Injury
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Intramedullary nailing is a well-established method for stabilisation of long-bone shaft fractures. It is still a controversy as to whether the procedure should be done by an unreamed or reamed technique. In the present animal study, 24 sheep were treated with intramedullary nailing. ⋯ This means that, especially during the first weeks of fracture healing, damage to the bone by the reaming process can be reduced by reaming with a reaming device with lowered cutting flutes and smaller drive-shaft diameter. Intramedullary pressure can be significantly reduced by using reaming systems with reduced drive-shaft diameters and deepened cutting flutes. In the early phase of fracture healing, callus formation can be influenced positively when using the RE system.
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Multicenter Study
The impact of fresh frozen plasma vs coagulation factor concentrates on morbidity and mortality in trauma-associated haemorrhage and massive transfusion.
Clinical observations together with recent research highlighted the role of coagulopathy in acute trauma care and early aggressive treatment has been shown to reduce mortality. ⋯ Although there was no difference in overall mortality between both groups, significant differences with regard to morbidity and need for allogenic transfusion provide a signal supporting the management of acute post-traumatic coagulopathy with coagulation factor concentrates rather than with traditional FFP transfusions. Prospective and randomised clinical trials with sufficient patient numbers based upon this strategy are advocated.
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Ipsilateral concomitant fractures of proximal extracapsular and distal femur are rare injuries and pose a great challenge for orthopaedics. In this study, we reviewed and examined the approaches and outcomes of this complex injury. ⋯ The nailing of a proximal femoral fracture and an LISS-DF fixation of a distal one could be a reliable and effective approach to handle ipsilateral concomitant fractures of a proximal extracapsular and distal femur.
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Winter epidemics of fractures have been described that greatly exceed normal seasonal variations and overwhelm resources. We investigated the relationship between severe weather warnings, the frequency of fractures, and fracture related workload. There was a significant increase in fractures with cold and inclement weather, mostly low-energy fractures treated with day-case surgery or in fracture clinics. ⋯ Hip fractures were not associated with weather. Severe weather warnings for icy roads were predictive of fracture epidemics (p<0.01) with an associated 40% (95% confidence limits 20-52%) increase in fractures. Meteorological Office issued severe weather warnings can provide a trigger to plan for an increased workload of low-energy fractures, with opportunities for anticipatory public health measures.
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Operations in trauma patients represent a second insult and the extent of the surgical procedures influences the magnitude of the inflammatory response. Our hypothesis was that a reamer-irrigator-aspirator (RIA) system would cause a lesser inflammatory response than traditional reaming (TR). ⋯ A procedure-related coagulation and fibrinolytic response was demonstrated in both reaming groups, with more pronounced response in the TR than in the RIA group. Elevated levels of cytokines were demonstrated related to reaming and nailing, with significantly higher IL-6 levels in the TR than in the RIA group.