Injury-International Journal of the Care of the Injured最新文献_第6页

The role of post-traumatic antifibrinolysis in the perioperative blood management of elderly patients with intertrochanteric fractures treated with PFNA: A randomised controlled trial 创伤后抗纤维蛋白溶解在接受 PFNA 治疗的转子间骨折老年患者围手术期血液管理中的作用：随机对照试验

IF 2.2 3区医学 Q3 CRITICAL CARE MEDICINE

Injury-International Journal of the Care of the Injured

Pub Date : 2024-10-24 DOI: 10.1016/j.injury.2024.111877

Gang Luo, Jiacheng Liu, Weidong Ni, Wei Huang

Background

This study aimed to evaluate the efficacy and safety of posttraumatic antifibrinolytic therapy with repeated doses of intravenous tranexamic acid (IV-TXA) in reducing perioperative hidden blood loss (HBL) in elderly intertrochanteric femur fracture (IFF) patients.

Method

112 elderly IFF patients who were admitted to our department from March 2020 to May 2021 were randomized to receive 100 ml of normal saline (Control group) or 1.5 g of TXA (TXA group) intravenously q12 h from postadmission day 1 (PAD1) to PAD3. Hemoglobin (Hb), hematocrit (Hct), fibrinogen degradation product (FDP), D-dimer (D-D), and coagulation parameters were recorded from PAD1 to postoperative day 3 (POD3). HBL was calculated using the gross formula and recorded as the primary outcome.

Result

The patients in TXA group had lower preoperative hidden blood loss(HBL), decline of hemoglobin(ΔHb), FDP (on PAD3), and D-D (on PAD3) compared with control group, while no difference was found in postoperative HBL, postoperative ΔHb and allogeneic blood transfusion (ABT) rate. In subgroup analyses, it was observed that patients who received the intervention within 24 h of injury and between 24 and 72 h of injury exhibited significantly lower preoperative HBL and ΔHb in the TXA group compared with the control group. Furthermore, the reduction in HBL and ΔHb was more pronounced in the former group. While for patients who received the intervention beyond 72 h after injury, no significant differences were observed in preoperative HBL and ΔHb between the two groups. Similarly, no significant differences were noted in postoperative HBL and ΔHb between the TXA and control groups across all subgroups. Additionally, no significant differences were identified in the incidence of venous thromboembolism (VTE) and mortality within one year between the two groups.

Conclusion

Post-traumatic antifibrinolytic therapy with repeated doses of intravenous TXA is effective and safe in reducing perioperative HBL for elderly IFF patients, especially for patients injured within 24 h.

背景本研究旨在评估创伤后抗纤维蛋白溶解治疗与重复剂量静脉注射氨甲环酸（IV-TXA）对减少老年股骨转子间骨折（IFF）患者围手术期隐性失血（HBL）的有效性和安全性。方法将2020年3月至2021年5月期间我科收治的112例老年股骨粗隆间骨折患者随机分为两组，从入院后第1天（PAD1）至PAD3，每12小时静脉注射100毫升生理盐水（对照组）或1.5克TXA（TXA组）。从入院后第 1 天（PAD1）到术后第 3 天（POD3），记录血红蛋白（Hb）、血细胞比容（Hct）、纤维蛋白原降解产物（FDP）、D-二聚体（D-D）和凝血参数。结果与对照组相比，TXA 组患者术前隐性失血（HBL）、血红蛋白（ΔHb）下降、FDP（PAD3）和 D-D（PAD3）均较低，而术后 HBL、术后ΔHb 和异体输血（ABT）率无差异。在亚组分析中观察到，与对照组相比，在受伤后 24 小时内以及受伤后 24 至 72 小时之间接受干预的患者在 TXA 组中的术前 HBL 和 ΔHb 显著降低。此外，前一组患者的 HBL 和 ΔHb 下降更为明显。而在受伤后 72 小时后接受干预的患者中，两组术前 HBL 和 ΔHb 没有明显差异。同样，在所有分组中，TXA 组和对照组的术后 HBL 和 ΔHb 也没有明显差异。此外，在静脉血栓栓塞症（VTE）的发生率和一年内的死亡率方面，两组之间也未发现明显差异。结论：使用重复剂量的静脉注射 TXA 进行创伤后抗纤维蛋白溶解治疗可有效、安全地降低老年 IFF 患者围手术期的 HBL，尤其是 24 小时内受伤的患者。

