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Thomas H Carter, Samuel P Mackenzie, Katrina R Bell, Marcus A Hollyer, Emma C Gill, Deborah J MacDonald, Andrew D Duckworth, Timothy O White
BACKGROUND: Whilst the lateral malleolus appears to be crucial in controlling anatomical reduction of the talus, the role of the medial malleolus is less clear. Medial sided complications including infection, damage to local structures and symptomatic hardware are not without morbidity. This study compares the outcomes of patients with bimalleolar or trimalleolar ankle fractures who underwent fibular nail stabilisation with or without medial malleolar fixation. METHODS: From a prospective single-centre trauma database, we identified 342 patients over a nine-year period who underwent fibular nail insertion to stabilise a bimalleolar or trimalleolar ankle fracture...
March 11, 2019: Injury
H Çabuk, Y İmren, S S Dedeoğlu, M Ç Kır, S Gürbüz, H Gürbüz
AIM: The screw length is important to achieve a stable fixation for medial malleoli fractures. We aimed to evaluate the optimal screw length for different age groups in surgically treated medial malleoli fractures. The second aim was to identify the utility of the distance of epiphyseal scar to joint line or joint line to medullary space for assessment of screw length. MATERIAL METHOD: 368 X-rays and computed tomography (CT) images of ankle joints were retrospectively evaluated for optimal screw length, epiphyseal scar to joint line distance, joint to medullary space distance...
March 11, 2019: Injury
Volker Alt, Hamish Simpson
No abstract text is available yet for this article.
March 8, 2019: Injury
Matjaž Groznik, Matej Cimerman, Lara Lusa, Nina Ružić Gorenjec, Alojz Ihan
BACKGROUND: Early diagnosis of acute posttraumatic osteomyelitis (POM) is of vital importance for avoiding devastating complications. Diagnosing POM is difficult due to the lack of a highly specific and sensitive test, such as in myocardial infarct, stroke and intracranial bleeding. Serum inflammatory markers, C-reactive protein (CRP), procalcitonin (PCT), white blood cells (WBC) can support clinical findings but they are not able to differentiate between inflammatory response to infection and the host response to non-infection insult with high specificity and sensitivity...
March 5, 2019: Injury
Xiang Zhang, Wei Shui, Weidong Ni, Zhenming Hu, Wei Huang, Gang Luo, Bo Qiao, Shuquan Guo
OBJECTIVE: Extensive incision associated with large-scale callus exfoliation and internal fixation is the common therapeutic approach employed by the majority of orthopaedists in the treatment of old femoral fractures. Inspired by the surgical techniques of intramedullary fixation and reduction by traction, the present study attempted to treat old femoral fractures with minimally invasive methods utilising the principles of biological osteosynthesis (BO). METHODS: A retrospective analysis involving 16 patients with old femoral fractures treated with combined traction, small incision, limited callus treatment, reduction by leverage and intramedullary fixation was conducted...
March 4, 2019: Injury
Brice Malgras, Olivier Aoun, Ghislain Pauleau, Guillaume Boddaert, Emmanuel Hornez, Renaud Dulou, Jean-Marc Delmas, Pierre Haen, Sophie Laversanne, Anna Crambert, Paul Balandraud
INTRODUCTION: The military operations carried out by the French armed forces, occasionally require the use of the Surgical Life-saving Module (SLM), to ensure the surgical support of its soldiers. Due to its extreme mobility and capacity of fast deployment, SLM is particularly useful in small-scale military operations, such as Special Forces missions. In 2017, the French SLM was for the first time used to ensure surgical support of allied forces, which were lacking forward surgical capabilities...
March 4, 2019: Injury
Giuseppe Toro, Federica Lepore, Giampiero Calabrò, Gabriella Toro, Marco Rossini, Michele Vasso, Alfredo Schiavone Panni
INTRODUCTION: Humeral shaft is a common site of fracture non-union. Biology and bone quality represent some of the problems that the orthopaedic surgeon has to face up in the elderly. The goals of treatment of humeral shaft non-union are the achievement of mechanical stability and creation of a favourable biologic environment. Bone graft and stem cells are some of the augmentation techniques available to reach these goals. PURPOSE: Evaluation of the outcomes of humeral shaft non-union in elderly population treated with cortical allograft and stem cells...
