Current Issue : April - June Volume : 2013 Issue Number : 2 Articles : 6 Articles
Background: Tibial nailing is a standard treatment of tibial fracture. Placing the nail in the wrong position will\r\nresult in poor fracture alignment and potentially damage to cortical bone. But the exactly entry point of this technique\r\nin Thai people has never been studied. In Chiang Mai University hospital, a tibial SIGN nail is commonly used in\r\ntibial shaft fracture.\r\nObjective: To identify the accurate entry point for tibial nailing with tibial SIGN nail, defined as the point which\r\nwill provide adequate fracture alignment.\r\nDesign: Cadaveric study\r\nMethods: Twelve cadavers with attached knee joints underwent tibial nailing with tibial SIGN nails. After\r\nplacement of the nail, the specimens underwent osteotomies at the level of 10 centimeters distal to the articular\r\nsurface. Multiple entry points were tested to determine fracture alignment. Medialââ?¬â??lateral and anteriorââ?¬â??posterior\r\ndisplacements from plain radiography were recorded for these various points of entry.\r\nResults: In coronal plane, the entry point at the sixty percent from medial edge of tibial plateau was identified as\r\nminimizing the medial-lateral displacement of the tibial shaft following fracture. In sagittal plane, the entry point of 20\r\nmm posterior to the tibial tubercle resulted in the least anterior-posterior displacement.\r\nConclusion: When tibial nailing with tibial SIGN nail was used, the entry point of 20 mm posterior to the tibial\r\ntubercle and sixty percent of the total distance from medial tibial plateau provided the accurate balance of fracture\r\nreduction....
Background: The aim of this survey study was to evaluate the current opinion and practice of trauma and\r\northopaedic surgeons in the Netherlands in the removal of implants after fracture healing.\r\nMethods: A web-based questionnaire consisting of 44 items was sent to all active members of the Dutch Trauma\r\nSociety and Dutch Orthopaedic Trauma Society to determine their habits and opinions about implant removal.\r\nResults: Though implant removal is not routinely done in the Netherlands, 89% of the Dutch surgeons agreed that\r\nimplant removal is a good option in case of pain or functional deficits. Also infection of the implant or bone is one\r\nof the main reasons for removing the implant (> 90%), while making money was a motivation for only 1% of the\r\nrespondents. In case of younger patients (< 40 years of age) only 34% of the surgeons agreed that metal implants\r\nshould always be removed in this category. Orthopaedic surgeons are more conservative and differ in their opinion\r\nabout this subject compared to general trauma surgeons (p = 0.002). Though the far majority removes elastic nails\r\nin children (95%).\r\nMost of the participants (56%) did not agree that leaving implants in is associated with an increased risk of\r\nfractures, infections, allergy or malignancy. Yet in case of the risk of fractures, residents all agreed to this statement\r\n(100%) whereas staff specialists disagreed for 71% (p < 0.001). According to 62% of the surgeons titanium plates are\r\nmore difficult to remove than stainless steel, but 47% did not consider them safer to leave in situ compared\r\nto stainless steel. The most mentioned postoperative complications were wound infection (37%), unpleasant\r\nscarring (24%) and postoperative hemorraghe (19%).\r\nConclusion: This survey indicates that there is no general opinion about implant removal after fracture healing\r\nwith a lack of policy guidelines in the Netherlands. In case of symptomatic patients a majority of the surgeons\r\nremoves the implant, but this is not standard practice for every surgeon...
Background: Purpose of the presented study is to answer the following questions: Are knee injuries associated\r\nwith trauma mechanisms or concomitant injuries? Do injuries of the knee region aggravate treatment costs or\r\nprolong hospital stay in polytraumatized patients?\r\nMethods: A retrospective analysis including 29.779 severely injured patients (Injury Severity Score [greater than or\r\nequal to] 16) from the Trauma Registry of the German Society for Trauma Surgery database (1993-2008) was\r\nconducted. Patients were subdivided into two groups; the \"Knee\" group (n=3.458, 11.6% of all patients) including all\r\nmultiple trauma patients with knee injuries, and the \"Non Knee\" group (n=26.321) including the remaining patients.\r\nPatients with knee injuries were slightly younger, less often male gender and had a significantly increased ISS.\r\nResults: Patients in the Knee group suffered significantly more traffic accidents compared to the Non Knee group\r\n(82% vs. 52%, p<0.001). These injuries were more often caused by car or motorbike accidents. Severe thoracic and\r\nlimb injuries (AIS[greater than or equal to]3) were more frequently found in the Knee group (p<0.001) while head\r\ninjury was distributed equally. The overall hospital stay, ICU stay, and treatment costs were significantly higher for\r\nthe Knee group (38.1 vs. 25.5 days, 15.2 vs. 11.4 days, 40,116 vs. 25,336 Euro, respectively; all p<0.001).\r\nConclusions: Traffic accidents are associated with an increased incidence of knee injuries than falls or attempted\r\nsuicides. Furthermore, severe injuries of the limbs and chest are more common in polytraumatized patients with\r\nknee injuries. At last, treatment of these patients is prolonged and consequently more expensive....
