Patrick T Delaplain, Cristobal Barrios, Dean Spencer, Michael Lekawa, Sebastian Schubl, Austin Dosch, Areg Grigorian, Megan Smith, Marija Pejcinovska, Jeffry Nahmias
INTRODUCTION: Guidelines surrounding abdominal seat belt sign (SBS) were made prior to the use of modern computed tomography (CT) imaging. We sought to prospectively determine whether a negative CT scan is associated with the absence of hollow viscus injury (HVI), and we hypothesized that trauma patients with an abdominal SBS without CT imaging findings would not have a hollow viscus injury (HVI). METHODS: A prospective cohort of patients with SBS was compiled over one year...
October 31, 2019: Injury
Marco Innocenti, Irene Dell'Acqua, Matteo Famiglietti, Livia Vignini, Giulio Menichini, Serena Ghezzi
PURPOSE: The aim of this report is to compare free perforator flaps and propeller flaps in the coverage of lower limb soft tissue defects. PATIENTS AND METHODS: 179 patients (age between 5 and 92 years old), underwent soft tissue reconstruction of the lower limb between January 2009 and January 2015, either by free flap or propeller flap. The two groups were retrospectively evaluated in order to assess the outcome, complications and potential risk factors. Correlations between risk factors and presence/absence of failure or complications have been evaluated with descriptive statistical analysis and a set of logistic regression models...
October 31, 2019: Injury
Lukun Sun, Hua Liu, Chuntao Xu, Bingxiang Yan, Hanyu Yue, Pingshan Wang
OBJECTIVE: To evaluate functional and radiological outcomes in distal femoral fracture patients (distal femoral shaft fractures or metaphyseal fractures) receiving indirect reduction and internal fixation with the minimally invasive percutaneous plate osteosynthesis (MIPPO) assisted by 3D printing navigation templates. METHODS: This retrospective study included all adult (≥18 years) patients who underwent MIPPO for distal femoral fracture (AO32/33) at PLA 960 Hospital, Jinan, China between January 1, 2013 and December 31, 2016...
October 31, 2019: Injury
Karel Kostlivý, Jan Bartoníček, Stefan Rammelt
OBJECTIVES: Posterior malleolar fractures (PM) have been linked to inferior outcome in malleolar fractures. This study aims to analyze the prevalence and pathoanatomy of PM fractures in Bosworth fracture-dislocations (BF). MATERIALS & METHODS: Radiographs and computed tomography (CT) scans of 13 patients treated at our institution and 97 cases published between 1947 and 2018, identified in a systematic literature search, were evaluated with respect to the pathoanatomy of BF...
October 31, 2019: Injury
Murtaza Kadhum, Pierre Sinclair, Chris Lavy
BACKGROUND: Injuries remain an important public health concern, resulting in considerable annual morbidity and mortality. In low- and middle-income countries (LMICs), the lack of appropriate infrastructure, equipment and skilled personnel compound the burden of injury, leading to higher mortality rates. As Advanced Trauma Life Support (ATLS) courses remain uneconomical and inappropriate in LMICs, the Primary Trauma Care (PTC) course was introduced to provide an alternative that is both sustainable and appropriate to local resources...
October 31, 2019: Injury
Helen M A Ingoe, William Eardley, Amar Rangan, Catherine Hewitt, Catriona McDaid
INTRODUCTION: A patient-relevant, focused Core Outcome Set (COS) is essential to the design of clinical trials dealing with chest wall trauma, in order to maximise quality of evidence regarding impact of interventions and to reduce research waste. METHODS: Outcome measures were collated by way of systematic review and entered into a three round Delphi consensus completed anonymously online. Participants were international clinicians and allied health professionals (AHP) involved in the treatment of rib fractures as well as patients who had experienced severe chest trauma...
October 31, 2019: Injury
Jonathan D Hodax, Brian H Cohen, Steven F DeFroda, Andrew D Sobel, Paul D Fadale
PURPOSE: Proximal fibula avulsion fractures, or "arcuate fractures", are an often discussed but poorly defined injury pattern which represent a destabilizing injury to the posterolateral corner of the knee. Historical and recent literature discussing reconstruction and repair techniques exist, but there has been little biomechanical evaluation of repair techniques. The purpose of this study was to evaluate the strength of three type of fixation techniques for arcuate fractures: bone tunnels, a screw and washer, and a novel suture anchor technique...
