Injury
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The need exists for perioperative blood management measures aimed at improving patient outcomes and reducing the risks of allogeneic blood transfusion (ABT). Our study aim is to discuss an algorithm to predict the need for perioperative blood transfusion in old patients with pertrochanteric femoral fractures. ⋯ An algorithm was devised to predict and manage the need for an ABT within 72h after surgery in patients with pertrochanteric femoral fractures. A reasonable transfusion program might reduce the complications caused by anaemia and effectively avoid the risks associated with ABTs.
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The MSF programme in Jordan provides specialized reconstructive surgical care to war-wounded civilians in the region. The short musculoskeletal functional assessment score (SMFA) provides a method for quantitatively assessing functional status following orthopaedic trauma. In June 2010 the Amman team established SMFA as the standard for measuring patients’ functional status. The objective of this retrospective study is to evaluate whether the SMFA scores can be useful for patients with chronic war injuries. ⋯ The ADI score in our sample appeared to be useful in two areas: (1) hospital course in patients with infection, where a high ADI score correlated with longer hospital stays and more surgeries, and (2) prognosis, which was better for non-infected patients who had high ADI scores. A scoring system that predicts functional outcome following surgical reconstruction of lower limb injuries would be enormously useful.
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The "induced membrane" technique described by Masquelet has been used successfully for many years for posttraumatic bone defect reconstruction, non-unions and osteomyelitis. The main advantages are the two-step surgical procedure that in case of primary infection allows repeated debridement if necessary, in case of internal fixation early weight bearing with decreased malalignment risk and it has a short learning curve. A theoretical application of this procedure is the management of acute severe traumatic bone loss of the limbs despite the lack of this experience in literature. We report on a Gustilo IIIB meta-epiphyseal fracture (AO 43-C3) of the leg with a 6 cm in length bone loss that was treated with the Masquelet technique.
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Surgical limb lengthening is undertaken to correct pathological short stature. Among the possible complications related to this procedure, painful and retractile scars are a cause for both functional and cosmetic concern. Our team has already shown the efficacy of autologous fat grafting in the treatment of scars with varying aetiology, so we decided to apply this technique to scars related to surgical correction of dwarfism. A prospective study was conducted to evaluate the efficacy of autologous fat grafting in the treatment of post-surgical scars in patients with short-limb dwarfism using durometer measurements and a modified patient and observer scar assessment scale (POSAS), to which was added a parameter to evaluate movement impairment. ⋯ There was a reduction of skin hardness and a clinical improvement of all POSAS parameters in all patients treated. Moreover, the newly introduced POSAS parameter appears to be reliable and we recommend that it is included to give a more complete evaluation of patient perception.
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Non-union of long bones is a significant consequence of fracture treatment. The ideal classification for non-union of long bones would give sufficient significant information to the orthopaedic surgeon to enable good management of the treatment required and to facilitate the creation of comparable study groups for research purposes. The Non-Union Scoring System (NUSS) is a new scoring system to assist surgeons in the choice of the correct treatment in non-union surgery. The aim of this study was to determine the evidence supporting the use of the NUSS classification in the treatment of non-unions of long bones and to validate the treatment algorithm suggested by this scoring system. ⋯ A statistical analysis of the first results we have obtained with the use of NUSS showed significant rates of union in all the evaluated groups. This indicates that NUSS could be an appropriate scoring system to classify and stratify non-unions and to enable the surgeon to choose the correct treatment.