Injury
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Multicenter Study
Early coagulation support protocol: A valid approach in real-life management of major trauma patients. Results from two Italian centres.
Early coagulation support (ECS) includes prompt infusion of tranexamic acid, fibrinogen concentrate, and packed red blood cells for initial resuscitation of major trauma patients. The aim of this study was to determine the effects, in terms of blood product consumption, length of stay, and in-hospital mortality, of the ECS protocol, compared to the massive transfusion protocol (MTP) in the treatment of major trauma patients. ⋯ The ECS protocol was effective in reducing blood product consumption compared to the MTP and confirmed the importance of early fibrinogen administration as a strategy of rapid coagulation. This novel approach may be adopted in real-life management of major trauma patients.
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The incidence of osteosynthesis is increased by volar anatomic plate used for treatment of distal radius fractures and this increases the incidence of wrist extensor tendon irritation, a postoperative complication of the aforementioned surgical technique. The purpose of this study; was to evaluate the intraoperative skyline view which is commonly used to prevent dorsal cortex penetration of distal screws during the surgical treatment of intra-articular distal radius fractures with comminuted dorsal cortex with CT (computed tomography) scanning to determine its effectiveness. In the literature review, no other study focused on similar fracture types was found. ⋯ The insertion of a distal screw 2 mm (millimeter) shorter than the length measured with the help of skyline view is considered to be a more effective method than other intraoperative methods for preventing dorsal cortex penetration. In addition, more comprehensive studies are required in order to recommend the mono-cortex fixation, in which distal screws measuring 4 mm shorter are used.
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Venous thromboembolism (VTE) is a serious complication that contributes to morbidity, mortality, and healthcare costs during the surgical care of patient with lower extremity fractures. Despite this, few recommendations on the topic exist and the literature on VTE incidence is incomplete. Therefore, this study will attempt to estimate annual incidence and trends in 30-day thrombotic events and mortality for the following fractures: (1) hip, (2) femur, (3) patella, (4) tibia and/or fibula, and (5) ankle. ⋯ III.
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Intramedullary nailing is the treatment of choice for shaft of femur fractures in adults. Antegrade nails involve entry through either piriformis fossa (PE) or greater trochanteric (GT) tip. The superiority of one entry point over the other is a matter of debate, and the present review was done to determine the same. ⋯ GT entry nails are superior to PE nails for treating shaft of femur fractures in adults. They have a shorter learning curve and better functional outcomes, however the rates of union are comparable in both.
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Randomized Controlled Trial Comparative Study
A qualitative study of patients' experience of recovery after a distal femoral fracture.
This qualitative study was conducted as part of a feasibility study for TrAFFix, (ISRCTN92089567), a randomised controlled trial that will compare two surgical interventions used to fix distal femoral fractures. Our aim was to understand patients' experiences of treatment and the early phase of recovery after a distal femoral fracture. While, much is known about the experience of recovery from hip fracture, little is known about whether patients with other lower limb fragility fractures experience the same concerns and challenges. ⋯ Our findings highlight the struggle patients endure while recovering after a distal femoral fracture and the limited rehabilitative support they receive after discharge from hospital. They reinforce the need to ensure a patient feels informed about their treatment and recovery and the need for greater support for patients to manage at home and move with confidence.