Pub Date : 2023-09-04DOI: 10.22141/1608-1706.2.24.2023.946
V.V. Shtroblya, S.S. Philip, S.M. Drogovoz
Background. Osteoarthritis of the knee (OAK) causes severe pain and sometimes disability, which reduces the quality of life and work capacity of patients. Today, the prevalence of OAK is increases; therefore, the development of methods for its treatment and the use of means that slow down or stop the progression of OAK are relevant. Since OAK is a slowly progressive disease, the search for effective drugs with minimal toxicity and a long-lasting effect, which prevent the destruction of articular cartilage and improve the working conditions of the patient, is ongoing. Thus, the main goals of OAK treatment are to reduce symptoms and slow the progression of the disease, which can reduce the negative impact of OAK on the patient’s functional capacity, as well as improve quality of life. OAK is characterized by the progressive destruction of the articular cartilage, especially when it bears a load. In the joint, cartilage aggrecan is the main structural component that provides hydrophilicity and allows to withstand compression loads. Aggrecan is a complex of proteoglycans with hyaluronic acid and is characterized by a high content of chondroitin sulfate chains, while proteoglycan consists of protein and glycosaminoglycan chains (the precursor of the latter is glucosamine).
{"title":"Pharmacological correction of the pathogenesis and symptoms of osteoarthritis of the knee","authors":"V.V. Shtroblya, S.S. Philip, S.M. Drogovoz","doi":"10.22141/1608-1706.2.24.2023.946","DOIUrl":"https://doi.org/10.22141/1608-1706.2.24.2023.946","url":null,"abstract":"Background. Osteoarthritis of the knee (OAK) causes severe pain and sometimes disability, which reduces the quality of life and work capacity of patients. Today, the prevalence of OAK is increases; therefore, the development of methods for its treatment and the use of means that slow down or stop the progression of OAK are relevant. Since OAK is a slowly progressive disease, the search for effective drugs with minimal toxicity and a long-lasting effect, which prevent the destruction of articular cartilage and improve the working conditions of the patient, is ongoing. Thus, the main goals of OAK treatment are to reduce symptoms and slow the progression of the disease, which can reduce the negative impact of OAK on the patient’s functional capacity, as well as improve quality of life. OAK is characterized by the progressive destruction of the articular cartilage, especially when it bears a load. In the joint, cartilage aggrecan is the main structural component that provides hydrophilicity and allows to withstand compression loads. Aggrecan is a complex of proteoglycans with hyaluronic acid and is characterized by a high content of chondroitin sulfate chains, while proteoglycan consists of protein and glycosaminoglycan chains (the precursor of the latter is glucosamine). ","PeriodicalId":9553,"journal":{"name":"Burns & Trauma","volume":"119 1","pages":""},"PeriodicalIF":5.3,"publicationDate":"2023-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76736196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-23DOI: 10.1177/14604086231187158
Carlos Satizabal Azuelo, M. P. Cabrera Méndez, Gustavo Adolfo Rozo López, Saith del Carmen Trouchon Jimenez, Diego Sanchez Cruz
To describe the clinical and surgical characteristics of external fixation technique to manage complex open proximal humerus fractures caused by high-energy firearm injuries at the Hospital Militar Central, Colombia. A retrospective case series of patients with open complex proximal humerus fractures (Gustilo & Anderson III A-B or Neer III and IV) caused by long range or fragmentation weapons treated with external fixation. The variables are demographic data, range of motion, consolidation measurements, and functional outcomes according to the Quick Disabilities of the Arm, Shoulder and Hand (Quick DASH) functional scale. Seven male patients, with high-energy injuries causing open complex proximal humerus fractures (Gustilo & Anderson III A-B or Neer III or IV) underwent surgical treatment with external fixation and arthrodiastasis. Median age was 21.0 (19–24) years, mean treatment duration was 5.6 (4–7) months, and all patients completed 15 months of follow-up. Mean postoperative active movement measurements were flexion: 80° (40°–120°), abduction 85.7° (40°–130°), external rotation: 24.7° (10°–45°), and internal rotation: 23.6° (10°–45°). Mean postoperative pain according to visual analog scale was 2.7 (1–4) and mean Quick DASH was 36.2 (15.9–58). Two patients presented postoperative complications, one case each of infection and osteitis. Complex open proximal humeral fractures caused by high-energy trauma treated with transarticular external fixation via arthrodiastasis show promising short-term and mid-term results with low complication rates, low levels of postoperative pain, and moderate functional results. This external fixation technique seems to be a valid option for the treatment of polytraumatic patients with humeral injuries. Longer follow ups and larger sample sizes studies must be presented to better characterize the clinical and satisfaction outcomes.
