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damage control orthopaedic surgery

S den Dunnen, J Dankelman, G M Kerkhoffs, G Tuijthof
In orthopaedic surgery, water jet drilling provides several advantages over classic drilling with rigid drilling bits, such as the always sharp cut, absence of thermal damage and increased manoeuvrability. Previous research showed that the heterogeneity of bone tissue can cause variation in drilling depth whilst water jet drilling. To improve control over the drilling depth, a new method is tested consisting of two water jets that collide directly below the bone surface. The expected working principle is that after collision the jets will disintegrate, with the result of eliminating the destructive power of the coherent jets and leaving the bone tissue underneath the focal point intact...
May 6, 2017: Journal of the Mechanical Behavior of Biomedical Materials
C-H Dong, Z-M Wang, X-L Zhao, A-M Wang
Hip surgeries count to the most frequent orthopaedic operations in older patients. Nonelective surgeries for hip fractures cause substantial economic burden because of high costs of medical treatment and high associated mortality. Surgery for hip fracture in the elderly comorbid patient still presents a challenge to orthopaedic surgeons. It is recommended that this surgery is performed within 48 hours after sustaining the hip fracture to decrease mortality. Yet the recommended early surgery (i.e. 48 hours after the incident) is not always feasible due to the frequent overall frailty of the patients or conditions of concomitant disease...
June 2016: European Review for Medical and Pharmacological Sciences
Yuan Zhu, Xiangyang Xu
BACKGROUND: Large cystic osteochondral defects of the talus can be challenging to treat. This retrospective control study looked at the use of osteochondral autograft transfer combined with cancellous allograft in patients with advanced cartilage and subchondral bone damage of the talus. METHODS: Thirteen patients were treated with large cystic osteochondral defect of the talus between February 2010 and July 2013. All of these cystic osteochondral defects were larger than 15 mm in diameter...
October 2016: Foot & Ankle International
Eimear B Dolan, David Tallon, Wing-Yee Cheung, Mitchell B Schaffler, Oran D Kennedy, Laoise M McNamara
Bone is often subject to harsh temperatures during orthopaedic procedures resulting in thermally induced bone damage, which may affect the healing response. Postsurgical healing of bone is essential to the success of surgery, therefore, an understanding of the thermally induced responses of bone cells to clinically relevant temperatures in vivo is required. Osteocytes have been shown to be integrally involved in the bone remodelling cascade, via apoptosis, in micro-damage systems. However, it is unknown whether this relationship is similar following thermal damage...
June 2016: Journal of the Royal Society, Interface
Gurmeet Singh, Vivek Jain, Dheeraj Gupta, Aman Ghai
Orthopaedic surgery involves drilling of bones to get them fixed at their original position. The drilling process used in orthopaedic surgery is most likely to the mechanical drilling process and there is all likelihood that it may harm the already damaged bone, the surrounding bone tissue and nerves, and the peril is not limited at that. It is very much feared that the recovery of that part may be impeded so that it may not be able to sustain life long. To achieve sustainable orthopaedic surgery, a surgeon must try to control the drilling damage at the time of bone drilling...
September 2016: Journal of the Mechanical Behavior of Biomedical Materials
Indira Devi Bhagavatula, Dhaval Shukla, Nishanth Sadashiva, Praveen Saligoudar, Chandrajit Prasad, Dhananjaya I Bhat
OBJECTIVE The physiological mechanisms underlying the recovery of motor function after cervical spondylotic myelopathy (CSM) surgery are poorly understood. Neuronal plasticity allows neurons to compensate for injury and disease and to adjust their activities in response to new situations or changes in their environment. Cortical reorganization as well as improvement in corticospinal conduction happens during motor recovery after stroke and spinal cord injury. In this study the authors aimed to understand the cortical changes that occur due to CSM and following CSM surgery and to correlate these changes with functional recovery by using blood oxygen level-dependent (BOLD) functional MRI (fMRI)...