February 27, 2019: Injury
David Gomez, Kristian Larsen, Brian J Burns, Michael Dinh, Jeremy Hsu
INTRODUCTION: Getting the right patient, to the right place, at the right time is dependent on a multitude of modifiable and non-modifiable factors. One potentially modifiable factor is the number and location of trauma centres (TC). Overabundance of TC dilutes volumes and could be associated with worse outcomes. We describe a methodology that evaluates trauma system reconfiguration without reductions in potential access to care. We used the mature trauma system of New South Wales (NSW) as a model given the perceived overabundance of urban major trauma centres (MTC)...
February 27, 2019: Injury
Emir Battaloglu, Marisol Figuero, Christopher Moran, Fiona Lecky, Keith Porter
Urethral injury in major trauma is infrequent, with complex problems of diagnosis and treatment. The aims of this study are to determine the incidence and epidemiological factors relating to urethral injury in major trauma, as well as determine if any additional prognostic factors are evident within this cohort of patients. A retrospective review of patients sustaining urethral injury following major trauma was made over a 6-year period, from 2010 to 2015. Quantitative analysis was made using the national trauma registry for England and Wales, the Trauma Audit and Research Network (TARN) database, identifying all patients with injury codes for urethral injury...
February 22, 2019: Injury
T H Rainer, K K C Hung, J H H Yeung, S K C Cheung, Y K Leung, L Y Leung, W B Goggins, H F Ho, C W Kam, N K Cheung, C A Graham
BACKGROUND: Trauma care systems in Asia have been developing in recent years, but there has been little long-term outcome data from injured survivors. This study aims to evaluate the trajectory of functional outcome and health status up to five years after moderate to major trauma in Hong Kong. METHODS: We report the five year follow up results of a multicentre, prospective cohort from the trauma registries of three regional trauma centres in Hong Kong. The original cohort recruited 400 adult trauma patients with ISS ≥ 9...
February 22, 2019: Injury
Ishaq Ibrahim, Paul T Appleton, John J Wixted, Joseph P DeAngelis, Edward K Rodriguez
INTRODUCTION: Implant cut-out remains a common cause of cephalomedullary nail (CMN) failure and patient morbidity following surgical treatment of intertrochanteric femur fractures. Recent studies have suggested an increased rate of CMN cut-out with helical blades as opposed to lag screws. We compared rates of overall cut-out between helical blades and lag screws and used bivariate and multivariate analysis to determine the role of proximal fixation method among other variables on risk for cut-out...
February 20, 2019: Injury
K Al-Hourani, M Stoddart, T J S Chesser
OBJECTIVE: To analyse whether early post-operative full weight bearing following syndesmotic ankle fixation affected radiographic outcomes suggestive of diastasis. DESIGN: Retrospective comparative cohort study over a two year period. SETTING: Level 1 trauma centre PATIENTS/PARTICIPANTS: 152 consecutive patients sustaining an unstable ankle fracture requiring syndesmotic stabilisation were included. Exclusions were 49 patients who had trimalleolar fixation without syndesmosis screws, one patient who had concomitant ankle and talar fracture...
February 20, 2019: Injury
Jorge Briceño, Bonnie Chien, Christopher Miller, Brian Velasco, John Y Kwon
The ankle gravity stress view (GSV) is often utilized to elucidate instability in patients with an apparent, isolated lateral malleolus fracture. While this has been demonstrated to have advantages over the manual external rotation stress test, positioning in the lateral decubitus position can be difficult, uncomfortable and time-intensive. We report a simple and safe technique that allows one to obtain a gravity stress view of the ankle with the patient seated.
February 18, 2019: Injury
Pietro Persiani, Lorena Martini, Filippo Maria Ranaldi, Anna Zambrano, Mauro Celli, Luca Celli, Patrizia D'Eufemia, Ciro Villani
INTRODUCTION: Patients with Osteogenesis Imperfecta (OI) Type 3 may exhibit both primitive deformities and secondary fracture malunions on a femoral level. The orthopaedic surgeon's objective is to cure the deformities in order to prevent fractures and to treat the fractures in order to prevent deformities, by using telescopic nails as the gold standard method of fixation. However, the titanium elastic nail (TEN) is indicated as a possible alternative in certain selected cases. MATERIALS AND METHODS: The Centre for Congenital Osteodystrophy of the Sapienza University of Rome follows 485 patients with osteogenesis imperfecta...
