33 research outputs found
Epidemiology of combined clavicle and rib fractures:a systematic review
Purpose The aim of this systematic review was to provide an overview of the incidence of combined clavicle and rib fractures and the association between these two injuries. Methods A systematic literature search was performed in the MEDLINE, EMBASE, and CENTRAL databases on the 14(th) of August 2020. Outcome measures were incidence, hospital length of stay (HLOS), intensive care unit admission and length of stay (ILOS), duration of mechanical ventilation (DMV), mortality, chest tube duration, Constant-Murley score, union and complications. Results Seven studies with a total of 71,572 patients were included, comprising five studies on epidemiology and two studies on treatment. Among blunt chest trauma patients, 18.6% had concomitant clavicle and rib fractures. The incidence of rib fractures in polytrauma patients with clavicle fractures was 56-60.6% versus 29% in patients without clavicle fractures. Vice versa, 14-18.8% of patients with multiple rib fractures had concomitant clavicle fractures compared to 7.1% in patients without multiple rib fractures. One study reported no complications after fixation of both injuries. Another study on treatment, reported shorter ILOS and less complications among operatively versus conservatively treated patients (5.4 +/- 1.5 versus 21 +/- 13.6 days). Conclusion Clavicle fractures and rib fractures are closely related in polytrauma patients and almost a fifth of all blunt chest trauma patients sustain both injuries. Definitive conclusions could not be drawn on treatment of the combined injury. Future research should further investigate indications and benefits of operative treatment of this injury
Epidemiology and outcome of rib fractures:a nationwide study in the Netherlands
Purpose Rib fractures following thoracic trauma are frequently encountered injuries and associated with a significant morbidity and mortality. The aim of this study was to provide current data on the epidemiology, in-hospital outcomes and 30-day mortality of rib fractures, and to evaluate these results for different subgroups. Methods A nationwide retrospective cohort study was performed with the use of the Dutch Trauma Registry which covers 99% of the acutely admitted Dutch trauma population. All patients aged 18 years and older admitted to the hospital between January 2015 and December 2017 with one or more rib fractures were included. Incidence rates were calculated using demographic data from the Dutch Population Register. Subgroup analyses were performed for flail chest, polytrauma, primary thoracic trauma, and elderly patients. Results A total of 14,850 patients were admitted between 2015 and 2017 with one or more rib fractures, which was 6.0% of all trauma patients. Of these, 573 (3.9%) patients had a flail chest, 4438 (29.9%) were polytrauma patients, 9273 (63.4%) were patients with primary thoracic trauma, and 6663 (44.9%) were elderly patients. The incidence rate of patients with rib fractures for the entire cohort was 29 per 100.000 person-years. The overall 30-day mortality was 6.9% (n = 1208) with higher rates observed in flail chest (11.9%), polytrauma (14.8%), and elderly patients (11.7%). The median hospital length of stay was 6 days (IQR, 3-11) and 37.3% were admitted to the intensive care unit (ICU). Conclusions Rib fractures are a relevant and frequently occurring problem among the trauma population. Subgroup analyses showed that there is a substantial heterogeneity among patients with rib fractures with considerable differences regarding the epidemiology, in-hospital outcomes, and 30-day mortality
Screw-blade fixation systems for implant anchorage in the femoral head : Horizontal blade orientation provides superior stability
Objectives: Despite continual improvement in the methods and devices used for treatment of proximal
femoral fractures, unacceptably high failure rates remain. Novel screw-blade implant systems, combining
a lag screw with a blade – the latter adding rotational stability to the femoral head – offer improvement
of osseous purchase, especially in osteoporotic bone. The aim of this study was to compare biomechanically the head element (HE) anchorage of two screw-blade implant systems differing in blade orientation
in the femoral head – vertical versus horizontal.
Methods: Twenty paired human cadaveric femoral heads were assigned to four groups (n = 10), implanted with either Rotationally Stable Screw-Anchor HE (RoSA-HE, vertical blade orientation) or Gamma3
Rotation Control Lag Screw (Gamma-RC, horizontal blade orientation) in center or off-center position, and
biomechanically tested until failure under progressively increasing cyclic loading at 2 Hz.
