Timothy Amos, Holly Bannon-Murphy, Meei Yeung, Julian Gooi, Silvana Marasco, Andrew Udy, Mark Fitzgerald
Aim To review the indications, complications and outcomes of extracorporeal membrane oxygenation (ECMO) in major trauma patients. Methods Single centre, retrospective, cohort study. Results Over a ten year period, from 13,420 major trauma patients, 11 were identified from our institutional trauma registry as having received ECMO. These patients were predominantly younger (mean 39 +/- 17 years), male (91%) and severely traumatised (median ISS 50, IQR 34 - 54). Veno-venous (VV) ECMO was used predominantly (n = 7, 64%), to treat hypoxic respiratory failure (mean PaO2/FiO2 ratio 69...
April 2, 2021: Injury
Harsh Wadhwa, Michael J Chen, Seth S Tigchelaar, Michael J Bellino, Julius A Bishop, Michael J Gardner
BACKGROUND: Acetabular fracture open reduction and internal fixation (ORIF) is generally associated with high intraoperative blood loss. Hypotensive anesthesia has been shown to decrease blood loss and intraoperative transfusion in total joint arthroplasty and posterior spinal fusion. In this study, we assessed the effect of reduction in intraoperative mean arterial pressures (MAPs) during acetabular fracture surgery on intraoperative blood loss and need for transfusion. METHODS: Three hundred and one patients with acetabular fractures who underwent ORIF at an academic Level 1 trauma center were retrospectively reviewed...
April 2, 2021: Injury
Soo Min Cha, Hyun Dae Shin, Seung Hoo Lee, Min Gyu Jin
BACKGROUND: We postulated that residual distal radioulnar joint (DRUJ) instability after distal diaphyseal or metaphyseal fracture in the radius or ulna may occur due to malaligned or malunited bony structures as well as primary or secondary soft issue stabiliser. Here, we report the outcomes of corrective osteotomy in a retrospective study. METHODS: Patients undergoing the osteotomy for DRUJ instability between March 2000 and February 2018 were included in the study...
April 1, 2021: Injury
Jae-Woo Cho, Won-Tae Cho, Seungyeob Sakong, Eic Ju Lim, Wonseok Choi, Seonghyun Kang, Beom-Soo Kim, Jin-Kak Kim, Chang-Wug Oh, Jong-Keon Oh
INTRODUCTION: The aim of this study was to analyze and describe the fracture patterns of the acetabular posterior wall based on quantitative measurements of the fracture characteristics. MATERIALS AND METHODS: Computed tomography images of 51 patients with acetabular posterior wall fractures from an initial cohort of 216 acetabular fractures were imported into a three-dimensional (3D) virtual software. The reconstructed 3D images were utilized to evaluate the following: (i) fracture line mapping on the inner articular and retro-acetabular surfaces, (ii) common zones of fracture and marginal impaction, and (iii) categorization by location and pattern of comminution...
April 1, 2021: Injury
Leah Rosenkrantz, Nadine Schuurman, Claudia Arenas, Maria F Jimenez, Morad S Hameed
BACKGROUND: The implementation of trauma registries has proven a highly effective means of injury control. However, many low and middle-income countries lack trauma registries. Those that have trauma registries vary widely in terms of both implementation and structure. We sought to identify the most common barriers that stand in the way of sustainable trauma registry implementation, and the types of strategies that have proven successful in overcoming these barriers. METHODS: We conducted a questionnaire of trauma registry stewards and researchers in LMICs...
March 30, 2021: Injury
Hu Qin, Tao Wu, Jun Liu, Gang Wang, Lei Fan, Boyao Wang, Yajun Shen
BACKGROUND: The present study aimed to investigate the effects of mucosa-associated lymphoid tissue lymphoma translocation protein (MALT)-1 on ankylosing spondylitis and its underlying mechanisms. METHODS: Proteoglycan induced ankylosing spondylitis (PGIA) mouse model was established and the expression patterns of MALT-1 were determined in joint tissue. Next, the mice were intraarticularly administrated with MALT-1 in the PGIA mouse model. Meanwhile, shRNA was intraarticularly administrated to PGIA mice...
