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Trauma orthopaedics

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https://www.readbyqxmd.com/read/28323807/the-trauma-collaborative-care-study-tccs
#1
Stephen T Wegener, Andrew N Pollak, Katherine P Frey, Robert A Hymes, Kristin R Archer, Clifford B Jones, Rachel B Seymour, Robert V OʼToole, Renan C Castillo, Yanjie Huang, Daniel O Scharfstein, Ellen J MacKenzie
Previous research suggests that the care provided to trauma patients could be improved by including early screening and management of emotional distress and psychological comorbidity. The Trauma Collaborative Care (TCC) program, which is based on the principles of well-established models of collaborative care, was designed to address this gap in trauma center care. This article describes the TCC program and the design of a multicenter study to evaluate its effectiveness for improving patient outcomes after major, high-energy orthopaedic trauma at level 1 trauma centers...
April 2017: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/28323806/improving-pain-management-and-long-term-outcomes-following-high-energy-orthopaedic-trauma-pain-study
#2
Renan C Castillo, Srinivasa N Raja, Katherine P Frey, Heather A Vallier, Paul Tornetta, Todd Jaeblon, Brandon J Goff, Allan Gottschalk, Daniel O Scharfstein, Robert V OʼToole
Poor pain control after orthopaedic trauma is a predictor of physical disability and numerous negative long-term outcomes. Despite increased awareness of the negative consequences of poorly controlled pain, analgesic therapy among hospitalized patients after orthopaedic trauma remains inconsistent and often inadequate. The Pain study is a 3 armed, prospective, double-blind, multicenter randomized trial designed to evaluate the effect of standard pain management versus standard pain management plus perioperative nonsteroidal anti-inflammatory drugs or pregabalin in patients of ages 18-85 with extremity fractures...
April 2017: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/28323801/predicting-acute-compartment-syndrome-pacs-the-role-of-continuous-monitoring
#3
Andrew H Schmidt, Michael J Bosse, Katherine P Frey, Robert V OʼToole, Daniel J Stinner, Daniel O Scharfstein, Vadim Zipunnikov, Ellen J MacKenzie
The diagnosis of acute compartment syndrome (ACS) is a common clinical challenge among patients who sustain high-energy orthopaedic trauma, largely because no validated criteria exist to reliably define the presence of the condition. In the absence of validated diagnostic standards, concern for the potential clinical and medicolegal impact of a missed compartment syndrome may result in the potential overuse of fasciotomy in "at-risk" patients. The goal of the Predicting Acute Compartment Syndrome Study was to develop a decision rule for predicting the likelihood of ACS that would reduce unnecessary fasciotomies while guarding against potentially missed ACS...
April 2017: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/28323798/supplemental-perioperative-oxygen-to-reduce-surgical-site-infection-after-high-energy-fracture-surgery-oxygen-study
#4
Robert V OʼToole, Manjari Joshi, Anthony R Carlini, Robert A Sikorski, Armagan Dagal, Clinton K Murray, Michael J Weaver, Ebrahim Paryavi, Alec C Stall, Daniel O Scharfstein, Julie Agel, Mary Zadnik, Michael J Bosse, Renan C Castillo
Supplemental perioperative oxygen (SPO) therapy has been proposed as one approach for reducing the risk of surgical site infection (SSI). Current data are mixed regarding efficacy in decreasing SSI rates and hospital inpatient stays in general and few data exist for orthopaedic trauma patients. This study is a phase III, double-blind, prospective randomized clinical trial with a primary goal of assessing the efficacy of 2 different concentrations of perioperative oxygen in the prevention of SSIs in adults with tibial plateau, pilon (tibial plafond), or calcaneus fractures at higher risk of infection and definitively treated with plate and screw fixation...
April 2017: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/28323797/local-antibiotic-therapy-to-reduce-infection-after-operative-treatment-of-fractures-at-high-risk-of-infection-a-multicenter-randomized-controlled-trial-vanco-study
#5
Robert V OʼToole, Manjari Joshi, Anthony R Carlini, Clinton K Murray, Lauren E Allen, Daniel O Scharfstein, Joshua L Gary, Michael J Bosse, Renan C Castillo
A number of clinical studies in the spine literature suggest that the use of local vancomycin powder may substantially reduce surgical site infections (SSIs). These studies are primarily retrospective and observational and few focus on orthopaedic trauma patients. This study is a phase III, prospective, randomized, clinical trial to assess the efficacy of locally administered vancomycin powder in the prevention of SSI after fracture surgery. The primary goal of the VANCO Study is to compare the proportion of deep SSI 6 months after fracture fixation surgery...
