Injury
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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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Meta Analysis
Unipolar versus bipolar hemiarthroplasty for displaced femoral neck fractures: A pooled analysis of 30,250 participants data.
To assess the clinical outcomes of unipolar versus bipolar hemiarthroplasty for displaced intracapsular femoral neck fractures in older patients and to report whether bipolar implants yield better long-term functional results. ⋯ Bipolar hemiarthroplasty is associated with better range of motion, lower rates of acetabular erosion and lower reoperation rates compared to the unipolar hemiarthroplasty but at the expense of longer operative time. Both were similar in terms of mortality, and surgical or medical outcomes. Future large studies are recommended to compare both methods regarding the quality of life.
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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.
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Meta Analysis
Timing of major fracture care in polytrauma patients - An update on principles, parameters and strategies for 2020.
Sustained changes in resuscitation and transfusion management have been observed since the turn of the millennium, along with an ongoing discussion of surgical management strategies. The aims of this study are threefold: a) to evaluate the objective changes in resuscitation and mass transfusion protocols undertaken in major level I trauma centers; b) to summarize the improvements in diagnostic options for early risk profiling in multiply injured patients and c) to assess the improvements in surgical treatment for acute major fractures in the multiply injured patient. ⋯ Multiple changes in management (resuscitation, transfusion protocols and balanced surgical care) have taken place. Moreover, improvement in mortality rates and complications associated with several factors were also observed. These findings support the view that the management of polytrauma patients has been substantially improved over the past 3 decades.
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Cerclage techniques are simple, yet effective techniques to treat certain fractures and are known as one of the first operative techniques in orthopaedic surgery. The days when a twisted metal wire was the only available cerclage technique nonetheless have passed and today there are many different materials and techniques available. This review evaluates the differences between metallic and non-metallic cerclage techniques, thereby looking at biomechanical, technical and biological aspects. ⋯ Currently metallic cerclage is mostly used to repair fractures because of its believed higher absolute strength. More recently though, non-metallic cerclage has been proven to withstand the same loads, while having a lower complication rate. This review suggests that mainly in the upper limb a non-metallic cerclage technique might become the golden standard, while in the lower limb both metallic and non-metallic cerclage techniques are complementary and dependent on indication.