Injury
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Comparative Study
A retrospective study of antibiotic prophylaxis value in surgical treatment of lower limb fracture.
Surgical site infections (SSI) are nosocomial infections that cause considerable problems in orthopaedic surgery. Antibiotic prophylaxis can be used to reduce the risk for SSI. There is no universal antibiotic that can be recommended for prophylaxis in terms of coverage of all possible pathogens because of antibiotic resistance, and there are no universal recommendations for different types of patients in terms of injury type, selected operation and risk factors for development of SSI. The aim of this study was to analyse the effectiveness of antibiotic prophylaxis in surgical treatment (ORIF) of closed lower limb fractures in young, healthy patients. ⋯ Antibiotic prophylaxis was ineffective in preventing SSI in patients with no risk factors for SSI who were undergoing ORIF for closed lower limb fractures.
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Distal tibial or pilon fractures are usually the result of combined compressive and shear forces, and may result in instability of the metaphysis, with or without articular depression, and injury to the soft tissue. The complexity of injury, lack of muscle cover and poor vascularity make these fractures difficult to treat. Surgical treatment of distal tibial fractures includes several options: external fixation, IM nailing, ORIF and minimally-invasive plate osteosynthesis (MIPO). Management of distal tibial fractures with MIPO enables preservation of soft tissue and remaining blood supply. This is a report of a series of prospectively studied closed distal tibial and pilon fractures treated with MIPO. ⋯ MIPO is a reliable method of treatment for distal tibial fractures; it provides a high union rate and good functional outcome with minimal soft tissue complications. Skin impingement remains a common complication with MIPO, but this can be solved by timely plate removal.
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Trauma hip fractures in elderly patients are associated with high postoperative long-term morbidity and mortality and premature death. The high mortality in these patients can be explained by various factors, including the fracture itself; the preoperative poor condition and comorbidities of these patients; the influence of stressors, such as surgery and type of anaesthesia, on the patient's condition; and the postoperative development of major complications, such as cardiac failure, pulmonary embolism, pneumonia, deep venous thrombosis and acute renal failure. Thus, the Surgical Apgar Score (SAS) could be a valuable tool for objective risk stratification of patients immediately after surgery, and to enable patients with higher risk to receive postoperative ICU care and good management both during and after the hospital stay. ⋯ The SAS shows how intraoperative events affect postoperative outcomes. Calculating the SAS in the operating theatre provides immediate, reliable, real-time feedback information about patient postoperative risk. The results of this study indicate that all trauma hip fracture patients with SAS≤4 should go to the ICU postoperatively and should be under intensive surveillance both during the hospital stay and after hospital discharge.
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The purpose of this study was to compare imaging modalities in the diagnosis of occult radial head and neck fractures and to assess the diagnostic value of ultrasound in diagnosing occult fractures of the radial head and neck. The study included 193 patients (101 male, 92 female) who were referred by trauma surgeons from January 2011 to July 2014 and presented with history of acute elbow trauma. The mean age of the patients was 37 years (range 15-82 years); 95 right and 98 left elbows were included in the study. ⋯ In conclusion, ultrasound imaging proved to be an effective method for diagnosing occult fractures of the radial head or neck when initial radiograms showed only intraarticular effusion. Ultrasound imaging is a cost-effective, easy-to-use and radiation-free method. For these reasons we recommend it for early detection of occult fracture in the emergency room.
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Knee stability after surgical anterior cruciate ligament (ACL) reconstruction using quadrupled hamstring tendons graft (gracilis and semitendinosus) was compared with that using the middle third of the patellar ligament. All subjects participating in this study had ACL rupture diagnosed by clinical examination and MRI and underwent identical surgical procedure apart from the choice of graft. A total of 112 patients with either patellar ligament or quadrupled hamstring tendons graft were evaluated for 24 months following surgery. ⋯ Clinical tests and a measuring instrument, the KT-1000 arthrometer, were used to evaluate knee stability after reconstruction. During the 24-month study there were no significant differences in clinical stability of the knee and the use of both grafts resulted in satisfactory knee stability. The difference between the groups according to the graft was noticed 6 months after reconstruction when the results obtained by a measuring instrument showed that knee stability was significantly higher with the patellar ligament graft (Fisher's exact test, p=0.022).