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1.
J Am Acad Orthop Surg ; 28(20): e878-e887, 2020 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-33030854

RESUMO

The talus is unique in having a tenuous vascular supply and 57% of its surface covered by articular cartilage. Fractures of the head, neck, or body regions have the potential to compromise nearby joints and impair vascular inflow, necessitating surgical treatment with stable internal fixation in many cases. The widely preferred approach for many talar neck and body fractures is a dual anterior incision technique to achieve an anatomic reduction, with the addition of a medial malleolar osteotomy as needed to visualize the posterior talar body. Percutaneous screw fixation has also demonstrated success in certain patterns. Despite this modern technique, osteonecrosis and osteoarthritis remain common complications. A variety of new treatments for these complications have been proposed, including vascularized autograft, talar replacement, total ankle arthroplasty, and improved salvage techniques, permitting some patients to return to a higher level of function than was previously possible. Despite these advances, functional outcomes remain poor in a subset of severely injured patients, making further research imperative.


Assuntos
Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Procedimentos Ortopédicos/métodos , Tálus/lesões , Tornozelo/cirurgia , Artroplastia de Substituição , Autoenxertos/irrigação sanguínea , Parafusos Ósseos , Fraturas Ósseas/complicações , Humanos , Osteoartrite/etiologia , Osteoartrite/terapia , Osteonecrose/etiologia , Osteonecrose/terapia , Osteotomia/métodos , Prognóstico , Recuperação de Função Fisiológica , Tálus/irrigação sanguínea
3.
Khirurgiia (Mosk) ; (10): 73-78, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33047589

RESUMO

The need for thromboprophylaxis in traumatological and orthopedic operations is determined by a constant increase in the level of injuries of the population, and as a result, fluctuating coagulation indicators. Risk factors inherent in modern society that correlate primarily with reduced physical activity and excessive consumption of unbalanced (carbohydrate) nutrition, bad habits (nicotinism, alcoholism and other toxic dependencies), increased life expectancy and comorbidity - these and other causes can lead to an increase in the incidence of vascular accidents in patients with large limb bone fractures. The goal is to compare the effectiveness and clinical safety of using parnaparin sodium (Fluxum) and enoxaparin sodium as the prevention of thrombosis in the treatment of lower limb bone fractures. MATERIAL AND METHODS: A comparative assessment of the effectiveness and clinical safety of thrombosis prevention in the treatment of lower limb bone fractures using low-molecular weight heparins: parnaparin sodium (Fluxum) and enoxaparin sodium. RESULTS: Taking into account the literature data on the significant risk of venous thromboembolic complications, we successfully conduct the thromboprophylaxis in patients with the traumatological and orthopedic profile, including in 2019 using the drug parnaparin sodium (Fluxum, «Alfasigma¼). Our own comparative clinical experience has shown that with the convenience of taking enoxaparin sodium and the completeness of the scheme, the prevention of thrombosis with the use of parnaparin sodium shows the tendency to better clinical effectiveness and safety. CONCLUSION: The choice of anticoagulants in traumatological and orthopedic practice, with obvious ease of use, provides the complete scheme for the prevention of thrombosis. Further research is needed on the routine use of sodium parnaparin in order to prevent thronbosis in the treatment of fractures of various localization.


Assuntos
Anticoagulantes/administração & dosagem , Enoxaparina/administração & dosagem , Fixação de Fratura/efeitos adversos , Fraturas Ósseas/cirurgia , Heparina de Baixo Peso Molecular/administração & dosagem , Trombose/prevenção & controle , Tromboembolia Venosa/prevenção & controle , Fraturas Ósseas/complicações , Humanos , Trombose/etiologia , Tromboembolia Venosa/etiologia
4.
J Trauma Acute Care Surg ; 89(4): 730-735, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33017134

