Journal of orthopaedic trauma
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The objective of this study was to analyze the appropriateness of transfer of patients with orthopaedic injuries to a Level I trauma center from surrounding Level II to IV centers. ⋯ There is a trend among community hospitals to transfer uninsured patients with benign orthopaedic injuries inappropriately to a Level I trauma center. This effect is magnified on weekends and at night. Strict regulation of the Emergency Labor Act and better communication between Level II to IV hospitals and Level I orthopaedic surgeons can decrease the inappropriate transfer of patients and reduce the burden on our healthcare system.
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Comparative Study
Comparison of three methods for measuring intracompartmental pressure in injured limbs of trauma patients.
To compare three commonly used methods and devices developed for measurement of intracompartmental pressure in injured limbs. ⋯ The methods were similar but not completely reliable for measuring intracompartmental pressure in trauma patients. Although all methods appeared useful as aids in diagnosis of compartment syndrome, intracompartmental pressure data, especially single readings, must be interpreted in view of clinical findings.
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Comparative Study
A biomechanical comparison of trochanteric nail proximal screw configurations in a subtrochanteric fracture model.
Historically, because of the magnitude of muscle forces exerted locally, as well as the commonly associated comminution, subtrochanteric fractures have been difficult to treat. Tencer et al found intramedullary nail fixation to be superior to lateral plate constructs in axial compression and combined bending. In addition, reconstruction-type intramedullary nails of more recent design have been shown to provide strength and stiffness superior to that supplied by the earlier antegrade intramedullary implants. A relatively new reconstruction nail, the DePuy VersaNail Troch Entry Nail (DePuy Orthopaedics, Inc., Warsaw, IN, USA), is unique in that it allows for two different proximal two-screw configurations: (1) the common parallel cephalomedullary arrangement and (2) a novel crossed-screw pattern. Our hypothesis was that the crossed-screw configuration would be as strong in axial loading as the cephalomedullary screw configuration. ⋯ This study shows that axial failure loads of the crossed-screw configuration were greater than those of the parallel screw configuration. Clinically, this provides the surgeon more options for stabilizing a subtrochanteric femur fracture. This decision may be made intra-operatively if necessary, facilitating fracture fixation and providing a stable construct.
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Appropriateness of patient transfer with associated orthopaedic injuries to a Level I trauma center.
To prospectively evaluate the appropriateness, indications, risk factors, and epidemiology of patients with orthopaedic injuries transferred to a Level I trauma center. ⋯ A total of 16.5% of transfers were deemed completely inappropriate by the accepting orthopaedic traumatologist. Most transfers, both appropriate and inappropriate, were attributed to either complete lack of orthopaedic coverage or a lack of expertise at the referring center.
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Comparative Study
A comparison of screw insertion torque and pullout strength.
Pullout strength of screws is a parameter used to evaluate plate screw fixation strength. However, screw fixation strength may be more closely related to its ability to generate sufficient insertion because stable nonlocked plate-screw fracture fixation requires sufficient compression between plate and bone such that no motion occurs between the plate and bone under physiological loads. Compression is generated by tightening of screws. In osteoporotic cancellous bone, sufficient screw insertion torque may not be generated before screw stripping. The effect of screw thread pitch on generation of maximum insertion torque (MIT) and pullout strength (POS) was investigated in an osteoporotic cancellous bone model and the relationship between MIT and POS was analyzed. ⋯ These results indicate that the ability of different screw designs to generate high screw insertion torque in a model of osteoporotic cancellous bone is unrelated to their pullout strength. Therefore, extrapolation of results for POS to identify optimal screw design for osteoporotic bone may not be valid. Screw designs that optimize MIT should be sought for fixation in osteoporotic bone.