Outcomes of polytrauma patients with diabetes mellitus.

BACKGROUND: The impact of diabetes mellitus in patients with multiple system injuries remains obscure. This study was designed to increase knowledge of outcomes of polytrauma in patients who have diabetes mellitus. METHODS: Data from the Trauma Audit and Research Network was used to identify patients who had suffered polytrauma during 2003 to 2011. These patients were filtered to those with known outcomes, then separated into those with diabetes, those known to have other co-morbidities but not diabetes and those known not to have any co-morbidities or diabetes. The data were analyzed to establish if patients with diabetes had differing outcomes associated with their diabetes versus the other groups. RESULTS: In total, 222 patients had diabetes, 2,558 had no past medical co-morbidities (PMC), 2,709 had PMC but no diabetes. The diabetic group of patients was found to be older than the other groups (P <0.05). A higher mortality rate was found in the diabetic group compared to the non-PMC group (32.4% versus 12.9%), P <0.05). Rates of many complications including renal failure, myocardial infarction, acute respiratory distress syndrome, pulmonary embolism and deep vein thrombosis were all found to be higher in the diabetic group. CONCLUSIONS: Close monitoring of diabetic patients may result in improved outcomes. Tighter glycemic control and earlier intervention for complications may reduce mortality and morbidity

Epoetin alfa reduces blood transfusion requirements in patients with intertrochanteric fracture

Purpose: The purpose of this study is to identify the potential benefits or complications from the use of epoetin alfa in patients with intertrochanteric fracture. Materials and Methods: Seventy-nine patients who sustained an intertrochanteric fracture were divided into 2 groups. One group received 10 daily doses of 20 000 IU of epoetin alfa beginning from the day of trauma, whereas the control group received placebo. Results: We found a statistically significant difference in the required units of allogenic blood used between the 2 groups (P = .034). The group that received epoetin alfa also showed an elevation of hematocrit and hemoglobin values, which was statistically significant at the seventh postoperative day (P = .019 and .015, respectively) compared to the control group. No complications were evident during our study. Conclusions: Patients with intertrochanteric fractures seem to benefit from the use of epoetin alfa because it is safe and reduces the need for blood transfusions. © 2010 Elsevier Inc

Isolated avulsion fracture of the tibial attachment of the posterior cruciate ligament

Avulsion injuries of the posterior cruciate ligament of the knee are relatively infrequent. Most authors recommend primary operative repair, but there have been only a few series with documented results. Twenty-three patients with an isolated avulsion type injury of the PCL were operated on in our department during the last 15 years. The diagnosis was made by clinical examination and imaging studies (X-ray, MRI). The aim of this retrospective study was to determine the difficulty or ease of the posterior open exposure for the general surgeon as well as to reaffirm the value of surgical repair and rigid fixation of the avulsed PCL

Cauda equina compression in an achondroplastic dwarf. Is complex anterior and posterior surgical intervention necessary?

We report the case of an achondroplastic dwarf who presented with partial paraplegia due to cauda equina compression. The patient had marked thoracolumbar kyphosis and spinal stenosis at L2-L3. Although only posterior decompression is recommended in the literature for the treatment of achondroplastic patients presenting with neurological problems, a staged anterior and posterior decompression and stabilization was considered necessary for the treatment of this particular patient due to the presence of kyphosis. Satisfactory clinical results were achieved and sustained for six years following this complex operation. © 2008 Sapkas et al; licensee BioMed Central Ltd

Biofilm and orthopaedic practice: the world of microbes in a world of implants

Biofilms are complex communities of surface-attached micro-organisms made up of single or multiple species. They grow in three stages, attachment of bacteria to the substratum followed by bacterial growth and division and then colonization of the surrounding area and the formation of the biofilm. While the basic mechanisms of biofilm-associated antimicrobial resistance are understood, research continues into biofilm- associated antimicrobial resistance. © 2009

The effect of static compression on the progression of bone healing. An experimental study on rabbits

We aimed to evaluate the effect of static compression on the progression of mid-diaphyseal bone healing. For this purpose, we used thirty-six New Zealand rabbits that were submitted to iatrogenic fracture of the tibial diaph-ysis that was reduced and stabilized using external fixation, with and without the application of static compression. Three-point bending was applied in order to assess the mechanical strains of the tibial bone healing. Samples from the callus were obtained in order to examine histomorphologically the biomechanical effect of repeated compression at the fracture site and to evaluate the progression of bone healing at different time intervals. Statistically significant differences were found between the three and six weeks concerning the parameters of fracture load, stiffness and toughness in favor of the group submitted to compression. Histomorphological evaluation confirmed that progression of fracture healing was more rapid under compression loading. We concluded that compression applied on the fracture edges enhances bone healing. © 2018 CIC Edizioni Internazionali s.r.l. All rights reserved

Radiological evaluation of the metal-bone interface of a porous tantalum monoblock acetabular component

Between January 1998 and December 1998, 82 consecutive patients (86 hips) underwent total hip arthroplasty using a trabecular metal monoblock acetabular component. All patients had a clinical and radiological follow-up evaluation at six, 12 and 24 weeks, 12 months, and then annually thereafter. On the initial post-operative radiograph 25 hips had a gap between the outer surface of the component and the acetabular host bed which from 1 to 5 mm. All patients were followed up clinically and radiologically for a mean of 7.3 years (7 to 7.5). The 25 hips with the 1 to 5 mm gaps were studied for component at two years using the Einzel-Bild-Roentgen-Analyse (EBRA) digital measurement At 24 weeks all the post-operative gaps were filled with bone and no acetabular had migrated. The radiographic outcome of all 86 components showed no radiolucent lines and no evidence of lysis. No acetabular implant was revised. There were no dislocations or other complications. The bridging of the interface gaps (up to 5 mm) by the trabecular metal monoblock acetabular component indicates the strong osteoconductive, and possibly osteoinductive, properties of trabecular metal

Prediction of Cobb angle in idiopathic adolescent scoliosis

We did a prospective study of 291 children and adolescents with idiopathic scoliosis to identify possible correlations between clinical (scoliometer value, age, height) and radiographic (Cobb angle, Nash-Moe rotation, Risser iliac apophysis classification) parameters to predict the curve angle. There was a statistically significant correlation between thoracic, thoracolumbar, and lumbar scoliometer values and the thoracic, thoracolumbar, and lumbar Cobb angles, respectively (Pearson’s r-0.685, 0.572, and 0.677, respectively). There was a statistically significant correlation between Cobb angle in the thoracic, thoracolumbar, and lumbar spine and the patients’ age and height. Mathematical formulas that predict the Cobb angle of thoracic, thoracolumbar, and lumbar scoliosis using the scoliometer measurements are reported