Injury
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Randomized Controlled Trial
Biomechanical analysis of dual versus lateral locked plating in elderly bicondylar tibial plateau fractures: Does medial comminution matter?
To assess dual plating versus lateral locked plate fixation of bicondylar tibial plateau fractures in an elderly cadaveric model with and without medial bone loss PARTICIPANTS: 10 pairs of elderly (range 78-93 years of age) fresh frozen tibias. ⋯ The results of this study demonstrate that a lateral locked plate may offer an alternative means of fixation in AO/OTA 41 C1 and C2 fractures.
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Randomized Controlled Trial
Comminuted intraarticular calcaneal fractures: Multiplanar VA locked plating and interlocked nailing incorporate longitudinal strut and provide superior stability - a biomechanical cadaveric study.
Treatment of comminuted intraarticular calcaneal fractures remains controversial and challenging. The aim of this study was to investigate the biomechanical performance of three different methods for fixation of such fractures. Comminuted calcaneal fractures, including Sanders III AB fracture of the posterior facet and Kinner II B fracture of the calcaneocuboid joint (CCJ) articular calcaneal surface, were created in 18 human cadaveric lower legs by osteotomizing. ⋯ Varus deformation of 10° between the calcaneal tuberosity and the lateral calcaneal fragments was reached at significantly lower number of cycles in Group 1 compared the other groups (P ≤ 0.017). Both cycles to 10° plantar gapping between the anterior process and the calcaneal tuberosity fragments, and 2 mm displacement at the CCJ articular calcaneal surface revealed no significant differences among the groups (P ≥ 0.773). From a biomechanical perspective, treatment of comminuted intraarticular calcaneal fractures using anterolateral variable-angle locking plate with additional longitudinal screws or interlocked nail in combination with separate transversal screws provides superior stability as opposed to lateral variable-angle locked plating only.
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Randomized Controlled Trial
Functional and radiological outcomes of primary ring fixator versus antibiotic nail in open tibial diaphyseal fractures: A prospective study.
Management of open fractures of tibia is still a matter of debate due to high incidence of infections. Traditionally external fixators have been advocated in managing open tibial fractures. Due to limited efficacy of systemic antibiotics, recently antibiotic coated intramedullary interlocking nails have been developed for the management of open tibia fractures. Therefore, we conducted this prospective randomized study to compare the functional and radiological outcomes of primary ring fixator versus antibiotic coated nail in open diaphyseal tibial fractures. ⋯ Level II.
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Reduction in patient-facing teaching encounters has limited practical exposure to Emergency Medicine for medical students. Simulation has traditionally provided an alternative to patient-facing learning, with increasing integration in courses. Rapid advancements in technology facilitate simulation of realistic complex simulations encountered in the emergency setting. This study evaluated the efficacy of high-fidelity simulation in undergraduate emergency trauma medicine teaching. ⋯ The findings suggest that simulation training within emergency medicine can result in significant increases in both competency and confidence. Benefits were observed over a six-week period. In the context of reduced patient-facing teaching opportunities, emergency medicine simulation training may represent an invaluable mechanism for delivery of teaching.
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Acute tibial fracture-related infection (FRI) is one of the most feared and challenging complications after a tibial fracture. The most appropriate treatment in this scenario is far from a resolved topic. Circular external fixators (CEFs) offer multiplanar control and minimize soft tissue injury using temporary implants far from the infected area. This study aimed to investigate the outcomes of two different types of CEFs (Ilizarov and hexapod) in the treatment of a series of acute tibial FRIs. ⋯ Definitive circular external fixation is an excellent treatment for acute tibial FRI. Both Ilizarov and hexapod systems offer a very high rate of fracture healing and infection eradication. Although both presented very low radiological post-operative residual deformity, the hexapod system showed less residual coronal translation deformity and better callus quality.