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Xiao B, Lu M, Chen X, Qiu D, He Y, Li X. Study on the risk factors of postoperative wound complications in patients with ankle fracture. Int Wound J 2024; 21:e14845. [PMID: 38584355 PMCID: PMC10999563 DOI: 10.1111/iwj.14845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 03/05/2024] [Accepted: 03/06/2024] [Indexed: 04/09/2024] Open
Abstract
Wound complications after surgery for ankle fractures can lead to catastrophic consequences. The purpose of this study was to evaluate the risk factors of postoperative wound complications in patients with ankle fracture and to determine their effects on prognosis. 200 patients with ankle fracture treated in our hospital from October 2021 to December 2023 were analysed retrospectively. The total incidence of postoperative wound complications was 19% (38/200). Type of complications: wound edge necrosis 15 cases (39.47%), dehiscence (reopening of wound) 13 cases (34.21%), delayed healing (>30 days) 10 cases (26.32%); Univariate analysis showed that patients' age, body mass index (BMI), current smoking, alcoholism, diabetes mellitus, injury mechanism, open fracture, wound classification, higher American Society of Anesthesiologists (ASA) score and operation time were all associated with postoperative wound complications. Multivariate Logistic regression model shows: age ≥60 years old OR3.671 (1.875-5.937), BMI OR1.198 (1.143-1.324), current smoking OR2.727 (1.251-5.602), alcoholism OR1.143 (1.034-1.267), complicated with diabetes OR2.763 (1.236-4.852), injury mechanism (high vs. low and medium energy) OR2.437 (1.238-4.786), open fracture OR1.943 (1.8262.139), wound classification (II vs. I) OR4.423 (1.73511.674), ASA score (III-IV vs. I-II) OR1.307 (1.113-2.194) was an independent risk factor for postoperative wound complications in patients with ankle fracture. Further, ROC curves showed that these nine independent influences had high accuracy and validity in predicting postoperative wound complications in patients with ankle fractures. In conclusion, independent risk factors for postoperative complications of ankle fracture were age >60 years, BMI, injury mechanism, open fracture, wound classification (II vs. I), ASA score, current smoking, and alcoholism. The wound classification (II vs. I) has the highest diagnostic value.
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Affiliation(s)
- Ben Xiao
- Orthopedic DepartmentBeijing TongRen Hospital Affiliated Capital Medical UniversityBeijingChina
| | - Meng Lu
- Orthopedic DepartmentBeijing TongRen Hospital Affiliated Capital Medical UniversityBeijingChina
| | - Xiaobin Chen
- Orthopedic DepartmentBeijing TongRen Hospital Affiliated Capital Medical UniversityBeijingChina
| | - Daojing Qiu
- Orthopedic DepartmentBeijing TongRen Hospital Affiliated Capital Medical UniversityBeijingChina
| | - Yuanming He
- Orthopedic DepartmentBeijing TongRen Hospital Affiliated Capital Medical UniversityBeijingChina
| | - Xuejun Li
- Orthopedic DepartmentBeijing TongRen Hospital Affiliated Capital Medical UniversityBeijingChina
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Cui C, Ma L, Qi X. Analysis of the associated factors in postoperative wound infection following open reduction and internal fixation for elbow fracture. Int Wound J 2024; 21:e14825. [PMID: 38613419 PMCID: PMC11015467 DOI: 10.1111/iwj.14825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 02/16/2024] [Accepted: 02/23/2024] [Indexed: 04/15/2024] Open
Abstract
Postoperative wound infections (PWIs) following open reduction and internal fixation (ORIF) for elbow fractures can significantly affect patient outcomes. Identifying associated risk factors is crucial for improving clinical practices and patient care. A retrospective analysis (June 2020-June 2023) at our institution involved 90 patients who underwent elbow ORIF. Thirty patients developed PWIs (case group), compared to 60 who did not (control group). Variables like anaemia, operation duration, hospital stay, blood loss, body mass index (BMI), age, hypoalbuminemia, smoking status, diabetes mellitus and open fractures were examined. Univariate and multivariate analyses determined the impact of these variables on PWI incidence, with statistical significance set at p < 0.05. The main pathogens identified were Escherichia coli among Gram-negative bacteria (59.46%) and Staphylococcus aureus among Gram-positive bacteria (40.54%). In the univariate analysis, hypoalbuminemia, anaemia, and lifestyle factors such as smoking showed higher prevalence in patients with PWIs. However, age and length of hospital stay did not significantly influence infection rates. The multivariate analysis further elucidated that anaemia, smoking, diabetes mellitus and open fractures were independent, significant predictors of PWIs. These findings highlight the complexity of factors influencing infection risk post-ORIF, underscoring the importance of both individual health conditions and surgical complications in patient outcomes. Anaemia, smoking, diabetes mellitus and open fractures significantly increase the risk of PWI after elbow ORIF. Early identification and management of these risk factors are imperative to reduce infection rates and improve postoperative recovery.
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Affiliation(s)
- Changwei Cui
- Department of Orthopedic SurgeryHebei Medical University Third HospitalShijiazhuangChina
- Department of Orthopedic SurgeryHebei Cangzhou Hospital of Integrated Traditional Chinese and Western MedicineCangzhouChina
| | - Lijie Ma
- Department of Orthopedic SurgeryHebei Medical University Third HospitalShijiazhuangChina
| | - Xiangbei Qi
- Department of Orthopedic SurgeryHebei Medical University Third HospitalShijiazhuangChina
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Humar P, Thayer J, Bengur FB, Villalvazo Y, Hu M, Unadkat J. Early Return of Motion in Patients With Intramedullary Screw Placement for Metacarpal and Phalangeal Fracture Fixation. Ann Plast Surg 2024; 92:S136-S141. [PMID: 38556662 DOI: 10.1097/sap.0000000000003849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
INTRODUCTION Hand fractures are associated with significant morbidity. Current management standards often result in prolonged immobilization, stiffness, and delayed return to functional use. Intramedullary (IM) compression screws offer minimal soft tissue disruption and early postoperative active motion. In this study, we describe our outcomes after intraosseous fracture fixation using IM cannulated headless screws for a multitude of fracture patterns. METHODS This study is a retrospective review of patients who underwent IM screw placement for fixation of metacarpal and phalangeal fractures by a single surgeon from 2017 to 2022. Data were collected to include patient demographics, fracture details, postoperative complications, and follow-up. Time to range of motion and return to unrestricted motion was recorded. RESULTS There were 69 patients with 92 fractures (n = 54 metacarpal, n = 38 phalanx). The median patient age was 45 years (range, 18-89 years) with 75.4% males. Majority presented with a single fracture (n = 50, 72.5%), and 38 patients (55.1%) had open fractures. Small finger was the most affected digit (n = 35, 37.6%). The median time to allow range of motion from surgery was 8.7 days (interquartile range, 0-32) with 32 days (interquartile range, 10-62) for unrestricted use of the hand. Thirty-five patients (50.7%) were allowed controlled motion from the first postoperative day. One patient had loss of reduction requiring reintervention for hardware removal, and 1 patient had superficial skin infection managed with oral antibiotics. CONCLUSIONS Our findings indicate that the IM screw provides reliable fixation for a wide variety of fracture patterns with a low complication rate and offers early return to functional use.
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Affiliation(s)
- Pooja Humar
- From the Department of Plastic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Jacob Thayer
- From the Department of Plastic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Fuat Baris Bengur
- From the Department of Plastic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Yadira Villalvazo
- From the Department of Plastic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Michael Hu
- From the Department of Plastic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA
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Yin C, Sun L. Risk factors contributing to postoperative surgical site infections in patients undergoing ankle fracture fixation: A systematic review and meta-analysis. Int Wound J 2024; 21:e14639. [PMID: 38153200 PMCID: PMC10961858 DOI: 10.1111/iwj.14639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 12/17/2023] [Accepted: 12/17/2023] [Indexed: 12/29/2023] Open
Abstract
Surgical site infections (SSIs) following ankle fracture fixation pose significant challenges in patient recovery and healthcare management. Identifying risk factors contributing to SSIs can aid in developing targeted prevention and treatment strategies. This systematic review and meta-analysis were conducted according to the PRISMA guidelines and the PICO framework. A comprehensive literature search across major databases, including PubMed, Embase, Web of Science and the Cochrane Library, was completed on September 26, 2023. The inclusion criteria encompassed peer-reviewed studies of various designs that investigated risk factors for SSIs post-ankle fracture fixation. Quality assessment was performed using the Newcastle-Ottawa Scale. Statistical analyses assessed heterogeneity and calculated combined effect sizes using fixed- or random-effects models, depending on the heterogeneity observed. The initial search yielded 1250 articles, with seven meeting the inclusion criteria after rigorous screening and full-text review. The included studies, conducted between 2006 and 2019, predominantly utilized case-control designs. The meta-analysis identified diabetes, open fractures, smoking, age, alcohol consumption, ASA score ≥3, high BMI, contaminated incisions, fracture dislocation and heart disease as significant risk factors for postoperative SSIs. Publication bias assessment showed no significant bias across studies. The identification of key risk factors such as diabetes, open fractures, smoking, advanced age, alcohol consumption, high ASA score, elevated BMI, contaminated incisions, fracture dislocation and heart disease is essential in managing SSIs post-ankle fracture fixation. Targeted interventions addressing these risk factors are crucial to reduce the incidence of SSIs and improve overall patient outcomes.
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Affiliation(s)
- Changxin Yin
- Department of Micro OrthopedicsShandong University of Traditional Chinese MedicineJinanChina
| | - Lu Sun
- Department of Micro OrthopedicsShandong Provincial Hospital of Traditional Chinese MedicineJinanChina
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Suliman A, Jayakumar N, Chaurasia B, Holliman D. Variations in the Neurosurgical Management of Depressed Skull Fractures in Adults: An International Cross-Sectional Survey. J Neurol Surg A Cent Eur Neurosurg 2024; 85:147-154. [PMID: 36482001 DOI: 10.1055/a-1994-9330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Depressed skull fractures have been well described since antiquity, yet its management remains controversial. Contentious issues include the use of prophylactic antibiotics and antiepileptics, the role of nonoperative management, and the replacement/removal of bone fragments. Our objective was to explore the management patterns of closed and open depressed skull fractures across the world. METHODS A 23-item, web-based survey was distributed electronically to the members of national neurosurgical associations, and on social media platforms. The survey was open for data collection from December 2020 to April 2021. RESULTS A total of 218 respondents completed the survey, representing 56 countries.With regard to open fractures, most respondents (85.8%) treated less than 50 cases annually. Most respondents (79.4%) offered prophylactic antibiotics to all patients with open fractures, with significant geographical variation (p < 0.001). Less than half of the respondents (48.2%) offered prophylactic antiepileptics. Almost all respondents (>90%) reported the following indications as important for surgical management: (1) grossly contaminated wound, (2) dural penetration, (3) depth of depression, and (4) underlying contusion/hematoma with mass effect. Most respondents treated less than 50 cases of closed depressed skull fractures annually. Most European respondents (81.7%) did not offer prophylactic antiepileptics in comparison to most Asian respondents (52.7%; p < 0.001). Depth of depression, an underlying hematoma/contusion with mass effect, and dural penetration were the most important surgical indications. CONCLUSIONS There remains a great degree of uncertainty in the management strategies employed across the world in treating depressed fractures, and future work should involve multinational randomized trials.
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Affiliation(s)
- Amir Suliman
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Nithish Jayakumar
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | | | - Damian Holliman
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
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Guryel E, Lee C, Barakat A, Robertson A, Freeman R. Primary Ankle Fusion Using an Antegrade Nail Into the Talus for Early Treatment of OTA Type C3 Distal Tibial Plafond Fractures: A Preliminary Report. Foot Ankle Int 2024; 45:208-216. [PMID: 38400748 DOI: 10.1177/10711007231224407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/26/2024]
Abstract
BACKGROUND Type C3 distal tibial plafond fractures consistently show poor outcomes with high complication rates and significant risk of posttraumatic arthritis. We describe a minimally invasive technique of performing a primary ankle fusion using an anterograde tibial nail and compare our early results to traditional methods of fixation. METHODS During the acute admission, the patient undergoes an arthroscopic preparation of the ankle joint and insertion of an anterograde nail into the talus. This technique is described in detail and presented alongside a retrospective 5-year review of all adult C3 distal tibial plafond fractures from our center. RESULTS Twenty-six patients (8 open fractures) had been fixed traditionally using open reduction internal fixation (24 patients) and circular frames (2 patients) with an average follow-up of 20 months. Those internally fixed had protected weightbearing for 3 months. Complications included deep infection (12%), nonunion (8%), malunion (4%), severe posttraumatic osteoarthritis (27%), and the secondary conversion to ankle replacement/fusion (12%) requiring an average of 3 reoperations.Six patients underwent primary fusion (3 open fractures) with an average follow-up of 18 months. Patients were allowed to immediately weightbear. There were no reported complications and the primary fusion group demonstrated shorter hospital stays, faster return to work, and higher mean self-reported foot and ankle score (SEFAS) compared to those treated with ORIF. CONCLUSION C3 distal tibial plafond fractures are difficult to manage and there has not been a satisfactory method of treating them that allows early return to work, has a low risk of complications, and reduces the risk of posttraumatic tibiotalar arthritis.We present our initial results with a method that uses traditional arthroscopic techniques to prepare the tibiotalar joint together with minimally invasive anterograde tibiotalar nailing. In this initial report of a small group of patients, we found that surgery can be performed once the swelling has subsided after injury and that allowing weightbearing as tolerated did not appear to have a negative effect on initial outcomes. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Enis Guryel
- University Hospitals Sussex NHS Foundation Trust, Major Trauma Centre, Royal Sussex County Hospital, Brighton, United Kingdom
| | - Conrad Lee
- University Hospitals Sussex NHS Foundation Trust, Major Trauma Centre, Royal Sussex County Hospital, Brighton, United Kingdom
| | - Ahmed Barakat
- University Hospitals Sussex NHS Foundation Trust, Major Trauma Centre, Royal Sussex County Hospital, Brighton, United Kingdom
| | - Alastair Robertson
- University Hospitals Sussex NHS Foundation Trust, Major Trauma Centre, Royal Sussex County Hospital, Brighton, United Kingdom
| | - Richard Freeman
- University Hospitals Sussex NHS Foundation Trust, Major Trauma Centre, Royal Sussex County Hospital, Brighton, United Kingdom
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Wu JP, Lu YT, Wei XX, Zou PX, Li YQ, Liu YZ, Canavese F, Xu HW. Epidemiological characteristics and distribution of pediatric supracondylar fractures in South China: a retrospective analysis of 760 cases. J Pediatr Orthop B 2024; 33:136-141. [PMID: 37129032 PMCID: PMC10829903 DOI: 10.1097/bpb.0000000000001089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 03/26/2023] [Indexed: 05/03/2023]
Abstract
To evaluate demographic characteristics and distribution of pediatric supracondylar fractures (SCFs) at a tertiary hospital in South China. A retrospective observational study was conducted on children aged 15 years or younger with a diagnosis of SCFs during the period from January 2016 to December 2018. Patients' medical records and radiographs were retrospectively analyzed for age at the time of injury, sex, site and mechanism of traumatic injury. A total of 760 patients with 761 SCFs were reviewed (453 males, 59.6%, and 307 females, 40.4%). There were 748 extension-type fractures (98.3%) and 13 flexion-type fractures (1.7%). Associated injuries were identified in 30/760 (3.9%) patients: associated fracture ( n = 15; 2%), nerve injury ( n = 12; 1.6%), open fracture ( n = 2; 0.2%) and compartment syndrome ( n = 1; 0.1%). Age at the time of fracture has a bimodal pattern with a first peak around the age of 1 year and a second peak around the age of 4-5 years. The fractures occurred mostly around 11 a.m. and between 4 and 9 p.m. in the evening. Most fractures occurred at home (50.7%), and falling down (62.2%) was the most frequent mechanism of injury. SCFs occurred most frequently in children aged 1 and 4-5 years, and during daylight hours. In about 96% of cases, these were isolated injuries, and falling down was found to be the most frequent traumatic mechanism. Based on our findings, targeted educational efforts and interventions can be set up in order to prevent the occurrence of SCFs in South China. Level of evidence: III.
