Injury
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Comparative Study
The utility of mini C-arm in the fixation of unstable paediatric supracondylar humeral fractures.
Pediatric supracondylar humerus fractures have traditionally been reduced and fixed with conventional C-arm (CCA) fluoroscopy guidance. With the increase in popularity of the newer mini C-arm (MCA) system within other fields of surgery due to its ease of use and lower radiation emission, the same adoption should be explored in pediatric orthopedic surgeries. The purpose of this study is to compare the MCA and CCA primarily in reduction and fixation outcomes and secondarily in other perioperative parameters. ⋯ Level III retrospective comparative study.
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Patients with multiple injuries including spinal cord injury (SCI) have low survivability. Little is known for the effect of SCI in their rehabilitation process. ⋯ Due to the rarity of eligible articles and the lack of homogenous accessing tools, a meta-analysis was not possible. There is a lack of a universal evaluation strategy or tool, for the severity of the multiple injured patients aiming at the rehabilitation outcome prognosis. Multiple-injured patients with SCI have longer rehabilitation LOS and functional outcomes compared to other polytrauma patients. Prospective studies are needed for evaluation of the differences according to the severity and the complexity of the injuries and the rehabilitation outcome depending on different rehabilitation methods and strategies.
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Photobiomodulation therapy (PBMT) using low-level laser influences the release of several growth factors involved in the formation of epithelial cells, fibroblasts, collagen and vascular proliferation, besides accelerating the synthesis of bone matrix due to the increased vascularization and lower inflammatory response, with significant increase of osteocytes in the irradiated bone. Considering its properties, beneficial effects and clinical relevance, the aim of this review was to analyze the scientific literature regarding the use of PBMT in the process of bone defect repair. ⋯ Many studies have shown that PBMT has positive photobiostimulatory effects on bone regeneration, accelerating its process regardless of parameters and the use of biomaterials. However, standardization of its use is still imperfect and should be better studied to allow correct application concerning the utilization protocols.
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The incidence of invasive treatment of rib fracture has increased significantly over the last decade however the evidence of improved patient outcomes to support this is lacking. A systematic review was performed to identify patient reported outcome measures (PROMs) used in the assessment of outcomes following chest wall injury. The quality of evidence for the psychometric properties of the identified PROMs was graded using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology. ⋯ The lack of validated outcome measures for rib fracture patients is a significant limitation of the current literature. Further studies are needed to provide validated outcome measures to ensure accuracy of the reported results and conclusions. As interventions for rib fractures have become more common in both research and clinical practice this has become an urgent priority.
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The diagnosis of instability in the apparent, isolated distal fibula fracture can be challenging and often necessitates stress radiography. Danis & Weber classified lateral malleolar fractures based on the level of the fracture in relation to the syndesmosis. While Weber B fractures occur at the level of the syndesmosis, some such injuries present with a long, oblique pattern extending well above the syndesmosis. Given the well-established literature demonstrating that fractures above the syndesmosis correlate with a higher level of concomitant syndesmotic and deltoid ligament injury, we hypothesize that increased fracture obliquity, length and height of Weber B fibula fractures similarly correlates with increased mortise instability. ⋯ Increased fracture obliquity, length and height of Weber B fibula fractures did not correlate with a higher incidence of mortise instability. Despite the lack of positive correlation, future studies should continue to investigate and identify radiographic parameters of distal fibula fractures that are most predictive of instability.