Injury
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Exposure of a tibial plateau fracture involving the posterolateral quadrant is challenging, and several approaches for treating these fractures have been introduced. However, these approaches may have limited applicability, and they can potentially cause neurovascular, musculotendinous, or ligamentous injury of the posterolateral corner. ⋯ We successfully exposed, reduced, and fixed the fracture using combined lateral femoral epicondylar osteotomy and a submeniscal approach. This combined modality can be used as an alternative surgical technique for the treatment of tibial plateau fractures involving the posterolateral quadrant.
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Case Reports
Hoffa's fracture - Lateral meniscus obstructing the fracture reduction - A case report.
Hoffa's fracture is a coronal fracture of the posterior femoral condyle and is an unusual injury. It can be easily missed on plain radiographs. There is no dearth of literature on Hoffa's fracture, its various presentations, management and rehabilitation principles. ⋯ The patient required mini arthrotomy to remove the meniscus from in between the bone fragments. The fracture was fixed with two anteroposterior screws and knee was immobilised in extension. A gentle knee range of movements was commenced after the wound had healed but weight bearing was delayed for 12 weeks.
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Optimal management of periprosthetic femoral fractures (PFF) around a well fixed prosthesis (Vancouver B1) remains controversial as adequate fixation needs to be achieved without compromising the stability of the prosthesis. The aim of this study was to highlight the effect of bone quality i.e. canal thickness ratio (CTR), and fracture topography i.e. fracture angle and its position in relation to the stem, on the biomechanics of a locking plate for a Vancouver B1 fracture. A previously corroborated simplified finite element model of a femur with a cemented total hip replacement stem was used in this study. ⋯ Results highlight that in good bone quality and acute fracture angles, single locking plate fixation is perhaps an appropriate management method. On the contrary, for poor bone quality and obtuse fracture angles alternative management methods might be required as the fixation might be under higher risk of failure. Clinical studies for the management of PFF are required to further support our findings.
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Twenty-two major trauma centres (MTCs) became operational across England on 1st April 2012. The aim of this study was to ascertain whether becoming an MTC has affected outcomes for elderly hip fracture patients at our institution. Eight hundred and twenty-four patients aged ≥60 years who sustained 841 consecutive hip fractures over a two-year period were included. ⋯ In the post-MTC group there was a significant increase in median delay to theatre for medically fit patients (25.5h vs 31.5h, p<0.0001), and there was a significant increase in post-operative medical complications (29.7% vs 37.6%, p=0.0160). There was no statistically significant difference in overall mortality rates, however 30-day mortality rose from 4.7% to 8.0% (p=0.0678). These results suggest that becoming an MTC has led to a significant increase in the delay to surgical management of our hip fracture patients with consequent increases in morbidity and mortality.
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Haemorrhagic shock after traumatic injury carries a high mortality. Therapeutic hypothermia has been widely used in critical illness to improve the outcome in haemorrhagic shock by activation of cardiac pro-survival signalling pathways. However, the role played by the mitochondria in the cardioprotective effects of therapeutic hypothermia remains unclear. We investigated the effects of therapeutic hypothermia on mitochondrial function and integrity after haemorrhagic shock using an in vitro ischaemia-reperfusion model. ⋯ Hypothermia treatment at 31 °C can ameliorate cardiomyocyte damage caused by simulated ischaemic reperfusion injuries. Mitochondrial calcium homeostasis, energy metabolism, and membrane integrity are preserved and play critical roles during therapeutic hypothermia treatment.