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Affiliation(s)
- Jian Ping Wu
- Department of Pediatric Orthopaedics, GuangZhou Women and Children's Medical Center, GuangZhou, China
| | - Yang Tao Lu
- Department of Pediatric Orthopaedics, GuangZhou Women and Children's Medical Center, GuangZhou, China
| | - Xing Xing Wei
- Department of Pediatric Orthopaedics, GuangZhou Women and Children's Medical Center, GuangZhou, China
| | - Pan Xin Zou
- Department of Pediatric Orthopaedics, GuangZhou Women and Children's Medical Center, GuangZhou, China
| | - Yi Qiang Li
- Department of Pediatric Orthopaedics, GuangZhou Women and Children's Medical Center, GuangZhou, China
| | - Yuan Zhong Liu
- Department of Pediatric Orthopaedics, GuangZhou Women and Children's Medical Center, GuangZhou, China
| | - Federico Canavese
- Department of Pediatric Orthopaedics, GuangZhou Women and Children's Medical Center, GuangZhou, China
- Department of Pediatric Orthopedic Surgery, Lille University Center and Faculty of Medicine Henri Warenbourg, Jeanne de Flandre Hospital, Lille, France
| | - Hong Wen Xu
- Department of Pediatric Orthopaedics, GuangZhou Women and Children's Medical Center, GuangZhou, China
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Joseph NM, Patel R, Freedman C, Cox K, Mir HR. Open Reduction And Internal Fixation of Tarsometatarsal (Lisfranc) Fracture Dislocations-Is Arthrodesis Necessary? J Am Acad Orthop Surg 2024; 32:178-185. [PMID: 37988566 DOI: 10.5435/jaaos-d-23-00696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 10/04/2023] [Indexed: 11/23/2023] Open
Abstract
INTRODUCTION Controversy remains regarding the optimal management of tarsometatarsal (Lisfranc) fracture dislocations. Open reduction and internal fixation (ORIF) and ORIF with primary arthrodesis (PA) have been described in the treatment of these injuries, although adverse sequelae remain problematic. Previous work has yielded small cohorts with heterogenous results. We aimed to describe the outcomes of Lisfranc fracture dislocations managed with ORIF and/or PA to identify risk factors for complications, such as nonunion and revision surgery. METHODS A retrospective review of 206 consecutive tarsometatarsal fracture dislocations that underwent surgical repair between 2015 and 2021 was performed. Time to radiographic union was noted. Complications were recorded, including revision surgery, infection, symptomatic implant removal, posttraumatic arthritis, secondary arthrodesis, and nonunion. A comparative subgroup analysis of outcomes by treatment modality (ie, PA versus ORIF) and by injury severity (isolated injury versus concomitant lower extremity fracture) were performed. Logistic regression analysis was performed to assess factors associated with revision surgery. RESULTS 104 patients met the inclusion criteria with a mean 13-month follow-up. Ninety-three (n = 93) patients underwent ORIF, and 11 patients underwent PA. Radiographic union was achieved in 94.2% of cases (98/104) at an average 106 days. Complications included superficial infection (3.8%), deep infection (7.7%), symptomatic implant removal (19.2%), posttraumatic arthritis (12.5%), secondary arthrodesis (4.8%), and nonunion (2.9%). No difference existed in the complication rates between those who underwent ORIF and those who underwent PA ( P = 0.50). Revision surgery rates were similar between patients who sustained isolated injuries and those with concomitant lower extremity fractures ( P = 0.31). Risk factors for revision surgery included open fractures (OR 4.01, P = 0.042) and previous psychiatric illness (OR 5.77, P = 0.016). DISCUSSION The vast spectrum of injury in Lisfranc fracture dislocations makes uniform treatment challenging. In this large consecutive series, few failed to achieve union or required secondary arthrodesis. Open fractures and previous psychiatric illness portended worse clinical outcomes. ORIF without PA remains a viable treatment in these injuries. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Noah M Joseph
- From the Florida Orthopaedic Institute, Temple Terrace, FL (Joseph, Mir), Department of Orthopaedic Surgery, University of South Florida Morsani College of Medicine, Tampa, FL (Patel, Freedman, Cox)
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9
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Taylor KF. CORR Insights®: Intravenous Cefazolin Achieves Sustained High Interstitial Concentrations in Open Lower Extremity Fractures. Clin Orthop Relat Res 2024; 482:384-385. [PMID: 37678398 PMCID: PMC10776153 DOI: 10.1097/corr.0000000000002856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 08/09/2023] [Indexed: 09/09/2023]
Affiliation(s)
- Kenneth F Taylor
- Chief Division of Hand Surgery, Department of Orthopaedics and Rehabilitation, Penn State, Milton S. Hershey Medical Center, Hershey, PA, USA
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Pan D, Mu Z, Liu R, Tang Y. Open fracture of posterior calcaneal tuberosity. Asian J Surg 2024; 47:1193-1194. [PMID: 37968213 DOI: 10.1016/j.asjsur.2023.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 11/03/2023] [Indexed: 11/17/2023] Open
Affiliation(s)
- Dong Pan
- Department of Orthopedics, Jiangnan Hospital Affiliated with Zhejiang Chinese Medical University, Hospital of Traditional Chinese Medicine of Xiaoshan District, Hangzhou, Zhejiang, China
| | - Zhuosong Mu
- Department of Orthopedics, Jiangnan Hospital Affiliated with Zhejiang Chinese Medical University, Hospital of Traditional Chinese Medicine of Xiaoshan District, Hangzhou, Zhejiang, China
| | - Renqi Liu
- Department of Orthopedics, Jiangnan Hospital Affiliated with Zhejiang Chinese Medical University, Hospital of Traditional Chinese Medicine of Xiaoshan District, Hangzhou, Zhejiang, China
| | - Yanghua Tang
- Department of Orthopedics, Hospital of Traditional Chinese Medicine of Xiaoshan District, Hangzhou, Zhejiang, China.
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Sain A, Arif S, Manyar H, Manzoor N, Wattage K, Halasa M, Metry A, Chia J, Prendergast E, Elkilany A, Aisabokhale O, Hussain F, Sohail Z. CURRENT CONCEPTS IN THE MANAGEMENT OF BOXER'S FRACTURE. Georgian Med News 2024:122-124. [PMID: 38609127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
Fractures of the metacarpal particularly the 5th metacarpal is quite common among all hand fractures and has a high incidence in male adult population. Proper management of these fractures plays a key role in rehabilitation and early return to work thus reducing the economic burden. Treatment of these injuries depends on the type of injury: whether it is a closed/open fracture, degree of angulation at the fracture site and also mal-rotation and shortening of the finger. Non-operative management is suitable for fractures which are closed, non-displaced and without angulation or rotation. Open fractures, fractures with angulation and/or mal-rotation and fractures with neuro-vascular injury are more suitable for operative management. The acceptable angulation for conservative management for most studies is 70 degrees. Buddy strapping with a Futura splint provides good functional results. In fractures requiring operative intervention, K-wire fixation is a minimally invasive method of fixation, which in most cases has good functional results. Plate and screw fixation, however, is preferred for cases with significant comminution or multiple metacarpal fractures.
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Affiliation(s)
- A Sain
- Worthing Hospital, University Hospitals Sussex NHS Foundation Trust, United Kingdom
| | - S Arif
- Worthing Hospital, University Hospitals Sussex NHS Foundation Trust, United Kingdom
| | - H Manyar
- Worthing Hospital, University Hospitals Sussex NHS Foundation Trust, United Kingdom
| | - N Manzoor
- Worthing Hospital, University Hospitals Sussex NHS Foundation Trust, United Kingdom
| | - K Wattage
- Worthing Hospital, University Hospitals Sussex NHS Foundation Trust, United Kingdom
| | - M Halasa
- Worthing Hospital, University Hospitals Sussex NHS Foundation Trust, United Kingdom
| | - A Metry
- Worthing Hospital, University Hospitals Sussex NHS Foundation Trust, United Kingdom
| | - J Chia
- Worthing Hospital, University Hospitals Sussex NHS Foundation Trust, United Kingdom
| | - E Prendergast
- Worthing Hospital, University Hospitals Sussex NHS Foundation Trust, United Kingdom
| | - A Elkilany
- Worthing Hospital, University Hospitals Sussex NHS Foundation Trust, United Kingdom
| | - O Aisabokhale
- Worthing Hospital, University Hospitals Sussex NHS Foundation Trust, United Kingdom
| | - F Hussain
- Worthing Hospital, University Hospitals Sussex NHS Foundation Trust, United Kingdom
| | - Z Sohail
- Worthing Hospital, University Hospitals Sussex NHS Foundation Trust, United Kingdom
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Chinta SR, Cassidy MF, Tran DL, Brydges HT, Ceradini DJ, Bass JL, Agrawal NA. Epidemiology of distal radius fractures: Elucidating mechanisms, comorbidities, and fracture classification using the national trauma data bank. Injury 2024; 55:111217. [PMID: 38029683 DOI: 10.1016/j.injury.2023.111217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 11/12/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND An update on the epidemiology of distal radius fractures in the United States is necessary, particularly as the elderly population grows. Additionally, age and frailty have been associated with complications following surgical fixation of DRFs. Herein, we utilize the National Trauma Data Bank, a robust nationwide resource, to investigate the relationship between demographics, comorbidities, injury and fracture characteristics, and admission details. METHODS Patients with isolated distal radius fractures were identified from the National Trauma Data Bank (2016-2019) according to ICD-10 codes. Univariate and multivariate regressions were conducted to determine independent risk factors for bilateral fractures, displaced fractures, open fractures, as well as length of hospital stay and adverse discharge disposition for patients undergoing inpatient surgical fixation. RESULTS The incidence of DRFs was 3.6/1,000 trauma-related emergency department visits and 10.8/1,000 upper extremity traumas. Trauma mechanism was significantly associated with displaced and open fractures. Age (OR 1.01, 95% CI 1.01-1.01), BMI (OR 1.02, 95% CI 1.01-1.02), smoking (OR 1.34, 95% CI 1.15-1.57), and alcohol level (trace: OR 2.18, 95% CI 1.41-3.29; intoxicated: OR 2.20, 95% CI 1.63-2.95) were significantly associated with open fractures. Machinery (β=2.04, 95% CI 1.00-3.08) and MVT (β=0.39, 95% CI 0.08-0.69) mechanisms were independent risk factors for longer length of stay. mFI-5 was an independent risk factor, in a stepwise fashion, for both length of stay and adverse discharge disposition. CONCLUSIONS High-energy mechanisms and risk factors for poor skin quality were significantly associated with open fractures. mFI-5 was an independent risk factor for longer length of stay and non-routine discharges in patients of all ages, despite controlling for other comorbidities, unrelated complications, and mechanism of injury. Trauma mechanism was an independent risk factor for prolonged length of stay only, particularly in patients younger than 65 years of age.
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Affiliation(s)
- Sachin R Chinta
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY 10016, USA
| | - Michael F Cassidy
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY 10016, USA
| | - David L Tran
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY 10016, USA
| | - Hilliard T Brydges
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY 10016, USA
| | - Daniel J Ceradini
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY 10016, USA
| | - Jonathan L Bass
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY 10016, USA
| | - Nikhil A Agrawal
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY 10016, USA.
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Bandebuche A, Munde K, Sharan S. Open lateral condyle Hoffa's fracture with intra-articular patella dislocation, quadriceps tendon rupture and PCL avulsion. BMJ Case Rep 2024; 17:e258433. [PMID: 38199661 PMCID: PMC10806859 DOI: 10.1136/bcr-2023-258433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024] Open
Abstract
We present a rare case of open lateral condyle Hoffa's fracture with concurrent patellar intra-articular dislocation, quadriceps rupture and posterior cruciate ligament (PCL) avulsion. The early adolescent male sustained these injuries in a road traffic accident. Diagnostic evaluation and a multidisciplinary approach guided treatment decisions. The patient underwent single-stage open reduction and internal fixation for the lateral condyle Hoffa's fracture and quadriceps tendon repair, while conservative management was chosen for the PCL avulsion. At the 1-year follow-up, the patient exhibited improved knee function.This case underscores the management of complex knee injuries and contributes to understanding unique injury patterns, enhancing patient care.
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Affiliation(s)
- Ajinkya Bandebuche
- Orthopaedics, Lokmanya Tilak Municipal General Hospital and Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
| | - Kishor Munde
- Orthopaedics, Lokmanya Tilak Municipal General Hospital and Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
| | - Sudhir Sharan
- Orthopaedics, Lokmanya Tilak Municipal General Hospital and Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
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Foster AL, Warren J, Vallmuur K, Jaiprakash A, Crawford R, Tetsworth K, Schuetz MA. A population-based epidemiological and health economic analysis of fracture-related infection. Bone Joint J 2024; 106-B:77-85. [PMID: 38160695 DOI: 10.1302/0301-620x.106b1.bjj-2023-0279.r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Aims The aim of this study was to perform the first population-based description of the epidemiological and health economic burden of fracture-related infection (FRI). Methods This is a retrospective cohort study of operatively managed orthopaedic trauma patients from 1 January 2007 to 31 December 2016, performed in Queensland, Australia. Record linkage was used to develop a person-centric, population-based dataset incorporating routinely collected administrative, clinical, and health economic information. The FRI group consisted of patients with International Classification of Disease 10th Revision diagnosis codes for deep infection associated with an implanted device within two years following surgery, while all others were deemed not infected. Demographic and clinical variables, as well as healthcare utilization costs, were compared. Results There were 111,402 patients operatively managed for orthopaedic trauma, with 2,775 of these (2.5%) complicated by FRI. The development of FRI had a statistically significant association with older age, male sex, residing in rural/remote areas, Aboriginal or Torres Strait Islander background, lower socioeconomic status, road traffic accident, work-related injuries, open fractures, anatomical region (lower limb, spine, pelvis), high injury severity, requiring soft-tissue coverage, and medical comorbidities (univariate analysis). Patients with FRI had an eight-times longer median inpatient length of stay (24 days vs 3 days), and a 2.8-times higher mean estimated inpatient hospitalization cost (AU$56,565 vs AU$19,773) compared with uninfected patients. The total estimated inpatient cost of the FRI cohort to the healthcare system was AU$156.9 million over the ten-year period. Conclusion The results of this study advocate for improvements in trauma care and infection management, address social determinants of health, and highlight the upside potential to improve prevention and treatment strategies.
