Injury
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Multicenter Study
Infection after operative fixation of tibia plateau fractures. A risk factor analysis.
Surgical fixation of tibial plateau fractures has been shown to improve long-term functional outcomes, but a major complication is that of postoperative infection which can be deleterious to long-term outcomes. This study aims to assess the impact of common comorbidities on the risk of postoperative infection. ⋯ This study has identified excessive alcohol consumption as the only independent risk factor for postoperative infection in patients with all types of tibial plateau fracture treated with operative fixation. No relationship between smoking, diabetes nor obesity was found for postoperative infection.
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Multicenter Study
Potential bone fragility of mid-shaft atypical femoral fracture: Biomechanical analysis by a CT-based nonlinear finite element method.
The authors previously reported a CT-based nonlinear finite element analysis (nonlinear CT/FEA) model to investigate loading stress distribution in the femoral shaft of patients with atypical femoral fractures (AFFs). This showed that stress distribution, influenced primarily by femoral bowing, may determine the location of AFF. Here, we demonstrate the locational characteristics associated with AFFs in an Asian, specifically Japanese, population regarding bone strength. This is the second report from our multicentre research project suggesting a possible new concept of diagnostic criteria or treatment according to AFF subtype. ⋯ AFF has different features, in terms of bone strength, depending on fracture location. At the very least, Japanese patients with mid-shaft AFF could be at high risk of hip fracture because of bone fragility, in contrast to the firm bone of subtrochanteric AFF. For internal fixation of mid-shaft AFF using an IM nail, cervical screw insertion toward the femoral head might be recommended to prevent possible hip fracture.
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Multicenter Study Comparative Study
Locking plates versus retrograde intramedullary nails in the treatment of periprosthetic supracondylar knee fractures. A retrospective multicenter comparative study.
Biomechanical studies demonstrated the superiority of retrograde supracondylar intramedullary nails (RIN) against locking plates (LP) for the treatment of periprosthetic supracondylar femoral fractures (PSFs); however, clinical results are still conflicting. This study aimed to compare LP and RIN, as well as, cemented and uncemented nails in the treatment of PSFs regarding fracture healing, complications and functional results. ⋯ PSFs with good bone stock can be treated equally with LP or RIN. Nails demonstrated advantages concerning the fracture healing potential. Orthopaedic surgeons need to be trained in both treatment options to manage PSFs. Cemented nails may increase stability and healing capacity in elderly osteoporotic patients; however, further studies are needed.
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Multicenter Study
Early coagulation support protocol: A valid approach in real-life management of major trauma patients. Results from two Italian centres.
Early coagulation support (ECS) includes prompt infusion of tranexamic acid, fibrinogen concentrate, and packed red blood cells for initial resuscitation of major trauma patients. The aim of this study was to determine the effects, in terms of blood product consumption, length of stay, and in-hospital mortality, of the ECS protocol, compared to the massive transfusion protocol (MTP) in the treatment of major trauma patients. ⋯ The ECS protocol was effective in reducing blood product consumption compared to the MTP and confirmed the importance of early fibrinogen administration as a strategy of rapid coagulation. This novel approach may be adopted in real-life management of major trauma patients.
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Multicenter Study
Prehospital prediction of severe injury in road traffic injuries: A multicenter cross-sectional study.
To develop and validate a risk stratification model of severe injury (SI) and death to identify and prioritize road traffic injury (RTI) patients for transportation to an appropriate trauma center (TC). ⋯ Risk prediction models of death and SI were developed with good calibration and excellent discrimination. The model should be useful for ALS response units in proper allocation of patients.