RESUMO
OBJECTIVES: To examine the effect of local aqueous tobramycin injection adjunct to perioperative intravenous (IV) antibiotic prophylaxis in reducing fracture-related infections (FRIs) following reduction and internal fixation of open fractures. DESIGN: Retrospective cohort study. SETTING: Single academic Level I trauma center. PATIENTS SELECTION CRITERIA: Patients with open extremity fractures treated with reduction and internal fixation with (intervention group) or without (control group) 80 mg of local aqueous (2 mg/mL) tobramycin injected during closure at the time of definitive fixation were identified from December 2018 to August 2021 based on population-matched demographic and injury characteristics. OUTCOME MEASURES AND COMPARISONS: The primary outcome was FRI within 6 months of definitive fixation. Secondary outcomes consisted of fracture nonunion and bacterial speciation. Differences in outcomes between the 2 groups were assessed and logistic regression models were created to assess the difference in infection rates between groups, with and without controlling for potential confounding variables, such as sex, fracture location, and Gustilo-Anderson classification. RESULTS: An analysis of 157 patients was performed with 78 patients in the intervention group and 79 patients in the control group. In the intervention group, 30 (38.5%) patients were women with a mean age of 47.1 years. In the control group, 42 (53.2%) patients were women with a mean age of 46.4 years. The FRI rate was 11.5% in the intervention group compared with 25.3% in the control group ( P = 0.026). After controlling for sex, Gustilo-Anderson classification, and fracture location, the difference in FRI rates between groups remained significantly different ( P = 0.014). CONCLUSIONS: Local aqueous tobramycin injection at the time of definitive internal fixation of open extremity fractures was associated with a significant reduction in FRI rates when administered as an adjunct to intravenous antibiotics, even after controlling for potential confounding variables. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Assuntos
Antibacterianos , Antibioticoprofilaxia , Fixação Interna de Fraturas , Fraturas Expostas , Infecção da Ferida Cirúrgica , Tobramicina , Humanos , Feminino , Masculino , Tobramicina/administração & dosagem , Fraturas Expostas/cirurgia , Fraturas Expostas/complicações , Pessoa de Meia-Idade , Estudos Retrospectivos , Antibacterianos/administração & dosagem , Infecção da Ferida Cirúrgica/prevenção & controle , Antibioticoprofilaxia/métodos , AdultoRESUMO
OBJECTIVES: To compare radiographic and clinical outcomes in nonoperative management of humeral shaft fractures treated initially with coaptation splinting (CS) followed by delayed functional bracing (FB) versus treatment with immediate FB. DESIGN: Retrospective cohort study. SETTING: Academic Level 1 Trauma Center. PATIENT SELECTION CRITERIA: Patients with closed humeral shaft fractures managed nonoperatively with initial CS followed by delayed FB or with immediate FB from 2016 to 2022. Patients younger than 18 years and/or with less than 3 months of follow-up were excluded. OUTCOME MEASURES AND COMPARISONS: The primary outcome was coronal and sagittal radiographic alignment assessed at the final follow-up. Secondary outcomes included rate of failure of nonoperative management (defined as surgical conversion and/or fracture nonunion), fracture union, and skin complications secondary to splint/brace wear. RESULTS: Ninety-seven patients were managed nonoperatively with delayed FB (n = 58) or immediate FB (n = 39). Overall, the mean age was 49.9 years (range 18-94 years), and 64 (66%) patients were female. The immediate FB group had less smokers ( P = 0.003) and lower incidence of radial nerve palsy ( P = 0.025), with more proximal third humeral shaft fractures ( P = 0.001). There were no other significant differences in demographic or clinical characteristics ( P > 0.05). There were no significant differences in coronal ( P = 0.144) or sagittal ( P = 0.763) radiographic alignment between the groups. In total, 33 (34.0%) humeral shaft fractures failed nonoperative management, with 11 (28.2%) in the immediate FB group and 22 (37.9%) in the delayed FB group ( P = 0.322). There were no significant differences in fracture union ( P = 0.074) or skin complications ( P = 0.259) between the groups. CONCLUSIONS: This study demonstrated that nonoperative treatment of humeral shaft fractures with immediate functional bracing did not result in significantly different radiographic or clinical outcomes compared to treatment with CS followed by delayed functional bracing. Future prospective studies assessing patient-reported outcomes will further guide clinical decision making. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Assuntos
