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polytrauma, diabetes

Eva Lehtonen, Harshadkumar Patel, Sierra Phillips, Martim Correia Pinto, Sameer Naranje, Ashish Shah
INTRODUCTION/AIM: Recent comparisons of suture versus metal staple skin closure on the rates of wound complications in orthopaedic surgeries have yielded conflicting results. Several studies have since started to approach this question based on anatomic location, comparing suture versus staple closure in total hip and knee arthroplasty and acetabulum fracture surgery. Ankle fractures are one of the most commonly treated fractures by orthopaedic surgeons with unique challenges to skin closure due to the lack of subcutaneous support...
December 2018: Foot
Lauren Fader, John Whitaker, Miguel Lopez, Bradley Vivace, Mauricio Parra, Jon Carlson, Rodolfo Zamora
PURPOSE: The purpose of this study was to compare healing time for diaphyseal tibia fractures (OTA/AO 42 A, B, C) treated with intramedullary nailing (IMN) in one geographic cohort using nonsteroidal anti-inflammatory drugs (NSAIDs) for post-operative pain control to that of another geographic cohort using opioid medications. The groups represent differing cultural approaches to post-operative pain control. We hypothesized there would be no difference in healing time. METHODS: Tibia fractures presenting at two level I trauma centers located in different countries between January 1, 2010 and December 31, 2017 were retrospectively screened for enrollment...
September 18, 2018: Injury
Krista L Haines, Suresh Agarwal, Hee Soo Jung
INTRODUCTION: Asian-Americans and Pacific Islanders are often considered as a uniform group when examining race in health outcomes. However, the generally favorable economic outcomes in this group belie significant socioeconomic variance between its heterogeneous subgroups. This study evaluates the impact of socioeconomic status on the health outcomes of Asian trauma patients. METHODS: From 2012 to 2015, 52,704 Asians who presented to trauma centers were registered with the National Trauma Data Bank with known disposition...
August 2018: Journal of Surgical Research
Prism S Schneider, Emilie Sandman, Paul A Martineau
Achieving fracture union is highly dependent on the initial inflammatory phase of fracture healing, which is influenced by both the local and systemic inflammatory environments. The rapidly emerging field of osteoimmunology involves the study of the interactions between the immune system and the skeletal system. Recent research has advanced the current state of knowledge regarding the effects of the surrounding soft-tissue injury, fracture hematoma, and the method of fracture fixation on the inflammatory phase of fracture healing...
May 15, 2018: Journal of the American Academy of Orthopaedic Surgeons
Krista L Haines, Hee Soo Jung, Tiffany Zens, Scott Turner, Charles Warner-Hillard, Suresh Agarwal
INTRODUCTION: End-of-life and palliative care are important aspects of trauma care and are not well defined. This analysis evaluates the racial and socioeconomic disparities in terms of utilization of hospice services for critically ill trauma patients. METHODS: Trauma patients ≥15 years old from 2012 to 2015 were queried from the National Trauma Databank. Chi-square and multivariate logistic regression analyses for disposition to hospice were performed after controlling for age, gender, comorbidities, injury severity, insurance, race, and ethnicity...
August 2018: American Journal of Hospice & Palliative Care
Kirsten Kortram, Hans Bezstarosti, Willem-Jan Metsemakers, Michael J Raschke, Esther M M Van Lieshout, Michael H J Verhofstad
PURPOSE: The purpose of this study was to identify risk factors for the development of infection after open fracture fixation. METHODS: A comprehensive search in all scientific literature of the last 30 years was performed in order to identify patient-, trauma-, diagnosis- and treatment-related risk factors. Studies were included when infectious complications were assessed in light of one or more risk factors. A meta-analysis was performed. Risk ratios (RR) or risk differences (RD) with 95% confidence intervals were calculated...
October 2017: International Orthopaedics
Husain Shabbir Ali, Fahmi Yousef Khan, Saibu George, Nissar Shaikh, Jameela Al-Ajmi
Objective. The purpose of this study is to collect data on epidemiology, microbiology, and outcome of VAP in our ICUs for reevaluation of the therapeutic strategies. Methods. This retrospective study involved all adult patients, 15 years of age or older, diagnosed with VAP in multidisciplinary ICUs at Hamad General Hospital between January 2010 and December 2012. Results. A total of 106 patients were enrolled. The mean incidence of VAP was 5.0 per 1000 ventilator-days. It was predominant among younger age group (<60 years), male patients (80...