October 31, 2019: Injury
Sandeep Rakhra, Emma-Leah Martin, Mark Fitzgerald, Andrew Udy
OBJECTIVE: To quantify the pharmacodynamic (PD) activity of daily subcutaneous (SC) enoxaparin as venous thromboembolism (VTE) prophylaxis in high-risk trauma patients admitted to the intensive care unit (ICU). METHODS: This was a prospective observational PD study conducted in the ICU of a state-wide major trauma referral centre. The study cohort included adult patients admitted to the ICU with a high risk of VTE, as defined by at least one of the following: age > 40 years, prior VTE, spinal cord injury (SCI), traumatic brain injury (TBI), major venous injury, pelvic fractures, spinal fractures requiring treatment, severe lower limb injuries, and major surgery >2 h in duration...
October 31, 2019: Injury
Markus Rupp, Daniel Popp, Volker Alt
Soft tissue management and fracture fixation including initial external fixation in Gustilo-Anderson type II and type III open fractures are cornerstones in the treatment but details on timing and type of wound closure, irrigation and debridement, systemic and local antibiotics, antimicrobial-coated implants and the use of Bone Morphogenetic Protein-2 remain controversial. This article looks at current clinical evidence of these items for the management of open fractures. Timing of debridement and wound closure remains critical...
October 25, 2019: Injury
Christian von Rüden, Oliver Trapp, Peter Augat, Fabian M Stuby, Jan Friederichs
Intraoperative imaging has been advanced substantially over the last decades. It supports localization of the region of interest, verification of the preoperatively classified fracture pattern, identification of correct insertion point of the implant, placement of instruments and fixation material, and verification of correct fracture reduction and implant positioning. While conventional fluoroscopic 2D imaging remains the gold standard in intraoperative imaging, critical anatomical regions are predestined for intraoperative 3D imaging...
October 24, 2019: Injury
L Johnson, J Messner, E J Igoe, P Foster, P Harwood
PURPOSE: To compare quality of life in children and adolescents with tibial fracture during treatment with either a definitive long-leg cast or Ilizarov frame. METHODS: A prospective, longitudinal cohort study was undertaken. Patients aged between 5 and 17 years with tibial fractures treated definitively using a long-leg cast or Ilizarov frame were recruited at first follow-up. Health related quality of life was measured at each clinic appointment during treatment using the Pediatric Quality of Life Inventory (PedsQL) [1]; a validated measure of age-adjusted physical and psychosocial functioning...
October 24, 2019: Injury
V Campana, G Ciolli, G Cazzato, E Giovannetti De Sanctis, C Vitiello, A Leone, F Liuzza, G Maccauro
INTRODUCTION: Given the recent criticisms in the literature regarding Synthes Variable Angle Locking Compression Plate (VA-LCP) Curved Condylar Plates, the purpose of this study was to evaluate functional outcome, fracture healing, and complications of distal femoral intra-articular fractures using this device. METHODS: Patients with distal femoral fractures treated with 4.5 mm VA-LCP Curved Condylar Plate were included in this retrospective study. Follow-ups were at 4 weeks, 3 months, 6 months and 1 year...
October 24, 2019: Injury
Thomas A Howard, Iain R Murray, Anish K Amin, A Hamish Simpson, Andrew C Hall
Articular cartilage has limited intrinsic regenerative potential. The maintenance of healthy articular cartilage is essential to prevent joint degeneration and the morbidity associated with arthritis. In this review, we outline the structure and function of healthy articular cartilage. We summarise some of the recent literature outlining the influence of surgical factors on chondrocyte health. These factors include mechanical injury from instrumentation and drilling, drying, and the influence of irrigation fluids, antimicrobial solutions and local anaesthetics...
October 24, 2019: Injury
Christine Schemitsch, Aaron Nauth
Recent research has identified a high prevalence of psychological illnesses in patients who have sustained orthopaedic trauma. Depressive symptoms in this patient population have been reported to range from 13% to as high as 56%. Moreover, symptoms of depression, catastrophic thinking, and post-traumatic stress disorder (PTSD), have been consistently shown to negatively impact patient outcomes following treatment for their traumatic injuries. Specifically, patients with higher levels of psychosocial dysfunction have shown increased levels of pain, disability, and complications throughout their recovery...