Braquetes , Fraturas do Úmero , Contenções , Humanos , Feminino , Estudos Retrospectivos , Masculino , Pessoa de Meia-Idade , Adulto , Idoso , Fraturas do Úmero/terapia , Adolescente , Idoso de 80 Anos ou mais , Adulto Jovem , Resultado do TratamentoRESUMO
OBJECTIVES: To review and evaluate the validity of common perceptions and practices regarding radiation safety in orthopaedic trauma. DESIGN: Retrospective study. SETTING: Level 1 trauma center. SUBJECTS: N/A. INTERVENTION: The intervention involved personal protective equipment. MAIN OUTCOME MEASUREMENTS: The main outcome measurements included radiation dose estimates. RESULTS: Surgeon radiation exposure estimates performed at the level of the thyroid, chest, and pelvis demonstrate an estimated total annual exposure of 1521 mR, 2452 mR, and 1129 mR, respectively. In all cases, wearing lead provides a significant reduction (90% or better) in the amount of radiation exposure (in both radiation risk and levels of radiation reaching the body) received by the surgeon. Surgeons are inadequately protected from radiation exposure with noncircumferential lead. The commonly accepted notion that there is negligible exposure when standing greater than 6 feet from the radiation source is misleading, particularly when cumulative exposure is considered. Finally, we demonstrated that trauma surgeons specializing in pelvis and acetabular fracture care are at an increased risk of exposure to potentially dangerous levels of radiation, given the amount of radiation required for their caseload. CONCLUSION: Common myths and misperceptions regarding radiation in orthopaedic trauma are unfounded. Proper use of circumferential personal protective equipment is critical in preventing excess radiation exposure.
Assuntos
Exposição Ocupacional , Cirurgiões Ortopédicos , Ortopedia , Exposição à Radiação , Cirurgiões , Humanos , Exposição Ocupacional/prevenção & controle , Doses de Radiação , Exposição à Radiação/prevenção & controle , Estudos RetrospectivosRESUMO
OBJECTIVE: To determine whether pre-existing psychiatric disorder is associated with potentially unnecessary fasciotomy. DESIGN: Retrospective cohort study. SETTING: Academic Level-1 trauma center. PATIENTS: All the patients with orthopaedic trauma undergoing leg fasciotomy at an academic Level I trauma center from 2006 to 2020. INTERVENTION: Pre-existing diagnosis of psychiatric disorder. MAIN OUTCOME MEASUREMENTS: Early primary wound closure and delayed primary wound closure. RESULTS: In total, 116 patients were included. Twenty-seven patients (23%) had a pre-existing diagnosis of psychiatric disorder with 13 having anxiety, 14 depression, 5 bipolar disorder, and 2 ADHD. Several patients had multiple diagnoses. Fifty-one patients (44%) had early primary closure (EPC), and 65 patients (56%) had delayed primary closure. Of patients with a psychiatric disorder, 52% received EPC compared with 42% of patients without a disorder, P = 0.38. This lack of a strong association did not seem to vary across specific psychiatric conditions. After adjusting for sex, age, injury type, and substance abuse, there was still no significant association between a psychiatric disorder and EPC with an odds ratio of 1.08 (95% CI, 0.43-2.75). CONCLUSIONS: Among patients with orthopaedic trauma undergoing emergent fasciotomy for acute compartment syndrome, a psychiatric disorder was not associated with a significantly increased rate of possibly unnecessary fasciotomy. Given the potential for a psychiatric condition to complicate the diagnosis of acute compartment syndrome, this data is somewhat reassuring; however, there remains a need for continued vigilance in treating patients with psychiatric conditions and research in this area. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Assuntos
Síndromes Compartimentais , Transtornos Mentais , Síndromes Compartimentais/diagnóstico , Síndromes Compartimentais/cirurgia , Fasciotomia/efeitos adversos , Humanos , Transtornos Mentais/complicações , Estudos Retrospectivos , Resultado do TratamentoRESUMO
SUMMARY: As the population is increasing in age, so increases the number of osteoporotic fractures. U-shaped sacral fractures can be difficult to diagnose and may be a source of disability in patients when left untreated. Many patients with osteoporotic fractures are of advanced age and may experience rapid medical decline when these fractures cause immobility. We present surgical options for U-shaped sacral fracture management.
