Eur J Trauma Emerg S
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Due to the demographic developments worldwide, fragility fractures represent an increasing problem for the public health system. The risk of developing osteoporosis increases with age and is relatively higher in women and in the Caucasian population. The stability of bone is reduced because of accentuation of the normal loss of bone mass in ageing, leading to an increased susceptibility to fracture with an increased rate of complications after surgical stabilization. ⋯ At this stage, the trauma surgeon should initiate diagnostic procedures, treatment of osteoporosis and tertiary prevention according to the European guidelines. Ultimately, all female patients older than 50 years and all male patients older than 60 years with fractures should be assessed and treated for bone quality. Orthogeriatric specialists or interdisciplinary orthogeriatric teams should initiate a specific surgical treatment followed by early rehabilitation in order to allow the elderly patient to return to daily living as soon as possible.
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Eur J Trauma Emerg S · Dec 2008
Helsinki Trauma Outcome Study 2005: Audit on Outcome in Trauma Management in Adult Patients in Southern Part of Finland.
The outcome performance of the adult patients trauma care in Helsinki University Hospital was compared with a sample of English hospitals. This was a first time such an audit on trauma care was conducted in Finland. Helsinki University Hospital submitted the Trauma Audit and Research Network (TARN, UK) data of adult trauma patients during 1 year period (from 1 September 2004 to 31 August 2005). ⋯ The patients were older and the mean ISS was higher in Helsinki (mean ISS in Helsinki 14 vs. 11 in England). The standardized W statistic (a measure of survival variation from the expected mean, per 100 patients) was + 3.0 (confidence intervals + 2.3 to + 3.8) for Helsinki University Hospital and + 0.2 (confidence intervals -0.1 to 0.4) for English hospitals. These results suggest that the organization of trauma care in Helsinki University Hospital area is more effective in preventing death after trauma in adults than that covering the present sample of English hospitals.
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Osteoporosis is a disease that leads to fragility fractures due to the loss of bone mass and bone microstructure. This review presents an update on the fundamental pathophysiological and pathomorphological mechanisms of bone loss. Pathomorphological characteristics such as perforations and microcallus formations are explained. ⋯ Hormones, such as estrogen, follicle stimulating hormone, and leptin, transcription factors, such as Runx2 and osterix, and the wnt signaling pathway are discussed in terms of their roles in bone cell differentiation and function. On the basis of current knowledge, osteoporosis can be diagnosed and treated and fractures can be prevented. However, it is likely that new and even more effective diagnostic and therapeutic strategies will emerge as our understanding of the remodeling process that controls osteoblast and osteoclast function increases.
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Eur J Trauma Emerg S · Dec 2008
Postoperative Protocol in the Prevention of Fragility Fractures in Patients with Osteoporosis-Related Fractures.
Osteoporosis is a multifactorial disorder that requires advanced diagnostic evaluation tools. It should not be considered to be an inevitable disease entity or as a logical consequence of the physiological ageing process. Osteoporosis can be diagnosed and - more importantly - properly treated. ⋯ Basic measures for fracture prevention, including dietary supplements of calcium and vitamin D, should be recommended and implemented for all patients, whereas only those patients with the diagnosis of a manifest osteoporosis should receive a specific pharmacotherapy. Antiresorptive and anabolic drugs that are licensed for the treatment of men or postmenopausal women with osteoporosis have been shown to effectively reduce the incidence of vertebral and non-vertebral fractures. An evaluation of the treatment efficiency should also be performed, such as routine clinical re-evaluation and the measuring of the bone mineral density by dual X-ray absortiometry, every 18-24 months after the initiation of the pharmacotherapy.
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Eur J Trauma Emerg S · Dec 2008
Should Echogenic Material in the Urinary Bladder Noticed on FAST Preclude Urinary Catheter Insertion in a Trauma Patient Until Further Evaluation?
Serious urethral and bladder injuries are most often associated with severe blunt trauma. The most common diagnostic tool used to assess lower urinary tract injuries is a retrograde urethrogram. However, the decision to place a Foley catheter is often made on clinical grounds during initial stabilization phase of a trauma victim. If there is a clinical suspicion of a urethral injury, a Foley catheter should not be introduced until further evaluation is made. Focused abdominal sonography for trauma (FAST) is a major tool for primary evaluation of trauma victims. Treating trauma patients, we encountered an unusual "pick up", namely, blood clots in the urinary bladder in two patients. ⋯ We report on two cases of severely traumatized patients on which FAST examination detected an echogenic material in the bladder. This correlated with severe injuries to the urethra and urinary bladder. Moreover, ignorance of this finding in a patient without obvious clinical signs of urethral injury (Patient 1) led to a Foley catheter insertion, and as a consequence, a complex jatrogenic injury to the urethra. On the basis of this study, we hypothesize that the presence of an echogenic material on FAST examination should be considered blood until proven otherwise, and a urinary bladder catheter should not be passed, even in the absence of clinical signs of urethral injury. Since urogenital trauma is rare, this concept should be validated in the prospective study in a high-volume trauma center.