Injury
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Randomized Controlled Trial Comparative Study
Comparison of the postoperative analgesic efficacies of intravenous acetaminophen and fascia iliaca compartment block inhip fracture surgery: A randomised controlled trial.
Managing pain during movement after hip fracture surgery is important for achieving earlier hip mobilisation and for preventing postoperative complications. In the present study, we tested the hypothesis that the fascia iliaca compartment block (FICB) would improve postoperative pain on movement compared with intravenous acetaminophen. ⋯ FICB improved postoperative pain on movement compared with intravenous acetaminophen without increasing the complication rate. However, the total number of rescue analgesics required and the time to first standing were not significantly different between the two groups.
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A novel Ti6Al4V adjustable locking plate (ALP) is designed to provide enhanced bone stability for segmental bone fractures and to allow precise positioning of disconnected segments. The design incorporates an adjustable rack and pinion mechanism to perform compression, distraction and segment transfer during plate fixation surgery. The aim of this study is to introduce the advantages of the added feature and computationally characterize the biomechanical performance of the proposed design. ⋯ An additional mechanical failure finite element test is also conducted on the rack and pinion to reveal how much torque can be safely applied to the mechanism by the surgeon. Simulation results predict that the new design is sufficiently strong to not fail under regular anatomical loading scenarios with close bending strength and fatigue life properties to clinically used locking compression plates. The novel ALP design is expected to be a good candidate for addressing problems regarding fixation of multi-fragmentary bone fractures.
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Randomized Controlled Trial Comparative Study
A qualitative study of patients' experience of recovery after a distal femoral fracture.
This qualitative study was conducted as part of a feasibility study for TrAFFix, (ISRCTN92089567), a randomised controlled trial that will compare two surgical interventions used to fix distal femoral fractures. Our aim was to understand patients' experiences of treatment and the early phase of recovery after a distal femoral fracture. While, much is known about the experience of recovery from hip fracture, little is known about whether patients with other lower limb fragility fractures experience the same concerns and challenges. ⋯ Our findings highlight the struggle patients endure while recovering after a distal femoral fracture and the limited rehabilitative support they receive after discharge from hospital. They reinforce the need to ensure a patient feels informed about their treatment and recovery and the need for greater support for patients to manage at home and move with confidence.
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The incidence of osteosynthesis is increased by volar anatomic plate used for treatment of distal radius fractures and this increases the incidence of wrist extensor tendon irritation, a postoperative complication of the aforementioned surgical technique. The purpose of this study; was to evaluate the intraoperative skyline view which is commonly used to prevent dorsal cortex penetration of distal screws during the surgical treatment of intra-articular distal radius fractures with comminuted dorsal cortex with CT (computed tomography) scanning to determine its effectiveness. In the literature review, no other study focused on similar fracture types was found. ⋯ The insertion of a distal screw 2 mm (millimeter) shorter than the length measured with the help of skyline view is considered to be a more effective method than other intraoperative methods for preventing dorsal cortex penetration. In addition, more comprehensive studies are required in order to recommend the mono-cortex fixation, in which distal screws measuring 4 mm shorter are used.
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Meta Analysis
Negative pressure wound therapy vs. conventional management in open tibia fractures: Systematic review and meta-analysis.
Severe open tibia fractures are disastrous injuries associated with a high incidence of complications. Negative pressure wound therapy (NPWT) is a novel treatment for open tibia fractures; however, its efficacy remains unclear. This is a systematic review and meta-analysis performed to evaluate the effect of NPWT on decreasing the infection rate, amputation rate, nonunion rate, and flap-related complications in open tibia fractures. ⋯ Lower rates of soft-tissue infection, nonunion, flap necrosis, and flap revision were observed in the NPWT group than in the conventional dressing group. However, additional high-quality studies are warranted to verify the efficacy of NPWT in the treatment of severe open tibia fractures. We could not make a definitive conclusion about the comparative efficacy of the 2 methods in terms of complications because of insufficient data.