Injury-International Journal of the Care of the Injured最新文献

{"title":"Women undergoing primary total hip arthroplasty (THA) for hip fracture have lower in-hospital mortality compared to men","authors":"Sumanth R. Chandrupatla ,&nbsp;Jasvinder A. Singh","doi":"10.1016/j.injury.2024.111970","DOIUrl":"10.1016/j.injury.2024.111970","url":null,"abstract":"<div><h3>Introduction</h3><div>We evaluated the association of patient sex with in-patient mortality and discharge disposition after primary total hip arthroplasty (THA) for hip fracture in the U.S.</div></div><div><h3>Methods</h3><div>Using the 2016–2019 U.S. National Inpatient Sample (NIS), we calculated adjusted odds ratios (aOR) and 95% confidence intervals (CI) of the association of sex with post-procedural complications and in-hospital mortality after primary THA for hip fracture, adjusting for demographics, social determinants of health, medical comorbidity, hospital characteristics, and post-procedural complications.</div></div><div><h3>Results</h3><div>There were 400,930 primary THA procedure hospitalizations for hip fracture in the 2016–2019 NIS data. In multivariable-adjusted analysis, compared to males, female sex was associated with lower in-hospital mortality following THA for hip fracture (aOR 0.65, 95 % CI 0.58 - 0.74; p &lt; 0.001). Multivariable-adjusted analysis showed that female sex was associated with higher odds of discharge to a non-home destination after a THA for hip fracture (aOR 1.14, 95 % CI 1.07 - 1.22; p &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>Female sex was associated with lower in-hospital mortality after a THA for hip fracture. Further insights into the protective mechanisms that mediate this lower mortality in women undergoing a THA for hip fracture are needed to achieve better outcomes for men in the future.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"55 12","pages":"Article 111970"},"PeriodicalIF":2.2,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142560815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recovery after neurologic injury in operative acetabular and pelvic fractures: Defining the natural history of foot drop","authors":"Colby C. Wollenman ,&nbsp;Cade A. Morris ,&nbsp;Ridge Maxson ,&nbsp;Claudia Davidson ,&nbsp;Jacquelyn S. Pennings ,&nbsp;Phillip M. Mitchell","doi":"10.1016/j.injury.2024.111974","DOIUrl":"10.1016/j.injury.2024.111974","url":null,"abstract":"<div><h3>Introduction</h3><div>Dorsiflexion weakness, or footdrop, is a well-described sequela of high-energy acetabular and pelvic trauma, but little data exists describing the factors related to neurologic recovery and the timeline therein. An improved understanding of these factors would facilitate prognostication, patient education, and treatment decision-making. The aim of this study was to compare neurologic recovery between acetabular and pelvic fractures, delineate factors associated with recovery, and determine the expected timeline of recovery.</div></div><div><h3>Methods</h3><div>A retrospective chart review was conducted at a level 1 tertiary referral center from 2000 to 2021 using CPT codes and keyword search functions to identify adult patients with neurologic injury in the setting of operative acetabular and/or pelvic ring trauma. Patients were included if they had documented, graded weakness not clearly explained by a concomitant injury (extremity or spine) following a pelvic/acetabular injury. Patients were followed to a minimum of 6 months follow-up or to neurologic recovery. Primary outcomes were the presence of motor recovery and time to initial and maximum recovery. The contributions of injury type and initial neurologic status were analyzed using logistic regression for impact on neurologic recovery.</div></div><div><h3>Results</h3><div>We identified 121 patients with neurologic injury and resultant footdrop in the setting of an operative pelvic ring or acetabular fracture. From this cohort, 58 patients (47.9 %) demonstrated some degree of neurologic recovery in follow-up. There was no difference in recovery when comparing injury type (pelvis vs. acetabulum). Any motor function (including flicker) at time of initial evaluation was predictive of recovery (OR 6.18, [2.00 – 19.14]; <em>p</em> = 0.002). Initial neurologic function also correlated with more rapid recovery in comparison to patients with initial absent neurologic function both in time to initial recovery (56 days vs 107 days; <em>p</em> = 0.016) and time to maximum recovery (153 days vs 241 days; <em>p</em> = 0.027).