RESUMO

BACKGROUND: The timing of definitive surgical stabilization is a controversial topic of pelvic and acetabular fracture (PAF) management. Historically, staged care with delayed definitive fixation was recommended; however, more recently, some centers have shown early definitive fixation to be feasible in most patients. We hypothesized that time to definitive fixation of PAF decreased without adverse outcomes. METHODS: A level 1 trauma center's prospective pelvic fracture database was retrospectively analyzed. A total of 341 of the 1,270 consecutive PAF patients had surgery between January 2009 and December 2018. Demographics, polytrauma status, hemodynamic stability, time to definitive operation, length of intensive care unit stay, hospital length of stay, mortality were recorded. Data is presented as mean ± SD, percentages. Statistical significance was determined at p < 0.05. RESULTS: There were 34 ± 8 per year operatively treated PAF patients during the study period. The demographics (age, 44.1 ± 18 years; 74.5% males) and injury severity (Injury Severity Score, 20; interquartile range, 16-29) did not change. Time to definitive fixation on average was 85 ± 113 hours (range, 0.8-1286 hours). Linear regression analysis demonstrated a decrease in time to definitive fixation considering all patients (ß = -0.186, p = 0.003). pelvic ring fractures with polytrauma (ß = -1.404, p = 0.03). and hemodynamically unstable patients (ß = -1.428, p = 0.037). There was no significant change in mortality, length of stay, or intensive care unit length of stay for the overall cohort or any subgroup. CONCLUSION: Time to definitive fixation in PAF has decreased during the last decade, with the largest decrease in time to fixation occurring in the hemodynamically unstable and pelvic fracture with polytrauma cohorts. The timely definitive internal fixation is achievable without increased length of stay. LEVEL OF EVIDENCE: Therapeutic/care management, level IV.


Assuntos
Acetábulo/lesões , Fixação Interna de Fraturas , Fraturas Ósseas/cirurgia , Pelve/lesões , Adolescente , Adulto , Austrália , Criança , Feminino , Fraturas Ósseas/complicações , Humanos , Escala de Gravidade do Ferimento , Tempo de Internação , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Traumatismo Múltiplo , Estudos Retrospectivos , Fatores de Tempo , Centros de Traumatologia , Adulto Jovem
5.
Seizure ; 83: 17-20, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33075672

RESUMO

PURPOSE: To compare epilepsy-related injuries in untreated or inadequately treated patients and patients on adequate treatment. METHODS: In a cross-sectional case-control study, seizure-related injuries in patients who were either on no treatment or inadequate treatment were compared with another group of patients receiving appropriate evidence-based epilepsy treatment. The inadequately treated patients or 'cases' were drawn from an outreach epilepsy clinic while the adequately treated patients or 'controls' were recruited from a tertiary care facility providing comprehensive epilepsy management. RESULTS: The odds of injury were eight times higher in inadequately treated patients or cases compared to the adequately treated patients or controls. After adjusting for gender, epilepsy duration, seizure frequency, current medication, and number of AEDs, the odds of injury were 15. 8 times higher in the cases. Major injuries such as burns, fractures, and tooth injuries were also higher in the cases. CONCLUSION: Untreated or inadequately treated epilepsy patients have a significantly higher risk of injuries. With adequate treatment, some of the risks of injury can be mitigated.


Assuntos
Epilepsia/terapia , Fraturas Ósseas/complicações , Convulsões/terapia , Traumatismos Dentários/etiologia , Adolescente , Adulto , Estudos de Casos e Controles , Criança , Pré-Escolar , Estudos Transversais , Feminino , Fraturas Ósseas/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Traumatismos Dentários/fisiopatologia , Adulto Jovem
6.
Orthop Clin North Am ; 51(4): 541-553, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32950224

RESUMO

Jones fractures in both elite and recreational athletes are best treated with surgical fixation, given superior results as compared to nonoperative management. While screw specifics remain controversial, intramedullary screw fixation is established as the standard surgical technique. Plate fixation also has shown excellent outcomes. Complications of refracture, nonunion, and delayed union require careful evaluation for contributions of early return to play, implant characteristics, and anatomic/metabolic abnormality. Revision fixation with autograft and biologic augmentation is supported in the literature, with ongoing inquiry to optimizing specific implants and adjuvants.


Assuntos
Fixação Intramedular de Fraturas , Fraturas Ósseas/cirurgia , Ossos do Metatarso/lesões , Atletas , Fraturas Ósseas/complicações , Fraturas Ósseas/diagnóstico por imagem , Humanos
7.
Clin Sports Med ; 39(4): 793-799, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32892967

RESUMO

Proximal fifth metatarsal fractures, specifically zones 2 and 3, are often treated surgically to lower risk of nonunion and shorten recovery and rehabilitation period. However, even with the advancement of surgical strategies, techniques, and implants, nonunions remain a challenge. One notable risk factor for a primary or recurrent Jones fracture is the cavovarus foot. If this is identified and a recurrent fifth metatarsal base fracture occurs, the surgeon should strongly consider addressing the malalignment in addition to revision open reduction internal fixation. This article provides guidelines for treatment of a recurrent fracture or nonunion with a concomitant cavovarus foot deformity.