目的:描述哥伦比亚中央军事医院采用外固定技术治疗高能火器伤所致复杂开放性肱骨近端骨折的临床和手术特点。回顾性分析了肱骨近端开放性复杂骨折(Gustilo & Anderson III A- b或Neer III和IV)患者的病例系列，这些骨折是由远距离或碎片化武器引起的，并采用外固定治疗。变量是人口统计数据、活动范围、巩固测量和根据手臂、肩膀和手的快速残疾(Quick DASH)功能量表的功能结果。7例高能损伤导致开放性复杂肱骨近端骨折(Gustilo & Anderson III A-B或Neer III或IV)的男性患者接受了外固定和关节分离手术治疗。中位年龄21.0(19-24)岁，平均治疗时间5.6(4-7)个月，所有患者均完成了15个月的随访。平均术后主动活动测量屈曲80°(40°-120°)，外展85.7°(40°-130°)，外旋24.7°(10°-45°)，内旋23.6°(10°-45°)。术后疼痛视觉模拟评分平均为2.7 (1-4)，Quick DASH平均为36.2(15.9-58)。术后出现并发症2例，感染和骨炎各1例。高能外伤所致复杂开放性肱骨近端骨折经关节分离经关节外固定治疗短期和中期效果良好，并发症发生率低，术后疼痛水平低，功能效果中等。这种外固定技术似乎是治疗肱骨损伤多发创伤患者的有效选择。必须进行更长时间的随访和更大样本量的研究，以更好地描述临床和满意度结果。
{"title":"The use of transarticular external fixation by arthrodiastasis in complex open proximal humeral fractures at Hospital Militar Central Colombia: A case series","authors":"Carlos Satizabal Azuelo, M. P. Cabrera Méndez, Gustavo Adolfo Rozo López, Saith del Carmen Trouchon Jimenez, Diego Sanchez Cruz","doi":"10.1177/14604086231187158","DOIUrl":"https://doi.org/10.1177/14604086231187158","url":null,"abstract":"To describe the clinical and surgical characteristics of external fixation technique to manage complex open proximal humerus fractures caused by high-energy firearm injuries at the Hospital Militar Central, Colombia. A retrospective case series of patients with open complex proximal humerus fractures (Gustilo & Anderson III A-B or Neer III and IV) caused by long range or fragmentation weapons treated with external fixation. The variables are demographic data, range of motion, consolidation measurements, and functional outcomes according to the Quick Disabilities of the Arm, Shoulder and Hand (Quick DASH) functional scale. Seven male patients, with high-energy injuries causing open complex proximal humerus fractures (Gustilo & Anderson III A-B or Neer III or IV) underwent surgical treatment with external fixation and arthrodiastasis. Median age was 21.0 (19–24) years, mean treatment duration was 5.6 (4–7) months, and all patients completed 15 months of follow-up. Mean postoperative active movement measurements were flexion: 80° (40°–120°), abduction 85.7° (40°–130°), external rotation: 24.7° (10°–45°), and internal rotation: 23.6° (10°–45°). Mean postoperative pain according to visual analog scale was 2.7 (1–4) and mean Quick DASH was 36.2 (15.9–58). Two patients presented postoperative complications, one case each of infection and osteitis. Complex open proximal humeral fractures caused by high-energy trauma treated with transarticular external fixation via arthrodiastasis show promising short-term and mid-term results with low complication rates, low levels of postoperative pain, and moderate functional results. This external fixation technique seems to be a valid option for the treatment of polytraumatic patients with humeral injuries. Longer follow ups and larger sample sizes studies must be presented to better characterize the clinical and satisfaction outcomes.","PeriodicalId":9553,"journal":{"name":"Burns & Trauma","volume":"1 1","pages":""},"PeriodicalIF":5.3,"publicationDate":"2023-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83272720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-23DOI: 10.1177/14604086231190802
Winny Li, A. Beckett, N. Ditkofsky, G. Lebovic, Michael Pierce, A. Petrosoniak
Computerized tomography is an essential element of the early diagnostic stages of trauma care for hemodynamically stable patients. However, there are inherent challenges and risks associated with the intra-hospital transport of critically injured trauma patients to the radiology suite and during the scanning process itself. We examined the frequency and nature of adverse events during computerized tomography among critically injured patients. This is a retrospective cohort study of adverse event in critically injured adult (>18 years old) trauma patients who underwent emergent computerized tomographic scan following evaluation in the trauma bay over a 22-month period who were either admitted to the intensive care unit or the operating room post computerized tomography. Data was abstracted from the hospital's trauma registry and chart review of electronic medical records. The frequency of adverse events during computerized tomography and the associated patient transport phases was recorded. Multivariable logistic regression was performed to assess the impact of adverse event on 7-day in-hospital mortality. Of the 526 critically injured trauma patients who underwent computerized tomographic scan during the study period, 17.3% (91/526) experienced one or more adverse event. The most common adverse events were hypotension n = 50 (9.5%), hypertension n = 18 (3.4%), initiation of vasopressors n = 11 (2.1%) and vomiting