</div></div><div><h3>Conclusions</h3><div>These results highlight the relatively poor prognosis for neurologic recovery in operative pelvic and acetabular injuries. Any initial neurologic function is predictive of likelihood of neurologic recovery and correlates with a more expedient neurologic recovery. Ultimately, this enables providers to better educate patients and facilitates decisions regarding further intervention.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"55 12","pages":"Article 111974"},"PeriodicalIF":2.2,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142554522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical challenges in Non-combatant Evacuation Operations","authors":"Bruno de La Villéon ,&nbsp;Alexandre Caubère ,&nbsp;Alexis Maffert ,&nbsp;Jérôme Planchon ,&nbsp;Franck Albisson ,&nbsp;Hugues de Martène ,&nbsp;Alexandre Noël ,&nbsp;Brice Malgras","doi":"10.1016/j.injury.2024.111961","DOIUrl":"10.1016/j.injury.2024.111961","url":null,"abstract":"<div><h3>Background</h3><div>Global uncertainties have prompted nations to adopt vigilant approaches to safeguard their citizens. Recent crises have compelled Western nations to undertake evacuations, ranging from peaceful scenarios to urgent military interventions. In April 2023, Sudan descended into civil war, prompting France to orchestrate a complex evacuation operation leveraging prepositioned forces in Djibouti.</div></div><div><h3>Materials &amp; Methods</h3><div>This retrospective observational study aims to analyze the surgical challenges encountered during Operation SAGITTAIRE (OS), focusing on human, technical, and logistical requirements for successful military interventions in multinational civilian populations.</div></div><div><h3>Results</h3><div>OS successfully evacuated 1017 individuals of 84 nationalities from Khartoum using road, sea, and air routes. Special forces teams, including the Surgical Life-saving Module (SLM), were mobilized alongside conventional military elements. The Joint Medical Surgical Center (JMSC) in Djibouti served as a permanent medical facility with comprehensive facilities and staff. Air Medical evacuations were performed for vicitms and surgical interventions were conducted, including damage control surgery, orthopedic procedures, and debridements. Five surgical evaluations and four surgical procedures were performed. The operation spanned 96 h without death. The SLM, deployed in Khartoum and within an aircraft, played a crucial role.</div></div><div><h3>Discussion</h3><div>OS highlighted the need for a comprehensive health support system. Challenges in assessing health needs led to the establishment of a substantial and adaptable system. The report emphasizes the importance of a comprehensive approach to support Non-combatant Evacuation Operations in French Doctrine.</div></div><div><h3>Conclusion</h3><div>OS showcased the French Health Military Service's capabilities in deploying a comprehensive damage control chain in challenging environments. This fatality-free success underlines the effectiveness of coordinated resuscitation, damage control, and transportation. Evacuation operations in non-combatant settings during civil wars pose formidable challenges, requiring a modular and adaptable support concept. Coordination, communication, logistical preparation, and training are crucial elements for successful management of such operations.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"55 12","pages":"Article 111961"},"PeriodicalIF":2.2,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142532201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fracture patterns in bicycle accidents: A descriptive national cohort study of fractures sustained in bicycle accidents in the Swedish Fracture Register 2015–2022","authors":"Sofie Josefsson ,&nbsp;Anders Brüggemann ,&nbsp;Olof Wolf ,&nbsp;Hans Peter Bögl","doi":"10.1016/j.injury.2024.111960","DOIUrl":"10.1016/j.injury.2024.111960","url":null,"abstract":"<div><h3>Introduction</h3><div>Bicycle accidents account for the majority of traffic-related accidents in Sweden. Despite the widespread everyday use of bicycles, little is known about the fracture panorama resulting from bicycle accidents. This study analysed the fracture patterns of bicycle accidents in Sweden in regard to fracture type, sex, age, and type of bicycle.</div></div><div><h3>Material and methods</h3><div>We retrieved data from the Swedish Fracture Register on all fractures caused by bicycle accidents between 2015 and 2022. The study population was comprised of both children and adults who had sustained one or more fractures in a bicycle accident as registered in the Swedish Fracture Register.