2016: BioMed Research International
Nuria Villalba, Adrian M Sackheim, Ivette A Nunez, David C Hill-Eubanks, Mark T Nelson, George C Wellman, Kalev Freeman
Endothelial dysfunction is a hallmark of many chronic diseases, including diabetes and long-term hypertension. We show that acute traumatic brain injury (TBI) leads to endothelial dysfunction in rat mesenteric arteries. Endothelial-dependent dilation was greatly diminished 24 h after TBI because of impaired nitric oxide (NO) production. The activity of arginase, which competes with endothelial NO synthase (eNOS) for the common substrate l-arginine, were also significantly increased in arteries, suggesting that arginase-mediated depletion of l-arginine underlies diminished NO production...
January 1, 2017: Journal of Neurotrauma
C Simpson, D Jayaramaraju, D Agraharam, S Gudipati, R Shanmuganathan, P V Giannoudis
PURPOSE: Diabetes has long been known to have an impact on bone repair. More recently, however, most diabetic patients receive medications to normalise this hyperglycaemic environment. To date, no studies have investigated the effects of diabetic medications on fracture healing in humans. METHOD: Patients were identified from two tertiary trauma centres. Inclusion criteria were adult patients having sustained a closed diaphyseal femoral or tibial fracture, treated surgically...
December 2015: European Journal of Orthopaedic Surgery & Traumatology: Orthopédie Traumatologie
Hoon-Sang Sohn, Won Ju Kim, Min Soo Shon
BACKGROUND: Current literatures describe good clinical outcomes of acute displaced fracture of clavicle treated with minimally invasive plate osteosynthesis (MIPO). But, there are little comparative data of the outcomes between open plating and MIPO techniques. We compared the outcomes of open plating and MIPO for treatment of acute displaced clavicular shaft fractures. MATERIALS AND METHODS: The author performed a retrospective review on a consecutive series of patients with clavicular shaft fracture who underwent open plating or MIPO...
August 2015: Injury
W-J Metsemakers, K Handojo, P Reynders, A Sermon, P Vanderschot, S Nijs
INTRODUCTION: Despite modern advances in the treatment of tibial shaft fractures, complications including nonunion, malunion, and infection remain relatively frequent. A better understanding of these injuries and its complications could lead to prevention rather than treatment strategies. A retrospective study was performed to identify risk factors for deep infection and compromised fracture healing after intramedullary nailing (IMN) of tibial shaft fractures. MATERIALS AND METHODS: Between January 2000 and January 2012, 480 consecutive patients with 486 tibial shaft fractures were enrolled in the study...
April 2015: Injury
Mirza Bišćević, Sejla Bišćević, Farid Ljuca, Barbara Ur Smrke, Ferid Krupić, Ćamil Habul
BACKGROUND: Postoperative infection after posterior spondylodesis of thoracic and lumbal spine is the most common complication, and a reason for revision surgery. Aim of this work is to analyze rate of postoperative spine infections at our institution, and to determine eventual risk factors. SUBJECTS AND METHODS: In our paper we analyze incidence of deep surgical infections after posterior spondylodesis, performed on our Spine department during last 5 years (September 1, 2008 - September 1, 2013)...
December 2014: Psychiatria Danubina
Patrick Burns, Pete Highlander, Andrew B Shinabarger
Injuries to the foot and ankle are often missed or underestimated in patients with polytrauma and are a source of long-term limitations. Injures below the knee are among the highest causes for unemployment, longer sick leave, more pain, more follow-up appointments, and decreased overall outcome. As mortalities decrease for patients with polytrauma a greater emphasis on timely diagnosis and treatment of foot and ankle injuries is indicated. Geriatric patients represent nearly one-quarter of trauma admissions in the United States...
October 2014: Clinics in Podiatric Medicine and Surgery
James Tebby, Fiona Lecky, Antoinette Edwards, Tom Jenks, Omar Bouamra, Rozalia Dimitriou, Peter V Giannoudis
BACKGROUND: The impact of diabetes mellitus in patients with multiple system injuries remains obscure. This study was designed to increase knowledge of outcomes of polytrauma in patients who have diabetes mellitus. METHODS: Data from the Trauma Audit and Research Network was used to identify patients who had suffered polytrauma during 2003 to 2011. These patients were filtered to those with known outcomes, then separated into those with diabetes, those known to have other co-morbidities but not diabetes and those known not to have any co-morbidities or diabetes...
