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Nonsurgical + management + fracture

Alessandro Aprato, Alessandro Casiraghi, Giovanni Pesenti, Marco Bechis, Alessandro Samuelly, Claudio Galante, Dario Capitani, Alessandro Massè
BACKGROUND: In the last 10 years, the rate of femur fractures treated within 48 h from trauma has been introduced as a performance index for hospital management in Italy. Literature showed a significant indirect correlation between early treatment and mortality/comorbidity. The aims of early treatment are pain management and reduction of time to ambulation. The purpose of this study is to evaluate whether early treatment has reduced time to ambulation in femur fracture. MATERIALS AND METHODS: All patients admitted to two level I trauma centers with proximal femoral fracture between 1/1/2017 and 31/12/2017 were included in this study...
February 13, 2019: Journal of Orthopaedics and Traumatology: Official Journal of the Italian Society of Orthopaedics and Traumatology
Moon Kyu Kim, Jun Jae Shin
BACKGROUND: Unstable atlas fractures with concomitant transverse atlantal ligament (TAL) injury may be conservatively managed by halo-vest immobilization (HVI) or surgically treated by various fixation techniques. Many surgeons prefer surgical management due to complications, nonunion, and further dislocations with HVI. There are no comparative studies on surgical and nonsurgical management of unstable atlas fractures. We retrospectively assessed the radiological and clinical outcomes of surgical reduction with fixation vs...
February 2, 2019: Acta Neurochirurgica
Andrew Jawa, Jason L Pittman, Michael P Carducci, Scott Koenig, Mohit Bhandari, Paul Tornetta
Background: In this study, we examined the difference that randomized trials favoring either surgery or nonsurgical treatment had on the surgical indications of American versus Canadian surgeons. Methods: One randomized trial favoring surgical management of clavicle fractures and another one favoring nonsurgical management of Achilles tendon ruptures were used. American and Canadian orthopaedic surgeons were surveyed regarding their surgical indications for these injuries...
December 2018: Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews
Peter R Ebeling, Kristina Akesson, Douglas C Bauer, Rachelle Buchbinder, Richard Eastell, Howard A Fink, Lora Giangregorio, Nuria Guanabens, Deborah Kado, David Kallmes, Wendy Katzman, Alexander Rodriguez, Robert Wermers, H Alexander Wilson, Mary L Bouxsein
Vertebral augmentation is among the current standards of care to reduce pain in patients with vertebral fractures (VF), yet a lack of consensus regarding efficacy and safety of percutaneous vertebroplasty and kyphoplasty raises questions on what basis clinicians should choose one therapy over another. Given the lack of consensus in the field, the American Society for Bone and Mineral Research (ASBMR) leadership charged this Task Force to address key questions on the efficacy and safety of vertebral augmentation and other nonpharmacological approaches for the treatment of pain after VF...
January 2019: Journal of Bone and Mineral Research: the Official Journal of the American Society for Bone and Mineral Research
Tsung-Yen Hsieh, Jamie L Funamura, Raj Dedhia, Blythe Durbin-Johnson, Chance Dunbar, Travis T Tollefson
Importance: Complications that arise after treatment of mandible fractures can result in significant morbidity. Identifying modifiable risk factors associated with these complications is valuable in guiding clinical practice for improved patient outcomes. Objective: To describe the risk factors associated with complications in patients undergoing treatment for mandible fracture. Design, Setting, and Participants: A retrospective review was conducted of 137 patients presenting to a tertiary care, level 1 trauma center with mandible fractures between January 1, 2014, and January 1, 2017...
January 24, 2019: JAMA Facial Plastic Surgery
Lauren H Redler, Elizabeth R Dennis
Adhesive capsulitis presents clinically as limited, active and passive range of motion caused by the formation of adhesions of the glenohumeral joint capsule. Radiographically, it is thickening of the capsule and rotator interval. The pathology of the disease, and its classification, relates to inflammation and formation of extensive scar tissue. Risk factors include diabetes, hyperthyroidism, and previous cervical spine surgery. Nonsurgical management includes physical therapy, corticosteroid injections, extracorporeal shock wave therapy, calcitonin, ultrasonography-guided hydrodissection, and hyaluronic acid injections...