Assuntos
Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Parafusos Ósseos , Fixação Interna de Fraturas , Humanos , Fraturas por Osteoporose/diagnóstico por imagem , Fraturas por Osteoporose/cirurgia , Sacro/diagnóstico por imagem , Sacro/lesões , Sacro/cirurgia , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/cirurgiaRESUMO
OBJECTIVE: To assess the effectiveness of reducing contamination using 2 methods of C-Arm draping compared with traditional methods. MATERIALS AND METHODS: The authors simulated an operating room using an extremity drape, commercially available C-Arm drapes, and C-Arm. A black light was placed above the field. A fluorescent powder was placed on the nonsterile portions of the field. Baseline light intensity was recorded by photo. The C-Arm was brought into the surgical field for orthogonal imaging for 15 cycles. A repeat photograph was taken to measure the increase in intensity of the fluorescent powder to assess degree of contamination. This was repeated 5 times for each configuration: standard C-Arm drape, a proprietary close-fitting drape, and a split drape secured to the far side with the split wrapped around the C-Arm receiver. Light intensity difference was measured and average change in intensity was compared. RESULTS: Compared with standard draping, the proprietary close-fitting drape resulted in a 71.3% decrease in contamination (4.84% vs. 16.90%, P = 0.101) that trended toward significance and the split drape resulted in a 99.5% decrease (0.09% vs. 16.90%, P = 0.017) that was statistically significant. CONCLUSION: Far side contamination can be reduced by using a split drape connecting the operative table to the C-Arm receiver, effectively "sealing off" contaminants. The proprietary close-fitting drape may also decrease contamination, but this was not statistically significant in this study. Use of the split drape technique will help prevent contamination and may ultimately lead to decreased infection risk.
Assuntos
Campos Cirúrgicos , Humanos , Salas Cirúrgicas , Infecção da Ferida CirúrgicaRESUMO
OBJECTIVE: Examine factors associated with fixation failure in patients treated with superior intramedullary ramus screws. DESIGN: Retrospective. SETTING: Single, Level 1 trauma center. PATIENTS: Unstable pelvic ring fractures amenable fixation that included superior intramedullary ramus screws. INTERVENTION: Percutaneously inserted intramedullary superior ramus screw fixation of superior pubic ramus (SPR) fractures. MAIN OUTCOME MEASUREMENTS: Loss of reduction (LOR) of the SPR fracture defined as >2 mm displacement on pelvic radiographs at any time point in follow-up. RESULTS: Two hundred eighty-five fractures in 211 patients (age 44, 95% confidence interval 40.8%-46.4%, 59.3% women, 55.1% retrograde screws) were included in the analysis. 14 (4.9%) of fractures had LOR. Patients were significantly more likely to have LOR as age increased (P = 0.01), body mass index (BMI) increased (P = 0.01), and if they were women (P < 0.01). There was a significantly decreased LOR (P < 0.01) as fractures moved further from the pubis symphysis. Retrograde screws were significantly (P < 0.01) more likely to have LOR. In SPR fractures treated with retrograde screws, failure was significantly associated with increasing BMI (P = 0.02), the presence of an inferior ramus fracture (P = 0.02), and trended toward significance with increasing age (P = 0.06), and decreased distance from the symphysis (P = 0.07). CONCLUSIONS: Superior ramus screws are associated with a low failure rate (4.9%), which is lower than previously reported. Retrograde screw insertion, distance from the symphysis, increasing age, increasing BMI, decreased distance from the symphysis, and ipsilateral inferior ramus fractures were predictors of failure. In these patients, alternative modalities should be considered, although low rates of failure can still be expected. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Assuntos