</div></div><div><h3>Results</h3><div>We included 33,384 fractures (25,960 in adults and 7424 in children) in 30,815 patients, with a dominance of fractures in men. The mean age at fracture was 41.6 years (SD 23). The majority of fractures (62.7 %, <em>n</em> = 20,932) were sustained via a low energy mechanism. Overall, the most commonly fractured body parts were the forearm (35.2 %, <em>n</em> = 11,747), the hand (15.6 %, <em>n</em> = 5,196) and the clavicle (13.7 %, <em>n</em> = 4,558). In children, fractures of the forearm (56.8 %, <em>n</em> = 4,215) clearly dominated, followed by the hand (11.7 %, <em>n</em> = 868), and the humerus (11.0 %, <em>n</em> = 816). In adults, the top 3 fracture locations were the forearm (29.0 %, <em>n</em> = 7,532), the hand (16.7 %, <em>n</em> = 4,328), and the clavicle (15.7 %, <em>n</em> = 4,086). Mountain bikes and road bikes showed a fracture panorama that was very similar with a predominance of fractures to the clavicle. Fractures were more common during the warm season.</div></div><div><h3>Conclusion</h3><div>The main finding is that bicyclists predominantly sustained fractures of the upper limb via low energy mechanisms. The fracture panorama differed by age, sex, and type of bicycle.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"55 12","pages":"Article 111960"},"PeriodicalIF":2.2,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142549797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of orthogeriatric co-management with prescription frequencies of anti-osteoporotic drugs in patients with fragility fractures: An observational study with health insurance data","authors":"Kilian Rapp ,&nbsp;Daniel Schöne ,&nbsp;Patrick Roigk ,&nbsp;Clemens Becker ,&nbsp;Andrea Jaensch ,&nbsp;Dietrich Rothenbacher ,&nbsp;Claudia Konnopka ,&nbsp;Hans-Helmut König ,&nbsp;Markus Gosch ,&nbsp;Thomas Friess ,&nbsp;Gisela Büchele","doi":"10.1016/j.injury.2024.111971","DOIUrl":"10.1016/j.injury.2024.111971","url":null,"abstract":"<div><h3>Background</h3><div>Geriatricians are increasingly involved in the treatment of fragility fractures. In Germany, hospitals that meet specific standards for orthogeriatric co-management (OGCM) are additionally certified as 'geriatric trauma centers.' One responsibility of OGCM is the appropriate management of osteoporosis through medication. We aimed to analyse the association between prescription frequencies of anti-osteoporotic drugs in hospitals with certified OGCM, those with non-certified OGCM, and those with no OGCM at all.</div></div><div><h3>Methods</h3><div>Claims data from nearly 200,000 patients aged 80 and older with an incident index fracture of the humerus, forearm, hip, pelvis, or spine, were obtained from a German health insurance. Hospitals were categorized into three groups: no OGCM, with OGCM, and with certified OGCM. The outcomes were new prescriptions for specific anti-osteoporotic drugs and vitamin D within 180 days after the index fracture. Crude incidences and adjusted incidence rate ratios (IRR) were calculated.</div></div><div><h3>Results</h3><div>Prescription rates of specific anti-osteoporotic drugs and vitamin D increased from hospitals with no OGCM to hospitals with OGCM and were highest in hospitals with certified OGCM. This pattern was observed across all fracture types, age groups, and both men and women, except for forearm fractures. For example, in hip fractures, the IRR for prescriptions of specific anti-osteoporotic drugs in hospitals with certified OGCM compared to those with no OGCM was 2.17 (95 % CI: 1.90–2.48).</div></div><div><h3>Conclusion</h3><div>OGCM, especially when coupled with certification as a 'Geriatric Trauma Center,' is associated with higher prescription rates of specific anti-osteoporotic drugs and vitamin D after fragility fractures in Germany.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"55 12","pages":"Article 111971"},"PeriodicalIF":2.2,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142554521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic factors of falls in hospitalized adults and elderly: An epidemiological and clinical analysis","authors":"Maria Nathalia Silva ,&nbsp;Yanne da Silva Camargo ,&nbsp;Tathiane Ribeiro da Silva ,&nbsp;Andrea M. Bernardes da Silva ,&nbsp;Diogo Fernandes dos Santos ,&nbsp;Douglas Eulálio Antunes","doi":"10.1016/j.injury.2024.111966","DOIUrl":"10.1016/j.injury.2024.111966","url":null,"abstract":"<div><h3>Background</h3><div>Falls are known to cause injuries ranging from minor to severe, resulting in local or systemic lesions. Addressing prognostic factors associated with falls is crucial for preventing this adverse event through the implementation of patient care protocols. This study aimed to explore the epidemiological, clinical, and pharmacological prognostic factors influencing falls in adult and elderly patients, assessing the timing and impact of these factors using survival curve analysis.