Assuntos
Mau Alinhamento Ósseo/cirurgia , Traumatismos do Pé/cirurgia , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Ossos do Metatarso/lesões , Redução Aberta/métodos , Reoperação/métodos , Mau Alinhamento Ósseo/etiologia , Traumatismos do Pé/complicações , Fraturas Ósseas/complicações , Fraturas não Consolidadas/complicações , Fraturas não Consolidadas/cirurgia , Humanos , Ossos do Metatarso/cirurgia , Recidiva
8.
J Orthop Trauma ; 34(10): e382-e388, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32947589

RESUMO

Orthopaedic trauma presents a unique and complex challenge in the initial phase of the coronavirus 2019 (COVID-19) global crisis. Little is currently known about the surgical practices in orthopaedic emergencies in the early days of the COVID-19 outbreak (1). This is a retrospective case series of 10 orthopaedic trauma patients who underwent fracture fixation in March 2020. Of the 10 patients testing COVID-19 positive, there were a total of 16 long bone fractures, 5 pelvic ring fractures, and 1 lumbar burst fracture. There were 7 (70%) males in this cohort. Two (20%) of the COVID-positive patients did not develop fever, leukocytosis, respiratory insufficiency, or positive imaging findings and were younger (average age 25.5 years) with fewer comorbidities (average 0.5) compared with the 8 symptomatic COVID-19-positive patients (56.6 years with 1.88 comorbidities). Advancement of COVID-19 pathogenesis with lung opacities and prolonged intubation occurred in all 5 patients who remained on ventilation postoperatively (range 9 hours-11 days). At the time of most recent follow-up, all patients survived, 1 continues to require ventilation support, 1 remains admitted without ventilation support, and 8 (80%) were discharged to home. LEVEL OF EVIDENCE:: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Transmissão de Doença Infecciosa/prevenção & controle , Fixação de Fratura/métodos , Fraturas Ósseas/complicações , Pneumonia Viral/epidemiologia , Medição de Risco/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções por Coronavirus/complicações , Infecções por Coronavirus/transmissão , Feminino , Seguimentos , Fraturas Ósseas/epidemiologia , Fraturas Ósseas/cirurgia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/transmissão , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Estados Unidos/epidemiologia , Adulto Jovem
9.
Am J Surg ; 220(6): 1395-1399, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32958159

RESUMO

BACKGROUND: Venous thromboembolism (VTE) in patients with major pelvic fractures who undergo preperitoneal pelvic packing (PPP) has not been investigated. We hypothesized that patients who undergo PPP are at high risk for VTE, thus early prophylactic anticoagulation and screening duplex are warranted. STUDY DESIGN: All patients requiring PPP from 2015 to 2019 were reviewed. Management and outcomes were analyzed. RESULTS: During the study period, 79 patients underwent PPP. Excluding the early deaths, 17 patients had deep venous thrombosis (DVT) and 6 had pulmonary emboli (PE); 4 patients had both DVT/PE. Overall mortality was 15%. Thirty-two patients underwent screening duplex within 72 h of admission and 10 were positive for DVT. CONCLUSION: Patients with complex pelvic trauma undergoing PPP have a 23% incidence of DVT and an additional 8% incidence of PE. 31% of screening ultrasounds are positive. The overall mortality was 15%. With a high incidence of VTE in this patient population, we recommend screening duplex ultrasounds.


Assuntos
Fraturas Ósseas/complicações , Hemorragia/prevenção & controle , Técnicas Hemostáticas/efeitos adversos , Ossos Pélvicos/lesões , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/etiologia , Ultrassonografia Doppler Dupla , Tromboembolia Venosa/diagnóstico por imagem , Tromboembolia Venosa/etiologia , Feminino , Hemorragia/mortalidade , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/mortalidade , Fatores de Risco , Tromboembolia Venosa/mortalidade
10.
Acta Orthop Traumatol Turc ; 54(4): 355-363, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32812872