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Affiliation(s)
- Andrew L Foster
- Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, Metro North Health, Brisbane, Australia
- Department of Orthopaedic Surgery, Royal Brisbane and Women's Hospital, Brisbane, Australia
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Jacelle Warren
- Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, Metro North Health, Brisbane, Australia
- Australian Centre for Health Services Innovation, Centre for Healthcare Transformation, Faculty of Health, Brisbane, Australia
| | - Kirsten Vallmuur
- Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, Metro North Health, Brisbane, Australia
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia
- Australian Centre for Health Services Innovation, Centre for Healthcare Transformation, Faculty of Health, Brisbane, Australia
| | - Anjali Jaiprakash
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Ross Crawford
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Kevin Tetsworth
- Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, Metro North Health, Brisbane, Australia
- Department of Orthopaedic Surgery, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Michael A Schuetz
- Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, Metro North Health, Brisbane, Australia
- Department of Orthopaedic Surgery, Royal Brisbane and Women's Hospital, Brisbane, Australia
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia
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Jirangkul P, Lorsuwannarat N, Wanichjaroen N. Precontoured dynamic compression plate using patient-specific 3D-printed models in minimally invasive surgical technique for midshaft clavicle fractures. Arch Orthop Trauma Surg 2024; 144:103-111. [PMID: 37658855 DOI: 10.1007/s00402-023-05042-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 08/17/2023] [Indexed: 09/05/2023]
Abstract
INTRODUCTION This study introduced a novel approach for the treatment of midshaft clavicle fractures, utilizing patient-specific 3D-printed models for accurate preoperative contouring of dynamic compression plates (DCPs) and an alternative minimally invasive plate osteosynthesis (MIPO) technique with precontoured DCPs through small vertical separated incisions. PATIENT AND METHODS Mirror image 3D clavicular models were reproduced from 40 patients with acute displaced midshaft clavicle fractures who underwent MIPO using precontoured DCPs inserted through small, vertical separated incisions. Exclusion criteria included patients with open fractures, pathological fractures, ipsilateral limb injury, skeletal immature patients, and those who had previous clavicle fractures or surgery. Postoperative evaluation was conducted using clinical and radiographic review. The Constant-Murley and American Shoulder and Elbow Surgeons Shoulder Scores were used for clinical evaluations, and the Patient and Observer Scar Assessment Scale was used to assess surgical scars. RESULTS The average time to union of all fractures was 12.88 weeks (range, 8-15) without loss of reduction. The patient-specific precontoured DCPs fitted well in all cases, with fracture consolidation and minimal three cortical sides connecting the fracture fragment. No hardware prominence and skin complications occurred, and clinical evaluation showed no existing difference compared with the contralateral sides. The average Constant-Murley and American Shoulder and Elbow Surgeons Shoulder Scores were 96.33 ± 3.66 and 93.26 ± 5.15, respectively. Two patients requested their implant removal, and scar qualities were satisfactory. CONCLUSIONS Our study demonstrated that the use of a patient-specific precontoured DCP, in combination with 3D printing technology, provides accurate preoperative planning, effective fracture reduction, and improved postoperative outcomes in displaced midshaft clavicle fractures. The MIPO with a patient-specific precontoured DCP through separated vertical incisions along the Langer's lines appears to be a promising option, regarding appearance, avoiding associated complications, and obviating the need for reoperation. These results suggest that this technique has merit and can be a viable option for the treatment of midshaft clavicle fractures.
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Affiliation(s)
- Puripun Jirangkul
- Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand.
| | | | - Nutthapong Wanichjaroen
- Department of Plastic Surgery, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
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Rust A, Samade R, Campbell AB, McManus T, Jain SA. Time to surgery and outcomes following open reduction and internal fixation of both-bone forearm fractures. Eur J Orthop Surg Traumatol 2024; 34:135-142. [PMID: 37368153 DOI: 10.1007/s00590-023-03560-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 04/23/2023] [Indexed: 06/28/2023]
Abstract
PURPOSE To determine the effect of time to surgery on outcomes following open reduction and internal fixation (ORIF) of both-bone forearm fractures (BBFFs). METHODS Ninety-nine patients who underwent ORIF of BBFFs in a single academic medical center over a 16-year time period were retrospectively reviewed. Demographic and clinical data including age, sex, current smoking status, time from injury to surgery (tsurg), presence of open injury, polytrauma status, and complications were obtained. Radiographs of the affected extremity were reviewed for fracture morphology, reduction quality, and time to union (or presence of nonunion). In addition to descriptive statistics, Chi-square and Wilcoxon-Mann-Whitney tests were used to compare categorical and interval, respectively, with a significance level of 0.05. RESULTS A tsurg > 48 h was associated with increased rate of delayed unions (tsurg < 48 h: 25% vs tsurg > 48 h: 59%, p = 0.03), but not complications (tsurg < 48 h: 44% vs tsurg > 48 h: 47%, p = 0.79). Open BBFFs were not associated with increased rates of delayed unions (closed: 16% vs open: 19%, p = 0.77) or complications (closed: 42% vs open: 53%, p = 0.29). A trend toward increased time to union with tsurg > 48 h was also seen, but did not reach significance (tsurg < 48 h: 13.5 weeks vs tsurg > 48 h: 15.7 weeks, p = 0.11). CONCLUSION A tsurg > 48 h is associated with an increased rate of delayed union, but not complications, after ORIF of BBFFs. LEVEL OF EVIDENCE Therapeutic Level III (Retrospective Cohort).
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Affiliation(s)
- Andrew Rust
- College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Richard Samade
- Hand and Upper Extremity Service, Hospital for Special Surgery, New York, NY, 10021, USA
- Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, TX, 75390, USA
| | - Andrew B Campbell
- College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Timothy McManus
- College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Sonu A Jain
- Departments of Orthopaedics and Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH, 43212, USA.
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Müller M, Bullinger Y, Pohlemann T, Orth M. [Clavicle fractures: practical approach in clinical routine]. Chirurgie (Heidelb) 2023; 94:1045-1056. [PMID: 37702744 DOI: 10.1007/s00104-023-01958-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/04/2023] [Indexed: 09/14/2023]
Abstract
Fractures of the clavicle are among the most common fractures. They typically result from a fall onto the lateral shoulder or the extended arm and are often related to sports and bicycle accidents. Obtaining the exact trauma mechanism, proper clinical findings and adequate X‑rays usually lead to the correct diagnosis. Non-displacement fractures can be treated conservatively with good results. Unstable and displaced fractures should be treated operatively. Open fractures or looming penetration are emergencies und should be treated immediately. In addition to fracture classification and morphology, other factors such as additional injuries and patient-related factors need to be considered in order to make an individualized therapy decision. In operative treatment, angular stable plating is the therapy of choice, and in most cases early functional aftercare is possible.
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Affiliation(s)
- M Müller
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum des Saarlandes, Kirrberger Straße 100, 66421, Homburg/Saar, Deutschland.
| | - Y Bullinger
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum des Saarlandes, Kirrberger Straße 100, 66421, Homburg/Saar, Deutschland
| | - T Pohlemann
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum des Saarlandes, Kirrberger Straße 100, 66421, Homburg/Saar, Deutschland
| | - M Orth
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum des Saarlandes, Kirrberger Straße 100, 66421, Homburg/Saar, Deutschland
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18
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Movassaghi K, Locker P, Kunze KN, Khoo KM, Hoekzema N. Predictors of Adverse Events in the Surgical Treatment of Adult Distal Humerus Fractures. Orthopedics 2023; 46:352-357. [PMID: 37018621 DOI: 10.3928/01477447-20230329-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
The purpose of this study was to identify surgical complications after distal humerus fracture fixation as well as correlations between these complications and patient variables. A total of 132 patients underwent open reduction and internal fixation of traumatic distal humerus fractures between October 2011 and June 2018. Included were adult patients who underwent surgical fixation and had more than 6 months of follow-up. Excluded were patients with inadequate radiographic imaging, less than 6 months of follow-up, and previous distal humerus surgery. Multivariate logistic regression models controlling for age and body mass index were used to determine preoperative factors predictive of postoperative complications. A total of 73 patients were included in this analysis. Surgical complications were reported for 17 patients. Reoperation was required for 13 patients. Open injury at presentation was predictive of delayed union. Predictors of subsequent elbow surgery included younger age, polytrauma, open fracture, and ulnar nerve injury at the time of injury. Radial nerve injury at the time of presentation was also a risk factor for postoperative radial nerve symptoms. Predictors of postoperative heterotopic ossification included older age. Thirty-one patients had an olecranon osteotomy during their open reduction and internal fixation and none went on to nonunion. There were 13 patients with ulnar nerve complications. Of these patients, 3 had undergone an ulnar nerve transposition. None of the other studied variables were predictors of complications, malunion, or nonunion at latest follow-up. Although open reduction and internal fixation is effective in treating distal humerus fractures, its complications cannot be overlooked. Open fractures are more likely to go on to delayed union. Ulnar nerve injury, open fracture, and polytrauma were predictive for reoperation. Older patients were less likely to have subsequent surgery but more likely to develop heterotopic ossification. By identifying at-risk patients, managing physicians can better prognosticate and counsel patients on their recovery. [Orthopedics. 2023;46(6):352-357.].
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Yildirim C, Görkem Muratoğlu O, Ordu S, Ceylan H, Can Muslu D, Atlihan D. Biomechanical comparison of three different surgical methods in the surgical treatment of distal tibial metaphyseal fractures. An animal model study. ULUS TRAVMA ACIL CER 2023; 29:1091-1097. [PMID: 37791442 PMCID: PMC10644082 DOI: 10.14744/tjtes.2023.66304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/24/2023] [Accepted: 09/15/2023] [Indexed: 10/05/2023]
Abstract
BACKGROUND The aim of this study is to investigate mechanical properties of minimally invasive plate osteosynthesis (MIPO), supracutaneousplating (SP), and unilateral external fixators (UEF) which can be performed for open tibial fractures. METHODS An unstable diaphysial tibia fracture was created in 60 fresh sheep tibia specimens by performing an osteotomy at the middle of bones. Specimens were divided into 3 groups. Specimens underwent fracture fixation with a standard MIPO technique, im-planting the plate 15 mm from the bone for SP group. Unilateral uniplanar external fixators were achieved for UEF group. First, thirty specimens (10 specimen for each group) were loaded vertically along the tibial axis to 1800 N. Second, other 30 preperated bones were used for cyclical loading to avoid metal fatigue. For dynamic tests, a 350 N force was applied for 10,000 cycles. RESULTS In compression testing (vertical loading up to 1800 N) of the three fixation instruments; construct stiffness was highest in MIPO group when compared with SP and UEF groups. While the stiffness of the MIPO group was similar to SP group, it was statistically higher than UEF group (P=0.08 and P=0.002, respectively). SP group was significantly stiffer than UEF group (P=0.0021). The mean peak load was highest in SP group and lowest in UEF group. The peak load in SP group was similar to the MIPO group, it was statistically higher than the UEF group (P=0.743 and P=0.002, respectively). CONCLUSION Based on the biomechanical properties from this in vitro animal model study, SP technique was biomechanically stronger than UEF and has similar biomechanical properties with MIPO in terms of axial loading.
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Affiliation(s)
- Cem Yildirim
- Department of Orthopaedic and Traumatology, Cam and Sakura City Hospital, Istanbul-Türkiye
| | | | - Samed Ordu
- Department of Orthopedic and Traumatology, Eskişehir Yunus Emre State Hospital, Eskisehir-Türkiye
| | - Hasan Ceylan
- Department of Orthopaedic and Traumatology, Cam and Sakura City Hospital, Istanbul-Türkiye
| | - Duran Can Muslu
- Department of Orthopedic and Traumatology, Brandenburg, Klinikum Dahme Spreewald Achenbach Krankenhaus, Germany
| | - Dogan Atlihan
- Department of Orthopedic and Traumatology, Haseki Training and Research Hospital, İstanbul-Türkiye
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20
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Yu X, Han F, Feng X, Wang X, Zhu Y, Ye C, Ji M, Chen Z, Tao R, Zhou Z, Wan F. Sea Cucumber-Inspired Aerogel for Ultrafast Hemostasis of Open Fracture. Adv Healthc Mater 2023; 12:e2300817. [PMID: 37340763 DOI: 10.1002/adhm.202300817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/29/2023] [Indexed: 06/22/2023]
Abstract
The symptomatic management of hemorrhagic shock complicated by open fractures is a great challenge, because it is also complicated by complex wound bleeding, bacterial infection, and bone defects. Inspired by the water absorption and cross-sectional microstructure of sea cucumbers, in this study, a new sea cucumber-like aerogel (GCG) is proposed. Its aligned porous structure and composition can stop bleeding rapidly and effectively with a blood clotting index of 3.73 ± 1.8%. More importantly, the data of in vivo hemostasis test in an amputating rat tail hemostatic model (15.69 ± 2.45 s, 26.95 ± 8.43 mg) and liver puncture bleeding model (23.77 ± 2.68 s, 36.22 ± 16.92 mg) also indicate the excellent hemostatic performance of GCG. In addition, GCG also shows a significant inhibitory effect on S. aureus and E. coli, which can prevent the occurrence of postoperative osteomyelitis. Not only that, after filling in the bone defect, it is shown that this GCG aerogel completely degrades eight weeks after surgery and induces new bone ingrowth, achieving functional regeneration after hemostasis of an open fracture defect. Generally, because of its combination of hemostatic, antibacterial, and osteogenic activities, this new aerogel is a promising option for open fractures treatment.
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Affiliation(s)
- Xinyu Yu
- Department of Orthopeadic Surgery, Affiliated Hospital of Nantong University, Nantong, 226001, China
| | - Fei Han
- Department of Orthopeadic Surgery, Affiliated Hospital of Nantong University, Nantong, 226001, China
| | - Xian Feng
- Department of Orthopeadic Surgery, Affiliated Hospital of Nantong University, Nantong, 226001, China
| | - Xin Wang
- Department of Dermatology, Affiliated Hospital of Nantong University, Nantong, 226001, China
| | - Yang Zhu
- Department of Orthopeadic Surgery, Affiliated Hospital of Nantong University, Nantong, 226001, China
| | - Cong Ye
- Department of Orthopeadic Surgery, Affiliated Hospital of Nantong University, Nantong, 226001, China
| | - Minrui Ji
- Department of Orthopeadic Surgery, Affiliated Hospital of Nantong University, Nantong, 226001, China
| | - Zhichao Chen
- Department of Orthopeadic Surgery, Affiliated Hospital of Nantong University, Nantong, 226001, China
| | - Ran Tao
- Department of Orthopeadic Surgery, Affiliated Hospital of Nantong University, Nantong, 226001, China
| | - Zhenyu Zhou
- Department of Orthopeadic Surgery, Affiliated Hospital of Nantong University, Nantong, 226001, China
| | - Fuyin Wan
- Department of Orthopeadic Surgery, Affiliated Hospital of Nantong University, Nantong, 226001, China
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Vincken L, van der Broeck L, Geurts J, Qiu Shao SS, Poeze M, Blokhuis TJ. The effect of post-traumatic long bone non-unions on health-related quality of life. Injury 2023; 54 Suppl 5:110929. [PMID: 37923507 DOI: 10.1016/j.injury.2023.110929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 06/08/2023] [Accepted: 07/06/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Fracture non-unions have a detrimental effect on patients due to reduced mobility and severe pain. Current literature on the quality of life in non-unions is limited, hence the purpose of this study, to quantify the health-related quality of life (HRQoL) among patients with post-traumatic long bone non-unions. It was hypothesized that the HRQoL of these patients is lower than the Dutch population standard as well as for multiple chronic diseases and musculoskeletal disorders. PATIENTS AND METHODS From January 2020 to December 2021, this study included consecutive patients who were referred to a multidisciplinary (trauma, orthopedic and plastic surgery), non-union clinic at the Maastricht UMC+. All non-unions were evaluated using the Non-Union Scoring System (NUSS) questionnaire. Patient reported HRQoL outcomes were acquired using the EQ-5D-5L questionnaire and the Lower Extremity Functional Scale (LEFS). RESULTS 50 patients were included, 18 females and 32 males, with a mean age of 55 years (± 15.5 SD). Eighteen patients presented with an open fracture, nine non-unions were infected and 39 patients had a lower extremity non-union. The mean NUSS score was 39.61 (± 14.6 SD). The mean EQ-5D-5L index score was 0.490 (± 0.261 SD), where patients experienced most problems with mobility. The mean EQ-5D-5L VAS was 61.4 (± 19.6 SD). The patients had a mean LEFS score of 28.7 (± 16.4 SD). The health-related quality of life was well below the age-corrected normative score of the Dutch population (EQ-5D-5L 0.857(p < 0.001); LEFS 77(p < 0.001)). This cohort's HRQoL was significantly lower than the HRQoL of multiple chronic and musculoskeletal disorders, including different forms of cancer and osteoarthritis. CONCLUSIONS This study has quantified the detrimental effect of post-traumatic long bone non-unions on patient's health-related quality of life, being significantly lower than the HRQoL of the Dutch population as well as for multiple chronic and musculoskeletal medical conditions. This cohort demonstrates a patient population in need of more specialized care with a low health-related quality of life.
