Injury
-
The current opioid epidemic is a national problem and an increasing concern for pediatric orthopedic patients. The utilization of non-opioid pain methods may help improve the over-prescribing and overuse of opioid medications. The present study is a pain medication usage study that aims to investigate the effects of an intraoperative bupivacaine (BP) fracture injection and IV paracetamol on postoperative opioid consumption when treating supracondylar fractures of the humerus in children. ⋯ Opioid abuse and overuse in children is part of a national healthcare crisis. The use of BP injected into the fracture at the time of surgery is safe, effective, and reduces the need for opioids. Furthermore, the combination of intraoperative BP and IV paracetamol demonstrated less utilization of opioids than BP alone.
-
Extracorporeal shockwave therapy is a treatment modality, originally introduced into the clinic as lithotripsie, which has also been successfully used in the last two decades in the non-invasive treatment of delayed or non-healing fractures. Initially, the mechanism of action was attributed to microfracture-induced repair, but intensive basic research has now shown that the shockwave generates its effect in tissue via mechanotransduction. ⋯ The attainable outcome is comparable to surgery but avoiding an open approach with associated potential complications. These advantageous properties with a clearly positive cost-benefit ratio make shockwave therapy a first line treatment in delayed and non-union fractures.
-
The fracture repair process is known to be delayed in postmenopausal women, under estrogen-deficient status. Osteoporotic fracture mainly occurs in the metaphyseal region of the long bone; however, most studies on fracture healing have focused on the diaphyseal region. In this study, we compared the repair process between metaphysis and diaphysis of ovariectomized (OVX) and Sham mice, and analyzed the effects of short-term estrogen administration in OVX mice. ⋯ Estrogen administration improved medullary callus formation in the diaphysis, however not in the metaphysis. The effect of ovariectomy on the repair process in diaphysis was greater than that in metaphysis. Our findings clarify the differences between the metaphysis and diaphysis repair process using OVX mouse model and suggest that the estrogen sensitivities differ between the sites during the bone repair process.