Injury
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Supracondylar femoral fractures account for a noticeable percentage of the femoral shaft fractures, affecting two etiological groups: high energy trauma in young men, with good bone quality, and older women with osteoporotic femur. Surgical treatment of those kind of fractures remains controversial, with different surgical options such as plate and sliding barrel locking condylar plate, less invasive stabilization system (LISS) or intramedullary nailing, which has emerged as a new fixation choice in the treatment of that type of fractures. The present work performs a comparative study about the biomechanical behavior of anterograde and retrograde nailing in supracondylar femoral fractures type A, in order to determine the best choice of nailing and locking configuration. ⋯ The study was focused on the immediately post-operative stage, verifying the appropriate stability of the osteosynthesis. The obtained results show a better biomechanical behavior for anterograde nails, providing a better stability from the point of view of global movements, lower stresses in screws, and less stress concentration in cortical bone. So, for the analyzed fractures and osteosyntheses types, anterograde nailing has demonstrated to be a better surgical option, being an excellent indication in supracondylar fractures of femur, with clear benefits compared to retrograde nailing, providing a better stabilization which enables for a more satisfactory fracture healing.
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Multicenter Study
Validation of a long bone fracture non-union healing score after treatment with mesenchymal stromal cells combined to biomaterials.
The available scores to clinically evaluate fracture consolidation encounter difficulties to interpret progression towards consolidation in long-bone non-union, particularly when incorporating biomaterials in the surgical treatment. The aims of this study were to validate the REBORNE bone healing scale in tibia, humerus and femur non-unions treated by a combination of mesenchymal stromal cells (MSCs) and biomaterials, through the interclass correlation (ICC) among raters, and to define reliability and concordance in anteroposterior and lateral radiographs, compared to computed tomography (CT).
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Risk factors for major adverse cardiovascular events after osteoporotic hip fracture repair surgery.
Osteoporotic hip fracture (OHF) is an increasingly frequent age-related pathology, which results in high rates of functional loss and mortality within the first year after surgery. This study assessed whether preoperative levels of brain natriuretic peptide (NT-proBNP) and troponin I were related to early occurrence (30d) of major adverse cardio-vascular events (MACE) after OHF repair surgery. During a 6-month period, perioperative clinical and analytical data from consecutive patients, without known history of cardiovascular disease and undergoing surgery for OHF repair at a single centre, were prospectively collected. ⋯ Overall, RBCT requirements and 30d mortality rate were also higher in MACE group. However, in multivariate analysis, only preoperative RBCT, creatinine >1 mg/dL and NT-proBNP >450 pg/mL remained as independent preoperative risks factors for postoperative MACE, while 95% confidence intervals of odds ratios were wide. Though our findings require confirmation in a larger multicentre cohort, identifying risk factors for early postoperative MACE after OHF repair surgery, might facilitate assessing patients' risk prior to and following surgery, and targeting them the appropriate preventive and/or therapeutic interventions.
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Pelvic injuries often result from high-energy trauma and lead to significant functional impairment. While the physical outcomes of these injuries have been widely studied, the psychological consequences remain largely unexplored. The purpose of this study was to examine psychosocial and functional outcomes of patients with pelvic trauma in the year after injury. ⋯ These data suggest that sustaining a traumatic pelvic injury increases the risk of diminished quality of life, both mentally and physically. Even one-year post-injury, participants experienced moderate physical pain and higher levels of PTSD, depression, and problematic alcohol use than would be expected in the general population. These findings highlight the need for an interdisciplinary approach to treating patients with pelvic injuries, including psychological screening and intervention in acute care and throughout recovery.
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Severe open tibial fractures are limb-threatening injuries. Outcomes depend on a complex interplay of patient, injury and treatment factors. 2009 guidelines from the British Orthopaedic Association (BOA) and British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) recommend prophylactic intravenous antibiotic administration within three hours of injury. More recent National Institute for Health and Care Excellence (NICE) 2016 guidelines recommend pre-hospital antibiotic administration where possible. This study aimed to analyse the impact of time to antibiotics on development of deep infection. ⋯ There are a variety of factors identified in the literature and in national policies and treatment guidelines as potentially modifiable to reduce the risk of deep infection following open fractures. In this study, time to antibiotic administration was not associated with the risk of developing deep infection. The results of this study demonstrate a low infection rate, which may be due to expedient expert care delivered by a dedicated orthoplastic service in line with national guidance where achievable.