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Affiliation(s)
- L Vincken
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, the Netherlands
| | - L van der Broeck
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, the Netherlands
| | - J Geurts
- Department of Orthopaedics, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - S S Qiu Shao
- Department of Plastic, Hand and Reconstructive Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - M Poeze
- Department of Trauma Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands; Department of Surgery, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands
| | - T J Blokhuis
- Department of Trauma Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands; Department of Surgery, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands.
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Tai JG, Ding ZY, Sun L, Cao YP, Ye GB, Hao P, Li W. [Analysis of the causes of soft tissue complications after volar locking plate for the treatment of dorsal displaced distal radius fractures]. Zhongguo Gu Shang 2023; 36:839-45. [PMID: 37735075 DOI: 10.12200/j.issn.1003-0034.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
OBJECTIVE To investigate the causes of soft tissue complications in patients with dorsal displacement distal radius fractures (DRF) after volar locking plate surgery. METHODS From July 2016 to May 2021, 112 patients with dorsal displacement DRF were treated with volar locking plate surgery, including 45 males and 67 females. The average age was (46.24±10.08) years old, ranging from 18 to 85 years old. According to whether there were soft tissue complications after operation, they were divided into complication group (40 cases) and non complication group (72 cases). Compared with preoperation, the radial metacarpal inclination and ulnar deflection angle, wrist flexion activity and dorsal extension activity, and grip strength of patients after operation were significantly improved (P<0.05). Compared with the non complication group, the proportion of patients in the complication group whose age was>60 years, body mass index (BMI) more than 30 kg·m-2, smoking, diabetes, fracture type C, open fracture and operation time more than 90 min was higher (P<0.05). The age, BMI, smoking, diabetes, fracture AO classification, fracture type and operation time were analyzed by multifactor Logistic regression to determine the independent risk factors affecting the occurrence of postoperative soft tissue complications of patients, establish a nomogram prediction model, and evaluate the model. RESULTS At the latest follow-up, the excellent and good rate of wrist joint function recovery was 83.93% (94/112), and the excellent and good rate of fracture reduction was 84.82% (95/112). Multivariate Logistic regression analysis showed that age more than 60 years old, diabetes, fracture type C, open fracture and operation time more than 90 min were independent risk factors for postoperative soft tissue complications (P<0.05). The receiver operating characteristic (ROC), calibration curve and clinical decision curve of the nomogram prediction model showed discrimination, accuracy and validity were good. CONCLUSION Age more than 60 years, diabetes mellitus, fracture type C, open fracture, and operation time more than 90 min are all independent risk factors for soft tissue complications after DRF volar plate fixation. In clinical treatment, perioperative soft tissue management should be done in such patients to prevent complications.
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Affiliation(s)
- Jin-Gu Tai
- Orthopaedic Center, Deyu Medical Ma'anshan General Hospital, Ma'anshan 243000, Anhui, China
| | - Zhi-Yong Ding
- Department of Orthopaedic Surgery, Nanjing Benji Hospital, Nanjing 210019, Jiangsu, China
| | - Liang Sun
- Orthopaedic Center, Deyu Medical Ma'anshan General Hospital, Ma'anshan 243000, Anhui, China
| | - Yun-Ping Cao
- Orthopaedic Center, Deyu Medical Ma'anshan General Hospital, Ma'anshan 243000, Anhui, China
| | - Guo-Bao Ye
- Orthopaedic Center, Deyu Medical Ma'anshan General Hospital, Ma'anshan 243000, Anhui, China
| | - Peng Hao
- Orthopaedic Center, Deyu Medical Ma'anshan General Hospital, Ma'anshan 243000, Anhui, China
| | - Wei Li
- Orthopaedic Center, Deyu Medical Ma'anshan General Hospital, Ma'anshan 243000, Anhui, China
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İğrek S, Ulusoy İ. E-scooter-related orthopedic injuries and the treatments applied: are these scooters a new means of transportation or a new source of trauma? BMC Emerg Med 2023; 23:110. [PMID: 37726669 PMCID: PMC10510217 DOI: 10.1186/s12873-023-00873-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 08/22/2023] [Indexed: 09/21/2023] Open
Abstract
INTRODUCTION E-scooters have become increasingly popular in Turkey due to easy accessibility. In parallel with this, the number of e-scooter-related injuries has increased gradually. The aim of this study was to determine the types of e-scooter-related orthopedic injuries, to evaluate hospitalization and surgical treatments, and to investigate the loss of work of patients and the burden incurred by the healthcare system. MATERIALS AND METHODS This retrospective multicentre study included all orthopaedic referrals, who were admitted to two major trauma departments in Diyarbakır from January 2022 to July 2022. Patient data were analyzed, including demographic characteristics, injury pattern, types of injury and subsequent treatment. RESULTS In a total of 62 patients, 105 orthopaedic injuries were identified, comprising 72.5% males and 27.5% females, with a median age of 34.21 years. Fifty-six (90.3%) patients were riders, and six were pedestrians. All associated e-scooters were rented. There were 44 fractures (41.9% of the total recorded injuries) including 8 (12.9%) open fractures. Surgery was required by 32 patients (51.6%) and 35 (56.4%) required hospital admission leading to hospitalization of 3.7 days on average. The average job loss of working patients after injury was determined as 2.4 months. Helmet use was detected in 6.4% of the e-scooter users, but no other protective equipment was detected in any of the patients. Furthermore, 19,3% of the patients had a blood alcohol level of > 10 mg/dl. CONCLUSIONS The injuries that may result from an e-scooter accident can have long-term hospitalization and long-term job loss in the community. This imposes a significant financial burden on the national healthcare system and adversely affects public health. There is a need for precautions to be implemented such as infrastructure organisation, increased awareness of motor vehicle riders and e-scooter riders, and increased enforcement of rule compliance including not using e scooters after alcohol consumption and the use of protective equipment.
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Affiliation(s)
- Servet İğrek
- Department of Orthopaedics and Traumatology, Selahaddin Eyyubi State Hospital, Diyarbakır, Turkey.
| | - İbrahim Ulusoy
- Department of Orthopaedics and Traumatology, Selahaddin Eyyubi State Hospital, Diyarbakır, Turkey
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Morisaki S, Yoshii K, Tsuchida S, Oda R, Fuke T, Takahashi K. The role of preoperative glycemic control in decreasing surgical site infections in lower extremity fractures. J Orthop Surg Res 2023; 18:700. [PMID: 37723461 PMCID: PMC10507903 DOI: 10.1186/s13018-023-04204-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/13/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Postoperative surgical site infections (SSIs) are an important complication to prevent in surgical treatment. Patients with diabetes mellitus (DM) have a higher risk of SSIs. Preoperative glycemic control is required. For patients with orthopedic trauma, the duration of preoperative glycemic control is limited because delaying operative treatment is difficult. However, whether preoperative glycemic control would decrease the risk of SSIs in diabetic patients with lower extremity fractures is unclear. The first aim of this study was to investigate the rate of SSIs among patients with DM who had undergone preoperative glycemic control, compared with that of patients without DM. As the secondary aim, we sought to demonstrate among patients with DM whether preoperative glycemic control would affect the development of SSIs between patients with controlled DM and patients with poorly controlled DM. METHODS In this retrospective cohort study, 1510 patients treated surgically for lower extremity fractures were enrolled. Data collected were patient age, sex, body mass index, history of DM, development of SSIs, tobacco use, the presence of an open fracture, the period between the day of injury and the operation, the length of surgery, and blood glucose levels on admission and on the day before surgery. RESULTS The rate of total SSIs was 6.0% among patients with DM and 4.4% among patients without DM (p = 0.31). Multivariate logistic regression revealed a significant association between the development of SSIs and the presence of DM (odds ratio, 1.79; 95% confidence interval 1.01-3.19; p = 0.047). The results of the secondary study revealed that the rate of early SSIs was significantly higher in the poorly controlled DM group than in the controlled DM group (5.9% vs. 1.5%; p = 0.032). However, multivariate logistic regression revealed that control levels of DM were not significantly associated with the development of SSIs. CONCLUSIONS Even though patients with DM had undergone preoperative glycemic control, SSIs were significantly associated with DM, especially when the patients had poorly controlled DM. This finding suggested that continuous glycemic control is important preoperatively and postoperatively to prevent SSIs.
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Affiliation(s)
- Shinsuke Morisaki
- Department of Orthopaedics, Saiseikai Shiga Hospital, Ohashi 2-4-1, Ritto, Shiga, 520-3046, Japan.
| | - Kengo Yoshii
- Department of Mathematics and Statistics in Medical Sciences, Kyoto Prefectural University of Medicine, Shimogamo Hangi-tyo Sakyo-ku 1-5, Kyoto, 606-0823, Japan
| | - Shinji Tsuchida
- Department of Orthopaedics, Kyoto Prefectural University of Medicine, Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Ryo Oda
- Department of Orthopaedics, Kyoto Prefectural University of Medicine, Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Tomoya Fuke
- Department of Diabetes and Endocrinology, Saiseikai Shiga Hospital, Ohashi 2-4-1, Ritto, Shiga, 520-3046, Japan
| | - Kenji Takahashi
- Department of Orthopaedics, Kyoto Prefectural University of Medicine, Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
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Kim DH, Jang HS, Kwak SH, Jung SY, Jeon JM, Ahn TY, Lee SH. Surgical outcomes of segmental diaphyseal forearm fractures in adults: a small case series on plate osteosynthesis, intramedullary nailing, and other surgical methods. BMC Musculoskelet Disord 2023; 24:731. [PMID: 37710239 PMCID: PMC10500880 DOI: 10.1186/s12891-023-06857-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 09/06/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Segmental fractures often result from high-energy or indirect trauma that causes bending or torsional forces with axial loading. We evaluated surgical outcomes of patients with forearm segmental diaphyseal fractures. METHODS We retrospectively analyzed data from patients with forearm segmental fractures for which they underwent surgery at the Pusan National University Trauma Center from March 2013 to March 2022. We also analyzed accompanying injuries, injury severity score (ISS), injury mechanism, occurrence of open fracture, surgical technique, and treatment results. RESULTS Fifteen patients were identified, one with bilateral segmental diaphyseal forearm bone fracture, for a total of 16 cases. Nine of the patients were male. The overall mean age was 50 years, and the mean follow-up period was 16.2 months. Six cases who underwent surgery using plate osteosynthesis achieved bone union without length deformity at final follow-up. Three of seven patients who underwent intramedullary nailing alone underwent reoperation due to nonunion. Six cases achieved bone union at final follow-up, three of which showed length deformity. Three patients underwent surgery using a hybrid method of IM nailing, plates, and mini cables. One patient who underwent surgery with a plate and one patient who underwent surgery with IM nailing alone showed nonunion and were lost to follow-up. CONCLUSION Plate osteosynthesis is considered the gold standard for treatment of adult forearm diaphyseal segmental fractures. In this study, IM nailing was associated with high rates of non-union and length deformity. However, the combination of IM nailing and a plate-cable system may be an acceptable alternative in segmental diaphyseal forearm fracture, achieving a union rate similar to that provided by plate fixation.
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Affiliation(s)
- Dong Hee Kim
- Departments of Orthopedic Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Hyo Seok Jang
- Department of Orthopedic Surgery, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Sang Ho Kwak
- Department of Orthopedic Surgery, SNU Seoul Hospital, Seoul, Republic of Korea
| | - Sung Yoon Jung
- Department of Orthopedic Surgery, College of Medicine, Dong-A University Hospital, Busan, Republic of Korea
| | - Jong Min Jeon
- Departments of Orthopedic Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Tae Young Ahn
- Department of Orthopedic Surgery, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Sang Hyun Lee
- Department of Orthopedic Surgery, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Republic of Korea.
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Chen Y, Liu Z, Lin Z, Lu M, Fu Y, Liu G, Yu B. The effect of Staphylococcus aureus on innate and adaptive immunity and potential immunotherapy for S. aureus-induced osteomyelitis. Front Immunol 2023; 14:1219895. [PMID: 37744377 PMCID: PMC10517662 DOI: 10.3389/fimmu.2023.1219895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/18/2023] [Indexed: 09/26/2023] Open
Abstract
Osteomyelitis is a chronic inflammatory bone disease caused by infection of open fractures or post-operative implants. Particularly in patients with open fractures, the risk of osteomyelitis is greatly increased as the soft tissue damage and bacterial infection are often more severe. Staphylococcus aureus, one of the most common pathogens of osteomyelitis, disrupts the immune response through multiple mechanisms, such as biofilm formation, virulence factor secretion, and metabolic pattern alteration, which attenuates the effectiveness of antibiotics and surgical debridement toward osteomyelitis. In osteomyelitis, immune cells such as neutrophils, macrophages and T cells are activated in response to pathogenic bacteria invasion with excessive inflammatory factor secretion, immune checkpoint overexpression, and downregulation of immune pathway transcription factors, which enhances osteoclastogenesis and results in bone destruction. Therefore, the study of the mechanisms of abnormal immunity will be a new breakthrough in the treatment of osteomyelitis.
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Affiliation(s)
- Yingqi Chen
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Southern Medical University Nanfang Hospital, Guangzhou, China
- Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Southern Medical University Nanfang Hospital, Guangzhou, China
| | - Zixian Liu
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Southern Medical University Nanfang Hospital, Guangzhou, China
- Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Southern Medical University Nanfang Hospital, Guangzhou, China
| | - Zexin Lin
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Southern Medical University Nanfang Hospital, Guangzhou, China
- Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Southern Medical University Nanfang Hospital, Guangzhou, China
| | - Mincheng Lu
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Southern Medical University Nanfang Hospital, Guangzhou, China
- Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Southern Medical University Nanfang Hospital, Guangzhou, China
| | - Yong Fu
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Southern Medical University Nanfang Hospital, Guangzhou, China
- Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Southern Medical University Nanfang Hospital, Guangzhou, China
- Trauma Center, Department of Orthopaedic Trauma, The Second Affiliated Hospital of Hengyang Medical College, South China University, Hengyang, China
| | - Guanqiao Liu
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Southern Medical University Nanfang Hospital, Guangzhou, China
- Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Southern Medical University Nanfang Hospital, Guangzhou, China
| | - Bin Yu
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Southern Medical University Nanfang Hospital, Guangzhou, China
- Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Southern Medical University Nanfang Hospital, Guangzhou, China
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Ren Y, Liu L, Sun D, Zhang Z, Li M, Lan X, Ni J, Yan MM, Huang W, Liu ZM, Peng AQ, Zhang Y, Jiang N, Song K, Huang Z, Bi Q, Zhang J, Yang Q, Yang J, Liu Y, Fu W, Tian X, Wang Y, Zhong W, Song X, Abudurexiti A, Xia Z, Jiang Q, Shi H, Liu X, Wang G, Hu Y, Zhang Y, Yin G, Fan J, Feng S, Zhou X, Li Z, He W, Weeks J, Schwarz EM, Kates SL, Huang L, Chai Y, Bin Yu MD, Xie Z, Deng Z, Xie C. Epidemiological updates of post-traumatic related limb osteomyelitis in china: a 10 years multicentre cohort study. Int J Surg 2023; 109:2721-2731. [PMID: 37247014 PMCID: PMC10498838 DOI: 10.1097/js9.0000000000000502] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 05/09/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND Post-traumatic related limb osteomyelitis (PTRLO) is a complex bone infection. Currently, there are no available microbial data on a national scale that can guide appropriate antibiotic selection, and explore the dynamic changes in dominant pathogens over time. This study aimed to conduct a comprehensive epidemiological analysis of PTRLO in China. METHODS The study was approved by the Institutional Research Board (IRB), and 3526 PTRLO patients were identified from 212 394 traumatic limb fracture patients at 21 hospitals between 1 January 2008 and 31 December 2017. A retrospective analysis was conducted to investigate the epidemiology of PTRLO, including changes in infection rate (IR), pathogens, infection risk factors and antibiotic resistance and sensitivity. RESULTS The IR of PTRLO increased gradually from 0.93 to 2.16% (Z=14.392, P <0.001). Monomicrobial infection (82.6%) was significantly higher than polymicrobial infection (17.4%) ( P <0.001). The IR of Gram-positive (GP) and Gram-negative (GN) pathogens showed a significant increase from the lowest 0.41% to the highest 1.15% (GP) or 1.62% (GN), respectively. However, the longitudinal trend of GP vs. GN's composition did not show any significance (Z=±1.1918, P >0.05). The most prevalent GP strains were Methicillin-sensitive Staphylococcus aureus (MSSA) (17.03%), Methicillin-resistant Staphylococcus aureus (MRSA) (10.46%), E. faecalis (5.19%) and S. epidermidis (4.87%). In contrast, the dominant strains GN strains were Pseudomonas Aeruginosa (10.92%), E. cloacae (10.34%), E. coli (9.47%), Acinetobacter Baumannii (7.92%) and Klebsiella Pneumoniae (3.33%). In general, the high-risk factors for polymicrobial infection include opened-fracture (odds ratio, 2.223), hypoproteinemia (odds ratio, 2.328), and multiple fractures (odds ratio, 1.465). It is important to note that the antibiotics resistance and sensitivity analysis of the pathogens may be influenced by complications or comorbidities. CONCLUSIONS This study provides the latest data of PTRLO in China and offers trustworthy guidelines for clinical practice. (China Clinical Trials.gov number, ChiCTR1800017597).
