Injury
-
Comparative Study
A comparison between the Major Trauma Centre management of complex open lower limb fractures in children and the elderly.
Open lower limb fractures can be devastating with outcomes determined by tissue damage and adherence to strictly defined care pathways. Managing such injuries in paediatric and elderly populations presents logistical and technical challenges to achieve best outcomes. Orthoplastic principles were developed mainly in the young adult population whereas requirements for paediatric and elderly patients need further understanding. ⋯ These results reflect both similarities and important differences in managing open fractures in the extremes of age. The specific challenges of each group of patients are discussed, including surgical aspects, but also the importance of orthoplastics infrastructure within the MTC and input from allied professionals to facilitate patient pathways.
-
Comparative Study
Biomechanical evaluation of osteoporotic fracture: Metal fixation versus absorbable fixation in Sawbones models.
The failure of osteoporotic fracture after internal fixation is mainly caused by the underlying bone loss and strength compromise. The aim of this study is to investigate whether absorbable internal fixation can provide adequate mechanical stability and a reduction in the incidence of failure of fixation caused by bone loss and stress shielding. ⋯ In this experimental set-up it was found that the stability of absorbable screws in osteoporotic bone was better than metal screws. The absorbable system tested can achieve good stability, and the destruction of osteoporotic bone is small, which can reduce the occurrence of bone failure. Considering that absorbable material avoids the need of second surgery (implant removal) and reduces the stress shielding effect, we believe that absorbable internal fixation can be considered for fixation treatment of osteoporotic fractures.
-
Calcaneus is the most common site of hindfoot fracture, frequently caused by fall from height or high energy trauma. The therapeutic strategy ranged from non-operative to ORIF (Open Reduction Internal Fixation). Indications for percutaneous fixation include soft tissue damage or relative contraindications to open surgery. ⋯ At postoperative follow-up mean Böhler's angle increased to 21.51 ± 4.17° (95% CI 18.5-24.5°; p < 0.01), and mean postoperative Gissane's angle was 121.74°±6.82° (95% CI 116.8°-126.6°). Mean AOFAS at the last follow-up was 70.4 ± 17.44 (95% CI 57.9-82.8). Our study demonstrates that percutaneous calcaneoplasty using VBS™ is an effective treatment for calcaneus fracture and capable to implement correction manoeuvre with clinical and radiographic outcomes comparable with other percutaneous stentoplasty.
-
There has been heightened interest in the effect of osteoanabolic agents on acceleration of fracture healing. ⋯ Short-term daily teriparatide used for osteoporosis treatment improved radiographic fracture healing of a hip fracture and reduced complication rates. However, because of the limited power of the study, additional randomized placebo-controlled trials are needed to determine the potential benefit of PTH as an adjunct to enhance fracture healing and its efficacy in broader populations with varying comorbidities and fracture types.
-
Displaced intra-articular calcaneal fractures (DIACF) represent a challenging and controversial issue in traumatology. Conservative treatment has been recommended to avoid surgical problems and complications. The final result, however, is often a painful malunioun of the calcaneus with peroneal impingement. Surgical treatment is gaining acceptance since it offers a chance to restore bone anatomy improving function as long as complications are avoided. ⋯ Ostheosytesis through an extended lateral approach restored bone morphology with a reasonable complications rate. The clinical results were good but a normal function and complete subtalar motion were rarely achieved.