Injury
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Review Meta Analysis
The local soft tissue status and the prediction of local complications following fractures of the ankle region.
Well-known risk factors (RF) for soft tissue complications following surgical treatment of fracture of the ankle region include diabetes, smoking, and the local soft tissue status. A weighted analysis might provide a risk profile that guides the surgical treatment strategy. The aim of this meta-analysis was to provide a risk profile for soft tissue complications following closed fractures of the ankle region. ⋯ Among all RFs for regional soft tissue complications, the most predictive is the local soft tissue status, while additional injuries or NPS RF were less predictive. The soft tissue damage can be quantified and outweighs the cofactors described in previous publications. The soft tissue status appears to have a more important role in the decision making of the treatment strategy when compared with comorbidities such as diabetes.
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Traumatic events are the leading cause of life-altering disability in adults of working age. The management of patients with traumatic injury has substantially improved due to development of sophisticated trauma centers increasing survival after injury. Unlike the adoption of the trauma system framework, the same has not occurred with specialized trauma recovery services to include mental and social health needs. This literature review will discuss unique issues facing trauma survivors, some current recovery programs available, outcomes and benefits of these programs, and barriers that impair widespread incorporation. ⋯ The enrollment of patients with traumatic injury in novel programs to enhance recovery has led to heightened self-efficacy, better coping mechanisms, and increased use of mental health services. Additionally, trauma recovery services have been shown to reduce recidivism and have generated cost savings for hospital systems. While positive outcomes have been demonstrated, they are not consistently predictable. Barriers for widespread implementation include limitations of time, funding, and institutional support. This article describes models of successful programs initiated within some trauma centers, which may be duplicated to serve future trauma survivors.
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Accidental hypothermia in trauma patients can contribute to cardiorespiratory dysfunction, acidosis, and coagulopathy, causing increased morbidity and mortality. The early recognition of the clinical signs of hypothermia and the accurate measurement of body temperature by prehospital care providers are essential to avoid deterioration. This review provides an overview of studies that examine the reliability of different core temperature measurement options, with a focus on the prehospital setting. ⋯ A thermistor-based tympanic thermometer that features insulation of the ear and a temperature probe with a cap is likely the most suitable option for prehospital body temperature measurement in trauma patients. These results are based on outdated literature with currently more novel temperature measurement devices available. Future studies are necessary to provide strong recommendations regarding temperature measurement due to emerging technology, the lack of studies, and the heterogeneity of existing studies.
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Extensor mechanism (EM) disruption after total knee arthroplasty (TKA) is rare, but can result in devastating outcomes for patients including inability to ambulate. Disruption can occur at the quadriceps tendon, patella, or patellar tendon. This complication can be traumatic, but is often atraumatic from an iatrogenic or degenerative etiology. ⋯ However, to date, there is still no consensus for the optimal EM reconstructive technique due to the heterogeneity and small sample sizes of published studies. The need to identify a consistent and effective surgical technique is paramount to restore quality of life to patients who suffer from EM disruption after TKA. The purpose of this review is to describe the osteology, vasculature, and EM of the knee, identify risk factors associated with EM disruption after TKA, outline the considerations for surgical management, as well as compare and analyze the latest contributions to the literature, in particular allograft versus synthetic mesh, in the reconstruction of the EM after TKA.
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The incidence of ankle fractures is increasing and the clinical outcome is highly variable. ⋯ PROSPERO registration number CRD42020184830.