Injury
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Orthopaedic trauma does not present in a linear fashion. Fluctuations in trauma volumes, after-hours surgery and surgical wait times impact orthopaedic surgeons and patients. There is little research focussing on how surgical trauma volumes change throughout the week. This study investigated the relationship between day of the week and surgical orthopaedic trauma volumes, after-hours surgery, and wait times for orthopaedic trauma patients. ⋯ With a lack of dedicated trauma resources on the weekend, a significant increase in after-hours surgery and surgical wait times was identified following surgical volumes peaking on Thursday and Friday. We suggest adapting resource allocation to reflect surgical volumes. Dedicated weekend orthopaedic trauma resources or an adaptable schedule during increased orthopaedic trauma have the potential to ease this bottleneck, improve patient care, and decrease hospital costs.
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Aseptic loosening after total hip replacement brings adverse health outcomes and increased risk for complications. The resorptive activity of inflammatory cells activated by the presence of wear-generated debris plays a critical role in debris-induced osteolysis. Previous studies indicate that the abnormally expressed LINC01534 plays a critical role in inflammatory responses. ⋯ In addition, we revealed that inhibition of miR-135b-5p or overexpression of PTPRT could antagonize the effects of LINC01534 knockdown on inflammation attenuation in hip chondrocytes. Mechanistically, we demonstrated that LINC01534/miR-135b-5p/PTPRT axis regulated the NF-κB signaling pathway in hip chondrocytes. Taken together, our findings suggest that LINC01534/miR-135b-5p/PTPRT axis might be a valuable therapeutic target for the treatment of debris-induced osteolysis.
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Periprosthetic fracture rate after short and long hip nails: Analysis of a regional health database.
Intertrochanteric hip fractures are a major socio-economic burden, and a significant source of morbidity and mortality. Treatment is generally surgical, with either a dynamic hip screw or a cephalomedullary hip nail. Recently, there has been a trend toward the use of hip nails. The use of short nails over long nails, which span the length of the femur, remains a source of controversy. Historically, short nails were associated with a higher periprosthetic fracture rate compared with long nails, however newer nail designs, appear to have resolved this issue. Small retrospective studies show a refracture rate similar in both long and short nails. Given the small sample size of current studies, it remains unclear if the refracture rate is indeed the same between treatment arms, or if studies are not sufficiently large to identify a difference between the two. A large database review would provide the practical next step to further explore this question. ⋯ This study did not find a statistical difference in periprosthetic fracture rate when comparing short and long cephalomedullary nails for the treatment of intertrochanteric fractures. Procedure time was shorter in the SN group. However, no difference in rate of blood transfusion was noted between patient groups. This study supports use of both nail type for hip fracture fixation, on the basis of periprosthetic fracture rate.
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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.