</div></div><div><h3>Methods</h3><div>A retrospective observational cohort study included 176 hospitalized patients experiencing falls, categorized into adults (&lt;60 years) and elderly (≥60 years). Binomial tests and logistic regression assessed variable associations, while Kaplan-Meier curves and Cox proportional hazards models analyzed survival.</div></div><div><h3>Results</h3><div>Overall, 25.9 % of adults and 33.3 % of the elderly experienced some form of injury (minor or moderate). Patients were alone during the fall in 77.6 % of cases for those under 60, compared to 50 % for those 60 and older (<em>p</em> &lt; 0.001). Falls from own height were the most common, occurring in 46.6 % of patients under 60 years and 66.7 % of elderly patients (<em>p</em> = 0.011). Among adults under 60, factors such as past alcohol history (<em>p</em> = 0.0276), falling alone (<em>p</em> = 0.0002), benzodiazepine use (<em>p</em> = 0.0001), antiarrhythmic/antihypertensive medication (<em>p</em> = 0.0005), and antipsychotics (<em>p</em> = 0.0001) were significantly associated with falls. In the elderly, significant factors included falling from one's own height (<em>p</em> = 0.0112), muscle weakness (<em>p</em> = 0.0183), gait disorders (<em>p</em> = 0.0443), vasodilators (<em>p</em> = 0.0107), antihistamines (<em>p</em> = 0.0003), and hypoglycemic agents (<em>p</em> = 0.0041). Survival curve analysis indicated women under 60 had a worse prognosis for falls compared to elderly women (<em>p</em> = 0.038). For the elderly, opioid use (<em>p</em> = 0.045) and muscle weakness (<em>p</em> = 0.037) represented poor prognostic factors compared to adults under 60. In Cox regression, only female sex in patients under 60 showed a higher risk (HR=1.47) compared to women over 60 (<em>p</em> = 0.0014). Although not significant in multivariate analysis, muscle weakness (<em>p</em> = 0.066) and opioid use (<em>p</em> = 0.0545) had proportional hazards of 1.37 and 1.12, respectively.</div></div><div><h3>Conclusion</h3><div>Female sex indicated poorer prognosis in &lt;60 s, while opioids and muscle weakness were concerning for the elderly. These findings emphasize the need for tailored care protocols to stratify patient fall risk and prognosis during hospitalization and develop effective preventive strategies in healthcare<strong>.</strong></div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"55 12","pages":"Article 111966"},"PeriodicalIF":2.2,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A comprehensive review of current trends in e-scooter associated injuries, associated outcomes, and effective interventions: Towards establishing sustainable prevention interventions","authors":"Sanjan Kumar ,&nbsp;Philip Lee ,&nbsp;Ruth Zagales ,&nbsp;Zackary Yates ,&nbsp;Minna Haddadi ,&nbsp;Jacob Strouse ,&nbsp;Tracy Zito ,&nbsp;Adel Elkbuli","doi":"10.1016/j.injury.2024.111967","DOIUrl":"10.1016/j.injury.2024.111967","url":null,"abstract":"<div><h3>Introduction</h3><div>This review aims to provide a comprehensive overview of electric-scooter (E-Scooter) injuries by evaluating the incidence, common mechanisms of injury, clinical outcomes, associated costs, and effective interventions for injury prevention.</div></div><div><h3>Methods</h3><div>A literature search using PubMed, Google Scholar, EMBASE, and ProQuest was performed to identify relevant articles published between July 10, 2014, and July 10, 2024. Outcomes of interest included epidemiologic trends of E-Scooter injuries, common mechanisms of injury, associated risk factors, clinical outcomes, and interventions to decrease E-Scooter injuries.</div></div><div><h3>Results</h3><div>A total of 41 articles were included in this study, with 39 evaluating the epidemiologic trends of e-scooter injuries, 22 the most common mechanisms of injury, 21 assessed intoxication, 15 assessed helmet usage, 33 determined patient's clinical outcomes, and 3 assessed effective interventions for decreasing the incidence of e-scooter injuries. Falls were the most common mechanism of injury; however, collisions with motor vehicles caused more severe injuries. Additionally, studies showed that up to 74 % of all E-Scooter injuries included alcohol intoxication, and over 80 % did not use a helmet leading to severe head injuries.