Fraturas Ósseas , Ossos Pélvicos , Adulto , Parafusos Ósseos , Feminino , Fixação Interna de Fraturas , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Osso Púbico , Estudos RetrospectivosRESUMO
BACKGROUND: Early administration of antibiotics and wound coverage have been shown to decrease the deep infection risk in all patients with Type 3 open tibia fractures. However, it is unknown whether early antibiotic administration decreases infection risk in patients with Types 1, 2, and 3A open tibia fractures treated with primary wound closure. QUESTIONS/PURPOSES: (1) Does decreased time to administration of the first dose of antibiotics decrease the deep infection risk in all open tibia fractures with primary wound closure? (2) What patient demographic factors are associated with an increased deep infection risk in Types 1, 2, and 3A open tibia fractures with primary wound closure? METHODS: We identified 361 open tibia fractures over a 5-year period at a Level I regional trauma center that receives direct admissions and transfers from other hospitals which produces large variation in the timing of antibiotic administration. Patients were excluded if they were younger than 18 years, had associated plafond or plateau fractures, associated with compartment syndrome, had a delay of more than 24 hours from injury to the operating room, underwent repeat débridement procedures, had incomplete data, and were treated with negative-pressure dressings or other adjunct wound management strategies that would preclude primary closure. Primary closure was at the descretion of the treating surgeon. We included patients with a minimum follow-up of 6 weeks with assessment at 6 months and 12 months. One hundred forty-three patients with were included in the analysis. Our primary endpoint was deep infection as defined by the CDC criteria. We obtained chronological data, including the time to the first dose of antibiotics and time to surgical débridement from ambulance run sheets, transferring hospital records, and the electronic medical record to answer our first question. We considered demographics, American Society of Anesthesiologists classification, mechanism of injury, smoking status, presence of diabetes, and Injury Severity Score in our analysis of other factors. These were compared using one-way ANOVA, chi-square, or Fisher's exact tests. Binary regression was used to to ascertain whether any factors were associated with postoperative infection. Receiver operator characteristic curves were used to identify threshold values. RESULTS: Increased time to first administration of antibiotics was associated with an increased infection risk in patients who were treated with primary wound closure; the greatest inflection point on that analysis occurred at 150 minutes, when the increased infection risk was greatest (20% [8 of 41] versus 4% [3 of 86]; odds ratio 5.6 [95% CI 1.4 to 22.2]; p = 0.01). After controlling for potential confounding variables like age, diabetes and smoking status, none of the variables we evaluated were associated with an increased risk of deep infection in Type 1, 2, and 3A open tibia fractures in patients treated with primary wound closure. CONCLUSION: Our findings suggest that in open tibia fractures, which receive timely antibiotic administration, primary wound closure is associated with a decreased infection risk. We recognize that more definitive studies need to be performed to confirm these findings and confirm feasibility of early antibiotic administration, especially in the pre-hospital context. LEVEL OF EVIDENCE: Level III, therapeutic study.
