Injury
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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.
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The purpose of this study was to establish typical dose values at orthopaedic operating rooms of the Larnaca General Hospital (LGH). Kerma area product (KAP), fluoroscopy time (FT) and cumulative air-kerma (Ka,r) measurements were collected for 821 patients who underwent common and reproducible trauma surgery over a five-year period, with three mobile C-arm systems; two equipped with an image-intensifier and one with a flat-panel detector. Dose indices were automatically extracted from radiation dose structured reports or DICOM meta-data files archived in the PACS, using custom-made software. ⋯ Additionally, when comparing surgical operations, only femur/trochanter long/short and tibia intramedullary nailing demonstrated a significant increase in median KAP, FT and Ka,r values compared to dynamic hip screw and fixation with a locking plate, respectively. The typical dose values reported could be used as a guide to appropriate levels of intra-operative fluoroscopy in orthopaedic trauma surgery at LGH, and to encourage further optimisation by providing a baseline for audit of local practice in the absence of national reference doses. These values could also contribute to the establishment of the first national DRLs for orthopaedic trauma surgery.
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Fragility fractures of the pelvis are becoming increasingly important in an ageing society. However, they are under-represented in the current research literature. In particular, unstable bilateral fragility fractures of the sacrum (FFP IVb) benefit from surgical treatment, but individual fracture patterns need to be considered in the surgical decision. This study describes the sacral anatomy in patients with FFP IVb pelvic fractures, with particular emphasis on the identification and evaluation of possible trans-sacral screw corridors, with particular emphasis on the transverse fracture components. ⋯ III.
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Intra-articular and comminuted fractures of the calcaneus constitute a significant orthopedic challenge. Calcaneal fracture management should primarily aim to achieve good clinical and biomechanical outcomes, pain reduction, and normal function following treatment. ⋯ We observed no significant differences between the experimental group and the healthy control group in terms of cadence, gait velocity, or stride length. Patients in experimental group showed significantly shortened stance and single support phases in the treated limb in comparison with those in the intact limb; the remaining gait parameters were similar in the treated and intact limb. We observed no significant differences between the treated limbs in the patient group and the nondominant limbs in the control group in terms of any gait parameters. In the follow-up, the average pain value on the VAS scale was 2.3. The median Böhler angle changed from 5.5° preoperatively to 28.5° postoperatively, p < 0.001. The median Gissane's angle was 119° before surgery and 143° after surgery, p < 0.001.The use of the Ilizarov method in the treatment of calcaneal fractures helps achieve sufficient normalization of most gait parameters, with their values similar to those observed in healthy volunteers. After treatment of calcaneal fractures using the Ilizarov method, radiological parameters improved. The biomechanical outcomes of calcaneal fracture treatment with the Ilizarov method are good.
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Several concerns regarding gender equality in orthopedic surgery do exists. The aim of this study was to (1) compare operative times, (2) compare mortality rates, (3) investigate gender disparities in hip fracture surgeries, and (4) analyze gender distribution among attending and resident surgeons performing Closed Reduction Internal Fixation (CRIF) and Hemiarthroplasty (HA) METHODS: All patients >75 years old treated for proximal femur fractures in a level-one trauma center in a four-year timeframe were retrospectively enrolled. Exclusion criteria were follow-up <3 years, incomplete data, active patients treated with total hip arthroplasty (THA) and other surgeries performed during the same anesthesia. Patients were grouped according to procedure: 1) Closed Reduction Internal Fixation (CRIF) and 2) Hemiarthroplasty (HA). Gender and level of expertise (residents or attending surgeon) of leading surgeons (male (M), female (F) and non-binary (NB)) was extracted from medical records. Operative time, mortality rates, and the likelihood of performing either CRIF or HA were compared across genders. ⋯ Despite orthopedics still being a male-dominated field, gender does not affect surgical outcomes or the likelihood of performing CRIF or HA. However, the focus should shift towards improving inclusivity in surgical education and practice by providing equal opportunities and removing social and educational barriers based on gender.