n = 8 (1.5%). One patient required re-intubation following endotracheal tube dislodgement and one patient required intubation following hypoxia post-sedation for agitation. Patient factors independently associated with adverse event were mechanical ventilation and blood product administration. When adjusted for injury severity score and age, patients who experienced adverse event were at increased odds of death (odds ratio: 2.2, 95% confidence interval: 1.11–4.36) compared to those who did not experience adverse event. Adverse events occur frequently in critically injured patients undergoing emergent trauma computerized tomography and may significantly impact clinical outcomes. This study provides important information to guide system and process-level improvements including optimized designs of the built environment and safety-informed protocols for high-risk patients undergoing emergent trauma computerized tomography.
{"title":"Who is at risk of clinical deterioration? Adverse events among trauma patients undergoing intra-hospital transport for emergent computerized tomography","authors":"Winny Li, A. Beckett, N. Ditkofsky, G. Lebovic, Michael Pierce, A. Petrosoniak","doi":"10.1177/14604086231190802","DOIUrl":"https://doi.org/10.1177/14604086231190802","url":null,"abstract":"Computerized tomography is an essential element of the early diagnostic stages of trauma care for hemodynamically stable patients. However, there are inherent challenges and risks associated with the intra-hospital transport of critically injured trauma patients to the radiology suite and during the scanning process itself. We examined the frequency and nature of adverse events during computerized tomography among critically injured patients. This is a retrospective cohort study of adverse event in critically injured adult (>18 years old) trauma patients who underwent emergent computerized tomographic scan following evaluation in the trauma bay over a 22-month period who were either admitted to the intensive care unit or the operating room post computerized tomography. Data was abstracted from the hospital's trauma registry and chart review of electronic medical records. The frequency of adverse events during computerized tomography and the associated patient transport phases was recorded. Multivariable logistic regression was performed to assess the impact of adverse event on 7-day in-hospital mortality. Of the 526 critically injured trauma patients who underwent computerized tomographic scan during the study period, 17.3% (91/526) experienced one or more adverse event. The most common adverse events were hypotension n = 50 (9.5%), hypertension n = 18 (3.4%), initiation of vasopressors n = 11 (2.1%) and vomiting n = 8 (1.5%). One patient required re-intubation following endotracheal tube dislodgement and one patient required intubation following hypoxia post-sedation for agitation. Patient factors independently associated with adverse event were mechanical ventilation and blood product administration. When adjusted for injury severity score and age, patients who experienced adverse event were at increased odds of death (odds ratio: 2.2, 95% confidence interval: 1.11–4.36) compared to those who did not experience adverse event. Adverse events occur frequently in critically injured patients undergoing emergent trauma computerized tomography and may significantly impact clinical outcomes. This study provides important information to guide system and process-level improvements including optimized designs of the built environment and safety-informed protocols for high-risk patients undergoing emergent trauma computerized tomography.","PeriodicalId":9553,"journal":{"name":"Burns & Trauma","volume":"490 1","pages":""},"PeriodicalIF":5.3,"publicationDate":"2023-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77337331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-25DOI: 10.1177/14604086231163665
Briony Seden, L. Cottey
{"title":"BestBET: Do abdominal examination findings in adult trauma patients correlate to intra-abdominal injury on CT?","authors":"Briony Seden, L. Cottey","doi":"10.1177/14604086231163665","DOIUrl":"https://doi.org/10.1177/14604086231163665","url":null,"abstract":"","PeriodicalId":9553,"journal":{"name":"Burns & Trauma","volume":"20 1","pages":""},"PeriodicalIF":5.3,"publicationDate":"2023-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82688175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-19DOI: 10.1177/14604086231187524
H. Aghababaeian, F. Yazdi