March 30, 2021: Injury
Claire Sokas, Juan Pablo Herrera-Escobar, Timothy Klepp, Ewelina Stanek, Haytham Kaafarani, Ali Salim, Deepika Nehra, Zara Cooper
INTRODUCTION: Trauma care for injured older adults is complicated by pre-existing chronic illness. We examined the association between chronic illness and post-injury function, healthcare utilization and quality of life. METHODS: Trauma patients ≥65 years with an Injury Severity Score (ISS) ≥9 discharged from one of three level-1 trauma centers were interviewed 6-12 months post-discharge. Patients were asked about new functional limitations, injury-related emergency department (ED) visits or readmission, and health-related quality of life (HRQoL)...
March 27, 2021: Injury
F Magee, A Wilson, M Bailey, D Pilcher, B Gabbe, R Bellomo
INTRODUCTION: Amongst critically ill trauma patients admitted to ICU and still alive and in ICU after 24 hours, it is unclear which trauma scoring system offers the best performance in predicting in-hospital mortality. METHODS: The Australia and New Zealand Intensive Care Society Adult Patient Database and Victorian State Trauma Registry were linked using a unique patient identification number. Six scoring systems were evaluated: the Australian and New Zealand Risk of Death (ANZROD), Acute Physiology and Chronic Health Evaluation III (APACHE III) score and associated APACHE III Risk of Death (ROD), Trauma and Injury Severity Score (TRISS), Injury Severity Score (ISS), New Injury Severity Score (NISS) and the Revised Trauma Score (RTS)...
March 26, 2021: Injury
Joshua J Van Wyngaarden, Brian Noehren, Paul E Matuszewski, Kristin R Archer
BACKGROUND: Patients with lower extremity fracture requiring surgical fixation often have poor long-term pain and disability outcomes. This indicates the need for a risk stratification tool that can inform patient prognosis early in recovery. The purpose of this study was to determine the predictive validity of the STarT-Lower Extremity Screening Tool (STarT-LE) in patients with lower extremity fracture requiring surgical fixation. MATERIALS AND METHODS: One-hundred and twenty-two patients (41...
March 26, 2021: Injury
Alexander Bonde, Trine G Eskesen, Jacob Steinmetz, Erwin M Schoof, Lene H D Blicher, Lars S Rasmussen, Martin Sillesen
BACKGROUND: Epigenetic changes have been described in trauma patients in the form of histone acetylation events, but whether DNA-methylation occurs remains unknown. We hypothesized that the combination of hemorrhage and saline resuscitation would alter DNA-methylation and associated proteomic profiles in the rat lung. METHODS: Ten rats were subjected to a pressure-controlled hemorrhage and resuscitation model consisting of hemorrhage to a mean arterial pressure (MAP) of 35mmHg for 90 minutes, followed by saline resuscitation to a MAP >70mmHg for 90 minutes (n=5) or sham (only anesthesia and cannulation)...
March 26, 2021: Injury
Kazuma Takashima, Ichiro Nakahara, Hidetoshi Hamada, Wataru Ando, Masaki Takao, Keisuke Uemura, Nobuhiko Sugano
INTRODUCTION: To evaluate the advantages of a carbon fiber-reinforced polyetheretherketone (CFR/PEEK) intramedullary nail on the diagnosis of fracture healing because of its radiolucency, we retrospectively reviewed radiographs and computed tomography (CT) images of trochanteric femoral fractures that underwent internal fixation with the CFR/PEEK intramedullary nail or a traditional metallic intramedullary nail. METHODS: Radiographs and CT images from 20 patients with intertrochanteric femoral fractures treated with a CFR/PEEK intramedullary nail and 20 similar patients treated with a metallic intramedullary nail were reviewed...
March 24, 2021: Injury
Wojciech Glinkowski, Alexander N Chelnokov
Detection of fracture healing (FH), which depends on assessment methods, is a crucial factor affecting treatment. The study aimed to examine orthopedic surgeons in terms of practical methods of fracture healing (FHA) assessment (physical, imaging, measurement, and laboratory) and to check whether surgeons participating in clinical and laboratory experiments or only clinical practitioners prefer different FHA methods. An International Survey on Fracture Healing Assessment Methods was developed and distributed through the Web-based survey portal...