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引用次数: 0

Association of elevated exosomal miR-21 levels with nonunion in clavicular fractures post-ORIF: A prospective analysis 外泌体 miR-21 水平升高与手术后锁骨骨折不愈合的关系：前瞻性分析

IF 2.2 3区医学 Q3 CRITICAL CARE MEDICINE

Injury-International Journal of the Care of the Injured

Pub Date : 2024-10-24 DOI: 10.1016/j.injury.2024.111963

Xiao Hou , Guoqing Peng , Wei Zhao , Xuemei Cheng , Qianqian Wang , Tian Gan , Qian Yang , Jian Zhang

Background

This study investigates the relationship between plasma exosomal miRNAs and nonunion risk following open reduction and internal fixation (ORIF) of clavicle fractures, aiming to identify predictive molecule to enhance patient management and personalized orthopedic care.

Methods

Conducted as a prospective cohort study at Taian City Central Hospital, participants included individuals with unilateral, closed clavicle fractures who underwent ORIF (n = 763, 546 males and 217 females). Plasma samples were collected preoperatively for exosome isolation and miRNA extraction, specifically analyzing miR-100, miR-124, miR-125b, and miR-21 using quantitative polymerase chain reaction (qPCR). Patients were classified into union and nonunion groups based on follow-up outcomes at a minimum of three months post-surgery.

Results

Out of 763 patients, 720 achieved union while 43 developed nonunion. Notably, the nonunion group exhibited significantly elevated exosomal miR-21 expression levels. Univariate analysis demonstrated a significant association between high miR-21 expression and nonunion occurrence (Relative Risk [RR] = 1.82, P = 0.0004). Multivariate logistic regression analysis corroborated this association (RR > 1.8, P < 0.05), adjusting for covariates. High miR-21 levels (3.12 to 7.89) were robustly associated with nonunion outcomes (RR > 4), independent of other factors. Receiver operating characteristic (ROC) curve analysis indicated certain clinical diagnostic value of miR-21 for predicting nonunion (Area Under the Curve [AUC] = 0.7885).

Conclusions

The elevated preoperative levels of exosomal miR-21 were significantly associated with an increased risk of bone nonunion at three months ORIF in patients with clavicle fractures, indicating that miR-21 holds potential as a non-specific predictive molecule.

研究背景本研究探讨了血浆外泌体miRNA与锁骨骨折切开复位内固定术（ORIF）后不愈合风险之间的关系，旨在确定预测分子，以加强患者管理和个性化骨科治疗：泰安市中心医院开展了一项前瞻性队列研究，参与者包括接受开放复位内固定术的单侧闭合性锁骨骨折患者（n = 763，其中男性 546 人，女性 217 人）。术前采集血浆样本进行外泌体分离和 miRNA 提取，利用定量聚合酶链反应（qPCR）分析 miR-100、miR-124、miR-125b 和 miR-21。根据术后至少三个月的随访结果，将患者分为联合组和非联合组：结果：在 763 名患者中，720 人获得了骨结合，43 人出现了骨不连。值得注意的是，非骨结合组的外泌体 miR-21 表达水平明显升高。单变量分析表明，miR-21高表达与发生骨不连之间存在显著关联（相对风险 [RR] = 1.82，P = 0.0004）。多变量逻辑回归分析证实了这种关联（RR > 1.8，P < 0.05），并调整了协变量。高水平的 miR-21（3.12 至 7.89）与不愈合结果密切相关（RR > 4），与其他因素无关。接收者操作特征（ROC）曲线分析表明，miR-21在预测骨不连方面具有一定的临床诊断价值（曲线下面积 [AUC] = 0.7885）：结论：锁骨骨折患者术前外泌体 miR-21 水平的升高与三个月手术后骨不愈合风险的增加显著相关，这表明 miR-21 具有作为非特异性预测分子的潜力。