Assuntos
Antibacterianos/administração & dosagem , Antibioticoprofilaxia/métodos , Fraturas Expostas/cirurgia , Infecção da Ferida Cirúrgica/prevenção & controle , Fraturas da Tíbia/cirurgia , Técnicas de Fechamento de Ferimentos , Adulto , Feminino , Humanos , Masculino , Tratamento de Ferimentos com Pressão Negativa , Redução Aberta/efeitos adversos , Redução Aberta/métodos , Estudos Retrospectivos , Fatores de Risco , Infecção da Ferida Cirúrgica/etiologia , Tíbia/cirurgia , Fatores de Tempo , Resultado do TratamentoRESUMO
INTRODUCTION: The early generations of proximal tibial locking plates demonstrated inferior results when compared to dual plating in bicondylar tibial plateau fractures with posteromedial fragments (PMF). Modern plates have multiple rows of locking screws and variable angle technology -which tote the ability to capture the PMF. The purpose of this study was to determine if the modern plates could capture the PMF in a large series of bicondylar tibial plateau fractures. MATERIALS & METHODS: Axial computer topography (CT) scans of 114 bicondylar tibial plateau fractures with PMF were analyzed. Five proximal tibia locking plates-in seven total configurations-were applied to radiopaque tibiae models. All possible screws were placed. Templates of screw trajectories were created based on the model CT scans. These were superimposed onto patient CT scan images to assess for screw penetration into the PMF. Number of screws fully within the PMF were recorded. Capture of the PMF was defined as having at least two screws within the fragment. RESULTS: On average, all plates were able to capture 81.6% of PMF with an average of 3.77 [95% Confidence Interval (CI): 3.47-4.07] screws. However, their ability to capture all fragments varied greatly, from 55.7%-95.2% in fixed angle constructs. Overall, variable angle constructs had a significantly higher capture rate (98.5% vs. 74.9%; p<0.0001) and more screws in the PMF (5.88 [95% CI: 5.58-6.17] vs 2.93 [95% CI: 2.62-3.24]; p<0.0001) when compared to fixed angle constructs. CONCLUSION: Newer generation locking plates vary greatly in their ability to capture the PMF. Variable angle technology dramatically increases the ability to capture the majority of PMFs. Prior biomechanical and clinical studies may yield substantially different results if repeated with these newer implants. Use of newer generation locked plates should not replace thorough preoperative planning.
Assuntos
Tíbia , Fraturas da Tíbia , Placas Ósseas , Fixação Interna de Fraturas , Humanos , Fraturas da Tíbia/diagnóstico por imagem , Fraturas da Tíbia/cirurgiaRESUMO
OBJECTIVE: To determine whether suprapatellar nailing (SPN) over time can decrease operative time and radiation exposure when compared with infrapatellar nailing (IPN) of tibial shaft fractures. DESIGN: Retrospective. SETTING: Single, Level 1 trauma center. PATIENTS: Extra-articular adult tibial shaft fractures treated with intramedullary nailing alone within a 7-year period. INTERVENTION: Patients were treated with SPN or IPN techniques based on the discretion of the operating surgeon. MAIN OUTCOME MEASUREMENTS: Operative time and radiation exposure. RESULTS: Three hundred forty-one fractures (SPN: 177, IPN: 164) were included in the analysis. No differences in patient body mass index, sex, or open fracture incidence existed between the 2 groups. A significant difference in average operative time (IPN 130 minutes vs. SPN 110 minutes, P < 0.01), fluoroscopy time (IPN 159 minutes vs. SPN 143 minutes, P = 0.02), and radiation dose (IPN 8.6 mGy vs. SPN 6.5 mGy, P < 0.01) existed between IPN and SPN. Early tibias treated with SPN had similar operative times (P = 0.11), fluoroscopy time (P = 0.94), and radiation dose (P = 0.34) compared with IPN. Later SPN patients had significantly lower operative time (P = 0.03), fluoroscopy time (P < 0.01), and radiation dose (P < 0.013) compared with earlier SPN. Regression analysis revealed with the increased use of SPN, operative time, fluoroscopy time, and radiation dose significantly decreased (P = 0.018, 0.046, 0.011). CONCLUSIONS: Tibia fractures treated with SPN have significantly decreased operative times and radiation exposure compared with those treated with IPN, after allowing time for the surgeon to gain sufficient experience with the technique. The surgeon should consider this when deciding to adopt this technique. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Assuntos
Fixação Intramedular de Fraturas , Exposição à Radiação , Fraturas da Tíbia , Adulto , Pinos Ortopédicos , Humanos , Curva de Aprendizado , Duração da Cirurgia , Estudos Retrospectivos , Fraturas da Tíbia/diagnóstico por imagem , Fraturas da Tíbia/cirurgia , Resultado do TratamentoRESUMO
Supracondylar femur fractures represent a challenging and common injury treated by many orthopedic surgeons. An array of surgical fixation options has been developed to help the treating surgeon restore normal anatomic alignment of these fractures, and lateral precontoured condylar femoral locking plates have become a common implant for most surgeons in treating these fractures. Although these precontoured plates provide significant benefit to the treating physician in regards to gaining appropriate bony fixation, common technical errors that may lead to malalignment when using these plates have been described. Avoiding these errors will help improve patient outcomes. Here, we describe a novel, inexpensive, and universally available technique that may aid the treating surgeon in restoring coronal alignment when treating distal femur fractures.
