Injury
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The purpose of this study is to assess the use of esketamine as procedural sedation for the reduction of paediatric forearm fractures in the emergency department (ED). A retrospective analysis was undertaken of forearm fractures between 1st January 2012 to 31st December 2016 which were treated with manipulation in ED using esketamine sedation. Patient demographics and fracture configuration were collected. ⋯ This study provides evidence that manipulation of paediatric forearm fractures using esketamine as procedural sedation in the ED is comparable to other methods in achieving acceptable outcomes. This is in addition to the potential for cost savings. However, future studies formally assessing cost effectiveness and patient outcomes are needed.
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Acute compartment syndrome (CS) is a common complication of tibia shaft fractures (TSFs), and occurs when the pressure inside a myofascial compartment rises and impairs tissue perfusion. If treatment is delayed due to a missed diagnosis, amputation or permanent loss of function can result. This study aims to determine the incidence, clinical associations, and risk factors for missed CS following surgical stabilization of tibia shaft fractures (TSFs) using data from the National Trauma Data Bank (NTDB). ⋯ Our research identified several significant risk factors for missed CS after TSF, as well as positive and negative associations. Male gender, age, and lifestyle choices such as alcohol use and smoking conferred increased risks. These variables may assist physicians in identifying at-risk patients who may benefit from increased monitoring, and potentially prevent the high morbidity associated with this condition.
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Observational Study
Do patients know their post-operative plan? A prospective cohort study of orthopaedic trauma patients at a level I trauma center.
Patient compliance with weight bearing and physical therapy recommendations is critical following an orthopedic injury. Proper compliance requires knowledge of the postinjury plan, but there is little published data regarding comprehension of postinjury recommendations among orthopedic trauma patients. We hypothesized that patient knowledge of weight bearing and physical therapy instructions following an orthopaedic injury would be poor. ⋯ Orthopedic trauma patients had a relatively poor understanding of even basic postinjury physical therapy instructions. This did not appear to be affected by age, gender, or socioeconomic factors. Orthopedic trauma surgeons should be aware of the significant potential for knowledge deficits among their patients and should make specific efforts to identify and correct those deficits.
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Total hip arthroplasty (THA) after femoral neck fracture (FNF) is associated with an increased risk of dislocation. The goals of our study were (1) to determine dislocation and revision rates when dual-mobility cups (DMCs) are used in these patients, (2) to analyze clinical and radiographic outcomes, survivorship, complications and mortality rate, and (3) to compare results between cemented and cementless cups. ⋯ Our findings suggest that using DMC in THA for FNF may prevent dislocation with a low revision rate. Cementless cups had a higher MDP than cemented cups.
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Hip fractures are a pathology that have emerged as a major subject over the years, due to increased prevalence and the multiple surgical treatments involved. The characterization and classification of the lesion is essential for proper surgical planning, with anteroposterior (AP), lateral and traction radiograph of the hip, paramount for decision-making. ⋯ Traction hip radiograph continues to be a useful tool in training environments to adequately classify an intertrochanteric fracture, considering it is a low-cost, minimal morbidity intervention, and is easily accessible. In similar studies, we found similar findings regarding the usefulness of traction to perform an adequate classification in people in training or in young orthopedists. It also influences to determine the potential instability, and this would modify the choice of the implant.