Injury
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Multicenter Study
Hybrid external fixation in the treatment of tibial pilon fractures: A retrospective analysis of 162 fractures.
To determine the efficacy of hybrid external fixation in the treatment of tibial pilon fractures. ⋯ Level IV Case series.
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Randomized Controlled Trial Multicenter Study Pragmatic Clinical Trial
Assessing protocol adherence in a clinical trial with ordered treatment regimens: Quantifying the pragmatic, randomized optimal platelet and plasma ratios (PROPPR) trial experience.
Medication dispensing errors are common in clinical trials, and have a significant impact on the quality and validity of a trial. Therefore, the definition, calculation and evaluation of such errors are important for supporting a trial's conclusions. A variety of medication dispensing errors can occur. In this paper, we focus on errors in trials where the intervention includes multiple therapies that must be given in a pre-specified order that varies across treatment arms and varies in duration. ⋯ Overall, PROPPR adherence to blood transfusion order pre-specified in the protocol was high, and the required order of transfusions for the 1:1:2 group was more difficult to achieve. The approaches proposed in this manuscript were useful in evaluating the PROPPR adherence and are potentially useful for other trials where a specific treatment orders with varying durations must be maintained.
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Extensor mechanism rupture is a serious event requiring prompt diagnosis and treatment. Patella fractures are reportedly six times more frequent than soft tissue injuries such as quadriceps or patella tendon ruptures. ⋯ Diagnosis can be deemed easy to make by demonstrating inability to actively extend the knee, this however can be easily overlooked and missed in a busy emergency department leading to a late diagnosis and necessitating more complex surgery. Earlier surgical intervention and rehabilitation tend to produce improved outcomes.
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Comparative Study
Mid to distal third tibial shaft fractures caused by gunshots: Characterization and incidence of distal intra-articular extension.
Spiral tibial shaft fractures are known to have a high rate of distal intra-articular extension; however, the risk of joint involvement caused by gunshots has not been thoroughly evaluated. The purpose of this study was to determine the incidence of intra- articular involvement in tibial shaft fractures caused by gunshots. The secondary purpose of this study was to assess the usefulness of ankle radiographs versus computed tomography (CT) scans in identifying these fractures. ⋯ The incidence of intra-articular involvement for tibial shaft fractures secondary to gunshot is less than that reported for spiral type fractures (11-45% vs. 25-58%). Although radiographs have a high specificity, the sensitivity is lower than expected, with worse outcomes if a fracture is missed. We recommend that a CT scan should be utilized to determine intra-articular extension in the setting of tibial shaft fractures caused by gunshots.
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The use of intermediate screws in fractured vertebrae has been proposed to decrease the number of fused levels in thoracolumbar fractures and to enable short fixations. The aim of this study was to evaluate the results of this technique and to establish predictive factors involved in loss of segmental kyphosis correction (LKC). ⋯ 3.