Assuntos
Mau Alinhamento Ósseo/prevenção & controle , Fraturas do Fêmur/cirurgia , Fixação Interna de Fraturas/métodos , Mau Alinhamento Ósseo/etiologia , Fraturas do Fêmur/diagnóstico por imagem , Fixação Interna de Fraturas/efeitos adversos , HumanosRESUMO
CASE: We present the case of a thirteen-year-old female who sustained a posterior wall acetabular fracture dislocation. She underwent urgent closed reduction and subsequent uncomplicated open reduction and internal fixation. Post reduction computed tomography demonstrated a concentrically reduced hip joint with no evidence of femoroacetabular impingement (FAI). She subsequently healed her fracture and returned to running activities; however, one year later presented with aching pain in her thigh. Radiographs demonstrated the development of a large osseous prominence on her anterolateral femoral neck consistent with femoroacetabular impingement. Based on these findings she was evaluated by a hip preservation specialist. She subsequently underwent successful hip arthroscopy for labral repair and femoral osteochondroplasty. She was eventually able to return to running sports with little pain. SUMMARY: We present a case of FAI presenting as a complication of acetabular fracture fixation. This should be discussed with patients presenting with traumatic hip dislocations as a possible complication of surgical fixation or possibly of the injury itself.
RESUMO
In acute trauma, pelvic ring instability can lead to hemorrhage and hemodynamic instability. Pelvic ring instability and displacement that is not stabilized may lead to chronic pain, sitting imbalance, and limb length inequality. Methods and timing of securing anterior pelvic ring injuries operatively is controversial and debatable. Many orthopaedic trauma surgeons would agree that acceptable methods to treat a disrupted anterior pelvic ring fracture include nonoperative care, external fixation, internal spanning fixators, intramedullary superior ramus screws, and open reduction internal fixation. We will review the indications for open reduction internal fixation fractures and disruptions of the anterior pelvic ring.
Assuntos
Fraturas Ósseas/cirurgia , Redução Aberta , Seleção de Pacientes , Ossos Pélvicos/lesões , HumanosRESUMO
BACKGROUND/OBJECTIVE: Despite effective therapies, rheumatoid arthritis (RA) can result in joint destruction requiring total joint arthroplasty to maintain patient function. An estimated 16% to 70% of those undergoing total joint arthroplasty of the hip or knee will receive a blood transfusion. Few studies have described risk factors for blood transfusion following total joint arthroplasty in patients with RA. The aim of this study was to identify demographic and clinical risk factors associated with receiving a blood transfusion following total joint arthroplasty among patients with RA. METHODS: A retrospective study (n = 3270) was conducted using deidentified patient health claims information from a commercially insured, US data set (2007-2009). Data analysis included descriptive statistics and multivariate logistic regression. RESULTS: Females were more likely to receive a blood transfusion (odds ratio [OR], 1.48; 95% confidence interval [CI], 1.16-1.87; p = 0.001). When compared with those in the South, patients residing the Midwest were less likely to receive a blood transfusion following total joint arthroplasty (OR, 0.56; 95% CI, 0.44-0.71). Relative to those receiving total knee arthroplasty, patients who underwent total hip arthroplasty were more likely to receive a blood transfusion (OR, 1.39; 95% CI, 1.14-1.70), and patients who underwent a total shoulder arthroplasty were less likely to receive a blood transfusion (OR, 0.14; 95% CI, 0.05-0.38; p < 0.001). Patients with a history of anemia were more likely to receive a blood transfusion compared with those who did not have this diagnosis (OR, 3.30; 95% CI, 2.62-4.14; p < 0.001). CONCLUSIONS: Risk factors for the receipt of blood transfusions among RA patients who have undergone total joint arthroplasty were identified.
