Injury
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The optimal time to intramedullary internal fixation for patients with isolated and unilateral femoral shaft fractures was investigated by the American College of Surgeons-Trauma Quality Improvement Program (ACS-TQIP). ⋯ Accelerated intramedullary internal fixation within 13.88 h was associated with a significantly decreased risk of PE compared with standard fixation in patients with isolated and unilateral femoral shaft fractures without additional mortality risks.
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Observational Study
Effectiveness of ultrasonography performed at the emergency department for pediatric elbow trauma cases.
Two-way direct radiography is the first-choice imaging method for pediatric patients presenting to the emergency department with elbow trauma. Although, unlike radiography, ultrasonography (US) is not used routinely, studies show that US can be used in the diagnosis of fractures in pediatric patients. ⋯ US should be considered as a diagnostic tool in cases of pediatric elbow traumas owing to its high sensitivity and negative predictive value. US, which is reproducible, ionizing radiation-free, and can be performed at the bedside, can considerably reduce unnecessary radiography in low-risk patients when evaluated along with physical examination findings among patients in the pediatric age group presenting with elbow trauma. We believe that the result of our study will contribute to patient care practices.
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Patella fractures are frequent injuries in the adult population. Initial study is made by plain radiographs and the standard set includes the skyline view of patella. Recommendation for use of this projection is variable among the experts, without data that support its performance in the diagnosis of patella fractures. The main purpose of this study was to determine the sensitivity of the antero-posterior and lateral view of the knee, without skyline view, in the diagnosis of patella fracture. ⋯ 140 patients were evaluated (70 cases and 70 controls). Sensitivity of the set without skyline view was 92.86% (CI 95% 0.90 - 0.96) and the standard set was 97.86% (CI 95% 0.96 - 0.99), without significant differences (p = 0.1) CONCLUSION: Sensitivity of the plain radiograph set without skyline view is non-inferior to the standard set. The routine use of skyline view when suspecting patella fractures is questionable.
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Humeral shaft fractures with extension to the proximal third are increasingly frequent and technically more demanding. Surgical management of proximal metaphyseal junction humeral fractures is challenging. The aim of this study was to assess the safety, reproducibility, and possibility of early and completed rehabilitation in the percutaneous treatment with helical plates in humeral shaft fractures with proximal extension. ⋯ The treatment of humeral shaft fractures with proximal extension based on a minimally invasive approach and osteosynthesis: percutaneous treatment with a twisted plate (helical plates), as this is a submuscular and extraperiosteal technique, is a safe and reproducible technique, and promotes early rehabilitation. In our opinion, it is surgical technique whose main requirement is a good knowledge of topographic anatomy.
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Epidemiologic data of 382 patients (189 men; 193 women) aged between 7 and 87 years who underwent osteosynthesis of the ankle in two trauma centers in a large Brazilian city. Electronic clinical records, preoperative and immediate postoperative radiographs in anteroposterior (AP), lateral and mortise views were evaluated. Pettrone's criteria were used to evaluate the quality of ankle fractures reduction. All radiographs were independently evaluated by two foot and ankle senior surgeons ⋯ Ankle fractures malreduction are associated with higher age, open fractures, and fracture-dislocations.