Injury
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Extensive incision associated with large-scale callus exfoliation and internal fixation is the common therapeutic approach employed by the majority of orthopaedists in the treatment of old femoral fractures. Inspired by the surgical techniques of intramedullary fixation and reduction by traction, the present study attempted to treat old femoral fractures with minimally invasive methods utilising the principles of biological osteosynthesis (BO). ⋯ Minimally invasive treatment is feasible for most patients with old femoral fractures of the trochanter and femoral shaft. This finding is consistent with BO principles, thereby providing a possible new method for the treatment of old femoral fractures.
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Observational Study
Zones matter: Hemodynamic effects of zone 1 vs zone 3 resuscitative endovascular balloon occlusion of the aorta placement in trauma patients.
Resuscitative endovascular balloon occlusion of the aorta (REBOA) has emerged as a therapy for hemorrhagic shock to limit ongoing bleeding and support proximal arterial pressures. Current REBOA algorithms recommend zone selection based on suspected anatomic location of injury rather than severity of shock. We examined the effects of Zone 1 versus Zone 3 REBOA in patients enrolled in the American Association for the Surgery of Trauma Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery (AORTA) Registry. ⋯ In the hypotensive trauma patient, initial Zone 1 REBOA provides maximal hemodynamic support. Algorithms recommending initial Zone 3 placement for hypotensive trauma patients should be reconsidered.
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Trauma is a global problem. The goal of optimising multidisciplinary trauma care through speciality education is a challenge. No single pathway exists to educate care providers in trauma knowledge, management and skills. Queen Mary University of London (QMUL) devised an online electronic learning (e-learning) Master's degree (MSc) in Trauma Sciences in 2011. E-learning is increasingly popular however low progression rates question effectiveness. The further post-graduate impact is unknown. Our goal was to establish whether this program is a successful method of delivering multidisciplinary trauma education to an international community. We hypothesized that graduating students make a global impact in trauma care, education and research. ⋯ Compared with other e-learning courses this Masters program has an enviable completion rate. Graduates go on to make an international multidisciplinary impact with diverse roles in clinical management, research and trauma education. This programme provides a robust trauma education curriculum. The QMUL Trauma Sciences MSc program is an excellent resource for clinicians participating in any form of trauma care or who wish to augment sub-speciality training in trauma.
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Tibial shaft fracture is common, accounting for 2% of all adult fractures. Large epidemiological follow ups are lacking and previous studies have shown great variation in incidence rates and trends. The aim of this population-based nationwide study was to analyze all tibial shaft fractures in Finland in 1997-2014 and to provide an update on current epidemiological data. ⋯ The incidence of tibial shaft fractures has markedly decreased in Finland between 1997 and 2014, mainly because of a declining trend in the incidence of fall-induced low-energy fractures. Reasons for this development are uncertain and therefore more comprehensive population-based epidemiological studies are needed to reveal the factual reasons behind the decrease.
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Comparative Study
A comparative study for the usage of Fidji cervical cages after multilevel anterior cervical discectomy and fusion.
Postoperative dysphagia is one major concern in the treatment for patients with cervical spine spondylosis by using anterior cervical discectomy and fusion (ACDF) with plating and cage system. ⋯ Fidji cervical cages could relieve postoperative dysphagia in the treatment of multilevel CSM with ACDF, especially at the first several months postoperatively.