Injury
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Randomized Controlled Trial
AO international consensus panel for metrics on a closed reduction and fixation of a 31A2 pertrochanteric fracture.
The foundations of an effective and evidence-based training program are the metrics, which characterize optimal performance. ⋯ Surgical procedures can be broken down into constituent, essential, and elemental tasks necessary for the safe and effective completion of a reference approach to a specified procedure. Procedure experts from 18 countries reached consensus on performance metrics for the fixation procedure. This metric-based characterization should form the basis of more quantitative validation studies to guide the construction of a proficiency-based progression training curriculum.
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Randomized Controlled Trial
Beyond the pillars of the ankle: A prospective randomized CT analysis of syndesmosis' injuries in Weber B and C type fractures.
This study compared clinical and radiographic results of patients who underwent stabilization of syndesmosis with one tricortical syndesmotic screw divided into three different groups: Group A without preoperative fractured ankle computed tomography (CT) scan, Group B with preoperative fractured CT scan, and Group C with preoperative bilateral ankle CT analysis. ⋯ Use of the pre-operative CT scan of the injured and uninjured ankle give to the surgeons the more and accurate information for the reduction and help him intraoperative in the correct maneuvers. The accuracy of the syndesmosis reduction determines better clinical outcomes.
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Randomized Controlled Trial Comparative Study
A double-blind, randomized controlled trial of gabapentin vs. placebo for acute pain management in critically ill patients with rib fractures.
Achieving adequate pain control for rib fractures remains challenging; prescription of alternatives to narcotics is imperative to curtail the current opioid epidemic. Although gabapentin has shown promise following elective thoracic procedures, its efficacy in patients with rib fractures remains unstudied. We hypothesized that gabapentin, as compared to placebo, would both improve acute pain control and decrease narcotic use among critically ill patients with rib fractures. ⋯ In this group of critically ill patients with rib fractures, gabapentin did not improve acute outcomes for up to one month of treatment.
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Randomized Controlled Trial Multicenter Study
Minimal impact of a care pathway for geriatric hip fracture patients.
Adherence to guidelines for patients with proximal femur fracture is suboptimal. ⋯ Implementation of a care pathway improved compliance to evidence, but no significant effect on patient outcomes was found. The impact of the collaboration between surgeons and geriatricians on adherence to guidelines and patient outcomes should be studied.
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Randomized Controlled Trial Multicenter Study
Cement augmentation of the Proximal Femoral Nail Antirotation (PFNA) - A multicentre randomized controlled trial.
New implant designs like the Proximal Femoral Nail Antirotation (PFNA) were developed to reduce failure rates in unstable pertrochanteric fractures in the elderly. Standardized implant augmentation with up to 6 mL of polymethylmethacrylate (PMMA) cement has been introduced to enhance implant anchorage by increasing the implant-bone interface in osteoporotic bone conditions. Biomechanically, loads to failure were significantly higher with augmentation. The primary objective of this study was to compare the mobility of patients with closed unstable trochanteric fractures treated by PFNA either with or without cement augmentation. ⋯ Augmentation of the PFNA blade did not improve patients' walking ability compared to the use of a non-augmented PFNA but might have the potential to prevent reoperations by strengthening the osteosynthesis construct.