</div></div><div><h3>Conclusion</h3><div>The incidence of E-Scooter related injuries rose significantly in recent years. These injuries typically result from falls and MVAs and are compounded by factors including limited helmet usage and riding while intoxicated. These contribute to the poorer clinical outcomes seen with E-Scooter injuries. However, there remains a significant paucity of literature focused on the outcomes of policies and interventions designed to reduce these injuries. Further investigation must address these gaps and discrepancies to inform future policies.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"55 12","pages":"Article 111967"},"PeriodicalIF":2.2,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142531802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A comparison between nail-plate constructs and the plate-on-plate technique in the treatment of proximal femoral peri-implant fracture","authors":"Yu-Chun Chuang ,&nbsp;Yen-Chun Chiu ,&nbsp;Chin-Hsien Wu ,&nbsp;Kun-Ling Tsai ,&nbsp;I-Ming Jou ,&nbsp;Yuan-Kun Tu ,&nbsp;Ching-Hou Ma","doi":"10.1016/j.injury.2024.111972","DOIUrl":"10.1016/j.injury.2024.111972","url":null,"abstract":"<div><h3>Study design</h3><div>A single-centre, retrospective cohort study.</div></div><div><h3>Objectives</h3><div>To compare the clinical outcomes between nail-plate constructs and the plate-on-plate technique in the treatment of proximal femoral peri-implant fracture (PFPIF).</div></div><div><h3>Methods</h3><div>Thirty-seven patients with PFPIF treated at our hospital were included. All patients underwent at least 1-year follow-up. Imaging studies and medical records, including walking ability, complications, and functional outcomes 1 year after surgery, were thoroughly reviewed.</div></div><div><h3>Results</h3><div>Twenty patients were treated with nail-plate constructs. Seventeen patients were treated with the plate-on-plate technique. The average surgical times in the plate-on-plate technique and nail-plate construct groups were 119.4 ± 23.4 min and 246.3 ± 48.0 min, respectively. The average blood losses in the plate-on-plate technique and nail-plate construct groups were 124.7 ± 41.6 mL and 434.3 ± 170.8 mL, respectively. The plate-on-plate technique group had a significantly shorter surgical time and less blood loss than the nail-plate construct group. No statistically significant differences were found in union time, ambulation status, 36-item Short Form Health Survey score, and complication rate between the two groups.</div></div><div><h3>Conclusion</h3><div>The plate-on-plate technique can be considered an alternative option to reduce operation time and blood loss in the treatment of PFPIF, especially for older patients and those who are less capable of sustaining long-term operation and anaesthetic exposure.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"55 12","pages":"Article 111972"},"PeriodicalIF":2.2,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142554614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"No difference in early outcomes comparing intramedullary versus extramedullary fibular fixation in operative ankle fractures","authors":"Kyle Auger,&nbsp;Ian S. Hong,&nbsp;McKenzie A. Mayer,&nbsp;Pasquale Gencarelli Jr.,&nbsp;Conner J. Robbins,&nbsp;Jaclyn M. Jankowski,&nbsp;Frank A. Liporace,&nbsp;Richard S. Yoon","doi":"10.1016/j.injury.2024.111973","DOIUrl":"10.1016/j.injury.2024.111973","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;The purpose of this study was to compare postoperative complications and outcomes of minimally invasive intramedullary fixation (IMF) versus plate fixation (PF) in the treatment of distal fibular fractures.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Materials and methods&lt;/h3&gt;&lt;div&gt;A retrospective review was performed from identifying all consecutive ankle fracture patients aged ≥18-years-old surgically managed between August 2017 to September 2022 at a tertiary care center with minimum 6 months clinical follow-up. Patients were grouped into those receiving intramedullary versus extramedullary fibular fixation. The primary outcomes were relevant demographic factors (diabetes, osteoporosis, charlson comorbidity index [CCI]), surgical time, complication rates, reoperation rates. Secondary outcomes included time to definitive fracture fixation, fracture characteristics (AO/OTA and Lauge-Hansen classification), syndesmotic instability requiring fixation and discharge disposition.