Assuntos
Artrite Reumatoide/cirurgia , Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Transfusão de Sangue/métodos , Adulto , Idoso , Artrite Reumatoide/diagnóstico , Artroplastia de Quadril/métodos , Perda Sanguínea Cirúrgica , Estudos de Coortes , Bases de Dados Factuais , Feminino , Seguimentos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Cuidados Pós-Operatórios/métodos , Falha de Prótese , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
CASE: We describe a case of delayed presentation of compartment syndrome in the anterior aspect of the thigh in a high school athlete. The patient had sustained a blow to the thigh 8 days prior to presentation, and had continued to practice football in the setting of undiagnosed coagulopathy. He presented with severe thigh pain and the inability to contract the thigh muscles. CONCLUSION: A high index of suspicion for compartment syndrome is indicated for patients with disproportionate pain, especially in the setting of relatively minor trauma. Underlying coagulopathy should be investigated in patients with compartment syndrome because there is a high incidence of bleeding disorders in this population.
Assuntos
Traumatismos em Atletas , Síndromes Compartimentais , Deficiência do Fator VII , Futebol Americano , Coxa da Perna , Adolescente , Traumatismos em Atletas/complicações , Traumatismos em Atletas/diagnóstico por imagem , Traumatismos em Atletas/cirurgia , Síndromes Compartimentais/complicações , Síndromes Compartimentais/diagnóstico por imagem , Síndromes Compartimentais/cirurgia , Deficiência do Fator VII/complicações , Deficiência do Fator VII/diagnóstico , Humanos , Masculino , Músculo Esquelético/lesões , Músculo Esquelético/cirurgia , Coxa da Perna/diagnóstico por imagem , Coxa da Perna/lesões , Coxa da Perna/cirurgiaRESUMO
Beginning practice as an orthopaedic traumatologist is an important event, when the groundwork is set up for the next few years of hard work. Plans must be made, resources allocated, staff hired, etc. to optimally support the newly practicing surgeon. Academic and nonacademic practice settings are possible, where the facets of practice (i.e., clinic, operating room, floor work, education, and research) may be quite different. The goal of this article is to discuss these differences between relatively academic and nonacademic practices, ultimately to allow the young orthopaedic traumatologist to form a "wish list" with which to start planning the logistics of his or her career.
Assuntos
Escolha da Profissão , Ortopedia , Pesquisa Biomédica , Desenho de Equipamento , Hospitais Universitários , Humanos , Salas Cirúrgicas/normas , Procedimentos Ortopédicos/instrumentação , Centros de Traumatologia/organização & administraçãoRESUMO
In contrast to open reduction internal fixation, percutaneous fixation is a relatively new option for operative fixation of acetabular fractures. The techniques for percutaneous insertion of anterior and posterior column screws have been previously described. For technical aspects of retrograde percutaneous posterior column screws, much attention has been paid to the proper start point. However, descriptions of proper trajectory and end point have not been as clearly delineated. Understanding of posterior column anatomy and its radiographic correlates are fundamental in the safe placement of this screw. Herein, we present technical advice for acquisition and interpretation of fluoroscopic images needed to ensure a safe trajectory and end point in retrograde percutaneous posterior column screw placement. We highlight our steps to ensure correct placement in a small series.