RESUMO

OBJECTIVE: The purpose of this study was to evaluate the types and the frequency of fractures, both in the pediatric and adult population during the COVID-19 pandemic and to find out the differences in comparison to the non-pandemic period. METHODS: Patients who were admitted to the hospital with a new fracture during pandemic period (March 16 to May 22, 2020) were evaluated. Control group consisted of patients with new fractures admitted to the hospital in the same date range in 2018 and 2019. The patients were divided into two groups as ≤16 years old (group 1) and >16 years old (group 2). The evaluation was based on the age and gender of the patients and localization of the fractures. Hospitalized and surgically treated patients were evaluated as well. RESULTS: A total of 1794, 1747, and 670 fractures were observed in 2018, 2019, and 2020, respectively. Mean age of the patients in group 1 was found to have decreased in the pandemic period (p<0.001). The most common fracture sites in the pediatric population were the distal forearm and distal arm, whereas hand, distal forearm, and foot were most common fracture sites in adults, in both pandemic and non-pandemic periods. The proportional increase in femoral and tibial shaft fractures in group 1, and toe, tibial shaft, and metacarpal fractures in group 2 was found to be statistically significantly (p<0.05). In group 1; 6.8%, 7.7%, and 14.6% of the fractures were treated surgically in 2018, 2019, and 2020, respectively (p<0.001). For group 2, these rates were 20.1%, 18.6%, and 18.1%, respectively (p=0.67). There were 48, 29, and 26 open fractures in 2018, 2019 and 2020, respectively (p=0.066). In pandemic period, duration of the hospital stay was significantly shorter for distal humerus and proximal femur fractures (p values= 0.001 and 0.017, respectively). CONCLUSION: We observed that the frequency of fractures decreased by approximately one-third during the pandemic period compared with that in the non-pandemic period. The mean age of the patients with a fracture in the pediatric group was found to have decreased also. Finger fractures in pediatric patients and metatarsal fractures in adult patients were found to have significantly decreased during the pandemic. LEVEL OF EVIDENCE: Level III, Diagnostic study.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Fraturas Ósseas/epidemiologia , Pneumonia Viral/epidemiologia , Centros de Atenção Terciária/estatística & dados numéricos , Adolescente , Adulto , Criança , Infecções por Coronavirus/complicações , Feminino , Fraturas Ósseas/complicações , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/complicações , Estudos Retrospectivos , Turquia/epidemiologia
11.
J Orthop Trauma ; 34(9): e349-e352, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32815850

RESUMO

The Virtual Fracture Clinic (VFC) has proved beneficial in reducing footfall within the hospital setting, improving the cost of running a trauma service, while satisfying the majority of referred patients. The mandatory upscaling of telemedicine use, specifically the enhancement of the VFC, amidst the COVID-19 pandemic, was analyzed. The remit of the VFC within our hospital was expanded so as to include all referred ambulatory trauma. Outcomes of our VFC review over the 6-week period following the introduction of the national Irish COVID-19-related restrictions were gathered. These outcomes were analyzed and compared with the corresponding 6-week period from 2019. A 77.2% increase in the VFC referral volume was observed throughout the COVID-19-related period. Patients were directly discharged in 55.2% of cases in 2020, as opposed to 47.8% in 2019 (P = 0.044); referred directly for physiotherapy in 32.9% of cases in 2020, as opposed to 28.9% in 2019 (P = 0.173); and referred to a fracture clinic in 11.9% of cases in 2020, as opposed to 23.7% in 2019 (P < 0.001). Also, 3.0% of patients returned to the clinic after discharge in 2020, compared with 4.4% in 2019 (P = 0.237); 4.5% of patients were referred for surgery in 2020, as opposed to 2.2% in 2019 (P = 0.105). The VFC proved to be an efficient tool in managing ambulatory trauma throughout the pandemic. Upscaling the VFC to include all ambulatory trauma is a safe, effective method in reducing clinic attendances and hospital footfall, whilst ensuring that high care standards are maintained. LEVEL OF EVIDENCE:: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Assistência Ambulatorial/organização & administração , Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Fraturas Ósseas/terapia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Telemedicina/organização & administração , Infecções por Coronavirus/epidemiologia , Fraturas Ósseas/complicações , Humanos , Pneumonia Viral/epidemiologia , Encaminhamento e Consulta
12.
J Am Acad Orthop Surg ; 28(15): e651-e661, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32732656

