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Trauma orthopaedics

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https://www.readbyqxmd.com/read/29682618/multidisciplinary-approach-to-improve-the-quality-of-below-knee-plaster-casting
#1
John Teudar Williams, Marta Kedrzycki, Yathish Shenava
Problem: In our trauma unit, we noted a high rate of incorrectly applied below-knee casts for ankle fractures, in some cases requiring reapplication. This caused significant discomfort and inconvenience for patients and additional burden on plaster-room services. Our aim was to improve the quality of plaster casts and reduce the proportion that needed to be reapplied. Methods: Our criteria for plaster cast quality were based on the British Orthopaedic Association Casting Standards (2015) and included neutral (plantargrade) ankle position, adequacy of fracture reduction and rate of cast reapplication...
2018: BMJ Open Quality
https://www.readbyqxmd.com/read/29678204/are-large-clinical-trials-in-orthopaedic-trauma-justified
#2
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/29677092/current-publication-rates-of-abstracts-presented-at-the-orthopaedic-trauma-association-annual-meetings-2005-2010
#3
Ryan Lee, Ishwarya S Mamidi, Alex Gu, Jordan S Cohen, William Probasco, James DeBritz
OBJECTIVES: To evaluate the publication rate of abstracts presented at the 2005-2010 Orthopaedic Trauma Association (OTA) Annual Meetings. METHODS: All abstracts from the 2005 to 2010 OTA meetings were identified through the OTA's official website. Each abstract was searched across PubMed and Google to determine its publication status. The overall publication rate of abstracts was determined, along with the first authors' sex, number of authors, time and journal of publication, and analyzed with statistical testing...
May 2018: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/29675629/-geriatric-trauma-center-dgu%C3%A2-evaluation-of-clinical-and-economic-parameters-a-pilot-study-in-a-german-university-hospital
#4
M Knobe, B Böttcher, M Coburn, T Friess, L C Bollheimer, H J Heppner, C J Werner, J-P Bach, M Wollgarten, S Poßelt, C Bliemel, B Bücking
BACKGROUND: Previous studies on orthogeriatric models of care suggest that there is substantial variability in how geriatric care is integrated in the patient management and the necessary intensity of geriatric involvement is questionable. OBJECTIVE: The aim of the current prospective cohort study was the clinical and economic evaluation of fragility fracture treatment pathways before and after the implementation of a geriatric trauma center in conformity with the guidelines of the German Trauma Society (DGU)...
April 19, 2018: Der Unfallchirurg
https://www.readbyqxmd.com/read/29652779/is-the-current-management-of-patients-presenting-with-spinal-trauma-to-district-general-hospitals-fit-for-purpose-our-experience-of-delivering-a-spinal-service-using-an-electronic-referral-platform-in-a-large-district-general-teaching-hospital-without-onsite
#5
Daniel S Hill, Hans Marynissen
STUDY DESIGN: A retrospective cross-sectional analysis. OBJECTIVE: To describe the provision of a spinal service using an electronic platform to direct management from an external spinal unit, and quantify time taken to obtain definitive management plans whilst under prescribed spinal immobilization. SUMMARY OF BACKGROUND DATA: Most attending district general hospitals following spinal trauma will have stable injuries and normal neurology, with only a small proportion requiring urgent transfer to a specialist centre...
April 12, 2018: Spine
https://www.readbyqxmd.com/read/29644324/gunshot-wounds-to-the-buttock-and-contralateral-thigh-presenting-with-intestinal-injury-without-history-of-abdominal-trauma-case-report
#6
Makgabo John Tladi
We present a clinical case of a patient who sustained a gunshot wounds to his right buttock (entrance), left thigh (exit), and right thumb, as well as intestinal injuries without history of abdominal trauma. Initially the abdominal injuries were not recognised and the patient did not mention an injury to the abdomen. For this reason he was unfortunately admitted to the orthopaedic ward first for further treatment of his thumb injury.
June 2017: Trauma Case Reports
https://www.readbyqxmd.com/read/29629591/displaced-femoral-neck-fractures-in-patients-60-years-of-age-or-younger-results-of-internal-fixation-with-the-dynamic-locking-blade-plate
#7
J H Kalsbeek, A D P van Walsum, J P A M Vroemen, H M J Janzing, J T Winkelhorst, B P Bertelink, W H Roerdink
Aims The objective of this study was to investigate bone healing after internal fixation of displaced femoral neck fractures (FNFs) with the Dynamic Locking Blade Plate (DLBP) in a young patient population treated by various orthopaedic (trauma) surgeons. Patients and Methods We present a multicentre prospective case series with a follow-up of one year. All patients aged ≤ 60 years with a displaced FNF treated with the DLBP between 1st August 2010 and December 2014 were included. Patients with pathological fractures, concomitant fractures of the lower limb, symptomatic arthritis, local infection or inflammation, inadequate local tissue coverage, or any mental or neuromuscular disorder were excluded...
