Injury
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With advances in osteosynthesis technology providing improved stability of fixation and better outcomes, surgical treatment has become the standard of care for distal femur fractures. Pre-contoured distal femoral locking plates are the most commonly used implants for fixation. ⋯ A flexible fixation construct allowing controlled axial micromotion could help stimulate the bone healing. In order to achieve this goal, plating construct stiffness can be modified by several methods.
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Unstable chest wall injuries can result from multiple rib fractures or a flail chest, and are associated with high rates of morbidity and mortality. Traditionally such injuries have been treated non-operatively, with mechanical ventilation when required, and pain management. ⋯ However, there are many challenges and controversies regarding indications for surgical fixation, patient selection, outcomes, and fixation strategy. Further research in this area is warranted to better answer these questions.
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The United States is in a prescription opioid crisis. Orthopedic surgeons prescribe more opioid narcotics than any other surgical specialty. The purpose of this study was to evaluate the state of opioid use after extremity trauma in orthopedic surgery. ⋯ Orthopedic trauma surgeons should tailor their postoperative opioid prescriptions to the individual patient and utilize alternative options in order to control postoperative pain. Patients should be counseled regarding narcotic addiction and dependence. Patients unable to manage pain postoperatively should be followed closely and receive the proper chronic pain management, mental and social health services referrals.
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Spinal cord injury (SCI) leads to vascular damage and disruption of blood-spinal cord barrier which participates in secondary nerve injury. Epidermal growth factor (EGF) is an endogenous protein which regulates cell proliferation, growth and differention. Previous studies reported that EGF exerts neuroprotective effect in spinal cord after SCI. ⋯ Moreover, antioxidant enzyme activities including catalase, superoxide dismutase (SOD) and glutathione peroxidase (GPx) were increased following EGF treatment similar to MP treatment. Our experiment also suggests that alteration of the ratio of Bcl-2 to Bax may result from decreased apoptosis following EGF treatment. As a conclusion, these results show, for the first time, that administration of EGF exerts its protection via regulating apoptotic and oxidative pathways in response to spinal cord injury in different regions of central nervous system.
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Osteosynthesis plate designs with high levels of anatomical compliance have been demonstrated to have numerous clinical benefits. The purpose of this paper is to introduce a systematic numeric approach for anatomic plate design on the example of the distal medial tibia. The advantage of using numeric approaches for plate design is to gain objective and complete anatomical input as opposed to cadaveric investigations with limited sample sizes. ⋯ The analyses revealed differences in the anatomical compliance of plates from different generations and manufacturers. The anatomical compliance of SOMA designed plates was statistically significantly better compared to all other plates in all groups "Short", "Intermediate" and "Long" and for both ethnicities "Caucasian" and "Asian" (P<0.001). The study has shown that using an underlying database with accompanying computational tools such as SOMA can be a powerful and efficient approach towards the development and advancement of osteosynthesis plates in trauma surgery, ultimately resulting in plates with high levels of anatomical compliance and potential clinical benefits.