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引用次数: 0

Manipulation of signaling pathways in bone tissue engineering and regenerative medicine: Current knowledge, novel strategies, and future directions 操纵骨组织工程和再生医学中的信号通路：当前知识、新策略和未来方向。

IF 2.2 3区医学 Q3 CRITICAL CARE MEDICINE

Injury-International Journal of the Care of the Injured

Pub Date : 2024-10-24 DOI: 10.1016/j.injury.2024.111976

Ahmad Oryan , Seyed Ali Afzali , Nicola Maffulli

During osteogenesis, a large number of bioactive molecules, macromolecules, cells, and cellular signals are activated to induce bone growth and development. The activation of molecular pathways leads to the occurrence of cellular events, ultimately resulting in observable changes. Therefore, in the studies of bone tissue engineering and regenerative medicine, it is essential to target fundamental events to exploit the mechanisms involved in osteogenesis. In this context, signaling pathways are activated during osteogenesis and trigger the activation of numerous other processes involved in osteogenesis. Direct influence of signaling pathways should allow to manipulate the signaling pathways themselves and impact osteogenesis. A combination of sequential cascades takes place to drive the progression of osteogenesis. Also, the occurrence of these processes and, more generally, cellular and molecular processes related to osteogenesis necessitate the presence of transcription factors and their activity. The present review focuses on outlining several signaling pathways and transcription factors influencing the development of osteogenesis, and describes various methods of their manipulation to induce and enhance bone formation.

在成骨过程中，大量生物活性分子、大分子、细胞和细胞信号被激活，以诱导骨骼的生长和发育。分子通路的激活导致细胞事件的发生，最终产生可观察到的变化。因此，在骨组织工程和再生医学研究中，必须以基本事件为目标，利用参与骨生成的机制。在这种情况下，信号通路在成骨过程中被激活，并触发激活参与成骨的许多其他过程。直接影响信号通路可以操纵信号通路本身并影响成骨过程。一系列相继发生的级联反应共同推动成骨过程的进展。此外，这些过程的发生，以及更广泛地说，与成骨相关的细胞和分子过程，都需要转录因子的存在及其活性。本综述重点概述了影响成骨过程的几种信号通路和转录因子，并介绍了操纵它们来诱导和促进骨形成的各种方法。

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引用次数: 0

Shock wave damage from the ventral side in primary blast injury: An experimental study in pigs 原发性爆炸伤害中来自腹侧的冲击波损伤：猪的实验研究

IF 2.2 3区医学 Q3 CRITICAL CARE MEDICINE

Injury-International Journal of the Care of the Injured

Pub Date : 2024-10-23 DOI: 10.1016/j.injury.2024.111982

Nobuaki Kiriu , Daizoh Saitoh , Yasumasa Sekine , Koji Yamamura , Ruka Sasa , Masanori Fujita , Hitoshi Tsuda , Satoshi Tomura , Tetsuro Kiyozumi

Aim/Purpose

This study aimed to apply a shock wave from the ventral side of a pig and examine its effect to use the results for new body armor production for humans.

Methods

Seven male hybrid pigs were used. Each pig was placed under general anesthesia on the experimental table in a blast tube in the left lateral position to expose the front chest area, and shock waves generated by compressed air at 3.0 MPa were applied. We examined changes in vital signs and arterial blood gas in the hyper-acute phase and computed tomography (CT) images, and autopsies were performed for organ damage after 3 h of observation. Pathological examination was performed for lung damage, which is considered a characteristic of shock wave injury.

Results

All seven pigs survived. Respiratory arrest occurred in two pigs; however, spontaneous breathing resumed promptly afterward. Hypotension occurred at a frequency of 4. No bradycardia or cardiac arrest was observed in any pig. In the arterial blood gas analysis before and immediately after shock wave exposure and 1 h later, PaO2 decreased immediately but tended to improve thereafter. CT revealed pulmonary contusions and multiple bulla-like lesions on the surface of the lungs. An autopsy showed lung injury in all pigs, particularly in five cases with bulla-like lesions of various sizes on the lung surface across all lobes. Pathological findings showed visceral pleural detachment with elastic fibers from the lung parenchyma, and the cavity lesion on the lung surface comprised bullae. The degree of intra-abdominal hemorrhage varied; however, all but one case showed splenic injury.