RESUMO

Fractures of the carpus can be debilitating injuries and often lead to chronic pain and dysfunction when not properly treated. Although scaphoid fractures are more common, fractures of the other carpal bones account for nearly half of all injuries of the carpus. Often missed on initial presentation, a focused physical examination with imaging tailored to the suspected injury is needed to identify these fractures. In addition to plain radiographs, advanced imaging such as CT and MRI are helpful in diagnosis and management. Treatment of carpal fractures is based on the degree of displacement, stability of the fracture, and associated injuries. Those that require surgical fixation often affect the congruency of the articular surfaces, are unstable, are at risk for symptomatic nonunion, are associated with notable ligamentous injury, or are causing nerve or tendon entrapment. Surgical strategies involve percutaneous Kirschner wires, external fixation, screws and/or plates, excision, or fusion for salvage. Owing to the intimate articulations in the hand, small size of the carpal bones, and complex vascular supply, carpal fracture complications include symptomatic nonunion, osteonecrosis, and posttraumatic arthritis.


Assuntos
Ossos do Carpo/lesões , Ossos do Carpo/cirurgia , Fixação de Fratura/métodos , Fraturas Ósseas/cirurgia , Procedimentos Ortopédicos/métodos , Osso Escafoide/lesões , Osso Escafoide/cirurgia , Artrite/etiologia , Placas Ósseas , Parafusos Ósseos , Fios Ortopédicos , Ossos do Carpo/irrigação sanguínea , Fraturas Ósseas/complicações , Humanos , Osteonecrose , Terapia de Salvação
13.
PLoS One ; 15(8): e0235628, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32745092

RESUMO

BACKGROUND: Emerging evidence suggests aspirin may be an effective venous thromboembolism (VTE) prophylaxis for orthopaedic trauma patients, with fewer bleeding complications. We used a patient-centered weighted composite outcome to globally evaluate aspirin versus low-molecular-weight heparin (LMWH) for VTE prevention in fracture patients. METHODS: We conducted an open-label randomized clinical trial of adult patients admitted to an academic trauma center with an operative extremity fracture, or a pelvis or acetabular fracture. Patients were randomized to receive LMWH (enoxaparin 30-mg) twice daily (n = 164) or aspirin 81-mg twice daily (n = 165). The primary outcome was a composite endpoint of bleeding complications, deep surgical site infection, deep vein thrombosis, pulmonary embolism, and death within 90 days of injury. A Global Rank test and weighted time to event analysis were used to determine the probability of treatment superiority for LMWH, given a 9% patient preference margin for oral administration over skin injections. RESULTS: Overall, 18 different combinations of outcomes were experienced by patients in the study. Ninety-nine patients in the aspirin group (59.9%) and 98 patients in the LMWH group (59.4%) were event-free within 90 days of injury. Using a Global Rank test, the LMWH had a 50.4% (95% CI, 47.7-53.2%, p = 0.73) probability of treatment superiority over aspirin. In the time to event analysis, LMWH had a 60.5% probability of treatment superiority over aspirin with considerable uncertainty (95% CI, 24.3-88.0%, p = 0.59). CONCLUSION: The findings of the Global Rank test suggest no evidence of superiority between LMWH or aspirin for VTE prevention in fracture patients. LMWH demonstrated a 60.5% VTE prevention benefit in the weighted time to event analysis. However, this difference did not reach statistical significance and was similar to the elicited patient preferences for aspirin.


Assuntos
Anticoagulantes/uso terapêutico , Aspirina/uso terapêutico , Enoxaparina/uso terapêutico , Fibrinolíticos/uso terapêutico , Fraturas Ósseas/complicações , Tromboembolia Venosa/prevenção & controle , Adulto , Idoso , Anticoagulantes/efeitos adversos , Aspirina/efeitos adversos , Enoxaparina/efeitos adversos , Feminino , Fibrinolíticos/efeitos adversos , Hemorragia/induzido quimicamente , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Tromboembolia Venosa/complicações , Adulto Jovem
15.
Orthopade ; 49(8): 702-709, 2020 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-32671414

RESUMO

BACKGROUND: The high demands that fracture-related infections put on patients, physicians and the healthcare system have led to the establishment of a international group of experts called the Fracture-Related Infection (FRI) Consensus Group, whose aim is to develop evidence-based treatment recommendations. DIAGNOSIS: Fracture-related infections are classified according to the time of occurrence, extent and treatment options. The diagnostic algorithm distinguishes between confirmatory and suggestive diagnostic criteria. If there are indications of an infection, tissue biopsy with microbiological and histological workup is recommended to confirm the diagnosis. THERAPY: The primary objective of FRI treatment is to achieve fracture consolidation, while avoiding osteomyelitis. Therapeutic options are removal of the implant, eradication of the infection with implant retention or suppression of FRI. A multidisciplinary team is recommended to develop a patient-specific, optimized surgical and antimicrobial therapy.