Results: Cycles to failure and failure load were significantly higher for Gamma-RC versus RoSA-HE in center position and not significantly different between them in off-center position, p = 0.03 and p = 0.22,
respectively. In center position, the progression of both rotation around implant axis and varus deformation over time demonstrated superiority of the implant with horizontal versus vertical blade orientation.
Compared with center positioning, off-center implant placement led to a significant decrease in stiffness,
cycles to failure and failure load for Gamma-RC, but not for RoSA-HE, p < 0.01 and p = 0.99, respectively.
Conclusion: Horizontal blade orientation of screw-blade implant systems demonstrates better anchorage in the femoral head versus vertical blade orientation in center position. As the stability of the implant system with horizontal blade orientation drops sharply in off-center position, central insertion is
its placement of choice
Trochanteric Femur Fractures: Application of Skeletal Traction during Surgery Does Not Alter Soft-Tissue Microcirculation
Background and Objectives: Wound infections provoked by alterations in microcirculation
are major complications in the treatment of trochanteric femur fractures. Surgical fracture fixation
on a traction table is the gold standard for treatment, but the effect on tissue microcirculation is
unknown. Microcirculation could be impaired by the pull on the soft-tissue or by a release of
vasoactive factors. We hypothesized that intraoperative traction impairs soft-tissue microcirculation.
Materials and Methods: In 22 patients (14 women, eight men), average age 78 years (range 36–96 ± 14),
with trochanteric femur fractures, non-invasive laser-Doppler spectrophotometry was used to assess
oxygen saturation, hemoglobin content, and blood flow in the skin and subcutaneous tissue before
and after application of traction. Measurements were recorded in nine locations around the greater
trochanter at a depth of 2, 8, and 15 mm before and after fracture reduction by traction. Results: No
differences were found in any depth with traction compared to without (oxygen saturation: p = 0.751,
p = 0.308, and p = 0.955, haemoglobin content: p = 0.651, p = 0.928, and p = 0.926, blood flow: p = 0.829,
p = 0.866, and p = 0.411). Conclusion: In this pilot study, the application of traction does not affect skin
and subcutaneous microcirculation in the surgery of proximal femur fractures
Difference in Pain, Complication Rates, and Clinical Outcomes After Suprapatellar Versus Infrapatellar Nailing for Tibia Fractures?:A Systematic Review of 1447 Patients
OBJECTIVES: To assess the effectiveness of suprapatellar (SP)-nailing versus infrapatellar (IP)-nailing of tibia fractures in anterior knee pain, complications (retropatellar chondropathy, infection, and malalignment) and physical functioning and quality of life. A clinical question-driven and thorough systematic review of current literature is provided. DATA SOURCE: PubMed and Embase databases were searched for studies published between 2010 and 2020 relating to SP and IP-nailing of tibia fractures. The study is performed in concordance with PRISMA-guidelines. STUDY SELECTION: Studies eligible for inclusion were randomized controlled trials, prospective and retrospective observational studies reporting on outcomes of interest. DATA EXTRACTION: Data extraction was performed independently by 2 assessors. Methodological quality and risk of bias was assessed according to the guidelines of the McMaster Critical Appraisal. DATA SYNTHESIS: Continuous variables are presented as means with SD and dichotomous variables as frequency and percentages. The weighted mean, standardized weighted mean differences, and 95% confidence interval were calculated. A pooled analysis could not be performed because of differences in outcome measures, time-points, and heterogeneity. RESULTS: Fourteen studies with 1447 patients were analyzed. The weighted incidence of anterior knee pain was 29% after SP-nailing and 39% after IP-nailing, without reported significance. There was a significant lower rate of malalignment after the SP-approach (4% vs. 26%) with small absolute differences in all planes. No substantial differences were observed in retropatellar chondropathy, infection, physical functioning, and quality of life. CONCLUSIONS: This systematic review does not reveal superiority of either technique in any of the respective outcomes of interest. Definitive choice should depend on the surgeon's experience and available resources. LEVEL OF EVIDENCE: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence