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Forty-one IMF patients (average age 55.3 ± 18.1yrs) and 162 PF patients (47.7 ± 17.4yrs) were identified and included in this study. Within the IMF group, 25 patients received IM nailing and 16 patients received percutaneous screw fixation. A greater proportion of IMF patients had diabetes (39 % vs 22 %, p &lt; 0.001), osteoporosis (22 % vs 3 %, p &lt; 0.001), and moderate or severe CCI (41 % vs 23 %, p = 0.017). Surgical time was significantly reduced when using IMF technique (80.4 ± 43.1 min vs 99.1 ± 43.1 min, p = 0.012). Overall complication rates or time to complication did not differ significantly between groups (p = 0.578 and p = 0.082, respectively); however, when sub-stratified, IMF patients trended towards experiencing fewer wound related complications versus PF patients (5 % vs 9 %, p = 0.291). No IMF patients experienced deep or superficial infections and only 2 (5 %) patients experienced wound dehiscence. Reoperation rates(15 % vs 10 %, p = 0.267) and time to fracture union (2.7 ± 2.2 mos vs 3.1 ± 2.0 mos, p = 0.301) did not differ significantly. At final follow-up (IMF: 15.0 ± 12.2 mos vs PF: 28.5 ± 19.5 mos), Olerud and Molander ankle score was significantly higher in IMF compared to PF (87.1 ± 14.2 vs 76.2 ± 22.6, p = 0.002).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;Patients in the IMF group at baseline had several comorbid medical conditions that put them at high risk for wound related complications, however, postoperatively they demonstrated higher functional scores and similar complication rates compared to the PF group. It is important to note, however, while we expected a higher rate of wound issues with the PF group, there were no significant differences in infection rates. Either IMF and PF is reliable for fixation and outcomes, and thus with proper soft tissue, biologically friendly technique, either IMF or PF is a reliable choice in the fixation of fibula fractures.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Level of evidence&lt;/h3&gt;&lt;","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"55 12","pages":"Article 111973"},"PeriodicalIF":2.2,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142532200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"VTE rates and risk factors in major trauma patients","authors":"Bibi Bassa ,&nbsp;Elizabeth Little ,&nbsp;David Ryan ,&nbsp;John Cronin ,&nbsp;Frank Lyons ,&nbsp;Fionnuala Ni Ainle ,&nbsp;Tomas Breslin","doi":"10.1016/j.injury.2024.111964","DOIUrl":"10.1016/j.injury.2024.111964","url":null,"abstract":"<div><h3>Background</h3><div>Venous thromboembolism (VTE) is a common and in some instances life-threatening complication following severe traumatic injury. Owing to a lack of high-quality evidence in VTE risk prediction and prevention in this cohort, major trauma patients receive variable VTE preventative care. The aim of this systematic review was to determine the reported rates of VTE in major trauma patients, and associated risk factors.</div></div><div><h3>Methods</h3><div>A comprehensive database search was conducted using EBSCO/MEDLINE, EMBASE, CINAHL, Cochrane and Scopus to identify studies published between 1990 and 2023. Original Studies quantifying the occurrence of and/or evaluating risk factors for VTE, PE and DVT in a defined population were eligible for inclusion. Five reviewers screened, appraised, and extracted data from the selected studies.</div></div><div><h3>Results</h3><div>A total of 22 studies fulfilled the inclusion criteria. Most studies were conducted in Northern America (72 %), followed by Asia (18 %), and Europe (9 %). Of the 22 studies, 17 were retrospective, 4 were prospective and 1 was the control arm of an RCT. The reported rates in included studies ranged from 0.39 % to 32 % (VTE), 0.59 % to 57.60 % (DVT) and 0.35 % to 24.0 % (PE). Operative procedure was the most consistently reported associated variable for DVT followed by <em>delays to prophylaxis</em> and pelvic injury. Lower extremity injury was the most frequently reported associated variable for PE followed by male sex and increased age. Age was the most frequently reported variable for both DVT and PE.</div></div><div><h3>Conclusion</h3><div>There exists significant variation in the reported rates of VTE in major trauma patients globally. Operative procedure, delays to prophylaxis and pelvic injury were the most consistently reported associated variables for DVT. Lower extremity injury followed by male sex and increased age were the most frequently reported associated variables for PE. Although studies indicate possible differences in risk factors for DVT and PE, heterogeneity in study characteristics and outcome reporting impedes any meaningful conclusions. Reconciliation of VTE rates in major trauma patients is necessary when comparing populations.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"55 12","pages":"Article 111964"},"PeriodicalIF":2.2,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142554520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}