Injury
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Multicenter Study
The impact of fresh frozen plasma vs coagulation factor concentrates on morbidity and mortality in trauma-associated haemorrhage and massive transfusion.
Clinical observations together with recent research highlighted the role of coagulopathy in acute trauma care and early aggressive treatment has been shown to reduce mortality. ⋯ Although there was no difference in overall mortality between both groups, significant differences with regard to morbidity and need for allogenic transfusion provide a signal supporting the management of acute post-traumatic coagulopathy with coagulation factor concentrates rather than with traditional FFP transfusions. Prospective and randomised clinical trials with sufficient patient numbers based upon this strategy are advocated.
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Multicenter Study Comparative Study
The timing of definitive fixation for major fractures in polytrauma--a matched-pair comparison between a US and European level I centres: analysis of current fracture management practice in polytrauma.
Early definitive stabilisation is usually the treatment of choice for major fractures in polytrauma patients. Modifications may be made when patients are in critical condition, or when associated injuries dictate the timing of surgery. The current study investigates whether the timing of fracture treatment is different in different trauma systems. ⋯ The current matched-pair analysis demonstrates that the timing of initial definitive fixation of major fractures is comparable between the US and Europe. Certain fractures are stabilised internally in a staged fashion regardless the trauma system, thus discounting previous apparent contradictions.
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Randomized Controlled Trial Multicenter Study
Should unstable extra-articular distal radial fractures be treated with fixed-angle volar-locked plates or percutaneous Kirschner wires? A prospective randomised controlled trial.
Fractures of the distal radius are commonly treated with cast immobilisation; however, those potentially unstable injuries with dorsal comminution may need operative intervention. This intervention is usually with manipulation and Kirschner wires but advances in locking-plate technology have enabled surgeons to achieve anatomical reconstruction of complex fracture patterns, even in poor-quality osteoporotic bone. To ascertain if fixed-angle volar-locked plates confer a significant benefit over manipulation and Kirschner-wire stabilisation, we prospectively randomised 56 adult patients with isolated, closed,unilateral, unstable extra-articular fractures into two treatment groups, one fixed with K-wires and the other fixed with a volar locking plate. ⋯ These were statistically better in the plate group at 3 and 6 months. Radiological assessment showed statistically better results at 6 weeks, 3 months and 6 months, postoperatively. In the plate group, there was no significant loss of fracture reduction.
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Several authors have identified on admission haemoglobin level as the most useful predictor of transfusion risk in patients with a hip fracture. A low postoperative haemoglobin unexplained by perioperative blood loss is not uncommon in these patients. The drop in haemoglobin after re-hydration prior to surgery should depend not only on the degree of dehydration but also on the amount of blood lost in the fracture. ⋯ The on admission haemoglobin level was found to be falsely reassuring and could lead to a very low postoperative haemoglobin level. This could prove to be dangerous for many patients especially if remains undetected for several hours. We recommend that all patients with subtrochanteric fractures,and all patients with intertrochanteric or intracapsular fractures with a haemoglobin of less than 12 g/dL on admission have a repeat haemoglobin level performed prior to their surgery.
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Multicenter Study
Treatment of posttraumatic sternal non-union with a locked sternum-osteosynthesis plate (TiFix).
Only a minority of sternal fractures require osteosynthesis. Unstable non-union of the sternum is a very disabling condition which often requires treatment. The method most often used is tension-wiring. ⋯ Mean age at trauma was 32.8 years, the implant used in all cases was an 8-hole titanium plate, the fixation of the screws is based on the principles of angular stable fixation. In all cases the index procedure was possible, in all cases there was bony healing at follow-up examination. Multidirectional locked plating offers a reliable method for the successful treatment of sternal nonunion and displaced fractures.