Injury
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Hospital-based hip fracture programs are essential for effective, efficient care of elderly patients who have sustained hip fractures. Many of the gains in outcomes and patient survival are a result of such integrated care models. We review the rationale, elements, and benefits of such programs across the spectrum of inpatient centers, including low-volume and high-volume community hospitals and trauma centers.
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When treating pain in the orthopaedic trauma patient opioids have classically represented the mainstay of treatment. They are relatively inexpensive and modestly effective for basic pain management. However, they are fraught with considerable side effects as well as the very high risk of addiction. ⋯ It is therefore of importance that the physician managing such patients's pain be experienced and well-versed in all these treatment modalities. We also provide a basic stepwise algorithm we have found useful in treating those with single extremity or single site trauma versus those patients with poly trauma and resultant multiple sources as pain generators. It is hoped that this breakdown of the different modalities along with a better understanding of each modality's potential benefits and indications will aid the surgeon in providing better care to patients following orthopedic trauma.
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Musculoskeletal (MSK) trauma is a major cause of disability and pain worldwide. Despite surgical advances following MSK injuries, poor functional outcomes following surgery remain a major public health concern. ⋯ Recent research has provided evidence that early rehabilitation with a multidisciplinary team can prevent these negative outcomes and improve functional outcomes following MSK trauma. In order to continue to optimize recovery, standardized rehabilitation protocols and technological advances are required.
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Early application of tourniquets has reduced injury death rates. At the end of 2013, the Israel Defense Forces Medical Corps completed a military-wide introduction of the Combat Application Tourniquet as the standard-issued tourniquet. The accompanying clinical practice guideline encouraged combat soldiers and medical teams towards a liberal use of tourniquets for extremity injuries, even when in doubt. ⋯ Following the IDF military-wide introduction of advanced tourniquets, the tourniquet application rate rose sharply, the use of old tourniquets ceased over time, and in-hospital amputation rate did not increase. These findings suggest that the awareness for haemorrhage control using advanced tourniquets rose.
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Review
Postoperative management considerations of the elderly patient undergoing orthopaedic surgery.
The elderly population is rapidly increasing, corresponding to an increase in orthopaedic surgical procedures for this group of patients. Current guidelines mostly concentrate on the patient's age when considering surgical fitness in the elderly. However, patient frailty may be a more significant factor when assessing postoperative risk in surgical management. In this article, we will analyse some of the factors associated with the postoperative care of the geriatric population after orthopaedic surgery. ⋯ There is a higher rate of postoperative complications in the surgical management of the elderly, and thus, special considerations following orthopaedic surgery in this patient group are necessary. Determining patient frailty based on clinical judgment using specific postoperative considerations could be a more reliable method in determining the surgical risk in the elderly patient. Additionally, more attention needs to be diverted towards early mobilization and patient education, as these factors can significantly help to avoid some of the postoperative complications that seem to affect the geriatric population.