April 2017: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/28323794/section-1-preventing-and-managing-infection-and-other-complications-after-orthopaedic-trauma
#6
(no author information available yet)
No abstract text is available yet for this article.
April 2017: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/28323765/misuse-of-opioids-in-orthopaedic-postoperative-patients
#7
Anup Gangavalli, Ajith Malige, George Terres, Saqib Rehman, Chinenye Nwachuku
OBJECTIVE: In light of the recent uptrend in the prescription of opioids, this study seeks to identify patterns of opioid misuse among orthopaedic postoperative patients and principal external sources in obtaining these medications. DESIGN: Ten-month survey-based study. SETTING: Two Level I trauma centers (urban and suburban). PATIENTS/PARTICIPANTS: Two hundred seven patients between the ages of 18 and 89 years who underwent surgical fixation of fractures involving the pelvis, long bones, or periarticular regions of the knee, ankle, elbow, and wrist...
April 2017: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/28291436/the-effects-of-radial-bowing-and-complications-in-intramedullary-nail-fixation-of-adult-forearm-fractures
#8
Ali Çağdaş Yörükoğlu, Ahmet Fahir Demirkan, Alp Akman, Ali Kitiş, Hande Usta
OBJECTIVES: This study aims to evaluate the effects of radial bowing changes on fracture healing and functional results in adult forearm intramedullary nail applications and complications of forearm nails that have been discussed rarely in the literature. PATIENTS AND METHODS: Twenty-three patients -11 with isolated radius and 12 with both radius and ulna fractures- (17 males, 6 females; mean age 38.6 years; range 18 to 69 years) who were operated between September 2009 and August 2014 were included in the study...
April 2017: Eklem Hastalıkları Ve Cerrahisi, Joint Diseases & related Surgery
https://www.readbyqxmd.com/read/28291414/is-cervical-disc-arthroplasty-good-for-congenital-cervical-stenosis
#9
Peng-Yuan Chang, Hsuan-Kan Chang, Jau-Ching Wu, Wen-Cheng Huang, Li-Yu Fay, Tsung-Hsi Tu, Ching-Lan Wu, Henrich Cheng
OBJECTIVE Cervical disc arthroplasty (CDA) has been demonstrated to be as safe and effective as anterior cervical discectomy and fusion (ACDF) in the management of 1- and 2-level degenerative disc disease (DDD). However, there has been a lack of data to address the fundamental discrepancy between the two surgeries (CDA vs ACDF), and preservation versus elimination of motion, in the management of cervical myelopathy associated with congenital cervical stenosis (CCS). Although younger patients tend to benefit more from motion preservation, it is uncertain if CCS caused by multilevel DDD can be treated safely with CDA...
March 10, 2017: Journal of Neurosurgery. Spine
https://www.readbyqxmd.com/read/28291185/efficacy-of-surgical-site-multimodal-drug-injection-following-operative-management-of-femoral-fractures-a-randomized-controlled-trial
#10
Daniel Koehler, J Lawrence Marsh, Matthew Karam, Catherine Fruehling, Michael Willey
BACKGROUND: Multimodal analgesia inclusive of periarticular injection with a local anesthetic agent has been rapidly assimilated, with demonstrated safety and efficacy, into the care of patients undergoing elective lower-extremity arthroplasty. The present study was performed to evaluate the efficacy and safety of a surgical-site, multimodal drug injection for postoperative pain control following operative management of femoral fractures. METHODS: There were 102 patients undergoing operative intervention (plate fixation, intramedullary device, or arthroplasty) for a broad range of femoral fracture patterns who were prospectively randomized either to receive an intraoperative, surgical-site injection into the superficial and deep tissues containing ropivacaine, epinephrine, and morphine or to receive no injection...