Assuntos
Acetábulo/lesões , Acetábulo/cirurgia , Parafusos Ósseos , Fixação Interna de Fraturas/instrumentação , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Cirurgia Assistida por Computador/métodos , Acetábulo/diagnóstico por imagem , Humanos , Posicionamento do Paciente/métodos , Implantação de Prótese/métodos , Intensificação de Imagem Radiográfica/métodosRESUMO
BACKGROUND: Bilateral asymmetric hip dislocation, with one hip dislocated posteriorly and with anterior dislocation of the contralateral hip, is a rare injury pattern. A total of 34 cases have been reported in English literature, but only 24 cases detail injury mechanism and patient demographic factors, 3 of which reported bilateral asymmetric hip dislocation in female patients. Only one report describes more than one example. We describe four patients with bilateral asymmetric hip dislocation, including one example in a female patient, which represents the largest case series to date. Pertinent anatomy, injury mechanism, treatment options, and prognosis are also discussed. METHODS: A literature review was conducted via PubMed using the term bilateral asymmetric dislocation. Review of additional reports cited by articles found by our search resulted in what we think to be an exhaustive list of cases reported to date.A medical record review of four patients treated at our institution, a Level I trauma center, was performed to compare our treatment methods and outcomes to those previously described. RESULTS: All four patients in our case series had satisfactory outcomes. Motor vehicle collision is the most common cause of bilateral asymmetric hip dislocation. CONCLUSION: Timely, accurate reduction of bilateral asymmetric hip dislocation is recommended for optimal outcomes. An understanding of pertinent anatomy about the hip joint allows the orthopedic surgeon to perform a safe, timely reduction. In the absence of an associated acetabular fracture, conservative management with weight-bearing restrictions typically leads to good outcomes without complications such as aseptic necrosis of the femoral head. LEVEL OF EVIDENCE: Therapeutic study, level V.
Assuntos
Luxação do Quadril/etiologia , Articulação do Quadril/cirurgia , Procedimentos Ortopédicos/métodos , Acidentes de Trânsito , Adulto , Feminino , Seguimentos , Luxação do Quadril/diagnóstico por imagem , Luxação do Quadril/cirurgia , Articulação do Quadril/diagnóstico por imagem , Humanos , Masculino , Tomografia Computadorizada por Raios X , Adulto JovemRESUMO
Contributions of the emissions from a U.K. regulated fossil-fuel power station to regional air pollution and deposition are estimated using four air quality modeling systems for the year 2003. The modeling systems vary in complexity and emphasis in the way they treat atmospheric and chemical processes, and include the Community Multiscale Air Quality (CMAQ) modeling system in its versions 4.6 and 4.7, a nested modeling system that combines long- and short-range impacts (referred to as TRACK-ADMS [Trajectory Model with Atmospheric Chemical Kinetics-Atmospheric Dispersion Modelling System]), and the Fine Resolution Atmospheric Multi-pollutant Exchange (FRAME) model. An evaluation of the baseline calculations against U.K. monitoring network data is performed. The CMAQ modeling system version 4.6 data set is selected as the reference data set for the model footprint comparison. The annual mean air concentration and total deposition footprints are summarized for each modeling system. The footprints of the power station emissions can account for a significant fraction of the local impacts for some species (e.g., more than 50% for SO2 air concentration and non-sea-salt sulfur deposition close to the source) for 2003. The spatial correlation and the coefficient of variation of the root mean square error (CVRMSE) are calculated between each model footprint and that calculated by the CMAQ modeling system version 4.6. The correlation coefficient quantifies model agreement in terms of spatial patterns, and the CVRMSE measures the magnitude of the difference between model footprints. Possible reasons for the differences between model results are discussed. Finally, implications and recommendations for the regulatory assessment of the impact of major industrial sources using regional air quality modeling systems are discussed in the light of results from this case study.