Conclusion

None of the pigs exposed to shock waves from the ventral side died; however, most showed multiple bullae on the lung surface with lung contusion and splenic injury, which may have been greater than those exposed from the dorsal side. This may be due to the direct impact of the shock wave proceeding from the epigastrium and subcostal region, which are not protected by the skeletal structure of the thorax. These characteristics should be considered when producing new body armor for humans to protect the body from shock waves.

目的本研究旨在从猪的腹侧施加冲击波并检查其效果，以便将结果用于人类新型防弹衣的生产。在全身麻醉的情况下，将每头猪置于实验台上的防爆管中，取左侧卧位以暴露前胸区域，并施加由 3.0 兆帕压缩空气产生的冲击波。我们检查了超急性期生命体征和动脉血气的变化以及计算机断层扫描（CT）图像，并在观察 3 小时后对器官损伤进行了解剖。对肺损伤进行了病理学检查，肺损伤被认为是冲击波损伤的特征之一。两头猪呼吸停止，但随后很快恢复了自主呼吸。发生低血压的频率为 4 次，没有观察到任何猪出现心动过缓或心跳停止。在冲击波暴露前和暴露后立即以及 1 小时后的动脉血气分析中，PaO2 立即下降，但随后趋于改善。CT 显示肺挫伤和肺表面多处鼓包样病变。尸检显示，所有猪的肺部都有损伤，尤其是有五头猪的肺表面出现了大小不等的鼓泡样病变，遍布所有肺叶。病理结果显示，内脏胸膜脱落，弹性纤维从肺实质中脱落，肺表面的空腔病变由鼓泡组成。结论从腹侧暴露于冲击波的猪无一死亡，但大多数猪的肺表面出现多个鼓包，并伴有肺挫伤和脾脏损伤，其程度可能比从背侧暴露于冲击波的猪更严重。这可能是由于冲击波从上腹部和肋下区域直接冲击所致，而上腹部和肋下区域不受胸部骨骼结构的保护。在为人类生产新的防弹衣以保护身体免受冲击波伤害时，应考虑到这些特征。

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引用次数: 0

Biomechanical comparison of Gofried positive support reduction of Pauwels type III femoral neck fractures: A finite elements analysis Pauwels III 型股骨颈骨折的 Gofried 正支撑复位术的生物力学比较：有限元分析

IF 2.2 3区医学 Q3 CRITICAL CARE MEDICINE

Injury-International Journal of the Care of the Injured

Pub Date : 2024-10-23 DOI: 10.1016/j.injury.2024.111979

Ming Ding , Zhihao Su , Daoyu Wang , Lan Mo , Jiong Mei , Wanju Sun , Shuang Li , Ming Ni

Objective

This study aims to investigate the biomechanical characteristics of non-anatomical reduction and different screw positions on the stability of Pauwels type III femoral neck fractures.

Methods

Three-dimensional finite element models of femoral neck fractures were constructed using CT images. Four types of internal fixation methods were simulated, including biplane double-supported screw fixation (BDSF), three inverted triangular parallel cannulated screws (3CS), new parallel cannulated screws with posterior screws moving down (New 3CS), and two parallel cannulated screws (2CS). von Mises stress and total displacement were compared between the fracture models after the femoral head was subjected to an axial load of 2100 N. Stress and displacement data for the implants and the femur were recorded for each fixation method and compared.

Results

The results demonstrated that positive reduction of a Pauwels type III femoral neck fracture provided greater stability than neutral or negative reduction. Specifically, the BDSF group showed the lowest maximum von Mises stress in the femur (17.66 MPa) in positive reduction, compared to 3CS (21.08 MPa), New 3CS (22.14 MPa), and 2CS (36.57 MPa). The total displacement of positive reduction in the BDSF group was 0.3143 mm, which was lower than in the 3CS (0.3498 mm), New 3CS (0.3343 mm), and 2CS (0.4533 mm) groups. The stress distribution in the positive support reduction group was lower than that of the other groups, indicating better load distribution. Among the three-screw fixation methods, the New 3CS system exhibited the highest stress in the screws (with a peak of 28.62 MPa), while the 2CS group displayed the highest stresses overall, both in the femur and the screws.