March 15, 2017: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/28291180/dynamic-stress-testing-is-unnecessary-for-unimalleolar-supination-external-rotation-ankle-fractures-with-minimal-fracture-displacement-on-lateral-radiographs
#11
Simo Nortunen, Hannu-Ville Leskelä, Heidi Haapasalo, Tapio Flinkkilä, Pasi Ohtonen, Harri Pakarinen
BACKGROUND: This study aimed to identify factors from standard radiographs that contributed to the stability of the ankle mortise in patients with isolated supination-external rotation fractures of the lateral malleolus (OTA/AO 44-B). METHODS: Non-stress radiographs of the mortise and lateral views, without medial clear space widening or incongruity, were prospectively collected for 286 consecutive patients (mean age, 45 years [range, 16 to 85 years]), including 144 female patients (mean age, 50 years [range, 17 to 85 years]) and 142 male patients (mean age, 40 years [range, 16 to 84 years]) from 2 trauma centers...
March 15, 2017: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/28289942/structured-reporting-of-mri-of-the-shoulder-improvement-of-report-quality
#12
Sebastian Gassenmaier, Marco Armbruster, Florian Haasters, Tobias Helfen, Thomas Henzler, Sedat Alibek, Dominik Pförringer, Wieland H Sommer, Nora N Sommer
OBJECTIVES: To evaluate the effect of structured reports (SRs) in comparison to non-structured narrative free text (NRs) shoulder MRI reports and potential effects of both types of reporting on completeness, readability, linguistic quality and referring surgeons' satisfaction. METHODS: Thirty patients after trauma or with suspected degenerative changes of the shoulder were included in this study (2012-2015). All patients underwent shoulder MRI for further assessment and possible surgical planning...
March 13, 2017: European Radiology
https://www.readbyqxmd.com/read/28285481/the-highest-impact-combat-orthopedic-and-extremity-injury-articles-in-the-past-70-years-a-citation-analysis
#13
Jason Nam, Woo S Do, Daniel J Stinner, Joseph C Wenke, Jean A Orman, John F Kragh
The objective of this study was to identify the most-cited peer-reviewed combat orthopedic and extremity injury articles published during the past 70 years. Orthopedic trauma presents ongoing challenges to both US civilian and military healthcare personnel. Improvements in combat trauma and extremity injury survival and quality of life are the result of advances in orthopedic trauma research. The Web of Science (including Science Citation Index) was searched for the most cited articles related to combat orthopedic trauma, published from 1940 to 2013...
2017: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
https://www.readbyqxmd.com/read/28277589/medical-missions-in-the-middle-east-an-orthopaedic-surgeon-s-experience-of-a-series-of-lower-extremity-cases
#14
Aiman Rifai, Todd P Pierce, Kimona Issa, Yasmine Rifai, Bartlomiej Szczech
Orthopaedic trauma accounts for a great deal of disability worldwide. There are many impoverished nations affected by war wherein victims suffer blast injuries associated with mines, missiles, high-powered gunshots, and bombings. One way to address this is through international medical missions sponsored by industrialized nations. It is imperative that practitioners have a basic understanding of the type of injuries that may be encountered in these nations impacted by war and conflict. Therefore, we described a small number of various lower extremity injuries seen by one orthopaedic surgeon during his volunteer medical mission to Jordan...
March 9, 2017: Surgical Technology International
https://www.readbyqxmd.com/read/28262280/shared-decision-making-in-the-management-of-midshaft-clavicular-fractures-nonoperative-treatment-or-plate-fixation
#15
Sarah Woltz, Pieta Krijnen, Sven A G Meylaerts, Arwen H Pieterse, Inger B Schipper
INTRODUCTION: Most patients with a displaced midshaft clavicular fracture can be treated either operatively or nonoperatively, with similar long-term outcomes. The treatment choice depends on individual preferences, and is therefore suited for a shared decision making (SDM) approach. However, little is known about SDM in fracture treatment. The purpose of this study was to evaluate the current daily practice of shared decisional behaviour in clavicular fracture treatment, in order to assess the need for improvement and set a baseline level for future research...