{"title":"Prehospital emergency care for severe and acute head and neck trauma: Lessons learned from the Qatar 2022 World Cup games","authors":"H. Aghababaeian, F. Yazdi","doi":"10.1177/14604086231187524","DOIUrl":"https://doi.org/10.1177/14604086231187524","url":null,"abstract":"","PeriodicalId":9553,"journal":{"name":"Burns & Trauma","volume":"41 1","pages":""},"PeriodicalIF":5.3,"publicationDate":"2023-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74211840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-18DOI: 10.1177/14604086231177124
Vimal Stanislaus, B. Mitra, Wen Zhang, Tom E Richardson, Nico Ng, Bjoern Picker, A. Madan, J. Mathew, M. Fitzgerald, Geoffrey W. Cloud
Blunt cerebrovascular injuries (BCVIs) are uncommon but associated with ischemic stroke and disability, particularly in younger adults. There is a paucity of literature on the incidence and risk factors for BCVI. The aim of this study was to report the incidence and clinical characteristics of patients diagnosed with BCVI at an adult level 1 trauma centre. This was a registry-based cohort study. The accessible sample was all patients in the Alfred Hospital Trauma Registry (AHTR) who presented from January 2014 to June 2021 and were recorded to have BCVI. The diagnosis of BCVI was confirmed by independent, blinded neuroradiologists prior to study inclusion. Demographics, injury mechanism and associated injuries of patients were extracted from the AHTR and patient medical records. There were 20,954 blunt trauma patients in the AHTR during the study period, of which 300 patients were confirmed to have 428 BCVIs. The incidence of BCVI was 1.4% (95%CI: 1.3–1.6). The mortality rate was 14% with a median survival time of 86 h from the time of injury. More men (65%) were diagnosed with BCVI than women and motor vehicle crashes (n = 180; 60%) were the most common mechanism of injury. Younger age, high transfer mechanisms, high injury severity, brain and chest trauma were associated with carotid artery injuries, while vertebral artery injuries were associated with older age, higher presenting GCS and cervical spinal injuries. The incidence of BCVI was low. The risk profile for patients with CAIs and VAIs were different. Consistent with the modified Denver criteria, high energy transfer mechanisms and cervical spinal injuries were identified to be high-risk features, but they impacted carotid and vertebral arteries differently. Any trauma involving these mechanisms should trigger investigation for the detection of BCVIs.
{"title":"The incidence and characteristics of clinically relevant blunt cerebrovascular injury at an adult level 1 trauma centre: A retrospective cohort study","authors":"Vimal Stanislaus, B. Mitra, Wen Zhang, Tom E Richardson, Nico Ng, Bjoern Picker, A. Madan, J. Mathew, M. Fitzgerald, Geoffrey W. Cloud","doi":"10.1177/14604086231177124","DOIUrl":"https://doi.org/10.1177/14604086231177124","url":null,"abstract":"Blunt cerebrovascular injuries (BCVIs) are uncommon but associated with ischemic stroke and disability, particularly in younger adults. There is a paucity of literature on the incidence and risk factors for BCVI. The aim of this study was to report the incidence and clinical characteristics of patients diagnosed with BCVI at an adult level 1 trauma centre. This was a registry-based cohort study. The accessible sample was all patients in the Alfred Hospital Trauma Registry (AHTR) who presented from January 2014 to June 2021 and were recorded to have BCVI. The diagnosis of BCVI was confirmed by independent, blinded neuroradiologists prior to study inclusion. Demographics, injury mechanism and associated injuries of patients were extracted from the AHTR and patient medical records. There were 20,954 blunt trauma patients in the AHTR during the study period, of which 300 patients were confirmed to have 428 BCVIs. The incidence of BCVI was 1.4% (95%CI: 1.3–1.6). The mortality rate was 14% with a median survival time of 86 h from the time of injury. More men (65%) were diagnosed with BCVI than women and motor vehicle crashes (n = 180; 60%) were the most common mechanism of injury. Younger age, high transfer mechanisms, high injury severity, brain and chest trauma were associated with carotid artery injuries, while vertebral artery injuries were associated with older age, higher presenting GCS and cervical spinal injuries. The incidence of BCVI was low. The risk profile for patients with CAIs and VAIs were different. Consistent with the modified Denver criteria, high energy transfer mechanisms and cervical spinal injuries were identified to be high-risk features, but they impacted carotid and vertebral arteries differently. Any trauma involving these mechanisms should trigger investigation for the detection of BCVIs.","PeriodicalId":9553,"journal":{"name":"Burns & Trauma","volume":"87 1","pages":""},"PeriodicalIF":5.3,"publicationDate":"2023-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80934999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-18DOI: 10.1177/14604086231185990