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Affiliation(s)
- YouLiang Ren
- Department of Orthopaedics, Second Affiliated Hospital of Chongqing Medical University
- Department of Orthopaedics, Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY
| | - Lei Liu
- Department of Orthopaedics, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen
- Department of Orthopaedics, West China Hospital, Sichuan University
| | - Dong Sun
- Department of Orthopaedics, First Affiliated Hospital of Army Medical University
| | - ZhengDong Zhang
- Department of Orthopaedics, West China Hospital, Sichuan University
- Department of Orthopedics, The First Affiliated Hospital of Chengdu Medical College, Chengdu
| | - Meng Li
- Department of Orthopaedics, Gansu Provincial Hospital
- Department of Orthopaedics, Lanzhou General Hospital of People’s Liberation Army, Lanzhou
| | - Xu Lan
- Department of Orthopaedics, Gansu Provincial Hospital
- Department of Orthopaedics, Lanzhou General Hospital of People’s Liberation Army, Lanzhou
| | - JiangDong Ni
- Department of Orthopaedics Surgery, Second Xiangya Hospital, Central South University, Changsha
| | - Ming-Ming Yan
- Department of Orthopaedics Surgery, Second Xiangya Hospital, Central South University, Changsha
| | - Wei Huang
- Department of Orthopaedics, First Affiliated Hospital of Chongqing Medical University, Chongqing
| | - Zi-Ming Liu
- Department of Orthopaedics, First Affiliated Hospital of Chongqing Medical University, Chongqing
- Institute of Sports Medicine Beijing Key Laboratory of Sports Injuries Peking University Third Hospital
| | - AQin Peng
- Department of Orthopaedics, Third Hospital of Hebei Medical University, Shijiazhuang
| | - YanLong Zhang
- Department of Orthopaedics, Third Hospital of Hebei Medical University, Shijiazhuang
| | - Nan Jiang
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou
| | - KeGuan Song
- Third Department of Orthopaedics, First Affiliated Hospital of Harbin Medical University, Harbin
| | - ZhiPeng Huang
- Third Department of Orthopaedics, First Affiliated Hospital of Harbin Medical University, Harbin
| | - Qing Bi
- Department of Orthopaedics, Zhejiang Provincial People's Hospital of Hangzhou Medical College, Hangzhou
| | - Jun Zhang
- Department of Orthopaedics, Zhejiang Provincial People's Hospital of Hangzhou Medical College, Hangzhou
| | - Qun Yang
- Department of Orthopaedics, First Affiliated Hospital of Dalian Medical University, Dalian
| | - Jun Yang
- Department of Orthopaedics, First Affiliated Hospital of Dalian Medical University, Dalian
| | - Yi Liu
- Department of Orthopaedics, Affiliated Hospital of Zunyi Medical University, Zunyi
| | - Wei Fu
- Department of Orthopaedics, Affiliated Hospital of Zunyi Medical University, Zunyi
- Department of Orthopaedics, Guizhou Provincial People’s Hospital
| | | | - YuanZheng Wang
- Department of Orthopaedics, Guizhou Provincial People’s Hospital
| | - WanRun Zhong
- Department of Orthopaedics Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine
| | - XingHua Song
- Department of Orthopaedics, First Hospital of Xinjiang Medical University, Ürümqi
- Department of Spine and Joint, The Affiliated Shunde Hospital of Jinan University, Foshan
| | | | - ZhiLin Xia
- Department of Orthopaedics, Second Hospital of Beijing Municipal Corps Chinese People's Armed Police
| | - Qing Jiang
- Department of Orthopaedics, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School
| | - HongFei Shi
- Department of Orthopaedics, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School
| | - XiMing Liu
- Department of Orthopaedics, Wuhan General Hospital of People's Liberation Army, Wuhan
| | - GuoDong Wang
- Department of Orthopaedics, Wuhan General Hospital of People's Liberation Army, Wuhan
| | - YunSheng Hu
- Department of Orthopaedics, Tangdu Hospital, Fourth Military Medical University, Xi'an
| | - YunFei Zhang
- Department of Orthopaedics, Tangdu Hospital, Fourth Military Medical University, Xi'an
| | - GuoYong Yin
- Department of Orthopaedics, First Affiliated Hospital of Nanjing Medical University, Nanjing
| | - Jin Fan
- Department of Orthopaedics, First Affiliated Hospital of Nanjing Medical University, Nanjing
| | - ShiQing Feng
- Department of Orthopaedics, Tianjin Medical University General Hospital, Heping, China
| | - XianHu Zhou
- Department of Orthopaedics, Tianjin Medical University General Hospital, Heping, China
| | - ZhengDao Li
- Department of Orthopaedics, First People’s Hospital of Xuzhou, Affiliated Hospital of China University of Mining and Technology
| | - WenBin He
- Department of Trauma Orthopaedics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai
| | - Jason Weeks
- Department of Orthopaedics, Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY
| | - Edward M Schwarz
- Department of Orthopaedics, Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY
| | - Stephen L Kates
- Department of Orthopedic Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Lei Huang
- Department of Orthopaedics, Peking University Jishuitan Hospital, Beijing
| | - YiMin Chai
- Department of Orthopaedics Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine
| | - MD Bin Yu
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou
| | - Zhao Xie
- Department of Orthopaedics, First Affiliated Hospital of Army Medical University
| | - ZhongLiang Deng
- Department of Orthopaedics, Second Affiliated Hospital of Chongqing Medical University
| | - Chao Xie
- Department of Orthopaedics, Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY
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Dworkin M, Agarwal-Harding KJ, Joseph M, Cahill G, Konadu-Yeboah D, Makasa E, Mock C. Indicators for the evaluation of musculoskeletal trauma systems: A scoping review and Delphi study. PLoS One 2023; 18:e0290816. [PMID: 37651448 PMCID: PMC10470913 DOI: 10.1371/journal.pone.0290816] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 08/16/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Trauma is a leading cause of mortality and morbidity, disproportionately affecting low- and middle-income countries. Musculoskeletal trauma results in the majority of post-traumatic morbidity and disability globally. The literature has reported many performance indicators relating to trauma care, but few specific to musculoskeletal injuries. STUDY OBJECTIVES The purpose of this study was to establish a practical list of performance indicators to evaluate and monitor the quality and equity of musculoskeletal trauma care delivery in health systems worldwide. METHODS A scoping review was performed that identified performance indicators related to musculoskeletal trauma care. Indicators were organized by phase of care (general, prevention, pre-hospital, hospital, post-hospital) within a modified Donabedian model (structure, process, outcome, equity). A panel of 21 experts representing 45 countries was assembled to identify priority indicators utilizing a modified Delphi approach. RESULTS The scoping review identified 1,206 articles and 114 underwent full text review. We included 95 articles which reported 498 unique performance indicators. Most indicators related to the hospital phase of care (n = 303, 60%) and structural characteristics (n = 221, 44%). Mortality (n = 50 articles) and presence of trauma registries (n = 16 articles) were the most frequently reported indicators. After 3 rounds of surveys our panel reached consensus on a parsimonious list of priority performance indicators. These focused on access to trauma care; processes and key resources for polytrauma triage, patient stabilization, and hemorrhage control; reduction and immobilization of fractures and dislocations; and management of compartment syndrome and open fractures. CONCLUSIONS The literature has reported many performance indicators relating to trauma care, but few specific to musculoskeletal injuries. To create quality and equitable trauma systems, musculoskeletal care must be incorporated into development plans with continuous monitoring and improvement. The performance indicators identified by our expert panel and organized in a modified Donabedian model can serve as a method for evaluating musculoskeletal trauma care.
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Affiliation(s)
- M. Dworkin
- Department of Orthopaedic Surgery, The Warren Alpert School of Medicine at Brown University, Providence, Rhode Island, United States of America
- Harvard Global Orthopaedics Collaborative, Boston, Massachusetts, United States of America
| | - K. J. Agarwal-Harding
- Harvard Global Orthopaedics Collaborative, Boston, Massachusetts, United States of America
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
| | - M. Joseph
- Global Health and Social Medicine Department, Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, United States of America
| | - G. Cahill
- Global Health and Social Medicine Department, Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, United States of America
| | - D. Konadu-Yeboah
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - E. Makasa
- Wits-SADC Regional Collaboration Centre for Surgical Healthcare, Department of Surgery, Faculty of Health Sciences, School of Clinical Medicine, University of Witwatersrand, Johannesburg, South Africa
- Department of Surgery, School of Medicine, University of Zambia, Lusaka, Zambia
- Department of Surgery, Ministry of Health, University Teaching Hospitals (UTHs), Lusaka, Republic of Zambia
| | - C. Mock
- Department of Surgery, University of Washington, Seattle, Washington, United States of America
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Thorne T, Kellam P, Nelson C, Li H, Zhang Y, Cizik A, Marchand L, Haller JM. Minimal Clinically Important Differences of Patient-Reported Outcomes Measurement Information System Physical Function in Patients With Tibial Shaft Fracture. J Orthop Trauma 2023; 37:401-406. [PMID: 36952600 PMCID: PMC10612014 DOI: 10.1097/bot.0000000000002600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/14/2023] [Indexed: 03/25/2023]
Abstract
OBJECTIVE To calculate the minimal clinically important differences (MCIDs) of patient-reported outcomes measurement information system physical function (PROMIS PF) scores for patients with operatively treated tibial shaft fractures. DESIGN Retrospective Cohort Study. SETTING A Level 1 trauma center. PATIENTS All operatively treated tibial shaft fractures identified by Current Procedural Terminology codes. INTERVENTION Enrolled patients treated acutely with operative fixation of their tibia. MAIN OUTCOME MEASUREMENTS MCIDs were calculated by distribution-based and anchor-based methods, calculated from PROMIS PF scores completed at least at two-time points postoperatively. MCIDs were calculated at different time points including overall, 7-12 weeks, 3-6 months, and 6-24 months. MCIDs were calculated for different subgroups including open fractures, closed fractures, any complications, and no complications. RESULTS MCID for PROMIS PF scores was 5.7 in the distribution-based method and 7.84 (SD 18.65) in the anchor-based method. At 6-24 postoperatively, the months the distribution-based MCID was 5.95 from a postoperative baseline 27.83 (8.74) to 42.85 (9.61), P < 0.001. At 6-24 months, the anchor-based MCID was 10.62 with a score difference between the improvement group of 16.03 (10.73) and the no improvement group of 5.41 (15.75), P < 0.001. Patients with open fractures (distribution-based 6.22 and anchor-based 8.05) and any complications (distribution-based 5.71 and anchor-based 9.29) had similar or higher MCIDs depending on the methodology used than the overall cohort MCIDs. CONCLUSION This study identified distribution-based MCID of 5.7 and anchor-based MCID of 7.84 calculated from PROMIS PF scores in operative tibial shaft fractures. Distribution-based methods yielded smaller MCIDs than anchor-based methods. These MCID scores provide a standard to compare clinical and investigational outcomes.
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Affiliation(s)
- Tyler Thorne
- University of Utah Department of Orthopaedic Surgery, Salt Lake City, UT
| | - Patrick Kellam
- University of Utah Department of Orthopaedic Surgery, Salt Lake City, UT
| | - Chase Nelson
- University of Utah Department of Orthopaedic Surgery, Salt Lake City, UT
| | - Haojia Li
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT
| | - Yue Zhang
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT
| | - Amy Cizik
- University of Utah Department of Orthopaedic Surgery, Salt Lake City, UT
| | - Lucas Marchand
- University of Utah Department of Orthopaedic Surgery, Salt Lake City, UT
| | - Justin M Haller
- University of Utah Department of Orthopaedic Surgery, Salt Lake City, UT
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Wu CQ, Hua Y, Liu YZ. [Risk factors of elbow stiffness after open reduction and internal fixation of intercondylar fracture of humerus]. Zhongguo Gu Shang 2023; 36:614-8. [PMID: 37475623 DOI: 10.12200/j.issn.1003-0034.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
OBJECTIVE To investigate the risk factors of elbow stiffness after open reduction and internal fixation of intercondylar fracture of humerus. METHODS From March 2015 to February 2019, 120 patients with humeral intercondylar fractures were treated with open fixation including 59 males and 61 females, aged from 25 to 77 years with an average of(53.5±3.2) years. According to the occurrence of elbow stiffness after operation, 120 patients were divided into stiffness group(37 cases) and control group(83 cases). The related factors of elbow stiffness were analyzed by single factor analysis, and the risk of elbow stiffness after internal fixation of humeral intercondylar fracture was analyzed by logistic regression factor. RESULTS There were 37 cases of elbow stiffness(stiff group), and 83 cases had no elbow stiffness(control group). The incidence of joint stiffness was 30.83%. There were significant differences between the stiffness group and the control group in age, injury energy, fracture to operation time, AO classification of fracture, open injury and postoperative premature or hyperactivity. Multivariate logistic regression analysis showed that age>50 years old, high energy injury, AO classification of fracture, open fracture and postoperative premature or hyperactivity were risk factors for elbow stiffness after internal fixation of humeral intercondylar fracture. The postoperative mobility and Mayo elbow performance score(MEPS) scores of the postoperative stiffness group were lower than those of the non-stiffness group with statistical significance(P<0.05). There were no significant differences in postoperative mobility and MEPS scores between flexion stiffness and rotation stiffness after humeral intercondylar fracture(P>0.05). CONCLUSION In view of the risk factors of elbow stiffness after internal fixation of humeral intercondylar fracture, reasonable operation plan and rehabilitation strategy should be formulated before operation to minimize the incidence of elbow stiffness.
