Injury
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Comparative Study Observational Study
Are current wireless monitoring systems capable of detecting adverse events in high-risk surgical patients? A descriptive study.
Adverse events are common in high-risk surgical patients, but early detection is difficult. Recent innovations have resulted in wireless and 'wearable' sensors, which may capture patient deterioration at an early stage, but little is known regarding their ability to timely detect events. The objective of this study is to describe the ability of currently available wireless sensors to detect adverse events in high-risk patients. ⋯ Current systems for remote wireless patient monitoring on the ward are capable of detecting abnormalities in vital sign patterns in patients who develop adverse events. Remote patient monitoring may have potential to improve patient safety by generating early warnings for deterioration to nursing staff.
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Review
Postoperative management considerations of the elderly patient undergoing orthopaedic surgery.
The elderly population is rapidly increasing, corresponding to an increase in orthopaedic surgical procedures for this group of patients. Current guidelines mostly concentrate on the patient's age when considering surgical fitness in the elderly. However, patient frailty may be a more significant factor when assessing postoperative risk in surgical management. In this article, we will analyse some of the factors associated with the postoperative care of the geriatric population after orthopaedic surgery. ⋯ There is a higher rate of postoperative complications in the surgical management of the elderly, and thus, special considerations following orthopaedic surgery in this patient group are necessary. Determining patient frailty based on clinical judgment using specific postoperative considerations could be a more reliable method in determining the surgical risk in the elderly patient. Additionally, more attention needs to be diverted towards early mobilization and patient education, as these factors can significantly help to avoid some of the postoperative complications that seem to affect the geriatric population.
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Intraoperative imaging has been advanced substantially over the last decades. It supports localization of the region of interest, verification of the preoperatively classified fracture pattern, identification of correct insertion point of the implant, placement of instruments and fixation material, and verification of correct fracture reduction and implant positioning. ⋯ Additional options such as perioperative virtual planning, simulation, and surgical training, 3D printing techniques and 3D augmented reality visualization may potentially open new windows to improve surgical results in fracture care. This manuscript presents an update on current and upcoming imaging techniques in orthopaedic and trauma surgery focusing on technical advances for decreasing malreduction, malalignment, and malposition, as well as tips and tricks for daily surgical practice in order to improve clinical outcomes and patients' and surgeons' safety.
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Intra-articular fractures are a unique subset of fractures as they involve a varying extent of damage to cartilage. The impact of this articular fracture causes significant microscopic and macroscopic changes, as well as biomechanical irregularities, which can lead to further cartilage damage, and ultimately cascade down the dreaded path to arthritis. ⋯ A comprehensive literature review was carried out to create a best available evidence guide to the acceptability of upper extremity and lower extremity articular fracture reductions. Ultimately, a perfect anatomic reduction is the best strategy to minimize abnormal loading and wear patterns, however this should be balanced with the realistic factors of each individual case, such as the level of difficulty, joint involved, surgical timing, and patient activity levels.
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Cardiac complications (CC) after injury are rare but contribute disproportionately to mortality. Variability in rates of CC and failure to rescue (FTR) after CC (FTR-C) within trauma systems may suggest opportunities for improvement, but we have not yet demonstrated the ability to identify high and low performers. We examined center-level rates of CC and FTR-C in a mature trauma system with the hypothesis that high-performing centers for each of these outcomes could be identified. ⋯ Rates of CC and FTR-C vary significantly between hospitals in mature trauma systems but high-performing centers can be identified. Inconsistent performance between metrics suggests unknown institutional factors underlie performance for CC and FTR.