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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Thrombocyte concentrate i.e. platelet-rich plasma (PRP) has become a popular adjunct for many surgical procedures. It is believed to improve bone and soft tissue healing. Recently antimicrobial effects of the autologous preparation were reported by several groups. In this study we investigated the antimicrobial effect of PRP against gram-negative microbes which frequently cause severe complications in orthopaedic trauma surgery. ⋯ With this study we demonstrate antimicrobial action of a popular adjunct for orthopaedic and trauma surgery against gram-positive and gram-negative bacteria. We have identified a possible mechanism of action via the secretion of HBD-3 as a first line defence in contaminated wounds and in elective application of PRP. This finding supports a broader spectrum of clinical indications for an autologous platelet preparation.
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Ipsilateral concomitant fractures of proximal extracapsular and distal femur are rare injuries and pose a great challenge for orthopaedics. In this study, we reviewed and examined the approaches and outcomes of this complex injury. ⋯ The nailing of a proximal femoral fracture and an LISS-DF fixation of a distal one could be a reliable and effective approach to handle ipsilateral concomitant fractures of a proximal extracapsular and distal femur.
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Intramedullary nailing is a well-established method for stabilisation of long-bone shaft fractures. It is still a controversy as to whether the procedure should be done by an unreamed or reamed technique. In the present animal study, 24 sheep were treated with intramedullary nailing. ⋯ This means that, especially during the first weeks of fracture healing, damage to the bone by the reaming process can be reduced by reaming with a reaming device with lowered cutting flutes and smaller drive-shaft diameter. Intramedullary pressure can be significantly reduced by using reaming systems with reduced drive-shaft diameters and deepened cutting flutes. In the early phase of fracture healing, callus formation can be influenced positively when using the RE system.