Injury
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Comparative Study
Is AC TightRope fixation better than Bosworth screw fixation for minimally invasive operative treatment of Rockwood III AC joint injury?
Injuries to the acromioclavicular (AC) joint are common in sports participants and may lead to instability or degenerative changes that require surgical intervention. Diagnostics include X-ray projections; MRI could also be a useful method. Surgical treatment of acute Rockwood type III AC dislocation varies on a case-by-case basis and includes coracoclavicular (CC) stabilisation with two techniques of minimal invasive fixation: the Bosworth screw and AC TightRope fixation (Arthrex, US). The aim of this study was to analyse whether there is a difference between these two surgical procedures in the quality of repair of CC ligaments by comparing preoperative and postoperative AC joint radiological and clinical findings. ⋯ MRI could be a useful method to evaluate quality of repair of CC ligaments. The minimally invasive surgical techniques used in this study showed similar radiological and clinical efficacy in the treatment of acute Rockwood type III AC dislocation, but AC TightRope fixation provided patients with significantly more treatment satisfaction and less inconvenience than Bosworth screw fixation.
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Comparative Study
Predictors of mortality among initially stable adult pelvic trauma patients in the US: Data analysis from the National Trauma Data Bank.
Pelvic fractures are associated with increased risk of death among trauma patients. Studies show independent risks predicting mortality among patients with pelvic fractures vary across different geographic regions. This study analyses national data to determine predictors of mortality in initially stable adult pelvic trauma patients in the US. ⋯ Geriatric and middle aged pelvic fracture patients experience higher mortality. Predictors of mortality in initially stable pelvic fracture patients are advanced age, injury severity, mental status, prolonged mechanical ventilation, and/or in-hospital blood product administration. These patients might benefit from transport to local level 1 or level 2 trauma centres.
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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).
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There is a clear lack of consensus on a validated definition of the term "polytrauma". This study presents and classifies the extent of injuries during wartime in Croatia using the Revised Trauma Score and Injury Severity Score (TRISS) and compares the scores with a clinical estimation based on subjective assessments of polytraumatised and non-polytraumatised patients. ⋯ The data show that clinical and subjective assessment of polytraumatised patients can be useful in the management of such cases and can be tested retrospectively using TRISS methodology.
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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.