Injury
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Three-dimensional imaging has changed the understanding and management of tibial plateau fractures. In the 1970s, Schatzker proposed a classification for tibial plateau fractures, which highlighted the morphology of the six principal types. ⋯ The extended classification introduced the split wedge fragment and the continuity of the rim as the determinants of joint stability and the critical role that this plays in the management of tibial plateau fractures. The current manuscript re-emphasizes contemporary concepts of tibial plateau stability and depicts key issues which must be considered when planning the definitive surgical fixation of tibial plateau fractures.
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Fracture-related infection (FRI) after the operative management of patella fractures is a serious complication that can result in prolonged hospitalization, multiple revision procedures and permanent functional impairment. Till today, treatment modalities and outcome of FRI of the patella are not well described. Therefore, the main objective of this retrospective cohort study was to evaluate treatment options, functional outcome and healthcare costs related to FRI of the patella. ⋯ FRI of the patella is a challenging complication and recurrence of infection not uncommon. Although multiple treatment modalities exist, a multidisciplinary patient-specific approach is crucial. An early or delayed onset infection can be managed with a DAIR approach, but only when the construct is stable and the soft tissue coverage adequate. In patients with an FRI, implant removal is preferred when the fracture has healed. A total patellectomy can be used as a salvage procedure in complex cases with acceptable functional results. Overall, FRI of the patella leads to both a negative impact on the functional status of the patient and a ninefold increase in total healthcare costs.
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Observational Study
Disparities in discharge patterns of admitted older patients with ocular trauma.
In older patients, poor vision from ocular trauma increases the likelihood of further injuries and repeat hospitalizations, underscoring the need for appropriate post-hospitalization care. We sought to evaluate disposition patterns of older patients admitted with ocular trauma. ⋯ Hispanic, black, male, and self-paying patients were disproportionately discharged home. Ocular injuries had low impact on ACF placement. Understanding these disparities will assist in developing guidelines for appropriate and equitable post-trauma rehabilitation in this vulnerable population.
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The approach to pure depression fractures (PDF) of the posterolateral tibial plateau (PTP) is classically a posterior approach via a metaphyseal osteotomy window with elevation of the depressed articular fragment. Other posterolateral approaches have been described but have been criticized for affecting reduction quality, and risks to the common peroneal nerve. ⋯ IV.
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Traumatic brain injuries (TBI) are a critical global health challenge, with disproportionate negative impact in low- and middle-income countries (LMICs). People who suffer severe TBI in LMICs are twice as likely to die than those in high-income countries, and survivors experience substantially poorer outcomes. In the hospital, patients with severe TBI are typically seen in intensive care units (ICU) to receive advanced monitoring and lifesaving treatment. ⋯ The findings point to the need for targeted interventions among young men, improvements in pre-hospital transportation and care, and continued efforts to increase the quality of surgical and ICU care in this setting. It is unlikely that poorer outcome among ICU patients was indicative of poorer care in the ICU; this finding was more likely due to lack of data on several factors that inform care decisions (e.g., comorbid conditions or injuries). Nevertheless, future efforts should seek to increase the capacity of ICUs in low-resource settings to monitor and treat TBI according to international guidelines, and should improve predictive modeling to identify risk for poor outcome.