Injury
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Osteoporotic tibial plateau fractures (TPFs) are difficult to treat with either open reduction internal fixation (ORIF) or acute total knee arthroplasty (TKA). They have high complication rates, poor outcomes and often fail in the short- to mid-term. We investigated the use of impaction bone grafting (IBG) as an adjunct to stabilise the fracture in a cohort of osteoporotic TPFs. ⋯ Impaction bone grafting shows promising results as an adjunct to the surgical stabilisation of osteoporotic TPFs. In this case series the technique provided enough fracture stability for patients to mobilise weight-bearing as tolerated immediately after surgery and achieve full weight-bearing by the sixth postoperative week. There was no failure of fixation and 7 of the 9 cases healed with minimal fracture displacement.
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To determine the association between race on severe heterotopic ossification (HO) following acetabular fracture surgery. ⋯ Race is associated with different rates of severe HO formation following acetabular fracture surgery. AA patients are significantly more likely to develop severe HO following acetabular fracture surgery when compared to Caucasian patients.
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Patients suffering traumatic brain and chest wall injuries are often difficult to liberate from the ventilator yet best timing of tracheostomy remains ill-defined. While prior studies have addressed early versus late tracheostomy, they generally suffer from the use of historical controls, which cannot account for variations in management over time. Propensity scoring can be utilized to identify controls from the same patient population, minimizing impact of confounding variables. The purpose of this study was to determine outcomes associated with early versus late tracheostomy by application of propensity scoring. ⋯ In the current era of increased health-care costs, early tracheostomy significantly decreased both pulmonary morbidity and critical care resource utilization. This translates to an appreciable cost savings, at minimum $52,173 per patient and a potential total savings of $2.8million/year for the entire LT cohort. For trauma patients requiring prolonged ventilator support, early tracheostomy should be performed.
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ASDH in the elderly is a common and increasing problem, and differs in its pathophysiology from ASDH in younger people. Admitting doctors may have difficulty identifying those elderly patients whose lesions may benefit from surgery. The objective of this study was to determine whether simple neuroradiological measurements could identify those patients, who need urgent neurosurgical referral for consideration for surgery. ⋯ Surgically relevant cases of ASDH in the elderly can be reliably and objectively identified by two easily performed scan measurements, haematoma thickness and midline shift. If used in routine practice, these measurements could clarify those patients who may need urgent neurosurgical referral and might avoid unnecessary transfer to neurosurgical units in this cohort.
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Comparative Study
Biomechanical comparison of long, short, and extended-short nail construct for femoral intertrochanteric fractures.
Short and long cephalomedullary (CM) nails are commonly used construct for fixation of intertrochanteric (IT) fractures. Each of these constructs has its advantages and its shortcomings. The extended-short (ES) CM nail offers a hybrid between long and short nail design that aims to combine their respective benefits. The goals of this study were to (1) biomechanically evaluate and compare construct stiffness for the long, short and ES constructs in the fixation of IT fractures, and to (2) investigate the nature of periprosthetic fractures of constructs implanted with these various designs. ⋯ Nail length and position of interlocking screw did not alter the biomechanical properties of the fixation construct in the presented IT fracture model. Periprosthetic fractures generated in this study had similar patterns to those seen clinically. This study also suggests that if a periprosthetic fracture is to occur, there is an increased probability of it happening around the site of the interlocking screw, regardless of nail design.