Assuntos
Antibacterianos/uso terapêutico , Desbridamento/métodos , Fraturas Ósseas/complicações , Fraturas Ósseas/cirurgia , Osteomielite/tratamento farmacológico , Complicações Pós-Operatórias/microbiologia , Infecção da Ferida Cirúrgica/diagnóstico , Infecção da Ferida Cirúrgica/terapia , Algoritmos , Biofilmes , Fraturas Ósseas/microbiologia , Humanos , Osteomielite/diagnóstico , Osteomielite/microbiologia , Complicações Pós-Operatórias/terapia , Infecção da Ferida Cirúrgica/microbiologia , Traumatologia
16.
Scand J Trauma Resusc Emerg Med ; 28(1): 65, 2020 Jul 13.
Artigo em Inglês | MEDLINE | ID: mdl-32660515

RESUMO

BACKGROUND: Pelvic fractures, especially when unstable, may cause significant haemorrhage. The early application of a pelvic circumferential compression device (PCCD) in patients with suspected pelvic fracture has established itself as best practice. Ambulance services conduct corresponding performance measurement. Quality indicators (QIs) are ideally based on high-quality evidence clearly demonstrating that the desirable effects outweigh the undesirable effects. In the absence of high-quality evidence, best available evidence should be combined with expert consensus. OBJECTIVES: The aim of the present study was to identify, appraise and summarize the best available evidence regarding PCCDs for the purpose of informing an expert panel tasked to evaluate the validity of the following QI: A patient with suspected pelvic fracture has a PCCD applied. METHODS: A rapid review of four databases was conducted to identify relevant literature published up until 9 June 2020. Systematic reviews, experimental, quasi-experimental and observational analytic studies written in English were included. One author was responsible for study selection and quality appraisal. Data extraction using a priori extraction templates was verified by a second reviewer. Study details and key findings were summarized in tables. RESULTS: A total of 13 studies were assessed to be eligible for inclusion in this rapid review. Of these, three were systematic reviews, one was a randomized clinical trial (crossover design), two were before-after studies, and seven were retrospective cohort studies. The systematic reviews included mostly observational studies and could therefore not be considered as high-level evidence. Overall, the identified evidence is of low quality and suggests that PCCD may provide temporary pelvic ring stabilization and haemorrhage control, although a potential for adverse effects exists. CONCLUSION: Given the low quality of the best available evidence, this evidence would need to be combined with expert consensus to evaluate the validity of a related quality indicator before its implementation.


Assuntos
Serviços Médicos de Emergência/métodos , Fraturas Ósseas/terapia , Hemorragia/prevenção & controle , Procedimentos Ortopédicos/normas , Ossos Pélvicos/lesões , Indicadores de Qualidade em Assistência à Saúde , Fraturas Ósseas/complicações , Hemorragia/etiologia , Humanos
18.
J Bone Joint Surg Am ; 102(13): 1116-1122, 2020 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-32618909

RESUMO

The SARS-CoV-2 (severe acute respiratory syndrome-coronavirus 2) was reported in Wuhan, Hubei Province, People's Republic of China, and, subsequently, in other provinces and regions across the People's Republic of China and >212 countries. COVID-19, the disease caused by this coronavirus, was declared a worldwide pandemic by the World Health Organization (WHO). The incidence of patients with fracture who are also positive for COVID-19 is on the rise. The diagnosis and management of such patients can be complicated as their clinical characteristics are heterogeneous. Furthermore, a surgical procedure can be particularly challenging given that the use of high-speed devices results in aerosol generation. In this study, we develop and propose globally applicable guidelines to fill this knowledge gap and we identify and propose the necessary protective strategies for medical personnel in an orthopaedic emergency department and in the inpatient wards. We also introduce diagnostic criteria, surgical complication management, and follow-up strategies for infected patients. These guidelines may be helpful to decrease the infection rate of orthopaedic trauma personnel and to provide diagnosis and treatment therapy for patients with fracture and COVID-19.