January 2, 2019: Journal of the American Academy of Orthopaedic Surgeons
Rachel Heidgerd, Jacqueline Morgan, Denise Schentrup
Distal radius fractures are one of the most common fractures patients experience. Although there are a variety of treatments, there is a lack of standardization as it relates to treatment of such fractures. The purpose of this study was to compare treatment outcomes between surgical and nonsurgical care of distal radius fractures to inform evidence-based guidelines for the management of distal radius fractures. A retrospective chart analysis was performed in the public university hospital setting on a sample of 60 patient health records divided equally into those treated surgically and nonsurgically...
January 2019: Journal of Trauma Nursing: the Official Journal of the Society of Trauma Nurses
Adam H Wells, Todd J Oswald, Navdeep Samra, L Keith Scott, Steven A Conrad
Flail chest is an uncommon consequence of traumatic injury. Medical management includes mechanical ventilation for internal pneumatic stabilization. Control of respiratory drive is necessary to avoid paradoxical movement and impairment of recovery. Traditional approaches include sedation and neuromuscular blockade, but these measures are at odds with current trends of keeping patients awake and implementing active rehabilitation. We hypothesized that extracorporeal carbon dioxide removal (ECCO2R) would suppress the respiratory drive sufficiently to permit synchronous mechanical ventilation, allowing rib fracture healing in an awake patient with extensive bilateral flail chest...
January 3, 2019: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Olena Mazurenko, Barbara T Andraka-Christou, Matthew J Bair, Areeba Y Kara, Christopher A Harle
BACKGROUND: Hospitals and clinicians aim to deliver care that is safe. Simultaneously, they are ensuring that care is patient centered, meaning that it is respectful of patients' values, preferences, and experiences. However, little is known about delivering care in cases in which these goals may not align. For example, hospitals and clinicians are facing the daunting challenge of balancing safe and patient-centered pain care for nonsurgical patients, due to lack of comprehensive care guidelines and complexity of this patient population...
December 24, 2018: Joint Commission Journal on Quality and Patient Safety
Mohit Bindal, Abhijit Joshi, Adithi Bhat, Venkatesh Anehosur
PURPOSE: This study measured the mandibular ramal height in patients with unilateral condylar fractures managed by the closed method using elastic intermaxillary fixation. Its correlation with facial asymmetry and condylar displacement was assessed. This will determine whether the treatment outcome is in favor of the closed or open method. MATERIALS AND METHODS: A prospective cohort study was performed. The study included patients with unilateral condylar fractures who reported to SDM Craniofacial Surgery and Research Centre, Dharwad, India...
November 26, 2018: Journal of Oral and Maxillofacial Surgery
T R Blattert, K J Schnake, O Gonschorek, S Katscher, B W Ullrich, E Gercek, F K Hartmann, S Mörk, R Morrison, M L Müller, A Partenheimer, S Piltz, M A Scherer, A Verheyden, V Zimmermann
STUDY DESIGN: Prospective clinical cohort study (data collection); expert opinion (recommendation development). OBJECTIVES: Treatment options for nonsurgical and surgical management of osteoporotic vertebral body fractures differ widely. Based on the current literature, the knowledge of the experts, and their classification for osteoporotic fractures (OF classification), the Spine Section of the German Society for Orthopaedics and Trauma has now introduced general treatment recommendations...
December 20, 2018: Der Orthopäde
Mai P Nguyen, Nicholas Prayson, Heather A Vallier
INTRODUCTION: Extremity involvement is common among nonfatal gunshot injuries. Most of these injuries are low energy in nature and may be associated with fractures. Although displaced fractures of lower extremity long bones are often treated surgically, the purpose of this study was to review our experience in managing incomplete femur fractures caused by gunshot penetration and to develop treatment recommendations. METHODS: We retrospectively reviewed clinical and radiographic data for 46 consecutive patients with incomplete femur fractures secondary to low-energy gunshot wounds...
December 5, 2018: Journal of the American Academy of Orthopaedic Surgeons
O De Carolis, C M Mori, G Vicenti, M Carrozzo, A Abate, V Caiaffa
Nonunion of the humeral shaft occurs in 2%-10% of nonsurgically treated fractures and in up to 15% of fractures treated by primary open reduction and internal fixation. Gunshot humerus shaft fractures are a frequent type of injury; the degree of comminution and bone loss, as well as soft tissue disruption may influence the healing process, causing major sequelae with loss of function. Here we describe a 30 years old midshaft nonunion of the humerus, that occurred in a young woman after a gunshot. She was initially treated with hanging cast with definitive nonunion and secondary loss of limb function...