F. Davies, M. O’Meara, C. Hudson
Penetrating neck injuries present as serious, life-threatening events which require advanced expeditious management if the patient is to survive without significant morbidity and mortality. In-hospital paradigms for high-volume centres include the use of Foley catheter balloon tamponade to temporarily or definitively control haemorrhage from carotid sheath structures, although these techniques are less commonly deployed in the field. We highlight the case of a 25-year-old male who presented to the ambulance service with three self-inflicted neck wounds – one to each of the zones of the neck. The zone 2 wound had transected the internal jugular vein and also the ipsilateral vertebral artery, causing severe haemorrhage leading to hypovolaemic cardiac arrest in a remote farmhouse location. He was treated with a modified tamponade technique, employing the use of a Rapid Rhino 900™ epistaxis catheter, secured with sutures into the zone 2 wound prior to inflation. This resulted in complete haemostasis, which allowed the patient to be volume resuscitated, anaesthetised and flown by air ambulance to the regional trauma centre. His injuries were treated and his recovery was interrupted only by a transient Horner's syndrome. This report showcases the first time this modification of a well-known in-hospital technique was deployed, which proved life-saving in this case and could be of use to others. We discuss the importance of catheter tamponade techniques as opposed to direct packing, in particular for those who need to be transported either within, between or to the hospital. This is in contradistinction to other authors advocating direct packing as the mainstay of treatment.
{"title":"Use of a Rapid Rhino in haemorrhage control for penetrating neck injury presenting in traumatic cardiac arrest","authors":"F. Davies, M. O’Meara, C. Hudson","doi":"10.1177/14604086231185990","DOIUrl":"https://doi.org/10.1177/14604086231185990","url":null,"abstract":"Penetrating neck injuries present as serious, life-threatening events which require advanced expeditious management if the patient is to survive without significant morbidity and mortality. In-hospital paradigms for high-volume centres include the use of Foley catheter balloon tamponade to temporarily or definitively control haemorrhage from carotid sheath structures, although these techniques are less commonly deployed in the field. We highlight the case of a 25-year-old male who presented to the ambulance service with three self-inflicted neck wounds – one to each of the zones of the neck. The zone 2 wound had transected the internal jugular vein and also the ipsilateral vertebral artery, causing severe haemorrhage leading to hypovolaemic cardiac arrest in a remote farmhouse location. He was treated with a modified tamponade technique, employing the use of a Rapid Rhino 900™ epistaxis catheter, secured with sutures into the zone 2 wound prior to inflation. This resulted in complete haemostasis, which allowed the patient to be volume resuscitated, anaesthetised and flown by air ambulance to the regional trauma centre. His injuries were treated and his recovery was interrupted only by a transient Horner's syndrome. This report showcases the first time this modification of a well-known in-hospital technique was deployed, which proved life-saving in this case and could be of use to others. We discuss the importance of catheter tamponade techniques as opposed to direct packing, in particular for those who need to be transported either within, between or to the hospital. This is in contradistinction to other authors advocating direct packing as the mainstay of treatment.","PeriodicalId":9553,"journal":{"name":"Burns & Trauma","volume":"82 1","pages":""},"PeriodicalIF":5.3,"publicationDate":"2023-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83999220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-18DOI: 10.1177/14604086231183582
Ramsha Ahmed, A. Ward, Elizabeth L. Thornhill