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Affiliation(s)
- Chang-Qing Wu
- Department of Orthopaedics and Traumatology, No.951 Hospital, Korla 841000, Xinjiang Uygur Zizhiqu, China
| | - Ying Hua
- Department of Orthopaedics and Traumatology, No.951 Hospital, Korla 841000, Xinjiang Uygur Zizhiqu, China
| | - Yong-Zhan Liu
- Department of Orthopaedics and Traumatology, No.951 Hospital, Korla 841000, Xinjiang Uygur Zizhiqu, China
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Alfort H, Von Kieseritzky J, Wilcke M. Finger fractures: Epidemiology and treatment based on 21341 fractures from the Swedish Fracture register. PLoS One 2023; 18:e0288506. [PMID: 37450469 PMCID: PMC10348528 DOI: 10.1371/journal.pone.0288506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 06/27/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND There is a lack of detailed epidemiological studies of finger fractures, the most common fracture of the upper extremity. METHODS Based on data of 21 341 finger fractures in the Swedish Fracture register, a national quality registry that collects data on all fractures, this study describes anatomical distribution, cause, treatment, age distribution, and result in terms of patient related outcome measures (PROMs). RESULTS The most common finger fracture was of the base of the 5th finger, followed by the distal phalanx in the 4th finger. Open fractures were most common in the distal phalanges, especially in the 3rd finger. Intraarticular fractures were most frequent in the middle phalanges. Fall accidents was the most common cause of a fracture. The mean age at injury was 40 years (38 for men, 43 for women). 86% of finger fractures in adults were treated non-operatively. Men were more frequently operated than women. Finger fractures did not affect hand function or quality of life and there were no relevant differences in PROMs between fracture type, treatment, or sex. CONCLUSION This study presents detailed information about the various types of finger fractures which can be used as point of reference in clinical work and for future studies.
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Affiliation(s)
- Henrik Alfort
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
- Department of Hand Surgery, Södersjukhuset, Stockholm, Sweden
| | - Johanna Von Kieseritzky
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
- Department of Hand Surgery, Södersjukhuset, Stockholm, Sweden
| | - Maria Wilcke
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
- Department of Hand Surgery, Södersjukhuset, Stockholm, Sweden
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OBEY MR, SHLYKOV MA, NICKEL KB, KELLER M, HOSSEINZADEH P. Incidence and risk factors for acute compartment syndrome in pediatric tibia fractures. J Pediatr Orthop B 2023; 32:401-404. [PMID: 35502734 PMCID: PMC9630170 DOI: 10.1097/bpb.0000000000000985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Acute compartment syndrome (ACS) is a rare complication following traumatic injuries in pediatric patients, and tibia fractures represent the most common cause of ACS. To determine the incidence and risk factors of developing ACS, State Inpatient Databases, State Emergency Department Databases, and State Ambulatory Surgery and Services Databases from the Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality, were used to retrospectively identify patients 1-18 years of age with tibia fractures from 2006 to 2015 (quarter 3). The HCUP Nationwide Emergency Department Sample for nationwide data was also queried. Multivariable generalized estimating equations models were used to determine risk factors associated with development of ACS. A total of 50 640 patients with tibia fractures were studied, and 309 cases of ACS were identified. The incidence of ACS was 0.6 and 5.5% in the all tibia and open tibia fracture groups, respectively. Twenty-three cases of ACS (7.4% of all ACS) were diagnosed after discharge from the index admission, which was more common in teens treated nonoperatively. Predictors of increased ACS risk in the all tibia fracture group included age 13-18 [relative risk (RR): 4.04)], open fractures (RR: 3.83), and motor vehicle crash (MVC) mechanism (RR: 5.69). Nationwide, open and operatively treated fractures had an increased ACS rate (3.98 and 5.51%, respectively). Teenagers, open fractures, and MVC mechanisms were most strongly associated with ACS. ACS can present in a delayed fashion, as evidenced by postindex cases.
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Affiliation(s)
- Mitchel R. OBEY
- Investigation performed at the St. Louis Children’s Hospital, St. Louis, MO
| | - Maksim A. SHLYKOV
- Investigation performed at the St. Louis Children’s Hospital, St. Louis, MO
| | - Katelin B. NICKEL
- Investigation performed at the St. Louis Children’s Hospital, St. Louis, MO
| | - Matthew KELLER
- Investigation performed at the St. Louis Children’s Hospital, St. Louis, MO
| | - Pooya HOSSEINZADEH
- Investigation performed at the St. Louis Children’s Hospital, St. Louis, MO
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33
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Demidov VV, Clark MA, Streeter SS, Sottosanti JS, Gitajn IL, Elliott JT. High-energy open-fracture model with initial experience of fluorescence-guided bone perfusion assessment. J Orthop Res 2023; 41:1040-1048. [PMID: 36192829 PMCID: PMC10067537 DOI: 10.1002/jor.25443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/12/2022] [Indexed: 02/04/2023]
Abstract
High-energy orthopedic injuries cause severe damage to soft tissues and are prone to infection and healing complications, making them a challenge to manage. Further research is facilitated by a clinically relevant animal model with commensurate fracture severity and soft-tissue damage, allowing evaluation of novel treatment options and techniques. Here we report a reproducible, robust, and clinically relevant animal model of high-energy trauma with extensive soft-tissue damage, based on compressed air-driven membrane rupture as the blast wave source. As proof-of-principle showing the reproducibility of the injury, we evaluate changes in tissue and bone perfusion for a range of different tibia fracture severities, using dynamic contrast-enhanced fluorescence imaging and microcomputed tomography. We demonstrate that fluorescence tracer temporal profiles for skin, femoral vein, fractured bone, and paw reflect the increasing impact of more powerful blasts causing a range of Gustilo grade I-III injuries. The maximum fluorescence intensity of distal tibial bone following 0.1 mg/kg intravenous indocyanine green injection decreased by 35% (p < 0.01), 75% (p < 0.001), and 87% (p < 0.001), following grade I, II, and III injuries, respectively, compared to uninjured bone. Other kinetic parameters of bone and soft tissue perfusion extracted from series of fluorescence images for each animal also showed an association with severity of trauma. In addition, the time-intensity profile of fluorescence showed marked differences in wash-in and wash-out patterns for different injury severities and anatomical locations. This reliable and realistic high-energy trauma model opens new research avenues to better understand infection and treatment strategies. Level of evidence: Level III; Case-control.
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Affiliation(s)
- Valentin V. Demidov
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Centre, Lebanon, NH
- Geisel School of Medicine, Dartmouth College, Hanover, NH
| | - Megan A. Clark
- Thayer School of Engineering, Dartmouth College, Hanover, NH
| | | | | | - I. Leah Gitajn
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Centre, Lebanon, NH
| | - Jonathan Thomas Elliott
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Centre, Lebanon, NH
- Geisel School of Medicine, Dartmouth College, Hanover, NH
- Thayer School of Engineering, Dartmouth College, Hanover, NH
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Graham SM, Render L, Maqungo S, Ferreira N, Marais LC, Held M, Laubscher M. Establishing a consensus on research priorities in orthopaedic trauma within South Africa. Eur J Orthop Surg Traumatol 2023; 33:533-540. [PMID: 36752822 DOI: 10.1007/s00590-022-03413-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 10/09/2022] [Indexed: 06/18/2023]
Abstract
BACKGROUND Musculoskeletal (MSK) injuries are one of the leading causes of disability worldwide. Despite improvements in trauma-related morbidity and mortality in high-income countries over recent years, outcomes following MSK injuries in low- and middle-income countries, such as South Africa (SA), have not. Despite governmental recognition that this is required, funding and research into this significant health burden are limited within SA. This study aims to identify research priorities within MSK trauma care using a consensus-based approach amongst MSK healthcare practitioners within SA. METHOD Members from the Orthopaedic Research Collaboration in Africa (ORCA), based in SA, collaborated using a two round modified Delphi technique to form a consensus on research priorities within orthopaedic trauma care. Members involved in the process were orthopaedic healthcare practitioners within SA. RESULTS Participants from the ORCA network, working within SA, scored research priorities across two Delphi rounds from low to high priority. We have published the overall top 10 research priorities for this Delphi process. Questions were focused on two broad groups-clinical effectiveness in trauma care and general trauma public health care. Both groups were represented by the top two priorities, with the highest ranked question regarding the overall impact of trauma in SA and the second regarding the clinical treatment of open fractures. CONCLUSION This study has defined research priorities within orthopaedic trauma in South Africa. Our vision is that by establishing consensus on these research priorities, policy and research funding will be directed into these areas. This should ultimately improve musculoskeletal trauma care across South Africa and its significant health and socioeconomic impacts.
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Affiliation(s)
- Simon M Graham
- Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom.
- Liverpool Orthopaedic and Trauma Service, Liverpool University Teaching Hospital Trust, Liverpool, United Kingdom.
- Orthopaedic Research Unit (ORU), Division of Orthopaedic Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
| | - Luke Render
- Liverpool Orthopaedic and Trauma Service, Liverpool University Teaching Hospital Trust, Liverpool, United Kingdom
| | - Sithombo Maqungo
- Orthopaedic Research Unit (ORU), Division of Orthopaedic Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
- Division of Global Surgery, University of Cape Town, Cape Town, South Africa
| | - Nando Ferreira
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Stellenbosch University, Cape Town, South Africa
| | - Leonard Charles Marais
- Department of Orthopaedic Surgery, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Michael Held
- Orthopaedic Research Unit (ORU), Division of Orthopaedic Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Maritz Laubscher
- Orthopaedic Research Unit (ORU), Division of Orthopaedic Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
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35
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Cruz JP, Cantrell CK, Johnson DJ, Gerlach EB, Butler BA. Outcomes of Iliac Wing Fractures: A Systematic Review of the Literature. J Surg Orthop Adv 2023; 32:139-147. [PMID: 38252598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
To review the literature on iliac wing fractures to assess outcomes of operative and nonoperative treatment. A search of PubMed, MEDLINE, and Cochrane Database of Systematic Reviews was performed. Articles reporting on iliac wing fractures without pelvic ring destabilization or intraarticular extension were included. Study information and patient data were collected, and a Methodological Index for Non-randomized Studies (MINORS) score was assigned to each article. In total, 19,363 articles were identified with 32 qualifying for inclusion. The articles included 131 patients with 133 fractures. The mean age was 43.6, and mean follow-up time was 41.9 months. Forty-eight (36%) fractures were treated operatively, and 85 (64%) were treated nonoperatively. Associated injuries included bowel injuries, other pelvic fractures, gunshot wounds, and arterial injuries. There is an absence of comparative studies between operative and nonoperative management of iliac wing fractures. Indications for operative management appear to depend on comminution, open fractures, and associated injuries. (Journal of Surgical Orthopaedic Advances 32(3):139-147, 2023).
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Affiliation(s)
- Jacquelyn P Cruz
- Department of Orthopaedic Surgery, Northwestern Feinberg School of Medicine, Chicago, Illinois
| | - Colin K Cantrell
- Department of Orthopaedic Surgery, Northwestern Feinberg School of Medicine, Chicago, Illinois
| | - Daniel J Johnson
- Department of Orthopaedic Surgery, Northwestern Feinberg School of Medicine, Chicago, Illinois
| | - Erik B Gerlach
- Department of Orthopaedic Surgery, Northwestern Feinberg School of Medicine, Chicago, Illinois
| | - Bennet A Butler
- Department of Orthopaedic Surgery, Northwestern Feinberg School of Medicine, Chicago, Illinois
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36
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Testa EJ, Marcaccio SE, Kosinski LR, Jones MC, Katarincic JA. Salter-Harris Type III Fracture of the Distal Phalanx: A Rare Juxtaphyseal Variant. Hand (N Y) 2022; 17:NP6-NP10. [PMID: 35311365 PMCID: PMC9608289 DOI: 10.1177/15589447221082165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Juxtaphyseal fractures of the distal phalanges of upper extremity digits are most commonly of the Salter-Harris II variety and occur most commonly in the thumb. The diagnosis of this injury is essential as it may present as an open fracture with a nailbed injury ("Seymour fracture"). However, an intra-articular, epiphyseal fracture may also occur and mimic a mallet deformity or Seymour fracture. Prompt diagnosis is essential to rule out an open fracture and obtain anatomical alignment and stability to attempt to reduce complications such as physeal arrest. Here, we present a patient with a displaced Salter-Harris type III fracture of his thumb distal phalanx and review his management and early-term outcome. We present this case to bring attention to this rare and unique injury, review the available literature, and discuss management and outcomes.
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Affiliation(s)
- Edward J. Testa
- Department of Orthopaedic Surgery, Brown University Warren Alpert School of Medicine, Providence, RI, USA
| | - Stephen E. Marcaccio
- Department of Orthopaedic Surgery, Brown University Warren Alpert School of Medicine, Providence, RI, USA
| | - Lindsay R. Kosinski
- Department of Orthopaedic Surgery, Brown University Warren Alpert School of Medicine, Providence, RI, USA
| | - Matthew C. Jones
- Department of Orthopaedic Surgery, Brown University Warren Alpert School of Medicine, Providence, RI, USA
| | - Julia A. Katarincic
- Department of Orthopaedic Surgery, Brown University Warren Alpert School of Medicine, Providence, RI, USA
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37
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Krettek C. [Changes in fracture and soft tissue management]. Unfallchirurgie (Heidelb) 2022; 125:771-775. [PMID: 36074147 DOI: 10.1007/s00113-022-01241-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/01/2022] [Indexed: 02/07/2023]
Affiliation(s)
- C Krettek
- Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
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38
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Jorgensen NB, Freyling M, Welyczko Z, Davies BM, Van De Pol GJ, Tetsworth K. Validation of a proposed radiographic bone defect classification system. Injury 2022; 53:3282-3288. [PMID: 36008171 DOI: 10.1016/j.injury.2022.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 08/12/2022] [Accepted: 08/12/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To clinically validate a recently proposed classification scheme of post-traumatic bone defects. METHODS AND MATERIALS Open fractures were classified utilising a newly introduced classification system. This classification system is based on plain radiographs, assessing the extent and local geometry of bone loss, including: D1 - Incomplete Defects; D2 - Minor/Sub-Critical (Complete) Defects (<2 cm); and D3 - Segmental/Critical Sized Defects (≥2 cm). Reliability was assessed among six independent assessors (three trauma orthopaedic surgeons and three orthopaedic training surgeons) using Fleiss' kappa tests. 43 open fractures from a tertiary referral trauma centre and their radiographic series were analysed. RESULTS Interobserver reliability testing demonstrated the proposed classification system had substantial agreement between the 6 observers, κ = 0.623 (z = 33.8), p < 0.001. Intraobserver variability showed a range of substantial to almost perfect agreement of each observer following a three-week interval between repeat assessments, κ range 0.69-0.914, p < 0.001. CONCLUSIONS In this representative validation cohort there was substantial agreement between observers when assessing a diverse range of bone defects following long bone open trauma, with highly reproducible assessments by both orthopaedic surgeons and trainee orthopaedic surgeons alike on an internal level. The classification scheme is based on conventional orthogonal radiographs and requires no sophisticated technology, and is therefore pragmatic and applicable to secondary, tertiary and quaternary levels of care for trauma patients. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Nicholas B Jorgensen
- Orthopaedic Department, Princess Alexandra Hospital, 199 Ipswich Rd, Woolloongabba, QLD 4129, Australia; Orthopaedic Department, Royal Brisbane and Women's Hospital, Australia.
| | - Molly Freyling
- Orthopaedic Department, Royal Brisbane and Women's Hospital, Australia
| | - Zhenya Welyczko
- Orthopaedic Department, Royal Brisbane and Women's Hospital, Australia
| | - Benjamin M Davies
- Department of Surgery, University of Cambridge, Cambridge, United Kingdom; OrthoSport Victoria, Melbourne, Australia
| | | | - Kevin Tetsworth
- Orthopaedic Department, Royal Brisbane and Women's Hospital, Australia
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Veliceasa B, Pertea M, Popescu D, Carp CA, Pinzaru R, Huzum B, Alexa O, Strobescu-Ciobanu C, Filip A. Floating-dislocated elbow in adults: Case reports and literature review. Medicine (Baltimore) 2022; 101:e30891. [PMID: 36181018 PMCID: PMC9524860 DOI: 10.1097/md.0000000000030891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Floating-dislocated elbow is a severe and extremely rare injury in adults. Reviewing the literature, we found around 6 case reports regarding floating-dislocated elbow in adults. PATIENT CONCERNS AND DIAGNOSES We report 2 cases of this unusual injury association. Both patients suffered a high energy trauma - fall from a height. Initial X-rays (radiography) revealed in both cases the fractures above and below the elbow (floating elbow) and associated elbow dislocation (floating-dislocated elbow). One case was a type IIIB Gustilo-Anderson open fracture-dislocation with an intra-articular component (olecranon fracture). INTERVENTIONS AND OUTCOMES Each case had his own management problem regarding what to treat first: the dislocation or the associated fractures? Fractures were treated surgically by reduction and internal fixation, and after elbow dislocation reduction, the upper limb was immobilized in a long, well-padded plaster, with the elbow in 90° of flexion, for 3 weeks. Bone union was observed radiographically at 2 months after surgery in both cases. At the 2-year follow-up we recorded full upper limb recovery in terms of muscular trophism and elbow full range of motion. LESSONS In addition to adding 2 new cases to a lower number of such lesion associations in adults, we also added a new variant of floating-dislocated elbow which has not been reported until now in the literature. Prompt management of these injuries, with stable fixation of the fractures allowed for early rehabilitation with excellent 2-years functional outcome.
