Injury
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Randomized Controlled Trial Comparative Study
Effects of unconsciousness during spinal immobilization on tissue-interface pressures: A randomized controlled trial comparing a standard rigid spineboard with a newly developed soft-layered long spineboard.
Immobilization of the spine of patients with trauma at risk of spinal damage is usually performed using a rigid long spineboard or vacuum mattress, both during prehospital and in-hospital care. However, disadvantages of these immobilization devices in terms of discomfort and tissue-interface pressures have guided the development of soft-layered long spineboards. We compared tissue-interface pressures between awake and anaesthetized (unconscious) patients during immobilization on a rigid spineboard and a soft-layered long spineboard. ⋯ This prospective randomized controlled trial shows that using a soft-layered spineboard compared to a rigid spineboard for spinal immobilization resulted in lower tissue-interface pressures in both awake volunteers and anaesthetized patients. Moreover, tissue-interface pressures on the soft-layered spineboard were lower in anaesthetized patients than in awake volunteers. These findings show the importance of using a soft-layered spineboard to reduce tissue-interface pressure, especially for patients who cannot relieve pressure themselves by changing position.
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This survey was conducted during the 38(th) Brazilian Congress of Orthopaedics and Traumatology to identify the opinion of Brazilian orthopaedic surgeons on the standard treatment of pelvic fractures. ⋯ Three hundred and fifty-two questionnaires were completed, and the following main observations were made: most orthopaedists prefer to use an external fixator in the iliac crest for the emergency stabilisation of pelvic injuries in haemodynamically unstable patients (79.5%); they consider a period of up to one week as optimal for fixation in stable patients (55.1%); they use a plate for the fixation of fractures of the iliopubic rami through a Pfannenstiel or ilio-inguinal approach (53.9%); and they use reconstruction plates for the fixation of fractures of the iliac wing (63.1%). Regarding other studied aspects, there was no predominance of more than 50% of the choices among respondents.
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Multicenter Study
Health-related quality of life after upper extremity injuries and predictors for suboptimal outcome.
The purpose of this study was to examine the impact of upper extremity injuries (UEIs) on health-related quality of life (HRQoL) in adult patients compared with victims of other types of injuries and with the general population, in order to establish recovery patterns of different types of UEIs and determine predictors for suboptimal outcome in the long term. ⋯ The impact of UEIs on HRQoL exceeds the health consequences of the group with all injuries. Proximal UEIs had a lower HRQoL and slower recovery than distal injuries. The predictors for the outcome on specific UEIs need to be further investigated in clinical studies, to understand how these differences affect patient-reported outcome measures. These data provide additional insight into treatment outcome and are needed to improve quality of care.
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Review
Interprosthetic femoral fractures: proposed new classification system and treatment algorithm.
Interprosthetic femoral fracture is a rare and challenging fragility fracture issue. Due to aging of the population, the incidence of this type of fracture is gradually and constantly increasing. There is no complete and specific interprosthetic femoral fracture classification system that indicates treatment and prognosis in the literature. The aim of the present study was to describe a new classification system for interprosthetic femoral fractures, and to present a case series and a treatment algorithm derived from the current evidence in the literature.
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The incidence of periprosthetic fractures has been reported to be between 1 and 20.9% and appears to be on the rise. Fractures that occur around the femoral stem, particularly when the stem is loose or there is a loss of bone stock pose a technical challenge. These are rare injuries and there is considerable debate regarding their optimal treatment. ⋯ One such technique is impaction bone grafting and revision to a long smooth tapered cemented stem. This allows the restoration of bone stock and the stable insertion of a prosthesis. The aim of this article is to discuss the theory behind impaction bone grafting, the technical aspects and challenges of this technique, including fracture reduction methods, and to appraise all the literature available on impaction bone grafting for periprosthetic fractures.