March 23, 2021: Injury
Piers D Mitchell, Mira Pecheva, Nishil Modi
OBJECTIVES: To determine the relative number of acute musculoskeletal injuries sustained by children due to different sports in a region of the UK, and assess the burden upon the NHS, through a cross sectional study. METHODS: Collection of data for every child aged 6-18 seen at the Peterborough City Hospital fracture clinic, whose sports injury was from 1st September 2018 - 31st August 2019 (1 school year; n=689). Data was gathered throughout the year by three children's orthopaedic surgeons, who consulted the clinic records, notes and x-rays of all children who had attended clinic...
March 21, 2021: Injury
Annalisa De Cicco, Giuseppe Toro, Francesco Oliva, Umberto Tarantino, Alfredo Schiavone Panni, Nicola Maffulli
INTRODUCTION: Long-term use of bisphosphonates (BPs) is associated with Atypical Femoral Fracture (AFF). Theoretically, periprosthetic femoral fractures (PFF) should be excluded from the diagnosis of AFF. However, recently several studies reported the occurrence of PPFs around a hip arthroplasty presenting features of an AFF. The present study describes the characteristics of Atypical Periprosthetic Femoral Fracture (APFF) and evaluates the effectiveness of their management through a PRISMA compliant systematic review of the published case reports and series...
March 21, 2021: Injury
Youssef M Khalafallah, Stephen D Lockey, Lolita Ramsey, Robert A Hymes, Jeff E Schulman
OBJECTIVE: Given the tremendous medical, social and financial costs of surgical site infections, the pressure to minimize these complications has been mounting. There remains a substantial gap in evidence-based practice for postoperative wound care after orthopaedic trauma surgery. The purpose of this study is to determine what standards are currently in practice for postoperative wound management. METHODS: A 16-question web-based survey was published on the Orthopaedic Trauma Association website and disseminated to members through the association's quarterly email...
March 21, 2021: Injury
Theerachai Apivatthakakul, Jason L Koerner, Sutiwat Luangsod, Thanawat Buranaphatthana, Joshua Parry, Michael Hadeed, August Funk, Stephen Stacey, Cyril Mauffrey
PURPOSE: Previous research has been unable to elucidate the exact factors that contribute to hip instability in the setting of posterior wall acetabular fractures. The purpose of this study was to determine the influence of posterior wall fracture fragment size and fracture angle on the stability of the hip joint in a cadaveric model. METHODS: Six fresh human cadavers (12 hips) were used. Specimens underwent pre-procedure CT evaluation and were then randomized to one of three groups: posterior wall fragment size (FS) of 15%, 20% and 25%...
March 21, 2021: Injury
Brittney M Williams, Laura Purcell, Linda Kayange, Jared Gallaher, Anthony Charles
INTRODUCTION: Bites are an important contributor to traumatic injury worldwide. In low- and middle-income countries, data regarding bite injuries outside of rabies is limited. Therefore, we sought to describe the injury characteristics and outcomes of bites in Lilongwe, Malawi, and determine risk factors for animals and human bites. METHODS: We performed a retrospective analysis of the Kamuzu Central Hospital trauma registry from 2008-2018. We performed Bivariate analyses comparing bite to non-bite trauma and human to animal bites...
March 21, 2021: Injury
Stefan Förch, Sabrina Sandriesser, Edgar Mayr, Falk Schrödl, Christian von Rüden, Peter Augat
BACKGROUND: Different stand-alone cerclage configurations and their optimal twisting techniques have been investigated over the years. This study tests for the stabilizing effect of different supplemental cerclage materials in combination with locked plating of distal tibia fractures. METHODS: Locking plate fixation of a distal tibial spiral fracture was tested as stand-alone and with supplemental cerclage materials (one cable, two cables, wire, fiber tape). Construct stiffness and fracture gap movements were investigated under quasi-static and dynamic loads and compared to the stand-alone locking plate...
March 21, 2021: Injury
M A Elbaset, Rasha T Abouelkheir, Ramy El-Baz, Rawdy Ashour, Yasser Osman
INTRODUCTION: To assess the predictors for conservative management failure and long term outcomes after isolated blunt high grade renal trauma (HGRT). METHODS:  A retrospective analysis of patients with isolated blunt HGRT (renal trauma grade ≥ IV) was conducted. Patients' demographics, clinical presentation, laboratory and radiological investigations, and different lines of treatment were retrieved. The primary outcome was to assess the predictors of conservative treatment failure (need for active bleeding control e...
March 21, 2021: Injury
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