June 2016: Neurosurgical Focus
Giovanni Bellanova, Francesco Buccelletti, Riccardo Berletti, Marco Cavana, Giorgio Folgheraiter, Francesca Groppo, Chiara Marchetti, Amelia Marzano, Alessandro Massè, Antonio Musetti, Tina Pelanda, Nicola Ricci, Gregorio Tugnoli, Damiano Papadia, Claudio Ramponi
AIM: Aim of this study is to analyze how the starting of Course of Trauma in our hospital improved survival and organization in management of polytraumatized patients. MATERIAL OF STUDY: We analysed all major trauma patients (Injury Severity Score (Injury Severity Score (ISS)> 15) treated at Emergency Department of the Santa Chiara Hospital between January 2011 and December 2014. The training courses (TC) were named "management of polytrauma" (MP) and "clinical cases discussion" (CCD), and started in November 2013...
2016: Annali Italiani di Chirurgia
P Bates, P Parker, I McFadyen, I Pallister
Trauma care has evolved rapidly over the past decade. The benefits of operative fracture management in major trauma patients are well recognised. Concerns over early total care arose when applied broadly. The burden of additional surgical trauma could constitute a second hit, fuelling the inflammatory response and precipitating a decline into acute respiratory distress syndrome, sepsis and multiple organ dysfunction syndrome. Temporary external fixation aimed to deliver the benefits of fracture stabilisation without the risk of major surgery...
May 2016: Annals of the Royal College of Surgeons of England
Loes W A H van Beers, Jakob van Oldenrijk, Vanessa A B Scholtes, Carel H Geerdink, Bob B A M Niers, Wouter Runne, Mohit Bhandari, Rudolf W Poolman
INTRODUCTION: Answering the demands of an increasingly young and active patient population, recent developments in total hip arthroplasty (THA) have shifted towards minimising tissue damage. The Collum Femoris Preserving (CFP) stem was developed to preserve the trochanteric region of the femur, which potentially preserves the insertion of the gluteus musculature. This might accelerate early postoperative rehabilitation and improve functional outcome. Currently the functional results of the CFP stem have not been compared with conventional straight stems in a randomised controlled trial (RCT)...
March 23, 2016: BMJ Open
Stein J Janssen, Hugo H Hermanussen, Thierry G Guitton, Michel P J van den Bekerom, Derek F P van Deurzen, David Ring
BACKGROUND: For greater tuberosity fractures, 5-mm displacement is a commonly used threshold for recommending surgery; however, it is unclear if displacement can be assessed with this degree of precision and reliability using plain radiographs. It also is unclear if CT images provide additional information that might change decision making. QUESTION/PURPOSES: We asked: (1) Does interobserver agreement for assessment of the amount and direction of fracture-fragment displacement vary based on imaging modality (radiographs only; 2-dimensional [2-D] CT images and radiographs; and 3-dimensional [3-D] and 2-D CT images and radiographs)? (2) Does the likelihood of recommending surgery vary based on imaging modality? (3) Does the level of confidence regarding the decision for treatment vary based on imaging modality? METHODS: We invited 791 orthopaedic surgeons to complete a survey on greater tuberosity fractures...
May 2016: Clinical Orthopaedics and related Research
Manuel Carcao, Pamela Hilliard, Miguel A Escobar, Luigi Solimeno, Johnny Mahlangu, Elena Santagostino
Despite recent improvements in the quality of care and treatment outcomes for haemophilia, joint disease remains a major concern for patients with and without inhibitors. Most bleeding episodes occur in the musculoskeletal system, and recurrent bleeding may result in progressive joint damage, leading to haemophilic arthropathy. Consequently, early identification and management of musculoskeletal bleeding episodes are important to prevent crippling deformities and dysfunction. Management strategies should aim at optimising joint function by reducing the frequency of, and preventing, joint bleeds...
December 2015: European Journal of Haematology
Max Talbot, E J Harvey, R Reindl, P Martineau, P Schneider
INTRODUCTION: Ultrasound-assisted external fixation of long bones has the potential to enhance extremity damage control surgery in locations without fluoroscopy, such as forward surgical elements, the intensive care unit, and spacecraft. This pre-clinical study specifically sought to evaluate orthopaedic surgeons' ability to sonographically define fracture patterns and the associated zone of injury in order to improve surgical decision-making and safely insert Schanz pin percutaneously...
