Injury
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Multicenter Study
Open lower limb fractures in the UK trauma system: A multicentre prospective audit of current practice.
Open fractures represent limb-threatening and life-changing injuries. Clear standards define how patients with these injuries should be managed in the UK. The study of open fractures is, therefore, a key measurable example of major trauma management as a whole. This study was conducted to characterise the demographic, assessment and treatment of patients sustaining lower limb open fractures across UK Regional Trauma Networks. ⋯ This study gives extensive new insight into the demographics and management of patients with open lower limb fractures in the UK, demonstrating a widespread involvement of TUs and consistent deviation from national standards.
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The process of bone healing largely recapitulates bone development in the embryo and ideally achieves complete restoration of bone shape and structure. However, because successful fracture healing requires tight interactions of numerous cell types and signaling molecules, any disruption of this highly coordinated processes can result in delayed healing or even non-union formation. The rate of fracture healing complications in orthopedic patients is reported to be 5-20%. ⋯ The three main investigated antagonists of the WNT signaling pathway, which can be blocked experimentally by antibodies, are Sclerostin, Dickkopf-1 and Midkine. Treating animals with antibodies against these proteins enhanced bone formation in the fracture callus. This indicates a therapeutic potential for these antibodies to accelerate fracture healing in patients with orthopedic complications.
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Significant functional disturbance, deformity, and malalignment may occasionally develop after healing of a fracture, especially one involving the lower extremities. This study sought to provide preliminary evidence of the effectiveness of chipping corrective osteotomy (CCO), which does not require autologous bone grafting, for treating malunion with lower extremity angular deformity. ⋯ Further evaluation in a larger series is needed to clarify the usefulness of CCO in correction of angular malunion.
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Given the drawbacks of a femoral intertrochanteric fracture classification based on 2-dimensional radiographic imaging, an artificial intelligence-based classification system- the Tang classification system-which uses 3-dimensional image analysis, has previously been developed. This study explored the reliability of the Tang classification by comparing the consistency of this classification with the conventional 2-dimensional femoral intertrochanteric fracture classification systems. ⋯ The current study suggests that the Tang classification system is more reliable than the Evans, Jensen, and AO/OTA classification systems for measuring intertrochanteric fractures of the proximal femur.
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Fractures of the pelvis and acetabulum are major injuries, often associated with hospitalization, reduced function and sometimes life-threatening conditions. Current data on nationwide incidence and treatment is sparse. Existing epidemiological studies are either single-centered or investigating only in-patients. The aim of this study was to investigate the epidemiology and treatment of pelvic and acetabular fractures in a nationwide register study including all adult patients in Sweden during 2001-2016. ⋯ The incidence of pelvic and acetabular fractures increased markedly in Sweden from 2001-2016. Pelvic fractures were more common among females and acetabular among males. The surgical rate was higher for acetabular compared to pelvic fractures. Major gender differences in treatment choices were found with higherproportion of men treated surgically for both fracture types, and in all age groups.