Injury
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Early application of tourniquets has reduced injury death rates. At the end of 2013, the Israel Defense Forces Medical Corps completed a military-wide introduction of the Combat Application Tourniquet as the standard-issued tourniquet. The accompanying clinical practice guideline encouraged combat soldiers and medical teams towards a liberal use of tourniquets for extremity injuries, even when in doubt. ⋯ Following the IDF military-wide introduction of advanced tourniquets, the tourniquet application rate rose sharply, the use of old tourniquets ceased over time, and in-hospital amputation rate did not increase. These findings suggest that the awareness for haemorrhage control using advanced tourniquets rose.
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Musculoskeletal (MSK) trauma is a major cause of disability and pain worldwide. Despite surgical advances following MSK injuries, poor functional outcomes following surgery remain a major public health concern. ⋯ Recent research has provided evidence that early rehabilitation with a multidisciplinary team can prevent these negative outcomes and improve functional outcomes following MSK trauma. In order to continue to optimize recovery, standardized rehabilitation protocols and technological advances are required.
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Review
Damage control articular surgery: Maintaining chondrocyte health and minimising iatrogenic injury.
Articular cartilage has limited intrinsic regenerative potential. The maintenance of healthy articular cartilage is essential to prevent joint degeneration and the morbidity associated with arthritis. ⋯ These factors include mechanical injury from instrumentation and drilling, drying, and the influence of irrigation fluids, antimicrobial solutions and local anaesthetics. We demonstrate that there is scope for improving cartilage viability at the time of surgery if simple chondroprotective measures are routinely adopted.
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Multicenter Study
Prehospital times and outcomes of patients who had hypotension at the scene after trauma: A nationwide multicentre retrospective study.
We aimed to investigate the association between prehospital times and outcomes of patients who had hypotension at the scene after trauma incidents. ⋯ Our analysis revealed that prehospital time was not significantly associated with in-hospital mortality among patients who had hypotension at the scene after trauma in the current emergency medical service system in Japan. Further studies are needed to validate our findings.
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The use of evidence based medicine to guide treatment decision making is widely supported by clinicians as a method to improve patient care and outcomes. Surgeons and physicians play a key role in both the design of clinical and translational research studies, as well as the implementation of the results. With the massive volume of published studies, it is increasingly difficult for clinicians to evaluate the literature and appropriately integrate novel findings into practice. With a focus on research studies in the field of orthopaedic surgery, the purpose of this review is to discuss which factors lead to impactful conclusions and clinical change, including the role of outcome selection, study design, presentation of results, and stakeholder involvement.