Conclusion

For Pauwels type III femoral neck fractures, a positive support reduction with BDSF fixation exhibited superior biomechanical performance than negative reduction. Based on the finite element analysis conducted in this study, the positive support reduction with BDSF fixation can enhance fixation stability, suggesting that non-anatomical reduction is recommended.

方法利用CT图像构建股骨颈骨折的三维有限元模型。模拟了四种内固定方法，包括双平面双支撑螺钉固定（BDSF）、三枚倒三角形平行套管螺钉（3CS）、后螺钉下移的新型平行套管螺钉（New 3CS）和两枚平行套管螺钉（2CS）。在股骨头承受 2100 N 的轴向载荷后，比较了不同骨折模型之间的冯米塞斯应力和总位移。具体而言，BDSF组在正位复位时股骨的最大von Mises应力（17.66 MPa）最低，而3CS（21.08 MPa）、新3CS（22.14 MPa）和2CS（36.57 MPa）最低。BDSF 组的正减位总位移为 0.3143 毫米，低于 3CS 组（0.3498 毫米）、新 3CS 组（0.3343 毫米）和 2CS 组（0.4533 毫米）。正向支撑减小组的应力分布低于其他组，表明载荷分布更好。在三螺钉固定方法中，新 3CS 系统的螺钉应力最大（峰值为 28.62 兆帕），而 2CS 组的股骨和螺钉整体应力最大。根据本研究进行的有限元分析，采用 BDSF 固定的正支撑复位可增强固定稳定性，建议采用非解剖复位。

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引用次数: 0

Development and validation of a preclinical canine model for early onset fracture-related infections 开发和验证早期骨折相关感染的临床前犬模型。

IF 2.2 3区医学 Q3 CRITICAL CARE MEDICINE

Injury-International Journal of the Care of the Injured

Pub Date : 2024-10-21 DOI: 10.1016/j.injury.2024.111957

Bryce W. Rigden , Aaron M. Stoker , Chantelle C. Bozynski , Tamara Gull , Cristi R. Cook , Keiichi Kuroki , James P. Stannard , James L. Cook

Fracture-related infections (FRIs) are a challenging complication in orthopaedics. Standard of care management for FRIs typically involves prolonged antibiotic therapies, irrigation and debridement (I&D) of the fracture site, and retention of fracture-fixation implants with or without exchange. Unfortunately, this treatment regimen is associated with treatment failure rates of up to 38 %, such that improved preventive and therapeutic interventions are needed. To test and develop these interventions, clinically relevant preclinical animal models are required. The purpose of this study was to develop and validate a canine model for early onset (<2 weeks) FRI that replicates its clinical, radiographic, bacteriologic, and histologic features. In this model, bilateral proximal fibular 1-cm ostectomies were created to mimic an open fracture, which was then stabilized using a plate and screws pre-incubated in methicillin-resistant Staphylococcus aureus (MRSA). After 7 days, I&D was performed and twice-daily systemic antibiotics were administered until the 17-day endpoint. This model consistently resulted in clinical signs of local infection, compromised wound healing, radiographic evidence for delayed bone healing and implant loosening, and implant-associated biofilm formation. Importantly, MRSA was isolated from deep tissue cultures in all dogs, and histological assessments detected bacteria and bacterial biofilms associated with all fracture-fixation implants at the study endpoint. These clinical, radiographic, bacteriologic, and histologic outcomes in conjunction with the capabilities for standard of care interventions, such as antibiotic treatment and I&D, verify that this preclinical canine model for early onset FRI effectively replicated the pathology associated with this commonly encountered complication of orthopaedic trauma.

