Injury
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Injuries remain an important public health concern, resulting in considerable annual morbidity and mortality. In low- and middle-income countries (LMICs), the lack of appropriate infrastructure, equipment and skilled personnel compound the burden of injury, leading to higher mortality rates. As Advanced Trauma Life Support (ATLS) courses remain uneconomical and inappropriate in LMICs, the Primary Trauma Care (PTC) course was introduced to provide an alternative that is both sustainable and appropriate to local resources. ⋯ Departmental, institutional and personal improvements may occur in clinical practice as a result of formal PTC training of trauma team members in LMICs. Further high-quality research is needed to evaluate this course's effects on observed change in clinical practice and patient outcomes. This may require long-term observational and epidemiological studies to assess improvements in morbidity and mortality. PROSPERO Registration Number: CRD42019133986.
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Multicenter Study
Orthopedic treatment and early weight-bearing for bimalleolar ankle fractures in elderly patients: Quality of life and complications.
Non-operative treatment of Weber's type B ankle fractures is essential in elderly patients. However, there is controversy in the post-reduction management of the fracture between the use of early weight-bearing or traditional treatment and non-weight-bearing for 6-8 weeks. There is limited evidence available regarding which rehabilitation regimen should be included. This study aimed to compare the quality of life and the number of complications between the two types of intervention (weight-bearing and non-weight-bearing). ⋯ Early weight-bearing improves the quality of life and functionality in elderly patients with Weber type B fracture without increasing complications.
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Induced membrane technique (IMT) is a well-established technique for treating segmental bone defects. Different variations of the technique have been described. Our objective was to evaluate radiological and functional outcome with IMT using a nail - graft filled titanium cage construct for segmental traumatic bone defects of the tibia. ⋯ Excellent union rates with good functional restoration can be achieved after IMT using the nail - cage construct for segmental tibial defects. Persistent infection is the biggest impediment for successful execution of the technique. Addition of a cage may also improve short-term functional outcome in terms of ability to weight bear and early return to work.
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Comparative Study
Clinical outcomes of PFNA-II in the Asian intertrochanteric fracture patients: Comparison of clinical results according to proximal nail protrusion.
This study intended to explore the clinical outcomes of PFNA-II, one of the commonly used fixation devices for intertrochanteric fractures and the association of clinical results with the extent of proximal nail protrusion. ⋯ Nail protrusion over the greater trochanter area occurs frequently after the surgical treatment of intertrochanteric fracture using PFNA-II. When the nail protruded into the greater trochanter, the number of patients who clinically complained of pain was statistically significantly high. We recommend a modification to the PFNA-II that would further shorten the proximal nail end suitable for the Asian population to achieve better clinical results in the fixation of intertrochanteric fractures.
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The quality of intertrochanteric fracture reduction has traditionally been evaluated using simple radiographs. However, subjective intraoperative evaluation and efforts to achieve a perfect reduction are essential for optimal outcomes. This study aimed to establish criteria for the intraoperative assessment of the quality of intertrochanteric fracture reduction and also analyzed postoperative outcomes in terms of reduction quality. ⋯ Good outcomes cannot be achieved with traction alone for femoral intertrochanteric fractures. Active management is required because accurate anteromedial cortex reduction, and restoration of neck-shaft angle and anteversion are essential in femoral intertrochanteric fractures.