2018: Journal of Bone and Joint Infection
https://www.readbyqxmd.com/read/29534410/-comparison-of-external-fixation-with-or-without-limited-internal-fixation-for-open-knee-fractures
#19
K N Li, H Lan, Z Y He, X J Wang, J Yuan, P Zhao, J S Mu
Objective: To explore the characteristics and methods of different fixation methods and prevention of open knee joint fracture. Methods: The data of 86 cases of open knee joint fracture admitted from January 2002 to December 2015 in Department of Orthopaedics, Affiliated Hospital of Chengdu University were analyzed retrospectively.There were 65 males and 21 females aged of 38.6 years. There were 38 cases treated with trans articular external fixation alone, 48 cases were in the trans articular external fixation plus auxiliary limited internal fixation group...
March 1, 2018: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
https://www.readbyqxmd.com/read/29526160/basic-principles-of-fracture-treatment-in-children
#20
Hakan Ömeroğlu
This review aims to summarize the basic treatment principles of fractures according to their types and general management principles of special conditions including physeal fractures, multiple fractures, open fractures, and pathologic fractures in children. Definition of the fracture is needed for better understanding the injury mechanism, planning a proper treatment strategy, and estimating the prognosis. As the healing process is less complicated, remodeling capacity is higher and non-union is rare, the fractures in children are commonly treated by non-surgical methods...
April 2018: Eklem Hastalıkları Ve Cerrahisi, Joint Diseases & related Surgery
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