骨折相关感染（FRIs）是骨科中一种具有挑战性的并发症。骨折相关感染的标准治疗方法通常包括长期抗生素治疗、骨折部位冲洗和清创（I&D），以及保留骨折固定植入物或不进行交换。遗憾的是，这种治疗方案的治疗失败率高达 38%，因此需要改进预防和治疗干预措施。为了测试和开发这些干预措施，需要临床相关的临床前动物模型。本研究的目的是开发并验证一种犬类早发性荨麻疹模型。

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引用次数: 0

Healthcare professionals beliefs and priorities for the rehabilitation of patients after ankle fracture surgery: A qualitative study 医护人员对踝关节骨折术后患者康复的信念和优先事项：定性研究。

IF 2.2 3区医学 Q3 CRITICAL CARE MEDICINE

Injury-International Journal of the Care of the Injured

Pub Date : 2024-10-20 DOI: 10.1016/j.injury.2024.111975

Christopher Bretherton , Ahmed Al-Saadawi , Prof Harbinder Sandhu , Prof Janis Baird , Prof Xavier Griffin

Objective

The study aims to understand healthcare professionals’ (HCPs) beliefs and practices in the treatment and rehabilitation of patients after ankle fracture surgery, with the goal of informing new rehabilitation interventions based on these insights.

Background

There is considerable variation in postoperative rehabilitation advice given to patients with ankle fractures, leading to inconsistent care. Prior studies have primarily focused on patients' experiences, making it crucial to explore HCPs' perspectives to identify areas for intervention.

Methods

The study utilised semi-structured interviews with HCPs involved in the multicentre randomised controlled Weightbearing in Ankle Fractures (WAX) trial. Interviewees included physiotherapists, consultant trauma and orthopaedic surgeons, and trainee surgeons. Interviews were conducted between February 2020 and December 2021. Data were analysed using a mixed deductive and inductive approach, aligning with the Behavioural Change Wheel framework to translate findings into potential intervention strategies.

Results

18 Interviews were conducted, revealing discrepancies between patient and HCP beliefs about recovery, particularly regarding weight-bearing and managing physical symptoms like swelling and numbness. HCPs expressed varying beliefs on the safety of early weight-bearing and recognised historical practice and medicolegal concerns influencing rehabilitation advice. Themes highlighted the need for clearer communication, standardised advice, and the impact of HCPs' remarks on patients' recovery confidence.

Conclusions

Findings underscore the mismatch between patient expectations and HCP guidance, emphasising the need for consensus on rehabilitation protocols. The study advocates for tailored rehabilitation pathways that address individual patient recovery trajectories, reduce dependency on HCPs, and encourage patient self-management.

研究目的本研究旨在了解医护人员（HCPs）在踝关节骨折术后患者的治疗和康复方面的信念和做法，目的是根据这些见解提供新的康复干预措施：背景：针对踝关节骨折患者的术后康复建议存在很大差异，导致护理不一致。之前的研究主要关注患者的经历，因此探讨医护人员的观点以确定干预领域至关重要：研究采用半结构化访谈的方式，对参与多中心随机对照踝关节骨折负重（WAX）试验的医疗保健人员进行访谈。受访者包括物理治疗师、创伤和矫形外科顾问医生以及实习外科医生。访谈于 2020 年 2 月至 2021 年 12 月期间进行。采用演绎和归纳相结合的方法分析数据，并与行为改变轮框架保持一致，以便将研究结果转化为潜在的干预策略：共进行了 18 次访谈，发现患者和保健医生对康复的看法存在差异，尤其是在负重和处理肿胀、麻木等身体症状方面。医疗保健人员对早期负重的安全性表达了不同的看法，并认识到历史实践和医疗法律问题对康复建议的影响。研究主题强调了更清晰的沟通、标准化建议的必要性，以及保健专业人员的言论对患者康复信心的影响：研究结果凸显了患者期望与医护人员指导之间的不匹配，强调了就康复方案达成共识的必要性。该研究提倡针对患者的个体康复轨迹量身定制康复路径，减少对保健医生的依赖，鼓励患者自我管理。

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引用次数: 0

An early analysis of polyetheretherketone (PEEK) plates for the surgical stabilization of rib fractures: A pilot study 用于手术稳定肋骨骨折的聚醚醚酮（PEEK）钢板的早期分析：试点研究

IF 2.2 3区医学 Q3 CRITICAL CARE MEDICINE

Injury-International Journal of the Care of the Injured

Pub Date : 2024-10-20 DOI: 10.1016/j.injury.2024.111969

Zachary M. Bauman , Yuqian Tian , Gregory Puthoff , Sarah Ann Whitbeck , Scott Gardner , Thomas W. White

Background

Surgical stabilization of rib fractures (SSRF) is a viable treatment option for rib fracture patients. Polyetheretherketone (PEEK) plates have become available for SSRF. The objective of this pilot study was to examine the use of PEEK plates for SSRF.