Percutaneous coronary revascularization in patients with formerly "refractory angina pectoris in end-stage coronary artery disease" – Not "end-stage" after all
<p>Abstract</p> <p>Background</p> <p>Patients with refractory angina pectoris in end-stage coronary artery disease represent a severe condition with a higher reduction of life-expectancy and quality of life as compared to patients with stable coronary artery disease. It was the purpose of this study to invasively re-evaluate highly symptomatic patients with formerly diagnosed refractory angina pectoris in end-stage coronary artery disease for feasible options of myocardial revascularization.</p> <p>Methods</p> <p>Thirty-four Patients formerly characterized as having end stage coronary artery disease with refractory angina pectoris were retrospectively followed for coronary interventions.</p> <p>Results</p> <p>Of those 34 patients 21 (61.8%) were eventually revascularized with percutaneous interventional revascularization (PCI). Due to complex coronary morphology (angulation, chronic total occlusion) PCI demanded an above-average amount of time (66 ± 42 minutes, range 25–206 minutes) and materials (contrast media 247 ± 209 ml, range 50–750 ml; PCI guiding wires 2.0 ± 1.4, range 1–6 wires). Of PCI patients 7 (33.3%) showed a new lesion as a sign of progression of atherosclerosis. Clinical success rate with a reduction to angina class II or lower was 71.4% at 30 days. Surgery was performed in a total of8 (23.5%) patients with a clinical success rate of 62.5%. Based on an intention-to-treat 2 patients of originally 8 (25%) demonstrated clinical success. Mortality during follow-up (1–18 months) was 4.8% in patients who underwent PCI, 25% in patients treated surgically and 25% in those only treated medically.</p> <p>Conclusion</p> <p>The majority of patients with end-stage coronary artery disease can be treated effectively with conventional invasive treatment modalities. Therefore even though it is challenging and demanding PCI should be considered as a first choice before experimental interventions are considered.</p
Imaging Long-Term Fate of Intramyocardially Implanted Mesenchymal Stem Cells in a Porcine Myocardial Infarction Model
The long-term fate of stem cells after intramyocardial delivery is unknown. We used noninvasive, repetitive PET/CT imaging with [18F]FEAU to monitor the long-term (up to 5 months) spatial-temporal dynamics of MSCs retrovirally transduced with the sr39HSV1-tk gene (sr39HSV1-tk-MSC) and implanted intramyocardially in pigs with induced acute myocardial infarction. Repetitive [18F]FEAU PET/CT revealed a biphasic pattern of sr39HSV1-tk-MSC dynamics; cell proliferation peaked at 33–35 days after injection, in periinfarct regions and the major cardiac lymphatic vessels and lymph nodes. The sr39HSV1-tk-MSC–associated [18F]FEAU signals gradually decreased thereafter. Cardiac lymphography studies using PG-Gd-NIRF813 contrast for MRI and near-infrared fluorescence imaging showed rapid clearance of the contrast from the site of intramyocardial injection through the subepicardial lymphatic network into the lymphatic vessels and periaortic lymph nodes. Immunohistochemical analysis of cardiac tissue obtained at 35 and 150 days demonstrated several types of sr39HSV1-tk expressing cells, including fibro-myoblasts, lymphovascular cells, and microvascular and arterial endothelium. In summary, this study demonstrated the feasibility and sensitivity of [18F]FEAU PET/CT imaging for long-term, in-vivo monitoring (up to 5 months) of the fate of intramyocardially injected sr39HSV1-tk-MSC cells. Intramyocardially transplanted MSCs appear to integrate into the lymphatic endothelium and may help improve myocardial lymphatic system function after MI
Perioperative management of external fixation in staged protocols: an international survey
Despite the frequent use of external fixation, various regimes of antibiotic prophylaxis, surgical technique and postoperative pin care exist and underline the lack of current evidence. The aim of the study was to assess the variability or consensus in perioperative protocols to prevent implant-associated infections for temporary external fixation in closed fractures of the extremities. A 26-question survey was sent to 170 members of the Traumaplatform. The survey included questions concerning demographics, level of training, type of training and perioperative protocols as: antibiotic prophylaxis, intraoperative management, disinfection and postoperative pin site care. All responses were statistically analysed, and intraoperative measures rated on a 5-point Likert scale. The responses of fifty orthopaedic trauma and general surgeons (response rate, 29.4%) were analysed. The level