October 24, 2019: Injury
Marko Bumbaširević, Tomislav Palibrk, Alexandru Valentin Georgescu, Panayotis Soucacos, Ileana Rodica Matei, Čedomir Vučetić, Radovan Manojlović, Dragan Marković, Pierluigi Tos, Slobodan Nikolić, Ivana Glišović Jovanović, Aleksandra Petrović, Aleksandar Lešić
The treatment of severely injured extremities still presents a very difficult task for trauma orthopaedic surgeons. Despite improvements in technology and surgical/microsurgical techniques, sometimes a limb must be amputated, otherwise severe and potentially fatal complications may develop. There is a well-established belief that severe open fractures should be left open. However, Godina proved wound coverage in the first 72 h (after an injury) to be safe and to bring good final results. So early wound cover (no later than one week after an injury) with well vascularized free flaps became the gold standard...
October 23, 2019: Injury
V Selvaraj, Sathish Devadoss, S Jayakumar, P Gururagavendra, A Devadoss
BACKGROUND: Tibial plateau fractures involving two or more columns were routinely assessed by two-dimensional radiography in the past. This often misled surgeons and attention was given only to the medial and lateral column without consideration of the posterior column, especially the postero-medial corner. Luo in 2010 introduced the new three-column classification system based on multiplanar computed tomography images. This study was conducted to assess the outcome after internal fixation of tibial plateau fractures involving two or more columns in our centre based on the column specific approach...
October 23, 2019: Injury
Matthias Fink, Bassil Akra
In May 2017 the European Medical Device Regulation (MDR) was published to replace the current Medical Device Directive (MDD) and the Active Implantable Medical Device Directive (AIMDD). After a transition period of 3 years (ending May 2020) the MDR will apply in the European Union (EU). With this new legislative framework, the requirements for placing new medical devices and keeping existing medical devices on the EU market will become more stringent. This is mainly due to the focus on clinical data for all medical devices regardless of their classification and the increased requirements on the post market surveillance system...
October 23, 2019: Injury
Maria Eliza Nedu, Ileana Rodica Matei, Alexandru Valentin Georgescu
INTRODUCTION: Dermatofibrosarcoma protuberans (DFSP) is a relatively rare malignant tumor, with important local aggressiveness. CASE REPORT: We present a case of a 59-years-old man with a history of Psoriasis and viral hepatitis C presented in our department with a giant lesion on the posterior trunk, of 24/36 cm, with pus and local bleeding, causing important anemia. The tumor was excised, creating an elliptical defect of around 34 × 42 cm down to fascial level, which was covered by two lateral flaps - modified Keystone type III...
October 23, 2019: Injury
Tanya Emanuela Avram, Maximilian Muntean, Botond Janko, Filip Ardelean, Cosmin Pestean, Radu Lacatus, Ileana-Rodica Matei, Alexandru Valentin Georgescu
INTRODUCTION: Free flaps require mastering microsurgical technique. In addition, breast reconstruction implies accuracy not only in flap survival, but also satisfying aesthetic outcome. Thus, such complex abilities can be acquired by creating experimental models for surgical training. MATERIALS AND METHODS: In accordance with relevant anatomy data found in literature, we chose a porcine model and performed a flap similar to the human deep inferior epigastric perforator (DIEP)...
October 22, 2019: Injury
Christina Kane, Jacob Jo, Jodi Siegel, Paul E Matuszewski, Eric Swart
PURPOSE: This study evaluated a series of geriatric femoral neck fracture treated with closed reduction percutaneous pinning (CRPP) at a single level-1 trauma center to determine if there are any simple, reliable, radiographic characteristics that can be used to predict increased risk of post-operative failure in nondisplaced and valgus impacted fracture patterns. METHODS: We conducted a retrospective cohort study of all patients with femoral neck fractures (AO/OTA 31B) who underwent CRPP over a 12-year period at a single Level 1 trauma center...
October 22, 2019: Injury
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