July 16, 2014: BMC Medicine
Ioana Marina Grintescu, Irina Luca Vasiliu, Ioana Cucereanu Badica, Liliana Mirea, Daniela Pavelescu, Andreea Balanescu, Ioana Cristina Grintescu
BACKGROUND & AIMS: Rapid onset of resistance to insulin is a prominent component of stress metabolism in multiple trauma patients. Recent studies have clarified the role of amino acids (especially glutamine) in glucose transportation and the benefits of parenteral alanyl-glutamine supplementation (0.3-0.6 g/kg/day) in glucose homeostasis. The aims of this study are to evaluate the incidence of hyperglycemic episodes and the need for exogenous insulin to maintain stable glucose levels in critically ill polytrauma patients supplemented with parenteral glutamine dipeptide (Dipeptiven(®)) versus standard nutritional support...
June 2015: Clinical Nutrition: Official Journal of the European Society of Parenteral and Enteral Nutrition
Mary Jo V Pugh, Erin P Finley, Laurel A Copeland, Chen-Pin Wang, Polly H Noel, Megan E Amuan, Helen M Parsons, Margaret Wells, Barbara Elizondo, Jacqueline A Pugh
BACKGROUND: A growing body of research on US Veterans from Afghanistan and Iraq [Operations Enduring and Iraqi Freedom, and Operation New Dawn (OEF/OIF)] has described the polytrauma clinical triad (PCT): traumatic brain injury (TBI), posttraumatic stress disorder (PTSD), and pain. Extant research has not explored comorbidity clusters in this population more broadly, particularly co-occurring chronic diseases. OBJECTIVES: The aim of the study was to identify comorbidity clusters among diagnoses of deployment-specific (TBI, PTSD, pain) and chronic (eg, hypertension, diabetes) conditions, and to examine the association of these clusters with health care utilization and adverse outcomes...
February 2014: Medical Care
Shishui Lin, Cyril Mauffrey, E Mark Hammerberg, Philip F Stahel, David J Hak
OBJECTIVE: The aim of this study was to identify risk factors for surgical site infections and to quantify the contribution of independent risk factors to the probability of developing infection after definitive fixation of tibial plateau fractures in adult patients. METHODS: A retrospective analysis was performed at a level I trauma center between January 2004 and December 2010. Data were collected from a review of the patient's electronic medical records. A total of 251 consecutive patients (256 cases) were divided into two groups, those with surgical site infections and those without surgical site infections...
July 2014: European Journal of Orthopaedic Surgery & Traumatology: Orthopédie Traumatologie
James Geiling, Joseph M Rosen, Ryan D Edwards
War-related medical costs for U.S. veterans of Iraq and Afghanistan may be enormous because of differences between these wars and previous conflicts: (1) Many veterans survive injuries that would have killed them in past wars, and (2) improvised explosive device attacks have caused "polytraumatic" injuries (multiple amputations; brain injury; severe facial trauma or blindness) that require decades of costly rehabilitation. In 2035, today's veterans will be middle-aged, with health issues like those seen in aging Vietnam veterans, complicated by comorbidities of posttraumatic stress disorder, traumatic brain injury, and polytrauma...
November 2012: Military Medicine
Joseph Borrelli, Chris Pape, David Hak, Joseph Hsu, Sheldon Lin, Peter Giannoudis, Joseph Lane
Bone healing after fracture occurs in a well-organized manner and involves a multitude of cell types, inflammatory cytokines, growth factors, prostaglandins, and certain vitamins. Some of the means by which alterations in these essential components affect bone repair are understood, whereas others still need to be delineated. Based on clinical experience and basic science research, certain clinical conditions have become associated with delays in bone repair after fracture. These conditions include chronic inflammation, diabetes, hypovitaminosis, aging, and polytrauma...
December 2012: Journal of Orthopaedic Trauma
André Bonnici, Carola-Ellen Ruiner, Lyne St-Laurent, David Hornstein
OBJECTIVE: To describe a probable interaction between enteral feeds and levodopa leading to neuroleptic malignant-like syndrome (NMLS) in a polytrauma patient with Parkinson's disease (PD). CASE SUMMARY: A 63-year-old morbidly obese male polytrauma patient with PD and type 2 diabetes mellitus was admitted to our intensive care unit postoperatively. Enteral feeds were administered per nasogastric tube and provided 0.88 g /kg/day of protein based on ideal body weight (IBW)...
September 2010: Annals of Pharmacotherapy
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