Assuntos
Infecções por Coronavirus/diagnóstico , Fixação de Fratura/normas , Fraturas Ósseas/diagnóstico , Fraturas Ósseas/cirurgia , Pandemias , Pneumonia Viral/diagnóstico , Betacoronavirus , Infecções por Coronavirus/complicações , Emergências , Fraturas Ósseas/complicações , Humanos , Assistência Perioperatória , Pneumonia Viral/complicações , Guias de Prática Clínica como Assunto
19.
J Am Acad Orthop Surg ; 28(18): 737-741, 2020 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-32618680

RESUMO

Lymphatic flow plays a notable role in the regulation of bone formation and remodeling. Chronic accumulation of the lymph fluid within tissues may lead to issues with proper bone healing after fractures, emphasizing the importance of proper management of lymphedema after trauma. Many associated risk factors place patients at risk for lymphedema, including previous surgery with nodal dissection, radiation therapy, infection, malignancy, family history of congenital lymphedema, and trauma. The benchmark imaging technique for the diagnosis of lymphedema is lymphoscintigraphy. Other modalities include duplex ultrasonography, CT, and MRI. First-line conservative treatment of lymphedema is compression. Complete decongestive therapy or complex physical therapy, also known as decongestive lymphatic therapy (DLT), has shown positive results in reducing lymphedema. Surgical interventions aim to either reconstruct and restore function of the lymphatic system or debulk and reduce tissues and fluids. Understanding the significance of lymphedema on bone healing and techniques available to recognize it are important factors in preventing delay in diagnosis and ensuring proper management of lymphedema after trauma.


Assuntos
Osso e Ossos/lesões , Fraturas Ósseas/complicações , Linfedema/etiologia , Linfedema/terapia , Osso e Ossos/fisiopatologia , Bandagens Compressivas , Tratamento Conservador/métodos , Diagnóstico por Imagem , Fraturas Ósseas/fisiopatologia , Humanos , Linfedema/diagnóstico , Linfedema/cirurgia , Procedimentos Ortopédicos/métodos , Modalidades de Fisioterapia , Cicatrização
20.
Am Surg ; 86(7): 873-877, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32720511

RESUMO

INTRODUCTION: The purpose of this study was to evaluate the utilization of pelvic binders, the proper placement of binders, and to determine any differences in blood product transfusions between combat casualties with and without a pelvic binder identified on initial imaging immediately after the injury. METHODS: We conducted a retrospective review of all combat-injured patients who arrived at our military treatment hospital between 2010 and 2012 with a documented pelvic fracture. Initial imaging (X-ray or computed tomography) immediately after injury were evaluated by 2 independent radiologists. Young-Burgess (YB) classification, pelvic diastasis, correct binder placement over the greater trochanters, and the presence of a pelvic external fixator (ex-fix) was recorded. Injury severity score (ISS), whole blood, and blood component therapy administered within the first 24-hours after injury were compared between casualties with and without a pelvic binder. RESULTS: 39 casualties had overseas imaging to confirm and radiographically classify a YB pelvic ring injury. The most common fracture patterns were anteroposterior (53%) and lateral compression (28%). 49% (19/39) did not have a binder or ex-fix identified on initial imaging or in any documentation after injury. Ten patients had a binder, with 30% positioned incorrectly over the iliac crest. ISS (34 ± 1.6) was not statistically different between the binder and the no-binder group. Pubic symphysis diastasis was significantly lower in the binder group (1.4 ± 0.2 vs 3.7 ± 0.5, P < .001). There was a trend toward decreased 24-hour total blood products between the binder and no-binder groups (75 ± 11 vs 82 ± 13, P = .67). This was due to less cryoprecipitate in the binder group (6 ± 2 vs 19 ± 5, P = .01). CONCLUSIONS: Pelvic binder placement in combat trauma may be inconsistent and an important area for continued training. While 24-hour total transfusions do not appear to be different, no-binder patients received significantly more cryoprecipitate.


Assuntos
Fraturas Ósseas/complicações , Fraturas Ósseas/terapia , Hemorragia/prevenção & controle , Militares , Dispositivos de Fixação Ortopédica , Ossos Pélvicos/lesões , Fixação de Fratura/instrumentação , Hemorragia/etiologia , Humanos , Estudos Retrospectivos
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