Injury
-
The timely and effective management of open fractures continues to be a challenge in modern orthopaedic practice. Lower limb high energy fractures with complex soft tissue injuries require multi-disciplinary care to achieve the best results. Despite an extensive published literature on open fractures, the timing of debridement and the most appropriate personnel to perform it continue to be a source of debate. ⋯ More recently, studies have proposed an alternative approach, with initial debridement and temporary fixation followed within 48 h with a further debridement, definitive fixation and flap cover with a combined orthoplastic team. Reported results have been favourable. This is a significant change in management and there are limited data at present to determine if this approach will improve results in the most complex open fractures.
-
The present minireview aims to provide a context for imagination of the timespan for bone infection evolution from the origin of cellular bone tissue to modern orthopedic surgery. From a phylogenetic osteomyelitis-bracketing perspective, and due to the time of osteocyte origin, bacteria might have been able to infect the skeleton for approximately 400 million years. Thereby, bone infections happened simultaneously with central expansions of the immune system and development of terrestrial bone structure. ⋯ Orthopedic surgery, including arthroplasty and osteosynthesis, favor introduction of bacteria and prosthesis/implant related infections are thus anthropogenic infections (anthropogenic; resulting from the influence of human beings on nature). In that light it is important to remember that the skeleton and immune system have not evolved for millions of years to protect titanium alloys and other metals, commonly used for orthopedic devices from bacterial invasion. Therefore, these relatively new orthopedic infection types must be seen as distinct with unique implant/prosthesis related pathophysiology and immunology.
-
Titanium implants are commonly used for surgical fixation in orthopedic trauma, and have many benefits compared to stainless steel implants. Despite these benefits, some orthopedic surgeons remain hesitant to use titanium implants due to concerns of difficulty with future implant removal, given concerns with cold-welding and screw strippage. The objective of this study was to assess difficulties associated with titanium plate and screw implant removal. ⋯ IV.
-
Uterine leiomyosarcoma represents a seldom-encountered subset within the spectrum of uterine malignancies. Occurrences of appendicular skeletal metastases in uterine leiomyosarcomas are infrequent. In this study, we examined patient surveys to elucidate the clinical characteristics and outcomes of individuals with uterine leiomyosarcoma exhibiting metastatic dissemination to these anatomical regions. We hypothesized that palliative surgical treatment would have no effect on survival in patients diagnosed with uterine leimyosarcoma with appendicular bone metastases. ⋯ IV.