Injury
-
Haemorrhagic shock and resuscitation (HS/R) following major trauma results in a global ischaemia and reperfusion injury that may lead to multiple organ dysfunction syndrome (MODS). Systemic activation of the immune system is fundamental to the development of MODS in this context, and shares many features in common with the systemic inflammatory response syndrome (SIRS) that complicates sepsis. An important advancement in the understanding of the innate response to infection involved the identification of mammalian toll-like receptors (TLRs) expressed on cells of the immune system. ⋯ Multi-organ dysfunction syndrome remains an important cause of morbidity and mortality in trauma patients, and current therapy is based on supportive care. Understanding the pathophysiology of HS/R will allow for the development of targeted therapeutic strategies aimed at minimising organ dysfunction and improving patient outcomes following traumatic haemorrhage. A review of the pathogenesis of haemorrhagic shock is presented, and the complex, yet critical role of TLR4 as both a key mediator and therapeutic target is discussed.
-
Comparative Study
Clinical outcome and complications using a polyaxial locking plate in the treatment of displaced proximal humerus fractures. A reliable system?
The surgical treatment of displaced proximal humeral fractures (ORIF) is a perpetual challenge to the surgeon. For this reason, the principle of polyaxiality was developed to provide an improved primary stability of the fracture through better anchorage of the screws, especially in osteoporotic bone. The aim of this study was to present clinical results with the polyaxial locking plate in the operative treatment of proximal humerus fractures in order to determine whether the technique of polyaxiality leads to better functional outcome and lower complication rates in comparison to monoaxial plates in the literature. ⋯ The data show that the combination of angular stability with the possibility of variable polyaxial screw direction is a good concept for reduction and fixation of displaced proximal humeral fractures, but anatomical reduction and medial support remain important preconditions for a good outcome. However, a significantly lower rate of complications or better clinical outcome than that reported in the literature could not be found.
-
Comparative Study
Isokinetic evaluation of pronation after volar plating of a distal radius fracture.
Pronator quadratus (PQ) is an important contributor to forearm pronation, and there is concern that volar plating of a distal radius fracture (DRF) may damage the PQ function. The purpose of this study was to determine whether isokinetic pronation strength would decrease considerably after volar locking plating of a DRF, and whether clinical outcomes would be affected by any pronation strength decrease. ⋯ In patients with a DRF treated by volar plating, pronation strength was not significantly different between the operated and normal sides at 1 year postoperatively, and decreases in pronation or supination strengths were not found to affect clinical outcomes as assessed by DASH scores. This study suggests that dissection of the PQ may have minimal clinical impact on forearm pronation function.
-
Numerous surgical methods are used to treat acromioclavicular (AC) joint dislocations, and an anatomical reconstruction using a free tendon graft has attracted considerable attention, particularly for chronic cases. The purpose of this study was to introduce the results of lateral half conjoined tendon (LHCT) and coracoacromial ligament (CAL) transfer for chronic type V injuries. ⋯ Despite the small study cohort, the results of LHCT and CAL transfer in chronic type V AC separation are promising. CAL transfer alone has been shown to be biomechanically insufficient for an AC reconstruction, particularly in chronic situations. The advantage of LHCT transfer is that it does not require a distant donor site or incur the costs of an allograft or implant.
-
The term 'polytrauma' lacks a universally accepted, validated definition. In clinical trials the commonly applied injury severity based anatomical score cut-offs are ISS > 15, ISS > 17 and a recently recommended AIS > 2 in at least two body regions (2 × AIS > 2). ⋯ 2 × AIS > 2 captured the greatest percentage of the worst outcomes and significantly larger % of the clinically defined polytrauma patients. 2 × AIS > 2 has higher accuracy and precision in defining polytrauma than ISS > 15 and ISS > 17. This simple, retrospectively also reproducible criteria warrants larger scale validation.