April 1, 2018: Bone & Joint Journal
https://www.readbyqxmd.com/read/29628687/megaprosthesis-versus-allograft-prosthesis-composite-for-massive-skeletal-defects
#8
REVIEW
Deepak Gautam, Rajesh Malhotra
Massive skeletal defects are encountered in the setting of tumors necessitating excision, failed total hip arthroplasty with periprosthetic bone loss, periprosthetic fracture, complex trauma, multiple failed osteosynthesis and infection. Reconstruction of the segmental defects poses a tremendous challenge to the orthopaedic surgeons. The goal of osseous reconstruction of these defects is to restore the bone length and function. Currently the most commonly employed methods for reconstruction are either a megaprosthesis or an Allograft Prosthesis Composite (APC)...
January 2018: Journal of Clinical Orthopaedics and Trauma
https://www.readbyqxmd.com/read/29627849/patient-related-outcomes-after-proximal-tibial-fractures
#9
Daniel Wenger, Karolin Petersson, Cecilia Rogmark
PURPOSE: The purpose of the study was to assess patient-related outcomes at short-term follow-up in patients with a proximal tibial fracture. METHODS: One hundred sixteen patients (119 fractures) treated at our institution during 2012 were retrospectively reviewed. Follow-up was 1.6 (SD ± 0.4) years post-injury, including the short musculoskeletal function assessment and visual analog scale for pain and satisfaction. Fractures were classified by the Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association classification and divided in two groups: simple and complex...
April 7, 2018: International Orthopaedics
https://www.readbyqxmd.com/read/29620609/the-use-of-closed-incision-negative-pressure-wound-therapy-in-orthopaedic-surgery
#10
Denis Nam, Robert A Sershon, Brett R Levine, Craig J Della Valle
Wound complications and surgical site infections after orthopaedic procedures result in substantial morbidity and costs. Traditional postoperative wound care consists of applying sterile, dry gauze and abdominal pads to the surgical site, with more frequent dressing changes performed in cases in which wound drainage is excessive. Persistent incisional drainage is of particular concern because it increases the risk of deep infection. The use of closed incision negative-pressure wound therapy (ciNPWT) to manage delayed wound healing was first reported a decade ago, and the benefits of this treatment modality include wound contraction with diminished tensile forces, stabilization of the wound environment, decreased edema and improved removal of exudate, and increased blood and lymphatic flow...
April 3, 2018: Journal of the American Academy of Orthopaedic Surgeons
https://www.readbyqxmd.com/read/29613949/reduced-dnase-enzyme-activity-in-response-to-high-post-injury-mitochondrial-dna-concentration-provides-a-therapeutic-target-for-sirs
#11
Daniel J McIlroy, Kyra Minahan, Simon Keely, Natalie Lott, Philip Hansbro, Doug W Smith, Zsolt J Balogh
BACKGROUND: Cell free mitochondrial DNA (mtDNA) is pro-inflammatory and has been detected in high concentrations in trauma patients' plasma. Deoxyribonuclease (DNase) is the free plasma enzyme responsible for the digestion of extracellular DNA. The relationship between mtDNA and DNase after major trauma is unknown. We hypothesized that DNase activity would be elevated after injury and trauma surgery, and would be associated with high concentrations of extracellular DNA. METHODS: 2-year prospective study was performed on 103 consecutive trauma patients (Male 81%, Age: 38 IQR 30-59 years; ISS: 18 IQR 12-26) who underwent standardised major orthopaedic trauma surgical interventions...
March 22, 2018: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29613939/orthopaedic-trauma-outcomes-in-developing-countries-commentary-on-an-article-by-nathan-n-o-hara-mha-et-al-the-socioeconomic-implications-of-isolated-tibial-and-femoral-fractures-from-road-traffic-injuries-in-uganda
#12
https://www.readbyqxmd.com/read/29613935/the-use-of-emergency-physicians-to-deliver-anesthesia-for-orthopaedic-surgery-in-austere-environments-the-expansion-of-the-emergency-physician-s-general-anesthesia-syllabus-to-orthopaedic-surgery
#13
Ogedad Pierre, John F Lovejoy, Robert Stanton, Richard Skupski, Harold Previl, Jerry Bernard, Lia Losonczy, Mark Walsh
BACKGROUND: Five billion people, primarily in low-income and middle-income countries, cannot access safe, affordable surgical and anesthesia care, particularly for orthopaedic trauma. The rate-limiting step for many orthopaedic surgical procedures performed in the developing world is the absence of safe anesthesia. Even surgical mission teams providing surgical care are limited by the availability of anesthesiologists. Emergency physicians, who are already knowledgeable in airway management and procedural sedation, may be able to help to fulfill the need for anesthetists in disaster relief and surgical missions...
