Injury
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Work-related musculoskeletal (MSK) injuries pose significant challenges to workers' health, productivity, and healthcare systems. Increased working from home since the onset of the COVID-19 pandemic may have affected the incidence and prevalence of work-related MSK injuries. Despite workers' compensation systems providing valuable data, underreporting remains a concern, necessitating additional data sources such as hospital admissions to better understand the burden of MSK injuries. ⋯ The study observed a gradual decrease in the overall incidence rate of hospital admissions for cumulative work-related MSK injuries over the last decade. Despite expectations of disruptions, no significant deviations in MSK injury trends were observed following the onset of the COVID-19 pandemic in Victoria, Australia.
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Femoral neck fractures, particularly Pauwels type II and III, pose significant challenges due to their vertical instability and susceptibility to complications such as non-union and avascular necrosis (AVN). Medial buttress plates (MBPs) have emerged as a promising adjunct in fixation, offering biomechanical advantages by neutralizing shearing forces and enhancing stability. However, the clinical efficacy of MBPs across different fixation techniques, plate configurations, and positioning remains unclear. ⋯ MBPs are a valuable adjunct in managing Pauwels type II and III femoral neck fractures, providing favourable outcomes with low rates of failure and complications. The combination of MBPs with various fixation techniques has shown promising results, highlighting the potential for improved stability and outcomes. Further research is needed to optimize plate size, screw type, positioning, and the role of MBPs in augmenting fixation techniques for these challenging fractures.
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Randomized Controlled Trial
An endpoint adjudication committee for the assessment of computed tomography scans in fracture healing.
Endpoint Adjudication Committees (EACs) benefit the quality of randomized control trials (RCTs) where outcomes depend on subjective interpretations. However, assembling a committee to adjudicate large datasets is cumbersome. In a recent RCT, the primary outcome was time to union following operative fixation of scaphoid non-union, with real or placebo adjunctive ultrasound treatment. Union status was determined with computed tomography (CT) scans interpreted by treating surgeons and radiologists. An EAC was established to deliberate discrepancies between radiologists' and surgeons' interpretations of union status. ⋯ This adjudication process provides a valuable research tool for reference by other clinical investigators whose RCTs' outcomes are dependent on interpretation of radiographic images.
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Multicenter Study
Low-grade infections in nonunion of the femur and tibia without clinical suspicion of infection - Incidence, microbiology, treatment, and outcome.
Treatment algorithms for fracture nonunion depend on the presence or absence of bacterial infection. However, it is often impossible to identify infection preoperatively. While some infections may present with clinical signs of infection, low-grade infections lack infection signs and have a clinical presentation similar to aseptic nonunion. ⋯ Our findings suggest that unexpected low-grade infection is frequently associated with nonunion. While expected and confirmed infected nonunion differs significantly from aseptic nonunion, low-grade infected nonunion is very similar to aseptic nonunion, except for intraoperative bacterial detection. In addition to antibiotic therapy, surgical nonunion revision with implant exchange and debridement appears to be highly effective in achieving consolidation of low-grade infected nonunion.
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Traumatic injury poses significant physical and psychological challenges, often resulting in psychological distress, encompassing symptoms of anxiety, depression and post-traumatic stress. Despite the recognised need for psychological care in trauma rehabilitation, there is limited empirical evidence of effective interventions tailored specifically for individuals with traumatic injuries, leading to a practice-evidence gap. ⋯ The review findings highlight the preliminary evidence supporting CBT as a viable option for reducing psychological distress following traumatic injury. However, this may be explained by the dominance of CBT in the literature due to its structured nature, availability and suitability for research, potentially limiting the visibility of alternative therapeutic approaches. Further, these findings are constrained by study limitations, including small sample sizes, heterogeneity of injury types and severity, reliance on self-reported outcomes, and limited follow-up data. Future research should aim to include longitudinal follow-up assessments and explore alternative therapeutic approaches to contribute to our understanding of meaningful trauma rehabilitation methods.