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Affiliation(s)
- Bogdan Veliceasa
- University of Medicine and Pharmacy “Grigore T. Popa” Iasi, Romania
- Department of Orthopaedics and Traumatology, “Sf. Spiridon” Emergency Hospital Iasi, Romania
| | - Mihaela Pertea
- University of Medicine and Pharmacy “Grigore T. Popa” Iasi, Romania
- Department of Plastic Surgery and Reconstructive Microsurgery, “Sf. Spiridon” Emergency Hospital Iasi, Romania
- * Correspondence: Mihaela Pertea, MD, PhD, University of Medicine and Pharmacy “Grigore T. Popa” Iasi, Romania and Department of Plastic Surgery and Reconstructive Microsurgery, “Sf. Spiridon” Emergency Hospital Iasi, Romania (e-mail: )
| | - Dragos Popescu
- University of Medicine and Pharmacy “Grigore T. Popa” Iasi, Romania
- Department of Orthopaedics and Traumatology, “Sf. Spiridon” Emergency Hospital Iasi, Romania
| | - Claudiu Adrian Carp
- University of Medicine and Pharmacy “Grigore T. Popa” Iasi, Romania
- Department of Orthopaedics and Traumatology, “Sf. Spiridon” Emergency Hospital Iasi, Romania
| | - Roxana Pinzaru
- University of Medicine and Pharmacy “Grigore T. Popa” Iasi, Romania
- Department of Orthopaedics and Traumatology, “Sf. Spiridon” Emergency Hospital Iasi, Romania
| | - Bogdan Huzum
- University of Medicine and Pharmacy “Grigore T. Popa” Iasi, Romania
- Department of Orthopaedics and Traumatology, “Sf. Spiridon” Emergency Hospital Iasi, Romania
| | - Ovidiu Alexa
- University of Medicine and Pharmacy “Grigore T. Popa” Iasi, Romania
- Department of Orthopaedics and Traumatology, “Sf. Spiridon” Emergency Hospital Iasi, Romania
| | - Cristina Strobescu-Ciobanu
- University of Medicine and Pharmacy “Grigore T. Popa” Iasi, Romania
- Department of Vascular Surgery, “Sf. Spiridon” Emergency Hospital Iasi, Romania
| | - Alexandru Filip
- University of Medicine and Pharmacy “Grigore T. Popa” Iasi, Romania
- Department of Orthopaedics and Traumatology, “Sf. Spiridon” Emergency Hospital Iasi, Romania
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Abstract
BACKGROUND Although various solutions have been recommended for cleansing wounds, normal saline is favoured as it is an isotonic solution and is not thought to interfere with the normal healing process. Tap water is commonly used in community settings for cleansing wounds because it is easily accessible, efficient and cost-effective; however, there is an unresolved debate about its use. OBJECTIVES To assess the effects of water for wound cleansing. SEARCH METHODS For this fifth update, in May 2021 we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta-analyses and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting. SELECTION CRITERIA We included all randomised controlled trials (RCTs) that assessed wound cleansing using different types of water (e.g. tap water, distilled, boiled) compared with no cleansing or with other solutions (e.g. normal saline). For this update, we excluded quasi-RCTs, thereby removing some studies which had been included in the previous version of the review. DATA COLLECTION AND ANALYSIS Two review authors independently carried out trial selection, data extraction and GRADE assessment of the certainty of evidence. MAIN RESULTS We included 13 trials in this update including a total of 2504 participants ranging in age from two to 95 years. Participants in the trials experienced open fractures, surgical wounds, traumatic wounds, anal fissures and chronic wounds. The trials were conducted in six different countries with the majority conducted in India and the USA. Three trials involving 148 participants compared cleansing with tap water with no cleansing. Eight trials involving 2204 participants assessed cleansing with tap water compared with cleansing with normal saline. Two trials involving 152 participants assessed cleansing with distilled water compared with cleansing with normal saline. One trial involving 51 participants also assessed cleansing with cooled boiled water compared with cleansing with normal saline, and cleansing with distilled water compared with cleansing with cooled boiled water. Wound infection: no trials reported on wound infection for the comparison cleansing with tap water versus no cleansing. For all wounds, eight trials found the effect of cleansing with tap water compared with normal saline is uncertain (risk ratio (RR) 0.84, 95% confidence interval (CI) 0.59 to 1.19); very low-certainty evidence. Two trials comparing the use of distilled water with normal saline for cleansing open fractures found that the effect on the number of fractures that were infected is uncertain (RR 0.70, 95% CI 0.45 to 1.09); very low-certainty evidence. One trial compared the use of cooled boiled water with normal saline for cleansing open fractures and found that the effect on the number of fractures infected is uncertain (RR 0.83, 95% CI 0.37 to 1.87); very low-certainty evidence. This trial also compared the use of distilled water with cooled boiled water and found that the effect on the number of fractures infected is uncertain (RR 0.59, 95% CI 0.24 to 1.47); very low-certainty evidence. Wound healing: results from three trials comparing the use of tap water with no wound cleansing demonstrated there may be little or no difference in the number of wounds that did not heal between the groups (RR 1.04, 95% CI 0.95 to 1.14); low-certainty evidence. The effect of tap water compared with normal saline is uncertain; two trials were pooled (RR 0.57, 95% CI 0.30 to 1.07) but the certainty of the evidence is very low. Results from one study comparing the use of distilled water with normal saline for cleansing open fractures found that there may be little or no difference in the number of fractures that healed (RR could not be estimated, all wounds healed); the certainty of the evidence is low. Reduction in wound size: the effect of cleansing with tap water compared with normal saline on wound size reduction is uncertain (RR 0.97, 95% CI 0.56 to 1.68); the certainty of the evidence is very low. Rate of wound healing: the effect of cleansing with tap water compared with normal saline on wound healing rate is uncertain (mean difference (MD) -3.06, 95% CI -6.70 to 0.58); the certainty of the evidence is very low. COSTS two trials reported cost analyses but the cost-effectiveness of tap water compared with the use of normal saline is uncertain; the certainty of the evidence is very low. Pain: results from one study comparing the use of tap water with no cleansing for acute and chronic wounds showed that there may be little or no difference in pain scores. The certainty of the evidence is low. Patient satisfaction: results from one study comparing the use of tap water with no cleansing for acute and chronic wounds showed that there may be little or no difference in patient satisfaction. The certainty of evidence is low. The effect of cleansing with tap water compared with normal saline is uncertain as the certainty of the evidence is very low. AUTHORS' CONCLUSIONS All the evidence identified in the review was low or very low certainty. Cleansing with tap water may make little or no difference to wound healing compared with no cleansing; there are no data relating to the impact on wound infection. The effects of cleansing with tap water, cooled boiled water or distilled water compared with cleansing with saline are uncertain, as is the effect of distilled water compared with cooled boiled water. Data for other outcomes are limited across all the comparisons considered and are either uncertain or suggest that there may be little or no difference in the outcome.
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Affiliation(s)
- Ritin Fernandez
- Centre for Research in Nursing and Health, St George Hospital, Kogarah, Australia
- School of Nursing, University of Wollongong, Wollongong, Australia
- Centre for Evidence Based Initiatives in Healthcare: a JBI Centre of Excellence, Wollongong, Australia
| | - Heidi L Green
- Centre for Research in Nursing and Health, St George Hospital, Kogarah, Australia
- Centre for Evidence Based Initiatives in Healthcare: a JBI Centre of Excellence, Wollongong, Australia
| | - Rhonda Griffiths
- School of Nursing and Midwifery, University of Western Sydney, Penrith South DC, Australia
| | - Ross A Atkinson
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Laura J Ellwood
- Centre for Research in Nursing and Health, St George Hospital, Kogarah, Australia
- Centre for Evidence Based Initiatives in Healthcare: a JBI Centre of Excellence, Wollongong, Australia
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Collopy K, Zimmerman L, Westmoreland AM, Powers WF. Prehospital Administration of Cefazolin in Trauma Patients. Air Med J 2022; 41:447-450. [PMID: 36153141 DOI: 10.1016/j.amj.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/31/2022] [Accepted: 06/07/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE A lack of research has become a barrier to the common use of prehospital antibiotics. The objective of this study is to further the limited research of prehospital antibiotics through evaluating the clinical impact, safety, and reliability of prehospital cefazolin administration in trauma patients. METHODS We completed a retrospective evaluation of adult trauma patients who were transported by a single air and ground critical care transport program between January 1, 2014, and June 30 2017. Two hundred eighty-two patients received prehospital cefazolin for deep wounds or open fractures before their arrival at a single level 2 trauma center during the study period. Patient demographics, mechanism of injury, injury type, infection rate, and identification of allergic reactions to cefazolin were also collected. RESULTS Of 278 patients in the final analysis, 35.3% (n = 98) were diagnosed with an open fracture and 58.6% (n = 163) had a deep tissue injury. Eighty-two percent of prehospital open fracture diagnoses were confirmed in the emergency department. The overall infection rate was 6%; 31.3% of patients received a second dose of cefazolin in the emergency department during the study period. No patients receiving prehospital cefazolin had allergic or anaphylactic reactions. The overadministration rate was 5% (n = 14). CONCLUSION Prehospital providers reliably identified open fractures, and prehospital cefazolin administration was not associated with anaphylactic reactions. This study population's infection rate of open fractures caused by traumatic injury was found to be 6%, and there was a low inappropriate administration rate.
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Affiliation(s)
- Kevin Collopy
- AirLink/VitaLink Critical Care Transport, Novant Health New Hanover Regional Medical Center, Wilmington, NC.
| | - Lisa Zimmerman
- Department of Pharmacy, Novant Health New Hanover Regional Medical Center, Wilmington, NC
| | | | - William F Powers
- AirLink/VitaLink Critical Care Transport, Novant Health New Hanover Regional Medical Center, Wilmington, NC; Department of Surgery, Novant Health New Hanover Regional Medical Center, Wilmington, NC
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Kilincoglu V, Gonder N, Demir IH, Acikgoz I, Karsli B. Fixation of open, unstable tuft fractures in toddlers and preschool-aged children using a 25-gauge hypodermic needle. J Pediatr Orthop B 2022; 31:486-492. [PMID: 34561384 DOI: 10.1097/bpb.0000000000000920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study aimed to assess the treatment process of open, unstable tuft fractures occurring in toddlers and preschool-aged children treated using a 25-gauge hypodermic needle in the emergency department, and the cosmetic and functional results achieved by this treatment. This retrospective cohort study included a total of 72 patients. Children aged two to six years were included in the study. Van Beek classification was used for the evaluation of nail bed injuries. Cosmetic results were evaluated on the basis of Zook classification whereas functional results were evaluated according to the Buck-Gramko score simplified by Nietosvaara et al . The patient population consisted of 52 men and 20 women. The mean age was 4 ± 1.33 years. The operating time was 19.17 ± 3.66 minutes and the time to union was 46.68 ± 4.84 days. While excellent and good functional results were obtained in 65 (90.2%) of the patients, excellent and very good cosmetic results were obtained in 51 (70.8%) patients. Unless there is an accompanying extremity fracture, unstable pediatric tuft fractures can be successfully fixed with a hypodermic needle in the emergency department. Gentle and precise repair of the nail bed may provide cosmetically and functionally satisfactory results.
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Affiliation(s)
- Volkan Kilincoglu
- Department of Orthopaedics and Traumatology, Gaziantep University School of Medicine
| | - Nevzat Gonder
- Department of Orthopaedics and Traumatology, T.C. Ministry of Health Islahiye State Hospital, Gaziantep, Turkey
| | - Ibrahim Halil Demir
- Department of Orthopaedics and Traumatology, Gaziantep University School of Medicine
| | - Irfan Acikgoz
- Department of Orthopaedics and Traumatology, Gaziantep University School of Medicine
| | - Burcin Karsli
- Department of Orthopaedics and Traumatology, Gaziantep University School of Medicine
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Landau AJ, Oladeji AK, Hosseinzadeh P. Assessment of Ethno-racial and Insurance-based Disparities in Pediatric Forearm and Tibial Fracture Care in the United States. J Am Acad Orthop Surg Glob Res Rev 2022; 6:e22.00126. [PMID: 35908228 PMCID: PMC10566840 DOI: 10.5435/jaaosglobal-d-22-00126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Despite growing attention to healthcare disparities and interventions to improve inequalities, additional identification of disparities is needed, particularly in the pediatric population. We used state and nationwide databases to identify factors associated with the surgical treatment of pediatric forearm and tibial fractures. METHODS The Healthcare Cost and Utilization Project State Inpatient, Emergency Department, and Ambulatory Surgery and Services Databases from four US states and the Nationwide Emergency Department Sample database were quarried using International Classification of Diseases codes to identify patients from 2006 to 2015. Multivariable regression models were used to determine factors associated with surgical treatment. RESULTS State databases identified 130,006 forearm (1575 open) and 51,979 tibial fractures (1339 open). Surgical treatment was done in 2.6% of closed and 37.5% of open forearm fractures and 7.9% of closed and 60.5% of open tibial fractures. A national estimated total of 3,312,807 closed and 46,569 open forearm fractures were included, 59,024 (1.8%) of which were treated surgically. A total of 719,374 closed and 26,144 open tibial fractures were identified; 52,506 (7.0%) were treated surgically. Multivariable regression revealed that race and/or insurance status were independent predictors for the lower likelihood of surgery in 3 of 4 groups: Black patients were 43% and 35% less likely to have surgery after closed and open forearm fractures, respectively, and patients with Medicaid were less often treated surgically for open tibial fractures in state (17%) and nationwide (20%) databases. CONCLUSIONS Disparities in pediatric forearm and tibial fracture care persist, especially for Black patients and those with Medicaid; identification of influencing factors and interventions to address them are important in improving equality and value of care.