Methods

A prospective, observational, multi-center study of patients undergoing SSRF with PEEK plates from 4/23 through 2/24. Standard indications for SSRF were followed and the decision to use PEEK plates was left to the discretion of the treating surgeon. Basic demographics were obtained. Outcomes included the number of rib fractures stabilized with PEEK plates, complications related to SSRF, and 6-month follow-up with chest computed tomography (CT) to assess healing of PEEK repaired fracture sites, identified as complete or incomplete union. Patients also answered a five-question quality-of-life survey regarding mobility, self-care, usual activities, chest pain/discomfort, and anxiety/depression. Answers were scaled 1 to 5 (1=worse condition possible; 5=best possible condition). Patients rated their health on a scale of 0 to 100 (100=closet to their health preinjury). All data was reported as descriptive.

Results

Forty-six patients were included. Average age was 57(±16) years; 82.6 % were male. Median ISS was 18 (IQR 14,29) and median chest-AIS was 4 (IQR 3,4). 219 rib fractures were stabilized with PEEK plates. Sixteen (34.8 %) had a combination (PEEK + titanium) procedure. Three patients had a complication: one required a second surgery for additional SSRF, and two patients were readmitted. Twenty-seven patients were surveyed at 6 months, and 19 agreed to CT scan. Eighty PEEK repaired rib fractures were assessed for healing. 80 % of fractures had complete union and no hardware failure. Quality-of-life survey averaged >4.5/category and mean overall health was 89.

Conclusion

PEEK plates for SSRF are safe and effective, allowing for adequate rib fracture healing and are associated with positive patient reported outcomes.

背景肋骨骨折手术稳定（SSRF）是肋骨骨折患者的一种可行治疗方法。聚醚醚酮（PEEK）钢板已可用于 SSRF。这项试验性研究的目的是检查 PEEK 钢板在 SSRF 中的使用情况。方法对 4/23 年至 2/24 年期间使用 PEEK 钢板进行 SSRF 的患者进行前瞻性、观察性、多中心研究。研究遵循 SSRF 的标准适应症，由主治医生决定是否使用 PEEK 夹板。我们获得了基本的人口统计数据。研究结果包括用PEEK钢板稳定的肋骨骨折数量、与SSRF相关的并发症以及6个月的胸部计算机断层扫描（CT）随访，以评估PEEK修复的骨折部位的愈合情况，分为完全愈合和不完全愈合。患者还回答了关于活动能力、自理能力、日常活动、胸痛/不适以及焦虑/抑郁等五个问题的生活质量调查。答案分为 1 到 5 级（1=可能的最差状况；5=可能的最佳状况）。患者对自己健康状况的评分从 0 到 100（100=与受伤前的健康状况接近）。所有数据均为描述性报告。平均年龄为 57（±16）岁；82.6% 为男性。ISS中位数为18（IQR为14,29），胸部AIS中位数为4（IQR为3,4）。219 根肋骨骨折用 PEEK 钢板固定。16名患者（34.8%）采用了组合（PEEK+钛）手术。三名患者出现了并发症：一名患者需要进行第二次手术以增加 SSRF，两名患者再次入院。27 名患者在 6 个月时接受了调查，19 名患者同意接受 CT 扫描。对 80 例 PEEK 修复的肋骨骨折进行了愈合评估。80%的骨折完全愈合，没有出现硬件故障。生活质量调查的平均值为4.5/类，平均总体健康状况为89.结论用于SSRF的PEEK钢板安全有效，能使肋骨骨折充分愈合，患者报告的结果也很好。

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引用次数: 0

Urban-rural disparities in fatal and non-fatal paediatric injuries after trauma – A national retrospective cohort study 创伤后致命和非致命儿科伤害的城乡差异 - 一项全国性回顾性队列研究。