December 2016: Journal of the Royal Army Medical Corps
Aaron R Merriam, Jay M Patel, Brian M Culp, Charles J Gatt, Michael G Dunn
BACKGROUND: Meniscus injuries in the United States result in an estimated 850,000 surgical procedures each year. Although meniscectomies are the most commonly performed orthopaedic surgery, little advancement has been made in meniscus replacement and regeneration, and there is currently no total meniscus replacement device approved by the Food and Drug Administration. HYPOTHESIS: A novel fiber-reinforced meniscus scaffold can be used as a functional total meniscus replacement...
October 2015: American Journal of Sports Medicine
Brice Malgras, Olivier Barbier, Ludovic Petit, Sylvain Rigal, François Pons, Pierre Pasquier
INTRODUCTION: On January 11th 2013, France launched Operation Serval in Mali following Resolution 2085 of the Security Council of the United Nations. Between January and March 2013, more than 4000 French soldiers were deployed to support the Malian National Army and the African Armed Forces. METHODS: All of the patients who had surgery during Operation Serval were entered into a computerised database. Patients' demographic data (age, sex, status) and types of performed surgical procedures (specialties, injury mechanisms) were recorded...
January 2016: Injury
(no author information available yet)
BACKGROUND: Several cross-sectional studies have estimated that the prevalence of femoroacetabular impingement (FAI) ranges from 14-17% among asymptomatic young adults to almost 95% among competitive athletes. With FAI, there is abnormal contact between the proximal femur and the acetabulum, resulting in abnormal mechanics with terminal motion such as hip flexion and rotation. This condition results from bony anomalies of the acetabular rim (Pincer) and or femoral head/neck junction (CAM) and typically causes hip pain and decreased hip function...
March 20, 2015: BMC Musculoskeletal Disorders
Laurent Mathieu, Benjamin Joly, Stéphane Bonnet, Antoine Bertani, Frédéric Rongiéras, François Pons, Sylvain Rigal
PURPOSE: Improved survival of combat casualties in modern conflicts is especially due to early access to damage control resuscitation and surgery in forward surgical facilities. In the French Army, these small mobile units are staffed with one general surgeon and one orthopaedic surgeon who must be able to perform any kind of trauma or non trauma emergency surgery. METHODS: This concept of forward surgery requires a solid foundation in general surgery which is no longer provided by the current surgical programs due to an early specialization of the residents...
October 2015: International Orthopaedics
Rory Morrison, Sam Adegbola, Vish Bhattacharya
INTRODUCTION: Intra-pelvic displacement of hip prostheses is an uncommon complication following arthroplasty surgery but can have significant detrimental effects on the patient. We present a case of a displaced hip prosthesis into the pelvic cavity and highlight the importance of pre-operative planning and investigation as well as choosing a suitable surgical approach. PRESENTATION OF CASE: A 69 year old lady with developmental dysplasia of the hips was found to have displacement of her prosthesis into the pelvis on day three following complex uncemented total hip replacement...
2015: International Journal of Surgery Case Reports
Waqas A Lughmani, Kaddour Bouazza-Marouf, Ian Ashcroft
Bone drilling is an essential part of many orthopaedic surgery procedures, including those for internal fixation and for attaching prosthetics. Estimation and control of bone drilling forces are critical to prevent drill-bit breakthrough, excessive heat generation, and mechanical damage to the bone. An experimental and computational study of drilling in cortical bone has been conducted. A 3D finite element (FE) model for prediction of thrust forces experienced during bone drilling has been developed. The model incorporates the dynamic characteristics involved in the process along with geometrical considerations...
February 2015: Journal of the Mechanical Behavior of Biomedical Materials
Jeffrey Manway, Peter Highlander
UNLABELLED: Open fractures have been associated with high rates of morbidity and mortality. Morbidity and mortality rates have improved with the advancements in infectious disease, plastic and reconstructive surgery, as well as damage control orthopaedics. Despite these advancements, few reports have focused on management of open foot and ankle fractures. This review outlines evidence-based principles for open fracture management and how these principles are applied to the foot and ankle...
February 2015: Foot & Ankle Specialist
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