December 2018: Injury
Christopher Vannabouathong, Nasir Hussain, Ernesto Guerra-Farfan, Mohit Bhandari
INTRODUCTION: The distal radius is the second most commonly fractured bone in the elderly population. Several approaches for management exist including both surgical and nonsurgical treatments. Evidence for alternative approaches remains inconclusive and often conflicting. METHODS: Electronic database searches were conducted to identify randomized trials that (1) enrolled adults with a distal radius fracture; (2) compared external fixation, intramedullary nailing, K-wires, plaster casting (PC), or plate fixation (PF) to one of the other treatments listed; and (3) reported on a functional outcome that categorized patients as "excellent" and "good" or reported fracture healing complication (loss of reduction, malunion, delayed union, nonunion, and refracture)...
November 13, 2018: Journal of the American Academy of Orthopaedic Surgeons
Sang-Yun Kim, Yong-Hoon Choi, Young-Kyun Kim
Purpose: Various complications occur when a maxillofacial fracture is malunionized or improperly resolved. Malocclusion is the most common complication, followed by facial deformity, temporomandibular joint disorder (TMD), and neurological symptoms. The purpose of this study was to evaluate the dental treatment of postoperative complications after maxillofacial fracture. Materials and methods: In this study, nine patients with a postoperative complication after maxillofacial fracture who had been performed the initial operation from other units and were referred to the authors' department had been included...
December 2018: Maxillofacial Plastic and Reconstructive Surgery
Helen S Philp, Gawain J C Hammond
OBJECTIVE: To describe the nonsurgical management of a cat with traumatic pneumoperitoneum. CASE SERIES SUMMARY: A 4-year-old cat was presented following vehicular polytrauma. Thoracic radiographs revealed 4 rib fractures, a scapular fracture, and pneumothorax. Abdominal ultrasound revealed a small volume of free abdominal fluid. Computed tomography showed a mild pneumoretroperitoneum and a pneumoperitoneum in the region of the porta hepatis. The cat was managed conservatively with close monitoring...
November 2018: Journal of Veterinary Emergency and Critical Care
Wei Xiang Lim, Ernest Beng Kee Kwek
The majority of hip fractures in elderly patients are managed surgically with superior outcomes. However, for patients who refuse surgery or are deemed medically unfit, traction used to be the mainstay of nonsurgical treatment, which is associated with prolonged hospitalization and inpatient complications from immobility. This study, therefore, aims to evaluate the outcomes of an early wheelchair mobilization protocol as an alternative nonsurgical treatment option. This is a retrospective study of 87 elderly patients who were managed nonsurgically for their hip fractures over a 1-year period...
May 2018: Journal of Orthopaedic Surgery
Amiethab A Aiyer, Erik C Zachwieja, Charles M Lawrie, Jonathan R M Kaplan
Isolated lateral malleolus fractures represent one of the most common injuries encountered by orthopaedic surgeons. Nevertheless, appropriate diagnosis and management of these injuries are not clearly understood. Ankle stability is maintained by ligamentous and bony anatomy. The deep deltoid ligament is considered the primary stabilizer of the ankle. In the setting of an isolated lateral malleolus fracture, identifying injury to this ligament and associated ankle instability influences management. The most effective methods for assessing tibiotalar instability include stress and weight-bearing radiographs...
January 15, 2019: Journal of the American Academy of Orthopaedic Surgeons
Douglas Beall, Morgan P Lorio, B Min Yun, Maria J Runa, Kevin L Ong, Christopher B Warner
Background: To update vertebral augmentation literature by comparing outcomes between vertebroplasty (VP), balloon kyphoplasty (BKP), vertebral augmentation with implant (VAI), and nonsurgical management (NSM) for treating vertebral compression fractures (VCFs). Methods: A PubMed literature search was conducted with keywords kyphoplasty , vertebroplasty , vertebral body stent , and vertebral augmentation AND implant for English-language articles from February 1, 2011, to November 22, 2016...
June 2018: International Journal of Spine Surgery
Perry O Hooper, Patrick J Bevan, Christopher Silko, Lutul D Farrow
Background: The true prevalence of displaced tibial-sided avulsion injuries of the posterior cruciate ligament (PCL; Video 1) is unknown, and the majority of data regarding management has been published in areas other than the Western world, such as China and India (perhaps due to the higher prevalence of two-wheeler motorcycle accidents in these areas). Despite the rarity of data, a better understanding of the approach, fixation techniques, and outcomes is necessary to provide quality patient care...
March 28, 2018: JBJS Essential Surgical Techniques
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