Introduction: The choice of optimal treatment in traumatic brain injured (TBI) patients is a challenge. The aim of\r\nthis study was to verify the neurological outcome of severe TBI patients treated with decompressive craniectomy\r\n(early < 24 h, late > 24 h), compared to conservative treatment, in hospital and after 6-months.\r\nMethods: A total of 186 TBI patients admitted to the ICU of the Emergency Department of a tertiary referral center\r\n(Careggi Teaching Hospital, Florence, Italy) from 2005 through 2009 were retrospectively studied. Patients treated\r\nwith decompressive craniectomy were divided into 2 groups: ââ?¬Å?early craniectomy groupââ?¬Â (patients who underwent\r\nto craniectomy within the first 24 hours); and ââ?¬Å?late craniectomy groupââ?¬Â (patients who underwent to craniectomy\r\nlater than the first 24 hours). As a control group, patients whose intracranial hypertension was successfully\r\ncontrolled by medical treatment were included in the ââ?¬Å?no craniectomy groupââ?¬Â.\r\nResults: Groups included 41 patients who required early decompressive craniectomy, 21 patients treated with late\r\ncraniectomy (7.7 days after trauma, on average), and 124 patients for whom intracranial hypertension was\r\nsuccessfully controlled through conservative treatment. Groups were comparable in age and trauma/critical illness\r\nscores, except for a significantly higher Marshall score in early craniectomized patients. The Glasgow Outcome Scale\r\nwas comparable between groups at ICU, at the time of hospital discharge and at 6 months.\r\nConclusions: In our sample, a late craniectomy in patients with refractory intracranial hypertension produced a\r\ncomparable 6-months neurological outcome if compared to patients responder to standard treatment. This data\r\nmust be reproduced and confirmed before considering as goal-treatment in refractory intracranial hypertension...
Background: The Comminuted subtrochanteric femoral fractures are considered as one of the most difficult\r\nfractures to treat in the orthopaedic literatures. The aim of this prospective study was to evaluate the indirect\r\nreduction and biological fixation technique with Dynamic condylar screw and plate fixation for the treatment of\r\ncomminuted subtrochanteric femoral fractures.\r\nMethod: Thirty one cases suffered from comminuted subtrochanteric fractures femur, AO classification (type\r\nC), were treated by biological fixation, indirect reduction method with Dynamic condylar screw and plate fixation.\r\nResults: The cases were followed up by clinical and radiological examination from 12 to 32 months (mean 22\r\nmonths). In all cases union in acceptable alignment were achieved from 15 to 24 weeks (range from 3 to 6 months)\r\n(mean 4.5 months) in all cases except, three cases (9.7%) with failures of the fixations due to osteoporosis and early\r\nfull weight bearing one week after surgery. With exception of 3 cases with fixation failures who excluded from the\r\nanalysis of the functional results, all the cases had good functional outcome as regarding to Harris hip score which\r\nvarying from 70 to 95 (mean 85).\r\nConclusion: Indirect reduction and biological fixation with Dynamic condylar screw and plate fixation is\r\nconsidered as a valuable cheap fixation method for the management of comminuted subtrochanteric fractures femur\r\nespecially in young patients� populations...
Study background: Thoracolumbar fractures are among the most common type of traumatic spine fractures.\r\nThe use of minimally invasive, percutaneous pedicle screw fixation for these fractures has been limited to case\r\nreports and small case series. The efficacy of this approach remains unclear.\r\nMethods: The evaluation and management of a patient with traumatic T12 burst fracture is presented. In\r\naddition, a literature review of the Medline and PubMed databases was conducted.\r\nResults: A total of 166 patients from 8 studies were identified. Average age was 46 years. Polytrauma was\r\nreported in 27% of patients. Average surgery time was 91 minutes, with an average blood loss of 95 milliliters.\r\nReported complications were non-healing fracture in 3(2%), infection in 1(0.6%), mal-positioned screw in 1(0.6%),\r\nand hematoma in 1(0.6%) at a median follow-up time of 26 months. Pain improved by an average of 6 points after\r\nsurgery according to visual analog score, and mean kyphosis correction in these studies was 8.5�°.\r\nConclusions: This review demonstrates that minimally invasive, percutaneous pedicle screw fixation is a viable\r\noption for the management of traumatic thoracolumbar fractures in neurologically intact patients. Patients who are\r\nolder and/or present with polytrauma may most benefit from this type of intervention....
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