February 27, 2017: Injury
https://www.readbyqxmd.com/read/28258304/orthopaedic-trauma-surgeons-and-direct-anterior-total-hip-arthroplasty-evaluation-of-learning-curve-at-a-level-i-academic-institution
#16
Philip J York, Stephanie L Logterman, David J Hak, Andreas Mavrogenis, Cyril Mauffrey
BACKGROUND: Interest in the direct anterior approach for total hip arthroplasty has increased over recent years; however, the potential for substantial complications exists, especially during the surgeon's learning curve. We evaluated the change in various metrics to help identify a single surgeon's learning curve. Additionally, we examined whether the learning curve was different for primarily arthroplasty versus trauma-trained surgeons. METHODS: We reported outcomes from the first 50 total hip arthroplasties performed through a direct anterior approach by a trauma fellowship-trained orthopaedic surgeon...
March 3, 2017: European Journal of Orthopaedic Surgery & Traumatology: Orthopédie Traumatologie
https://www.readbyqxmd.com/read/28249884/unusual-morel-lavallee-lesion-of-the-knee-region-in-an-elderly-patient
#17
Walid El Kininy, Shane Davy, Murali Sayana
The Morel-Lavallee lesion (MLL) of the knee region has been described in the Orthopaedic literature, and all of those were fit and healthy young participants sustaining sports-related trauma to the knee. We describe a case of an elderly woman, on aspirin and prophylactic clexane, who sustained a low-energy injury to the right knee and developed an MLL of the knee region. A delayed recognition, led to the persistence of the MLL as a diffuse haematoma, which subsequently became colonised with methicillin-resistant Staphylococcus aureus We discuss the management of a case and highlight the importance of early identification and management of MLL of the knee region...
March 1, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28246046/a-comparison-of-minimally-invasive-approach-vs-conventional-approach-for-volar-plating-of-distal-radial-fractures
#18
Xu Zhang, Xiangye Huang, Xinzhong Shao, Hongwei Zhu, Jianxin Sun, Xianhui Wang
BACKGROUND: The aim of this study was to introduce and to evaluate the functional results of volar plating of distal radial fractures through a longitudinal minimally invasive approach. METHODS: From January 2010 to January 2013, 157 patients with distal radial fractures were randomly allocated to group A (n = 83; 49 men, 34 women; mean age: 42 (18-67)) and B (n = 74; 46 men, 28 women; mean age: 41 (22-65)), including type A2, A3, B3, C1, and C2 fractures, based on AO Foundation and Orthopaedic Trauma Association Classification...
February 25, 2017: Acta Orthopaedica et Traumatologica Turcica
https://www.readbyqxmd.com/read/28243953/the-role-of-biomarkers-for-the-diagnosis-of-implant-related-infections-in-orthopaedics-and-trauma
#19
Abtin Alvand, Maryam Rezapoor, Javad Parvizi
Diagnosis of implant-related (periprosthetic joint) infections poses a major challenge to infection disease physicians and orthopaedic surgeons. Conventional diagnostic tests continue to suffer from issues of accuracy and feasibility. Biomarkers are used throughout medicine for diagnostic and prognostic purposes, as they are able to objectively determine the presence of a disease or a biological state. There is increasing evidence to support the measurement of specific biomarkers in serum and/or synovial fluid of patients with suspected periprosthetic joint infections...
February 28, 2017: Advances in Experimental Medicine and Biology
https://www.readbyqxmd.com/read/28236034/treatment-of-infected-non-unions-with-segmental-defects-with-a-rail-fixation-system
#20
Srikanth Mudiganty, Arup Kumar Daolagupu, Arun Kumar Sipani, Satyendra Kumar Das, Arijit Dhar, Parag Jyoti Gogoi
We conducted this study to evaluate the use of rail fixation system in infected gap non-union of femur and tibia as an alternative to the established Ilizarov circular fixator technique. Prospective study. The study was done in the Department of Orthopaedic surgery in a medical school and level I trauma center to which the authors are/were affiliated. Between June 2010 and June 2015, 40 patients with infected gap non-union of femur and tibia were treated with the rail fixation system. Patients who were willing to undergo surgery and participate in the post-operative rehabilitation were included in the study...
April 2017: Strategies in Trauma and Limb Reconstruction
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