Injury
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Review Practice Guideline
Standards of open lower limb fracture care in the United Kingdom.
Open fractures of the lower limb remain a potentially devastating group of injuries that are challenging to manage. The primary aims of treatment are to optimise limb function and avoid serious complications such as infection and non-union, which are costly for both the patient and healthcare system. ⋯ These have served to standardise care for these injuries in the United Kingdom. The aim of this review is to update our colleagues on the current standard of lower limb open fracture care in the United Kingdom, and the impact this has had on patient outcomes.
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During the SARS-COV-2 pandemic and consequent government measures to prevent the overwhelming of public hospitals, emergency department (ED) orthopaedic turnout was significantly altered. This study compared the turnout of patients with upper extremity (UE) and hand & wrist (H&W) emergencies during the SARS-COV-2 pandemic, with the same period of 2019, in the public and private sector. ⋯ The extent of lockdown was unprecedented in recent years. The reduction of orthopaedic, UE and H&W emergencies during lockdown can be attributed to the fear of contracting the virus in the hospitals and even more in hospitals serving as COVID-19 reference centers. Despite the decrease -in absolute numbers- of patients, the increased percentages of UE to total orthopaedic and of H&W to total orthopaedic emergencies in 2020 in both hospitals, reflect the new hobbies' uptake and the increase of domestic accidents during the lockdown, despite overall activity decrease, and underline the necessity of presence of hand surgeons in the EDs. This is one of the very few population-based studies worldwide to show trends in incidence of different injuries of the UE at a regional level during the pandemic, and its results could affect future health care policies.
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According to the classification of Judet and Letournel, all double column acetabular fractures will certainly involve the disruption of the quadrilateral plate (QLP). Accurate reduction and reliable fixation of QLP is the key to obtain a normal congruent hip joint and avoid postoperative arthritis. The aims of this study were to assess the biomechanical properties of a novel dynamic anterior plate-screw system (named DAPSQ) and to compare its biomechanical stability with buttress-plate construct. ⋯ In this in vitro biomechanical study, DAPSQ plate and quadrilateral screws fixation of a double column acetabular fracture involving the QLP resulted in a better fixation construct than the traditional suprapectineal pelvic reconstruction plate and 1/3 tube buttress plate fixation.
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Randomized Controlled Trial
Wound drainage after proximal femoral nail antirotation (PFNA) fixation may negatively affect the patients with intertrochanteric fractures: A prospective randomized controlled trial.
The effect of using closed suction drainage system with the proximal femoral nail antirotation (PFNA) system fixation on outcomes in treating intertrochanteric fractures (ITFs) is still unknown. This prospective randomized controlled trial aimed to examine whether routine drainage is useful for PFNA fixation in ITFs. ⋯ Blood transfusion requirement and TBL were higher in the drained group than in the undrained group of PFNA fixation for ITFs. In addition, the closed drainage system may have manifested no short-term benefit for wound condition postoperatively.
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Tracheobronchial injuries are rare but feasibly life-threatening conditions. A prompt diagnosis and early management can be lifesaving. Due to the unspecific symptoms and indirect radiological signs the diagnosis often delays. ⋯ In case of suspected tracheobronchial injury, a high index of suspicion is required for early diagnosis. Most commonly respiratory distress, subcutaneous emphysema and pneumothorax are found on physical examination. Prompt intubation below the site of the injury and early laryngo- or bronchoscopic examination have priority, as we did in our cases. A primary anastomosis is required with minimal resection during urgent operation. A better outcome is to be expected when extubation is done early after surgery. We offer ordinal steps that should be taken to lead to a prompt management and good long-term outcome based on the literature and our experiences.