April 4, 2018: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/29602782/kite-surfing-epidemiology-of-trauma
#14
Lisa Dunne, Evelyn Murphy, Peter Hugh Dawson, Michael Leonard
Kite surfing has become an increasingly popular recreational activity worldwide. Thrill seekers can span the water at high speeds and reach great heights risking injury and death. We report the case of a young kite surfer who sustained a fracture dislocation of the right acetabulum that required specialised surgical management. We present this case with a review of the literature outlining the incidence of pelvic and acetabular fractures in the kitesurfing community. Overall, there is a low incidence of pelvic fractures in comparison with other orthopaedic traumas reported among kite surfers, and the most commonly injured sites are the foot and ankle...
March 29, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29589502/comparison-between-a-multicentre-collaborative-closed-loop-audit-assessing-management-of-supracondylar-fractures-and-the-british-orthopaedic-association-standard-for-trauma-11-boast-11-guidelines
#15
MULTICENTER STUDY
R Goodall, H Claireaux, J Hill, E Wilson, F Monsell, Boast Collaborative, P Tarassoli
Aims Supracondylar fractures are the most frequently occurring paediatric fractures about the elbow and may be associated with a neurovascular injury. The British Orthopaedic Association Standards for Trauma 11 (BOAST 11) guidelines describe best practice for supracondylar fracture management. This study aimed to assess whether emergency departments in the United Kingdom adhere to BOAST 11 standard 1: a documented assessment, performed on presentation, must include the status of the radial pulse, digital capillary refill time, and the individual function of the radial, median (including the anterior interosseous), and ulnar nerves...
March 1, 2018: Bone & Joint Journal
https://www.readbyqxmd.com/read/29588023/managing-soft-tissues-in-severe-lower-limb-trauma-in-an-ageing-population
#16
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/29582942/-fluoroscopic-based-navigation-in-orthopaedic-trauma-a-review-of-a-large-center-s-experience
#17
Yoram A Weil, Meir Liebergall, Rami Mosheiff, Amal Khoury
INTRODUCTION: Computer Assisted Orthopaedic Surgery (CAOS) was introduced in the late 1990's and early 2000's. Since then its application in orthopaedic trauma has been utilized mainly as augmented fluoroscopy for intraoperative navigation. From 2010 our center implemented an advanced system allowing further expansion of this technology. AIMS: The aim of this study was to describe the experience with an advanced fluoroscopic based CAOS system in our center. METHODS: The BrainLabTM Trauma 3...
March 2018: Harefuah
https://www.readbyqxmd.com/read/29576239/epidemiology-and-outcomes-of-traumatic-knee-dislocations-isolated-vs-multi-trauma-injuries
#18
Genevieve Darcy, Elton Edwards, Raphael Hau
BACKGROUND AND PURPOSE: Traumatic dislocation of the knee (TKD) is a rare injury, accounting for approximately 0.02% of orthopaedic injuries. They are a challenging entity for orthopaedic surgeons to manage, and can have devastating consequences. The aim of this study was to describe the epidemiology of traumatic knee dislocations (TKD'S) and contrast the incidence of neurovascular injury between isolated and multi-trauma dislocations as well as key patient reported outcomes achieved between these groups...
February 21, 2018: Injury
https://www.readbyqxmd.com/read/29570497/radiation-exposure-and-health-risks-for-orthopaedic-surgeons
#19
Roman A Hayda, Raymond Y Hsu, J Mason DePasse, Joseph A Gil
Orthopaedic surgeons are routinely exposed to intraoperative radiation and, therefore, follow the principle of "as low as reasonably achievable" with regard to occupational safety. However, standardized education on the long-term health effects of radiation and the basis for current radiation exposure limits is limited in the field of orthopaedics. Much of orthopaedic surgeons' understanding of radiation exposure limits is extrapolated from studies of survivors of the atomic bombings in Hiroshima and Nagasaki, Japan...
April 15, 2018: Journal of the American Academy of Orthopaedic Surgeons
https://www.readbyqxmd.com/read/29568784/does-the-lever-sign-test-have-added-value-for-diagnosing-anterior-cruciate-ligament-ruptures
#20
Miranda C Lichtenberg, Christiaan H Koster, Lennart P J Teunissen, Frits G J Oosterveld, Annelieke M K Harmsen, Daniel Haverkamp, Daniel Hoornenborg, Robert P Berg, Frank W Bloemers, Irene R Faber
Background: Diagnosing an anterior cruciate ligament (ACL) rupture based on a physical examination remains a challenge for both surgeons and physical therapists. The lever sign test was developed to overcome the practical limitations of other tests and to optimize diagnosis. An evaluation of the measurement properties of the lever sign test is needed to make adequate interpretations in practice. Purpose: To evaluate the reliability and diagnostic value of the lever sign test...
March 2018: Orthopaedic Journal of Sports Medicine
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