Injury
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Observational Study
Delay in detection and treatment of perioperative anemia in hip fracture surgery and its impact on postoperative outcomes.
Elderly patients with hip fractures are at high risk for perioperative anemia as a result of fracture- and surgery-related blood loss. The detection of anemia is dependent on intermittent blood samples and therefore might be delayed, potentially leading to a significant delay in transfusion. This study aimed to investigate the possible delay in perioperative anemia detection, accumulated perioperative anemia-associated burden, peripheral perfusion, and their association with patient outcomes in elderly patients with hip fracture. ⋯ This study showed a delay in transfusion threshold detection, and the presence of significant associations between low SpHb or time with low SpHb and postoperative outcomes.
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Improved pain assessment and management in the emergency department (ED) is warranted. We aimed to determine the impact on pain management, of adding symptoms and signs to pain assessment. ⋯ Adding symptoms and signs to pain assessment of patients admitted with soft tissue injuries decreased the use of strong opioids, without affecting pain relief efficacy.
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The purpose of this study is to determine the biomechanical properties of the bicortical off-axis screw fixation for stabilizing of Pauwels III femoral neck fractures compared with other fixation methods. ⋯ The results of this biomechanical study show statistically significant increases in axial stiffness and ultimate failure load for the off-axis screw placed in bicortical fashion. Once the off-axis screw was positioned unicortically, the largest fracture diastasis was observed as compared to the other two methods.
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Minimal invasive plating (MIPO) techniques for humeral shaft fractures appear to have fewer complications and higher union rates compared to open reduction and internal fixation (ORIF). It is questionable if this also applies to simple humeral shaft fractures, as simple fractures are generally treated with absolute stability which cannot be obtained with MIPO. This raises the question whether biology or biomechanics is more important in fracture healing. This study was developed to investigate the biomechanical part of this equation. The aim of the study was to compare relative stability to absolute stability in simple humeral shaft fractures with regard to fracture healing METHODS: This was a retrospective study of all patients treated with plate fixation for AO/OTA type A1-B3 humeral shaft fractures. Patients were categorized into two groups: absolute stability and relative stability. Both groups were compared with regard to time to radiological union and full weight bearing RESULTS: Thirty patients were included in the relative-stability-group with either an AO/OTA type A (n = 18) or type B (n = 12) humeral shaft fracture and a mean age of 55 (SD 21) years. A total of 46 patients were included in the absolute-stability-group: 27 patients had a type A and 19 type B fracture. The mean age in this group was 45 (SD 19) years. Median follow-up was 12 months (IQR 8-13). Minimally invasive approach was used in 15 (50%) patients in the relative stability group. Time to radiological union was significantly shorter in the absolute-stability-group with a median of 14 (IQR 12-22) versus 25 (IQR17-36) weeks and HR 2.60 (CI 1.54-4.41)(p < 0.001). This difference remained significant after correction for type of approach (adjusted HR 3.53 CI 1.72-7.21) (p 0.001). There was no significant difference in time to full weight bearing. The addition of lag screws in the absolute stability group did not influence time to radiological healing or full weight bearing. ⋯ Absolute stability for simple humeral shaft fractures leads to a significantly shorter time to radiological union compared to relative stability. The addition of lag screws to gain interfragmentary compression does not reduce fracture healing time.
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Tibial shaft fractures treated with antegrade rigid tibial intramedullary nailing has been supported worldwide. However, the optimal inlet for nailing is still controversial. Practically, varied inlets may significantly affect the tibial alignment. This retrospective study intended to utilize magnetic resonance imaging (MRI) to investigate the optimal inlet for antegrade tibial nailing. ⋯ The optimal inlet for antegrade rigid tibial intramedullary nailing may be at a site 3 mm laterally to the medial edge of the PT. There are normally no differences for the nail inlet between men and women. The PT splitting approach for nail insertion may require modification.