Ankle fractures have an incidence of around 90,000 per year in the United Kingdom. They affect younger patients following high energy trauma and, in the elderly, following low energy falls. Younger patients with pre-existing comorbidities including raised BMI or poor bone quality are also at risk of these injuries which impact the bony architecture of the joint and the soft tissues leading to a highly unstable fracture pattern, resulting in dislocation. At present, there is no literature exploring what effect ankle fracture-dislocations have on patients’ quality of life and activities of daily living, with only ankle fractures being explored. Relevant question formatting was utilised to generate a focused search. This was limited to studies specifically mentioning ankle injuries with a focus on ankle fracture-dislocations. The number of patients, fracture-dislocation type, length of follow up, prognostic factors, complications and outcome measures were recorded. Nine hundred and thirty-nine fractures were included within the studies. Eight studies looked at previously validated foot and ankle scores, two primarily focused on the American Orthopaedic Foot and Ankle Society score (AOFAS), three on the foot and ankle outcome score (FAOS), and one study on the Olerud–Molander score (OMAS). Patient, injury, and management factors were identified as being associated with poorer clinical outcomes. Not only are age and BMI a risk factor for posttraumatic osteoarthritis but they were also identified as prognostic indicators for functional outcome in this review. Patients sustaining a concurrent fracture-dislocation were found to have poorer clinical outcomes, and the timing and success of reduction further influenced outcomes. This review found that the quality of reduction was directly related to the patients’ functional outcomes post-follow up, and the risk of developing posttraumatic osteoarthritis, which was more frequent in patients sustaining Bosworth fractures, posterior malleolar fractures, and in patients with increasing age. IV.
{"title":"Patient-reported outcomes and prognostic factors in ankle fracture-dislocation: A systematic review","authors":"Ramsha Ahmed, A. Ward, Elizabeth L. Thornhill","doi":"10.1177/14604086231183582","DOIUrl":"https://doi.org/10.1177/14604086231183582","url":null,"abstract":"Ankle fractures have an incidence of around 90,000 per year in the United Kingdom. They affect younger patients following high energy trauma and, in the elderly, following low energy falls. Younger patients with pre-existing comorbidities including raised BMI or poor bone quality are also at risk of these injuries which impact the bony architecture of the joint and the soft tissues leading to a highly unstable fracture pattern, resulting in dislocation. At present, there is no literature exploring what effect ankle fracture-dislocations have on patients’ quality of life and activities of daily living, with only ankle fractures being explored. Relevant question formatting was utilised to generate a focused search. This was limited to studies specifically mentioning ankle injuries with a focus on ankle fracture-dislocations. The number of patients, fracture-dislocation type, length of follow up, prognostic factors, complications and outcome measures were recorded. Nine hundred and thirty-nine fractures were included within the studies. Eight studies looked at previously validated foot and ankle scores, two primarily focused on the American Orthopaedic Foot and Ankle Society score (AOFAS), three on the foot and ankle outcome score (FAOS), and one study on the Olerud–Molander score (OMAS). Patient, injury, and management factors were identified as being associated with poorer clinical outcomes. Not only are age and BMI a risk factor for posttraumatic osteoarthritis but they were also identified as prognostic indicators for functional outcome in this review. Patients sustaining a concurrent fracture-dislocation were found to have poorer clinical outcomes, and the timing and success of reduction further influenced outcomes. This review found that the quality of reduction was directly related to the patients’ functional outcomes post-follow up, and the risk of developing posttraumatic osteoarthritis, which was more frequent in patients sustaining Bosworth fractures, posterior malleolar fractures, and in patients with increasing age. IV.","PeriodicalId":9553,"journal":{"name":"Burns & Trauma","volume":"3 1","pages":""},"PeriodicalIF":5.3,"publicationDate":"2023-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83362935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-18DOI: 10.1177/14604086231184505
A. Naveed, Robert Christopher Adams-McGavin, A. Beckett, E. Colak, J. Rezende-Neto, N. Ahmed, David Gomez
