Injury
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Pelvic fractures (PF) occur in up to 9 % of trauma cases, primarily from high-impact events, and are associated with increased morbidity and mortality due to frequent concomitant injuries. Thoracolumbar (TL) spinal fractures, particularly at the T10-L2 junction, are also common in high-energy trauma but are less frequently examined in association with PF. Missed TL fractures can lead to serious neurological deficits. Although Advanced Trauma Life Support (ATLS) recommends screening for TL fractures in trauma patients, no standardized guidelines exist. This study aims to explore the relationship between PF and TL fractures in trauma patients and to identify key variables associated with these injuries. ⋯ Pelvic fractures from high-impact trauma are strongly associated with concomitant TL fractures, which lead to worse clinical outcomes. Routine TL spine screening in these patients is recommended to ensure timely diagnosis and treatment.
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Ballistic fractures of the femoral neck, rare injuries that overwhelmingly affect younger adults, pose significant challenges to the treating surgeon. However, there is limited literature that the treating surgeon can leverage to guide their treatment decisions. The goal of this study is to describe the demographics, associated injuries, outcomes, and complications associated with ballistic femoral neck fractures. ⋯ Nearly 1 in 3 patients with ballistic femoral neck fractures sustain concomitant vascular injury and almost half sustain another osseous injury. In this series, only 62 % of patients who underwent operative reduction and fixation healed their fractures, and nearly 40 % of patients treated with operative reduction and fixation developed a post-operative complication. Given the poor outcomes and high complication rates associated with these injuries, surgeons should counsel patients with ballistic femoral neck fractures accordingly. Further research into the optimal treatment of ballistic femoral neck fractures is needed.
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Fracture-related infection (FRI) is a feared complication in orthopaedic trauma surgery. They are associated with multiple surgical interventions and prolonged antibiotic treatment duration, and hence, increased costs. The objective of this study was to assess the costs of FRI treatment in a Tertiary Swiss Trauma Center and to identify the variables associated with increased costs. ⋯ This study illustrates the financial burden of FRI in a DRG system and identifies potential drivers for these costs. Since repeated surgeries or unplanned surgical revisions are drivers of costs, optimal pre-operative planning and coordination between the involved disciplines is key to minimize costs. Management in multidisciplinary teams that are specialized in the treatment of these complex and cost-intensive patients may therefore reduce the financial burden.
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During revision surgery for the management of patients presenting with long-bone upper extremity nonunion, it is crucial to rule out fracture-related infection (FRI). This is especially true if there are clinical signs suggestive of FRI, or if there is a history of prior FRI, open wound fracture, or surgery. This study aimed to determine the efficacy of frozen section analysis (FSA) in providing real-time diagnosis of FRI in patients with upper-limb long-bone nonunion undergoing revision surgery. ⋯ FSA showed high sensitivity and specificity for the detection of active infection during revision surgery for nonunion of the upper limb. Owing to its high negative predictive value, it can reliably rule out active infections during revision surgery. Since the results are obtained immediately during revision surgery, this approach offers the significant advantage of enabling real-time decision-making.
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An increasing number of patients with hip fracture are taking oral anticoagulation medication including direct oral anticoagulants (DOAC). The management of these patients regarding the timing of surgery and occurrence of complications remains contentious. The aim of this study was to compare treatment and outcomes for hip fracture patients taking anticoagulation. ⋯ Current policies on the timing of surgery and anticoagulation are safe.