IF 2.2 3区医学 Q3 CRITICAL CARE MEDICINE

Injury-International Journal of the Care of the Injured

Pub Date : 2024-10-20 DOI: 10.1016/j.injury.2024.111968

June Alette Holter , Elisabeth Jeppesen , Trond Dehli , Eyvind Ohm , Torben Wisborg

Introduction

Paediatric trauma is a leading cause of death, with correlations between trauma outcomes and geographical locations. Certain rural regions of Norway face a higher risk of trauma-related fatalities compared to the nationwide population. Among adults, the risk of both fatal and non-fatal injuries rises with increased rurality. The study aimed to investigate whether there is an increased risk of fatal and non-fatal injuries for children in rural areas across the entire country, as well as any changes over two decades.

Materials and methods

We conducted a retrospective cohort study of fatal and non-fatal paediatric injuries by accessing two national registries for all trauma-related patients under the age of 18. All cases were stratified into six groups according to level of centrality based on a national index used as a proxy for rurality. For inter-group comparison, urban-rural disparities were evaluated using Pearson`s Chi-square test, linear regression, and relative risk (RR).

Result

1,059 paediatric deaths were included in the study period from 2002 to 2021. The mortality rate increased linearly with increased rurality (r = 0.985, p < .001). The overall mortality risk was 2.4 times higher in the most rural group compared to the most urban (RR = 2.37, 95 %CI 1.78 – 3.14, p < .001). Most deaths occurred pre-hospital (73 %), the total number of fatalities was highest in the age group 16 to 17 (42 %), and transport-related injury (32 %) was the most common cause of death. The relative risk of non-fatal injury was significantly higher for all centrality groups compared to most urban, and the highest rate was seen in sub-rural areas (RR = 1.39, 95 %CI 1.37 - 1.42, p < .001).

Conclusion

The mortality rate increased linearly across all levels of centrality, and the relative risk was 2.4 times higher in the most rural population compared to the most urban population. To effectively target primary prevention and enhance trauma care for paediatric patients in rural areas, a deeper epidemiological understanding and more comprehensive studies are essential.

简介儿童创伤是导致死亡的主要原因之一，创伤结果与地理位置有关。与全国人口相比，挪威某些农村地区因创伤致死的风险更高。在成年人中，致命和非致命外伤的风险随着农村人口的增加而上升。本研究旨在调查全国农村地区儿童的致命和非致命伤害风险是否增加，以及二十年来的变化情况：我们通过访问两个国家登记册，对所有 18 岁以下与创伤相关的患者进行了一次致命和非致命儿童伤害的回顾性队列研究。所有病例都根据作为乡村地区代表的国家指数的中心化水平被分为六组。为了进行组间比较，使用皮尔逊卡方检验、线性回归和相对风险（RR）对城乡差异进行了评估。死亡率随着乡村地区的增加而线性上升（r = 0.985，p < .001）。最偏远农村组的总体死亡风险是最偏远城市组的 2.4 倍（RR = 2.37，95 %CI 1.78 - 3.14，p < .001）。大多数死亡发生在入院前（73%），16 至 17 岁年龄组的死亡总人数最高（42%），与交通相关的伤害（32%）是最常见的死亡原因。与大多数城市相比，所有中心地带组的非致命伤害相对风险都明显较高，而农村以下地区的非致命伤害相对风险最高（RR = 1.39, 95 %CI 1.37 - 1.42, p < .001）：结论：死亡率在所有中心程度上都呈线性增长，与城市人口相比，农村人口的相对风险是城市人口的 2.4 倍。为了有效地针对农村地区的儿科患者进行初级预防并加强创伤护理，必须对流行病学进行更深入的了解和更全面的研究。

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引用次数: 0

What is the best surgical treatment for the geriatric patient with a severe ankle or pilon fracture – TTC nail or ORIF? 对于严重踝关节或皮隆骨折的老年患者，最佳手术治疗方法是 TTC 钉还是 ORIF？

IF 2.2 3区医学 Q3 CRITICAL CARE MEDICINE

Injury-International Journal of the Care of the Injured

Pub Date : 2024-10-19 DOI: 10.1016/j.injury.2024.111978

Gareth Ryan MD , Manjot Birk MD , Richard Buckley MD FRCS

引用次数: 0