Injury最新文献

Introduction: Atypical femoral fractures (AFFs) are a rare type of subtrochanteric or diaphyseal fracture frequently associated with the use of bisphosphonates (BPs). They are a clinical entity often overlooked, for which a correct clinical-instrumental classification is essential for a successful treatment. Nowadays, there is no accurate data on their real incidence. The aim of this work is to evaluate the period prevalence of AFFs and their risk factors, and to compare actual results with a previous study conducted at the same Institution seven years previously.

Materials and methods: The same methodology used in the previous study, conducted by the same Authors, was applied. Radiographs of all subtrochanteric and diaphyseal femoral fractures in patients over 60 years treated at a single Institution between January 2018 and February 2020 were reviewed, and cases that displayed the AFFs definition criteria were identified. Current and previous medical and pharmacological history were collected, and osteometabolic evaluation through the execution of first level blood tests, with the addition of a valuation of 25(OH)-vitamin D and parathormone was performed.

Results: Out of 40 subtrochanteric or diaphyseal femoral fractures in patient aged 60 years or older, four cases (10 %) presented a characteristic radiographic pattern significative for AFFs, in comparison with a 5 % observed in the previous study. All four patients were women with a positive (current or previous) history of BPs consumption.

Discussion: The efficacy of BPs for the prevention of osteoporotic fractures is widely demonstrated. However, particularly prolonged use of these drugs may increase the risk of developing AFFs in some patients. The incidence of AFFs is higher than that reported in the literature, if evaluated only for the subtrochanteric and diaphyseal sites (essential diagnostic criterion in the definition of AFFs). In our study, the incidence of AFFs doubled after seven years. The present data also confirm the frequent association between the use of BPs and the onset of AFFs.

Introduction: In recent years, a discernible shift has occurred in the approach to knee pathologies, specifically in the management of acute fractures. Traditionally, fractures were primarily treated through osteosynthesis, whereas prosthesis replacement was primarily reserved for degenerative issues. Outcomes of this investigation aim to elucidate the potential indications and contraindications for the use of prosthetic interventions in the management of such fractures and to propose a scoring system that can be adopted for the choice between the two different approaches.

Methods: A retrospective observational study was conducted on patients treated for periarticular knee fractures, with a focus on elderly patients. Patients aged older than 65 years treated in three Italian centers were recruited. Inclusion criteria comprised fractures around the knee, including distal femur types 33-A, 33-B, and 33-C, and proximal tibia types 41-A, 41-B, and 41-C, in accordance with the AO/OTA classification. Surgical treatment with osteosynthesis or arthroplasty was required and investigated.

Results: Between August 2017 and October 2022, 91 patients with periarticular knee fractures underwent surgical treatment, 23.1 % males and 76.9 % females, with 78 % undergoing osteosynthesis and 22 % acute total knee replacement. Distal femoral fractures constituted 37.4 %, while 62.6 % were proximal tibial fractures. Average age at surgery was 76.4 years. Patient outcomes were assessed using PROMs, revealing generally positive results, including survivorship of 95 % at the final follow-up for both groups using the Kaplan Meier survival estimate. The study introduces a novel Total Knee Replacement Indication Scoring System (TKRISS) based on the AO Classification.

Conclusions: Nowadays osteosynthesis remains the main treatment for fractures around the knee. In a geriatric patient's population and in carefully selected patients replacement can be a valid option for early weight bearing and quicker recovery comparing to fixation. The Total Knee Replacement Indication Scoring System provides a useful tool for healthcare to assess the potential indication for TKR in the context of knee fractures. It integrates a range of relevant factors, acknowledging the complex nature of patient care. Further clinical research and validation are essential to refine and optimize this scoring system.

Background: An abnormal shock index (SI) is associated with greater injury severity among children with trauma. We sought to empirically-derive age-adjusted SI cutpoints associated with major trauma in children, and to compare the accuracy of these cutpoints to existing criteria for pediatric SI.

Methods: We performed a retrospective cohort study using the 2021 National Trauma Data Bank (NTDB) Participant Use File. We included injured children (<18 years), excluding patients with traumatic arrests, mechanical ventilation upon hospital presentation, and inter-facility transfers. Our outcome was major trauma defined by the standardized triage assessment tool (STAT) criteria. Our exposure of interest was the SI. We empirically-derived upper and lower cutpoints for the SI using age-adjusted Z-scores. We compared the performance of these to the SI, pediatric-adjusted (SIPA), and the Pediatric SI (PSI). We validated the performance of the cutpoints in the 2019 NTDB.

Results: We included 64,326 and 64,316 children in the derivation and validation samples, of whom 4.9 % (derivation) and 4.0 % (validation) experienced major trauma. The empirically-derived age-adjusted SI cutpoints had a sensitivity of 43.2 % and a specificity of 79.4 % for major trauma in the validation sample. The sensitivity of the PSI for major trauma was 33.9 %, with a specificity of 90.7 % among children 1-17 years of age. The sensitivity of the SIPA was 37.4 %, with a specificity of 87.8 % among children 4-16 years of age. Evaluated using logistic regression, patients with an elevated age-adjusted SI had 3.97 greater odds (95 % confidence interval [CI] 3.63-4.33) of major trauma compared to those with a normal age-adjusted SI. Patients with a depressed SI had 1.55 greater odds (95 % CI 1.36-1.78) of major trauma. The area under the receiver operator characteristic curve (AUROC) for the empirically-derived model (0.62, 95 % CI 0.61-0.63) was similar to the AUROC for PSI (0.62, 95 % CI 0.61-0.63); both of which were greater than the SIPA model (0.58, 95 % CI 0.57-0.59).

Conclusion: Age-adjusted SI cutpoints demonstrated a mild gain in sensitivity compared to existing measures. However, our findings suggest that the SI alone has a limited role in the identification of major trauma in children.

Background: There is a global surge in blast injuries, which are associated with high morbidity and mortality. To our knowledge, there are no guidelines for the management of blast injuries in the trauma bay.

Methods: This single-center retrospective cohort study utilized data on all patients admitted to our emergency department (ED) with terror- or combat-related injuries between October 7, 2023 (Gaza Iron Swords War onset) and February 4, 2024. The primary outcome was trauma severity indicated by either an injury severity score (ISS) >15 and/or need for acute care. We also analyzed the mechanisms of injuries, focusing on those resulting from blasts.

Results: Of 208 patients who were admitted following terror-and combat related injuries, 109 patients (101 males [93 %], median age 24.0 years) were admitted following blast injuries. Of them, 88 % were military personnel and 12 % were civilians, with a median ISS of 8 [IQR:4.0-17.0]. The level of trauma was severe in 48 patients (44 %). Tertiary sub-category of blast injuries (P =0.004), chest (P =0.032), abdomen (P =0.018), and lower extremities (P =0.044) injuries were significantly associated with severe trauma. Blast injuries mandated the urgent availability of specialist personnel and appropriate equipment to contend with multiple life-threatening sequelae of exposure to blasts upon the arrival of the victims to emergency services.

Conclusion: Blast injuries present unique challenges in management and demand a multidisciplinary approach and specialized resources. We present an algorithm for terror- and combat-related blast injuries treated in our trauma bay. The step-by-step procedures may be applicable to any blast injury sustained under variable conditions.