Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Feb 2002
Randomized Controlled Trial Comparative Study Clinical TrialResults of a prospective randomised study comparing a non-invasive surgical zipper versus intracutaneous sutures for wound closure.
A prospective randomised study was undertaken to investigate the advantages and disadvantages of a non-invasive surgical zipper (Medizip) vs intracutaneous sutures skin closure in orthopaedic surgery. The study group consisted of 120 consecutive patients, 45 men and 75 women with a mean age of 47 years. The Medizip was used in 20 surgical knee wounds, 20 hip wounds and 20 orthopaedic spine wounds. ⋯ Patients were positive in their assessment of the wound healing progress and results; they found the skin closure device agreeable to wear. The scar result was rated very good in 82% (n = 4 9) of the zipper group, and 85% (n = 5 1) in the intracutaneous group (p = 0 .67). Based on the results obtained, the non-invasive skin closure system Medizip represents a safe option in the spectrum of surgical wound treatment.
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Arch Orthop Trauma Surg · Feb 2002
Comparative StudyHumeral shaft fractures as predictors of intra-abdominal injury in motor vehicle collision victims.
To assess the utility of humeral shaft fractures as predictors of organ injuries and skeletal injuries in multiply injured patients involved in motor vehicle collisions (MVCs). A prospectively collected database of multiply injured motor vehicle occupants with an Injury Severity Score (ISS) greater than 12 admitted to a level I regional trauma centre during a 102-month period (January 1992 to June 2000) was reviewed to assess skeletal and organ injuries associated with a humeral shaft fracture. The effect of occupant location within the vehicle, the point of collision, and the use of a seat belt restraint was also examined to identify trends in injury patterns. ⋯ A lateral collision impact showed a trend towards increased splenic and hepatic injuries within the humeral shaft fracture group. The presence of a humeral shaft fracture in a multiply injured patient involved in a MVC is significantly associated with an increased incidence of both upper and lower extremity fractures and liver injury. Moreover, humeral shaft fractures may serve as a predictor of potential intra-abdominal pathology in multiply injured trauma patients involved in MVCs.
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Arch Orthop Trauma Surg · Feb 2002
Comparative StudyRequirements for NF-kappaB activation in hemorrhagic shock.
The activation of nuclear factor (NF)-kappaB contributes to the dysfunctional inflammatory response accompanying resuscitation from hemorrhagic shock (HS), in part through induction of pro-inflammatory cytokines including granulocyte colony-stimulating factor (G-CSF) and interleukin (IL)-6. In previous studies, we demonstrated that G-CSF and IL-6 up-regulation required both the ischemic and resuscitation phases of HS. In this study, we examined whether or not both phases of HS were required for NF-kappaB activation and the kinetics of its activation. ⋯ NF-kappaB activity did not increase in any of the unresuscitated groups compared with sham controls. In contrast, resuscitation as early as 1 h following HS resulted in increased NF-kappaB activity compared with both the unresuscitated shock group and sham controls; NF-kappaB activation persisted for 8 h. Thus, NF-kappaB activation requires both phases of HS, occurs rapidly following resuscitation, and persists throughout the early stages of dysfunctional inflammation following resuscitation.
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Arch Orthop Trauma Surg · Feb 2002
Comparative StudySurgical treatment of basal joint disease of the thumb: comparison between resection-interposition arthroplasty and trapezio-metacarpal arthrodesis.
Thirty-six thumbs with symptomatic osteoarthritis of the first carpometacarpal joint were treated either by trapezio-metacarpal arthrodesis (n = 18) or resection-tendon-interposition arthroplasty (n = 18). The mean follow-up of the 29 patients was 42 months. ⋯ No difference in grip strength between the operated and the normal contralateral hand could be established. Nevertheless, the arthrodesis seems to be the procedure causing fewer problems (only one patient not completely satisfied) and is therefore preferred over the resection-tendon-interposition arthroplasty.
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Arch Orthop Trauma Surg · Feb 2002
Case ReportsSacral insufficiency fracture, an unsuspected cause of low-back pain in elderly women.
Sacral insufficiency fractures (SIF) usually occur in elderly women and are secondary to various conditions, mainly postmenopausal or steroid-induced osteoporosis and radiation therapy. They are often overlooked or confused clinically and radiographically with metastatic disease. We report a case of a 72-year-old woman who presented to our department with severe low-back pain. ⋯ Computed tomography (CT) confirmed sclerotic changes interpreted as insufficiency fractures through both sacral alae. Increased awareness of these fractures may help to avoid unnecessary investigations and treatment. Bed rest and analgesia followed by rehabilitation provide good relief of symptoms.