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Affiliation(s)
- Andrew J. Landau
- From the Department of Orthopaedic Surgery; Washington University School of Medicine, St. Louis, MO
| | - Afolayan K. Oladeji
- From the Department of Orthopaedic Surgery; Washington University School of Medicine, St. Louis, MO
| | - Pooya Hosseinzadeh
- From the Department of Orthopaedic Surgery; Washington University School of Medicine, St. Louis, MO
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Ding T, Xia K, Chen QY. [Exploration of relationship between postoperative serum caveolin-1 contents and delayed healing of tibial fracture patients]. Zhongguo Gu Shang 2022; 35:527-531. [PMID: 35730221 DOI: 10.12200/j.issn.1003-0034.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To explore relationship between postoperative serum caveolin-1 contents after open reduction and internal fixation and delayed healing of tibial fracture patients. METHODS From April 2018 to June 2020, 134 tibial fracture patients underwent open reduction and internal fixation were included, and divided into delayed healing group and normal healing group according to fracture healing condition. Contents of serum caveolin-1 protein before operation, 1, 4, 8, 12 weeks after operation between two groups were compared. Influencing factors of delayed healing was analyzed by Logistic regression model, and predictive value of serum caveolin-1 protein on delayed healing was analyzed by receiver operating characteristic(ROC) curve. RESULTS Fracture healing was evaluated at 4 months after fracture, 93 patients healed well and 41 patients delayed heal. At 1, 4, 8 and 12 weeks, content of serum caveolin-1 protein in delayed healing group was lower than that of normal healing group(P<0.05). There were statistical difference in smoking, diabetes, open fracture and Gutlio Ⅲ fracture between delayed healing group and normal healing group(P<0.05). Smoking, diabetes, open fracture, Gustlio Ⅲ fracture, decrease of serum caveolin-1 protein at 4 and 8 weeks after operation were risk factor of delayed healing by Logistic analysis(P<0.05). By ROC curve analysis, content of serum caveolin-1 protein had predictive value for delayed fracture, the best cut-off values were 12.45 ng/ml and 12.52 ng/ml respectively, corresponding sensitivity were 45.34%, 43.90%, and specificity were 80.65% and 87.10% (P<0.05). CONCLUSION Decrease of serum caveolin-1 protein content at 4 and 8 weeks after open reduction and internal fixation for tibia fracture patients were related with delayed healing. Detection of serum caveolin-1 protein content at 4 and 8 weeks after operation has predictive value for delayed healing.
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Affiliation(s)
- Tao Ding
- Department of Orthopaedics, the 901st Hospital of Joint Logistics Support Force of PLA, Hefei 230031, Anhui, China
| | - Ke Xia
- Department of Orthopaedics, the 901st Hospital of Joint Logistics Support Force of PLA, Hefei 230031, Anhui, China
| | - Qian-Yong Chen
- Department of Orthopaedics, the 901st Hospital of Joint Logistics Support Force of PLA, Hefei 230031, Anhui, China
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Köksal A, Çamurcu Y, Dırvar F, Yapıcı F, Akgün H, Kaya O. An evaluation of the characteristics of orthopedic pediatric traumas during the COVID-19 pandemic lockdown period. ULUS TRAVMA ACIL CER 2022; 28:94-98. [PMID: 34967433 PMCID: PMC10443156 DOI: 10.14744/tjtes.2020.67681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/05/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND The purpose of this study is to investigate the effects of implemented social isolation measures on the characteristics of orthopedic pediatric traumas during this COVID-19 pandemic lockdown period. METHODS Patients who were admitted at our center between two time periods: April 3, 2019-May 31, 2019 (no lockdown period) and April 3, 2020-May 31, 2020 (lockdown period) were included to the study. Group 1 comprised 743 patients who were treated during no lockdown period, whereas Group 2 comprised 615 patients who were treated during lockdown period. Patients' medical records and radiographs were reviewed through our hospital's computer database. In addition, we recorded each patients' age and gender, their definite diagnosis, the anatomic location of the trauma, the type of trauma (fracture, dislocation, tendon injury, ligament injury, fracture dislocation, open fracture, etc.), the type of pediatric fracture (displaced fracture, torus fracture, epiphyseal fracture, pathological fracture, etc.), and the treatment method (non-operative/operative). RESULTS The mean age of the patients was significantly lower in Group 2 (p<0.001). There were significant differences between the groups in terms of anatomic locations of the traumas (p<0.001). The types of the traumas, pediatric traumas, and treatment were significantly different between the groups (p<0.001, p<0.001, and p<0.001, respectively). The frequency of operative treatment was significantly higher in Group 2 (p<0.001). CONCLUSION Our results demonstrated significant differences in patients' demographics as well as trauma characteristics during COVID-19 pandemic.
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Affiliation(s)
- Alper Köksal
- Department of Orthopaedics and Traumatology, University of Health Sciences, Baltalimanı Bone Diseases Training and Research Hospital, İstanbul-Turkey
| | - Yalkin Çamurcu
- Department of Orthopaedics and Traumatology, İstanbul Atlas University Faculty of Medicine, İstanbul-Turkey
| | - Ferdi Dırvar
- Department of Orthopaedics and Traumatology, University of Health Sciences, Baltalimanı Bone Diseases Training and Research Hospital, İstanbul-Turkey
| | - Furkan Yapıcı
- Department of Orthopaedics and Traumatology, Erzincan Binali Yıldırım University Faculty of Medicine, Erzincan-Turkey
| | - Hakan Akgün
- Department of Orthopaedics and Traumatology, University of Health Sciences, Baltalimanı Bone Diseases Training and Research Hospital, İstanbul-Turkey
| | - Ozan Kaya
- Department of Orthopaedics and Traumatology, University of Health Sciences, Baltalimanı Bone Diseases Training and Research Hospital, İstanbul-Turkey
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Lai CY, Lai PJ, Tseng IC, Su CY, Hsu YH, Chou YC, Yu YH. Postoperative Reduction Quality May Be the Most Important Factor That Causes Worse Functional Outcomes in Open and Closed Pelvic Fractures. World J Surg 2022; 46:568-576. [PMID: 34973073 PMCID: PMC8803804 DOI: 10.1007/s00268-021-06386-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2021] [Indexed: 11/26/2022]
Abstract
Background Data on the functional outcomes of patients with open pelvic fractures after osteosynthesis are limited, and whether open fracture is a risk factor for worse outcomes, as compared with closed fracture, remains unclear. This study aimed to compare the functional outcomes of patients with open and closed pelvic fractures and evaluate potential factors that might affect outcomes. Methods Overall, 19 consecutive patients with open pelvic fractures and 78 patients with closed pelvic fractures between January 2014 and June 2018 were retrospectively reviewed. All fractures were surgically treated, with a minimal follow-up period of three years. Patients’ demographic profile, associated injuries, management protocol, quality of reduction, and outcomes were recorded and analyzed. Results Patients with open pelvic fractures had higher new injury severity score, higher incidence of diverting colostomy, and longer length of stay. Both radiological and functional evaluations revealed no significant differences between the two groups at 1-year and 3-year evaluations. Multiple logistic regression analysis identified poor radiological outcomes (using Lefaivre criteria) and longer length of stay as risk factors for worse short-term functional outcomes. At 3-year evaluation, fair-to-poor radiological outcomes (using Matta/Tornetta and Lefaivre criteria) and the presence of diverting colostomy were potential risk factors. Conclusions Compared with closed pelvic fracture, open pelvic fracture was not an indicator of worse functional outcomes. Functional outcomes may be comparable between patients with open and closed pelvic fractures at different time points within three years postoperatively. Achieving anatomical reduction in a fracture is crucial, because it might affect patient satisfaction.
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Affiliation(s)
- Chih-Yang Lai
- Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital, Linkou Branch, and Chang Gung University, Tao-Yuan, Taiwan. 5, Fu-Hsin St. Kweishan, 33302, Tao-Yuan, Taiwan
| | - Po-Ju Lai
- Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital, Linkou Branch, and Chang Gung University, Tao-Yuan, Taiwan. 5, Fu-Hsin St. Kweishan, 33302, Tao-Yuan, Taiwan
| | - I-Chuan Tseng
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan Branch, Tao-Yuan City, Taiwan
| | - Chun-Yi Su
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Keelung Branch, Kee-Lung City, Taiwan
| | - Yung-Heng Hsu
- Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital, Linkou Branch, and Chang Gung University, Tao-Yuan, Taiwan. 5, Fu-Hsin St. Kweishan, 33302, Tao-Yuan, Taiwan
| | - Ying-Chao Chou
- Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital, Linkou Branch, and Chang Gung University, Tao-Yuan, Taiwan. 5, Fu-Hsin St. Kweishan, 33302, Tao-Yuan, Taiwan
| | - Yi-Hsun Yu
- Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital, Linkou Branch, and Chang Gung University, Tao-Yuan, Taiwan. 5, Fu-Hsin St. Kweishan, 33302, Tao-Yuan, Taiwan.
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Eirini G, Valeria K, Stylianos K, Maria A, Ioannis K, Pavlos P. Motor vehicle - pedestrian occupational accident: A case report study. Soud Lek 2022; 67:3-6. [PMID: 35387464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
A rare case of serious non-fatal pedestrian-motor vehicle accident in the constructions sector is described, leading to severe orthopedic trauma and disability. A 49-year-old male worker was admitted to the orthopedic department due to reported occupational injury. The accident occurred at the workplace during the construction of a cycling road, where the victim as pedestrian was referred to be crashed by a motor vehicle at his left lower extremity. He consequently fell on the ground and the vehicle drifted his whole limb with its caterpillar. The patient bore occupational trauma with extensive avulsion and degloving injury of the left lower extremity, extensive hematoma formation of the extreme foot, subtalar and tarsometatarsal dislocation, open fracture of the ankle joint, intraarticular calcaneal fracture, potential vascular injury (segmentation) of the posterior tibial artery, while peroneal and dorsalis pedis arteries were identified intact in Doppler examination of the lower limb. Construction industry is one of the most hazardous industries, concerning the occupational fatality rates. Occupational injury is the leading cause of morbidity in the employed population and adversely affects productivity. Forensic evaluation focuses on the mechanism and biomechanics of the injury and enlightens the potential contribution of external factors. The forensic approach adds to the understanding of a single occupational incident and, thus, the establishment of more effective preventive strategies and the improvement of safety regulations at workplace.
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Wichlas F, Hofmann V, Moursy M, Strada G, Deininger C. No implant, no solution, lost cases to surgery: orthopedic trauma triage for surgery in an NGO hospital in Sierra Leone. Arch Orthop Trauma Surg 2022; 142:805-811. [PMID: 33459821 PMCID: PMC7811951 DOI: 10.1007/s00402-020-03747-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 12/19/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION In low-income countries (LIC), international surgeons face the fact that there are patients they cannot treat. The goal of this study was to identify and analyze patients lost to treatment. MATERIAL AND METHODS We analyzed retrospectively the data of 282 trauma victims from a non-governmental organizational (NGO) hospital in Sierra Leone, Africa. During a 3-month period (10.10.2015-08.01.2016), these patients had 367 injuries and underwent 263 orthopedic surgeries. Despite a clear indication, some patients did not receive surgical treatment. We identified these injuries and the reason why they could not be operated. The anatomic region of the injury was evaluated and if they had a bone or soft tissue defect or were infected. RESULTS We identified 95 (25.89%) injuries in 70 patients (47 males; 23 females) that were not be operated. The reasons were lack of specific implants (no implant group; N = 33), no treatment strategy for the injury (no solution group; N = 29), and patients that were lost (lost patient group; N = 33), almost equally distributed by 1/3. In the no implant group were mainly closed fractures and fractures of the pelvis and the proximal femur. The implants needed were locking plates (N = 19), proximal femoral nails (N = 8), and implants for pelvic surgery (N = 6). In the no solution group were nearly all bone (P < 0.0000), soft tissue defects (P < 0.00001) and infections (P = 0.00003) compared to the rest and more open fractures (P < 0.00001). In the lost patients group, most fractures were closed (24 out of 33, P = 0.033). These fractures were mostly not urgent and were postponed repeatedly. CONCLUSION One quarter of the patients did not receive the surgical treatment needed. Besides acquisition of implants, surgical skills and expertise could be a solution for this issue. Nevertheless, these skills must be passed to local surgeons.
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Affiliation(s)
- F Wichlas
- Department of Orthopedics and Traumatology, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020, Salzburg, Austria.
- No Limit Surgery, Ernest-Thun-Strasse 6, 5020, Salzburg, Austria.
| | - V Hofmann
- Department of Orthopedics and Traumatology, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020, Salzburg, Austria
- No Limit Surgery, Ernest-Thun-Strasse 6, 5020, Salzburg, Austria
| | - M Moursy
- Department of Orthopedics and Traumatology, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020, Salzburg, Austria
| | | | - C Deininger
- Department of Orthopedics and Traumatology, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020, Salzburg, Austria
- No Limit Surgery, Ernest-Thun-Strasse 6, 5020, Salzburg, Austria
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Zelle BA. CORR Insights®: Ninety-Day Follow-up Is Inadequate for Diagnosis of Fracture-related Infections in Patients with Open Fractures. Clin Orthop Relat Res 2022; 480:147-149. [PMID: 34463659 PMCID: PMC8673983 DOI: 10.1097/corr.0000000000001964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 08/11/2021] [Indexed: 01/31/2023]
Affiliation(s)
- Boris A Zelle
- Professor, Vice Chair of Research, Department of Orthopaedics, UT Health San Antonio, San Antonio, TX, USA
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50
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Deng JT, Gao JH, Qu HS, Cheng H, Sun SK, Yang XT. [Treatment of open fracture of lower limb in high altitude area]. Zhongguo Gu Shang 2021; 34:1132-1135. [PMID: 34965630 DOI: 10.12200/j.issn.1003-0034.2021.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To explore the treatment methods and experience of open fracture of lower limb in high altitude area. METHODS From January 2016 to January 2021, 62 patients with open fractures of lower limbs were treated by staged surgery with the concept of injury control orthopedics, emphasizing wound treatment and combining various fracture fixation methods. There were 51 males and 11 females, ranging in age from 14 to 59 years old, with a mean of (37.2±12.3) years old; and the course of disease ranged from 7 to 59 days, with a mean of (23.7±15.5) days. According to Gustilo Anderson classification, there were 14 cases of typeⅠ, 24 cases of typeⅡ, 14 cases of typeⅢA, 8 cases of typeⅢB and 2 cases of typeⅢC. The fracture repair and wound healing were observed, and the clinical efficacy was evaluated by Johner-Wruhs evaluation standard. RESULTS Fifty-five patients were followed up, and the duration ranged from 4 to 36 months, with a mean of (14.7±8.5) months, and 7 cases were lost to follow-up. According to Johner-Wruhs evaluation criteria, 33 cases got an excellent result, 16 good, 4 poor and 2 bad. The wound healing was poor in 2 cases, partial necrosis of Achilles tendon in 1 case, nonunion of fracture in 1 case and delayed healing of fracture in 2 cases. CONCLUSION It is an effective method to treat the open fracture of lower extremity in high altitude area to pay attention to the management of soft tissue injury, the management of wound moisturizing, staged operation of fracture and full protection of blood supply at the fracture end. Paying attention to the treatment of soft tissue injury and the management of wound moisturizing, staged operation of fracture and full protection of blood supply at the fracture end are effective methods for the treatment of open fracture of lower limbs in high altitude areas.
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Affiliation(s)
- Jiang-Tao Deng
- Department of Trauma Orthopaedics, Army 952 Hospital, Golmud 816099, Qinghai, China
| | - Jian-Hua Gao
- Department of Trauma Orthopaedics, Army 952 Hospital, Golmud 816099, Qinghai, China
| | - Heng-Shun Qu
- Department of Trauma Orthopaedics, Army 952 Hospital, Golmud 816099, Qinghai, China
| | - Huan Cheng
- Department of Trauma Orthopaedics, Army 952 Hospital, Golmud 816099, Qinghai, China
| | - Shi-Kui Sun
- Department of Trauma Orthopaedics, Army 952 Hospital, Golmud 816099, Qinghai, China
| | - Xue-Tao Yang
- Department of Trauma Orthopaedics, Army 952 Hospital, Golmud 816099, Qinghai, China
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