Injury
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In Denmark, guidelines from the Danish Orthopedic Society recommend that patients older than 65 years who sustain a Colles' fracture should be referred to assessment of underlying osteoporosis. An assessment of referral rates at our hospital during the period October 2010-September 2013 showed that none were referred. Due to this, an automatic out-patient referral system for assessment of underlying osteoporosis was established. With this system, patients are referred directly from the Emergency Department (ED). The purpose of this study was to assess how effective this new referral system was at improving referral rates for assessment of osteoporosis and to evaluate how many more cases of osteoporosis that was identified with this practice during the period October 2013-September 2014. ⋯ The results show that this type of automatic referral system can be an effective way of increasing the number of patients diagnosed with and treated for osteoporosis. It also shows that involvement of the ED in the screening for osteoporosis can be an effective way of increasing referral rates leading to higher rates of diagnosed osteoporosis. The early identification and initiating of treatment might result in a lower rate of secondary and potentially more severe osteoporotic fractures.
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The reamer-irrigator-aspirator is increasingly being used to harvest autologous bone graft from the femur. The purpose of this study was to investigate the extent of neo-vascularisation and new bone formation that occurs within the medulla following the procedure, and determine if new bone formation would potentially allow a repeat bone harvest in those individuals subsequently requiring further bone graft. Eleven patients who had undergone femoral bone harvest were examined with MRI. ⋯ Intense vascularisation of the endostial cortical surface and neo-vascularisation of the haematoma within the canal occurred as soon as 3 months following bone harvest. From as early as 14 months the tissue was replaced by normal intramedullary bone. The formation of new bone within the medullary canal gives the potential for a repeat reaming, should further bone graft be required at a later date.
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Despite modern advances in fracture care, deep (implant-related) infection remains a problem in the treatment of tibia fractures. There is some evidence that antibiotic-coated implants are beneficial in the prevention of this sometimes devastating complication. In the following study we describe our results using a gentamicin-coated intramedullary tibia nail (Expert Tibia Nail (ETN) PROtect™) for the surgical treatment of complex open tibia fracture and revision cases. ⋯ Musculoskeletal complications place a cost burden on total healthcare expenditure. Better understanding of the epidemiology and pathogenesis is essential because this can lead to prevention rather than treatment strategies. The purpose of the study was to evaluate a gentamicin-coated tibia nail in the prevention of deep (implant-related) infection. In our patient population no deep infections occurred after placement of the gentamicin-coated nail. Following this study and literature data, antibiotic-coated implants seem a potential option for prevention of deep infection in trauma patients. In the future this statement needs to be confirmed by large randomised clinical trials.
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Non-union continues to be the most devastating complication after fracture fixation. Its treatment can be prolonged and often unpredictable. The burden to the patient, surgeon and health care system can be immense. ⋯ We undertook a systematic review of the literature in order to identify the most common and important risk factors based on the hierarchy of level of evidence. Accordingly, a stratification scale was formed which highlighted 10 risk factors including; an open method of fracture reduction, open fracture, presence of post-surgical fracture gap, smoking, infection, wedge or comminuted types of fracture, high degree of initial fracture displacement, lack of adequate mechanical stability provided by the implant used, fracture location in the poor zone of vascularity of the affected bone, and the presence of the fracture in the tibia. Clinicians should take in to account these findings when managing patients with long bone fractures, particularly the femur and tibia in order to minimise the risk of non-union.