February 15, 2019: Injury
Giovanni Vicenti, Giuseppe Solarino, Massimiliano Carrozzo, Silvana De Giorgi, Lorenzo Moretti, Angelo De Crescenzo, Biagio Moretti
PURPOSE: The purpose of this systematic review was to address the treatment of multiligament knee injuries in three major aspects, specifically (1) surgical versus nonoperative treatment, (2) repair versus reconstruction of injured ligamentous structures, and (3) early versus late surgery of damaged ligaments. METHODS: Two independent reviewers performed a search on PubMed from 1966 to March 2016 using Levy's review as a starting-point, and the same terms "knee dislocation," "multiple ligament-injured knee," and "multiligament knee reconstruction...
February 15, 2019: Injury
Elizabeth Benjamin, Alberto Aiolfi, Gustavo Recinos, Kenji Inaba, Demetrios Demetriades
INTRODUCTION: Optimal timing of pharmacological thromboprophylaxis (VTEp) in patients with severe pelvic fractures remains unclear. The high risk of venous thromboembolic (VTE) complications after severe pelvic fractures supports early VTEp however concern for fracture-associated hemorrhage can delay initiation. Patients with pelvic fractures also frequently have additional injuries that complicate the interpretation of the VTEp safety profiles. To minimize this problem, the study included only patients with isolated severe pelvic fractures...
February 14, 2019: Injury
Chien-Hua Wu, Shih-Wei Huang, Yen-Nung Lin, Chyan-Yeong Wang, Tsan-Hon Liou, Kwang-Hwa Chang
BACKGROUND: Having motor impairment since childhood and being at risk of osteoporosis and falls, adults with polio would be more likely to suffer a hip fracture (HF) and may experience different epidemiological characteristics from the general population. OBJECTIVE: To estimate the risk and incidence of HF in adults with polio. DESIGN: Using a national database, we conducted a population-based cohort study. We identified patients with polio using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code of 138...
February 14, 2019: Injury
Michal Bartnikowski, Nicole Bartnikowski, Anna Woloszyk, Romano Matthys, Vaida Glatt
The purpose of this study was to determine whether differences in structural and material properties of bone between different mouse strains influence the fracture patterns produced under experimental fracture conditions. Femurs of C57BL/6 (B6), C3H/HeJ (C3H), and DBA/2 (DBA) strains were evaluated using micro-computed tomography (μCT), measurements derived from radiographic images and mechanical testing to determine differences in the geometry and mechanical properties. A fracture device was used to create femoral fractures on freshly sacrificed animals using a range of kinetic energies (∼20-80mJ) which were classified as transverse, oblique, or comminuted...
February 13, 2019: Injury
Ruipeng Zhang, Yingchao Yin, Shilun Li, Jialiang Guo, Zhiyong Hou, Yingze Zhang
OBJECTIVE: Fracture line of the sacrum always involves the Zone II region because sacral foramina are anatomically and physiologically weak regions of the sacrum. The purpose of this study is to compare the therapeutic effects of a sacroiliac screw and a minimally invasive adjustable plate (MIAP) for Zone II sacral fractures. METHODS: Patients with unilateral Zone II sacral fractures fixed with a unilateral sacroiliac screw or MIAP from August 2009 to January 2016 were recruited into this study and were divided into two groups: group A (sacroiliac screw) and group B (MIAP)...
February 13, 2019: Injury
Jan Herzog, Robert Wendlandt, Sebastian Hillbricht, Rainer Burgkart, Arndt-Peter Schulz
INTRODUCTION: The annual incidence of proximal femoral fractures is 100-150/100,000 and continues to increase with an aging population. Cut-out of hip screws after fracture fixation has been quoted as 8% in the literature. The tip-apex distance (TAD) is the strongest predictor for cut-out after operative fracture stabilisation. The aim of this study was to evaluate the novel ADAPT system (Adaptive Positioning Technology, Stryker, USA), a navigation device for intramedullary nailing of trochanteric fractures and its effect on optimising the TAD...
February 13, 2019: Injury
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