of experience was more than 5 years in 92% (n = 46) with up to 50 closed fractures of the extremities annually treated with external fixation in 80% (n = 40). Highest consensus could be identified in the following perioperative measures: preoperative antibiotic prophylaxis with a second-generation cephalosporin (86%, n = 43), changing gloves if manipulation of the external fixator is necessary during surgery (86%, n = 43; 4.12 points on the Likert scale), avoid overlapping of the pin sites with the definitive implant site (94%, n = 47; 4.12 points on the Likert scale) and soft tissue protection with a drill sleeve (83.6%, n = 41). Our survey could identify some general principles, which were rated as important by a majority of the respondents. Futures studies' focus should elucidate the role of perioperative antibiotics and different disinfection protocols on implant-associated infections after temporary external fixation in staged protocols. This study provides Level IV evidence according to Oxford centre for evidence-based medicin
Trochanteric Femur Fractures: Application of Skeletal Traction during Surgery Does Not Alter Soft-Tissue Microcirculation
Background and Objectives: Wound infections provoked by alterations in microcirculation are major complications in the treatment of trochanteric femur fractures. Surgical fracture fixation on a traction table is the gold standard for treatment, but the effect on tissue microcirculation is unknown. Microcirculation could be impaired by the pull on the soft-tissue or by a release of vasoactive factors. We hypothesized that intraoperative traction impairs soft-tissue microcirculation. Materials and Methods: In 22 patients (14 women, eight men), average age 78 years (range 36-96 ± 14), with trochanteric femur fractures, non-invasive laser-Doppler spectrophotometry was used to assess oxygen saturation, hemoglobin content, and blood flow in the skin and subcutaneous tissue before and after application of traction. Measurements were recorded in nine locations around the greater trochanter at a depth of 2, 8, and 15 mm before and after fracture reduction by traction. Results: No differences were found in any depth with traction compared to without (oxygen saturation: p = 0.751, p = 0.308, and p = 0.955, haemoglobin content: p = 0.651, p = 0.928, and p = 0.926, blood flow: p = 0.829, p = 0.866, and p = 0.411). Conclusion: In this pilot study, the application of traction does not affect skin and subcutaneous microcirculation in the surgery of proximal femur fractures
New Generation of Superior Single Plating vs Low-Profile Dual Mini-Fragment Plating in Diaphyseal Clavicle Fractures. A Biomechanical Comparative Study
BACKGROUND: Recently, a new generation of superior clavicle plates was developed featuring the variable angle locking technology for enhanced screw positioning and a less prominent and optimized plate-to-bone fit design. On the other hand, mini-fragment plates in dual plating mode have demonstrated promising clinical results. The aim of the current study was to compare the biomechanical competence of single superior plating using the new generation plate versus dual plating using low-profile mini-fragment plates.
METHODS: Sixteen paired human cadaveric clavicles were pairwise assigned to two groups for instrumentation with either a superior 2.7 mm Variable Angle Locking Compression Plate (Group 1), or with one 2.5 mm anterior combined with one 2.0 mm superior matrix mandible plate (Group 2). An unstable clavicle shaft fracture (AO/OTA 15.2C) was simulated by means of a 5mm osteotomy gap. Specimens were cyclically tested to failure under craniocaudal cantilever bending, superimposed with bidirectional torsion around the shaft axis and monitored via motion tracking.
RESULTS: Initial construct stiffness was significantly higher in Group 2 (9.28 ± 4.40 N/mm) compared to Group 1 (3.68 ± 1.08 N/mm), p=0.003. The amplitudes of interfragmentary motions in terms of axial and shear displacement, fracture gap opening and torsion, over the course of 12,500 cycles were significantly higher in Group 1 compared to Group 2, p≤0.038. Cycles to 2mm shear displacement were significantly lower in Group 1 (22792 ± 4346) compared to Group 2 (27437 ± 1877), p=0.047.
CONCLUSION: From a biomechanical perspective, low-profile 2.5/2.0 dual plates can be considered as a useful alternative for diaphyseal clavicle fracture fixation especially in less common unstable fracture configurations. 2.7 single superior variable angle locking plates and can therefore be considered as a useful alternative for diaphyseal clavicle fracture fixation especially in less common unstable fracture configurations