The spleen is the most frequently injured solid organ after blunt trauma and a trial non-operative management (NOM) has become the standard of care in hemodynamically stable patients. It remains uncertain which patients are at increased risk of non-operative management failure (NOMF) at initial presentation. We explored whether clinical variables including the contemporary rotational thromboelastography (ROTEM) parameters are predictive of NOMF. Data for all adult patients with a blunt splenic injury was collected retrospectively at St. Michael’s Hospital in Toronto, Canada between 2005 and 2021. Those who underwent a splenectomy within 4 hours of presentation were classified as direct operative management (OM), while those who had a splenectomy after 4 hours of observation were classified as NOM failure. Vital signs on arrival and injury characteristics were collected. Logistic regression was used to identify predictors of OM and predictors of NOM failure. Seven hundred and seventeen patients were identified with splenic injury during our study period. The median Injury Severity Score (ISS) was 27 (IQR 17–36), and 19% ( n = 134) had a shock index of 1 or more. One hundred and eleven (15.5%) underwent direct operative management. A shock index above 1 and increasing spleen injury severity were strong predictors of patients undergoing direct OM. The remaining 606 patients underwent NOM of which 59% ( n = 357) of these were admitted to the ICU. NOM failure occurred in 7.4% ( n = 45) with a median time to NOM failure of 23 (IQR 8–72) hours. The American Association for the Surgery of Trauma (AAST) spleen injury severity was the major factor significantly associated with NOM failure. The only major predictor of NOMF available on arrival is increased spleen injury grade. Other clinical variables such as age, vital signs on arrival, and bloodwork were not significantly able to predict NOM failure. Additional investigation is required to identify novel predictors of NOM failure.
{"title":"Can we predict failure of non-operative management of blunt splenic injuries on arrival? A comparison of predictors of immediate splenectomy versus splenectomy secondary to non-operative management failure","authors":"A. Naveed, Robert Christopher Adams-McGavin, A. Beckett, E. Colak, J. Rezende-Neto, N. Ahmed, David Gomez","doi":"10.1177/14604086231184505","DOIUrl":"https://doi.org/10.1177/14604086231184505","url":null,"abstract":"The spleen is the most frequently injured solid organ after blunt trauma and a trial non-operative management (NOM) has become the standard of care in hemodynamically stable patients. It remains uncertain which patients are at increased risk of non-operative management failure (NOMF) at initial presentation. We explored whether clinical variables including the contemporary rotational thromboelastography (ROTEM) parameters are predictive of NOMF. Data for all adult patients with a blunt splenic injury was collected retrospectively at St. Michael’s Hospital in Toronto, Canada between 2005 and 2021. Those who underwent a splenectomy within 4 hours of presentation were classified as direct operative management (OM), while those who had a splenectomy after 4 hours of observation were classified as NOM failure. Vital signs on arrival and injury characteristics were collected. Logistic regression was used to identify predictors of OM and predictors of NOM failure. Seven hundred and seventeen patients were identified with splenic injury during our study period. The median Injury Severity Score (ISS) was 27 (IQR 17–36), and 19% ( n = 134) had a shock index of 1 or more. One hundred and eleven (15.5%) underwent direct operative management. A shock index above 1 and increasing spleen injury severity were strong predictors of patients undergoing direct OM. The remaining 606 patients underwent NOM of which 59% ( n = 357) of these were admitted to the ICU. NOM failure occurred in 7.4% ( n = 45) with a median time to NOM failure of 23 (IQR 8–72) hours. The American Association for the Surgery of Trauma (AAST) spleen injury severity was the major factor significantly associated with NOM failure. The only major predictor of NOMF available on arrival is increased spleen injury grade. Other clinical variables such as age, vital signs on arrival, and bloodwork were not significantly able to predict NOM failure. Additional investigation is required to identify novel predictors of NOM failure.","PeriodicalId":9553,"journal":{"name":"Burns & Trauma","volume":"22 1","pages":""},"PeriodicalIF":5.3,"publicationDate":"2023-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84194027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-10DOI: 10.1177/14604086231186032
Arjun Gupta, Priya Singh, Daniel Badin, Kevin C. Mo, Marc Greenberg, F. Musharbash, Alice J. Hughes, J. Ficke, A. Aiyer
Racial and ethnic disparities remain a major problem in orthopedic surgery, driving inequitable resource distribution, disparate clinical outcomes, and increased healthcare costs. The objective of this study was to investigate potential racial/ethnic disparities in the incidence and injury patterns of orthopedic lower extremity trauma (LET) in the United States over the past 10 years, as well as differences in final disposition outcomes. The National Electronic Injury Surveillance System database was queried for all orthopedic LET presenting to U.S. emergency departments from 2010 to 2020. Incidence rate ratios (IRR) were used to compare incidence rates between racial/ethnic groups. Multivariate logistic regression was performed to compare disposition outcomes. Black/African Americans (Black/AAs) consistently experienced the highest incidence of LET over the 10-year period analyzed (709.108 per 100,000 person-years), followed by Whites (547.159 per 100,000 person-years). Furthermore, Black/AAs had the highest incidence of polytrauma (114.19 per 100,000 person-years), over 1.7x greater than Whites (IRR: 1.73 [95% confidence interval (CI): 1.72–1.75]). Black/AAs had over 2-fold higher odds of death after LET compared to Whites (adjusted odds ratio [aOR] 2.15 [95% CI: 1.78–2.59]). By 2019 to 2020, the incidence of deaths among Black/AAs reached more than triple that of Whites (IRR: 3.50 [95% CI: 2.74–4.46]). Black/AAs were also the most likely to be discharged against medical advice (AMA) (aOR: 1.94 [95% CI: 1.92–1.96]), and the least likely to be admitted as inpatients (aOR: 0.683 [95% CI: 0.679–0.688]). Despite Black/AAs experiencing a disproportionately higher incidence of LET and over 2-fold greater odds of death compared to Whites, they were also the most likely to be discharged AMA and least likely to be admitted as inpatients. Understanding the effects of conscious/unconscious biases and the importance of effective communication and patient education may help physicians ensure that injuries in this patient population are not prematurely discharged, potentially improving clinical outcomes, and reducing mortality. III.
{"title":"Racial disparities in lower extremity orthopaedic injuries presenting to U.S. emergency departments from 2010 to 2020","authors":"Arjun Gupta, Priya Singh, Daniel Badin, Kevin C. Mo, Marc Greenberg, F. Musharbash, Alice J. Hughes, J. Ficke, A. Aiyer","doi":"10.1177/14604086231186032","DOIUrl":"https://doi.org/10.1177/14604086231186032","url":null,"abstract":"Racial and ethnic disparities remain a major problem in orthopedic surgery, driving inequitable resource distribution, disparate clinical outcomes, and increased healthcare costs. The objective of this study was to investigate potential racial/ethnic disparities in the incidence and injury patterns of orthopedic lower extremity trauma (LET) in the United States over the past 10 years, as well as differences in final disposition outcomes. The National Electronic Injury Surveillance System database was queried for all orthopedic LET presenting to U.S. emergency departments from 2010 to 2020. Incidence rate ratios (IRR) were used to compare incidence rates between racial/ethnic groups. Multivariate logistic regression was performed to compare disposition outcomes. Black/African Americans (Black/AAs) consistently experienced the highest incidence of LET over the 10-year period analyzed (709.108 per 100,000 person-years), followed by Whites (547.159 per 100,000 person-years). Furthermore, Black/AAs had the highest incidence of polytrauma (114.19 per 100,000 person-years), over 1.7x greater than Whites (IRR: 1.73 [95% confidence interval (CI): 1.72–1.75]). Black/AAs had over 2-fold higher odds of death after LET compared to Whites (adjusted odds ratio [aOR] 2.15 [95% CI: 1.78–2.59]). By 2019 to 2020, the incidence of deaths among Black/AAs reached more than triple that of Whites (IRR: 3.50 [95% CI: 2.74–4.46]). Black/AAs were also the most likely to be discharged against medical advice (AMA) (aOR: 1.94 [95% CI: 1.92–1.96]), and the least likely to be admitted as inpatients (aOR: 0.683 [95% CI: 0.679–0.688]). Despite Black/AAs experiencing a disproportionately higher incidence of LET and over 2-fold greater odds of death compared to Whites, they were also the most likely to be discharged AMA and least likely to be admitted as inpatients. Understanding the effects of conscious/unconscious biases and the importance of effective communication and patient education may help physicians ensure that injuries in this patient population are not prematurely discharged, potentially improving clinical outcomes, and reducing mortality. III.","PeriodicalId":9553,"journal":{"name":"Burns & Trauma","volume":"53 1","pages":""},"PeriodicalIF":5.3,"publicationDate":"2023-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88421300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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