Injury
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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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Multicenter Study Observational Study
The effective dose due to scattered radiation at patients during primary osteosynthesis; a multicenter prospective observational study.
During osteosynthesis of a fracture patients are exposed to the primary radiation of an X-ray image and scattered (secondary) radiation. The primary objective was to measure the amount of scattered radiation at the thyroid, breast tissue, and gonads of patients undergoing primary osteosynthesis of acute fractures. The secondary objective was to calculate the effective dose caused by scattered radiation. ⋯ This is the first study that presents that no radiation protection for patients undergoing an osteosynthesis is necessary.
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Timing and type of fracture fixation in the multiply-injured trauma patient have been important and controversial topics. Ideal care for these patients come from providers who communicate well with one another in a team fashion and view the whole person, rather than focusing on injury to individual systems. ⋯ However, insufficient assessment and understanding of the physiological status of polytraumatized patients at the time of major orthopaedic procedures, potentially with inclusion of multiple other procedures in the same setting resulted in more morbidity, swinging the pendulum of care toward initial Damage Control Orthopaedics to minimize surgical insult. More recently, iterative assessment of response to resuscitation using Early Appropriate Care guidelines, suggests definitive fixation of most axial and femoral injuries within 36 h after injury appears safe in resuscitated patients, as measured by improvement of acidosis.
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Review
Management of Lower Extremity Fractures in the Elderly: A Focus on Post-Operative Rehabilitation.
Fractures in the elderly population are increasing in incidence and represent a rising burden of disease. It is difficult for the elderly population to adhere to restricted weight bearing, and immobility poses significant risks and increased morbidity. ⋯ This review examines published literature regarding lower extremity fracture management in the elderly, with a focus on post-operative rehabilitation. While extensive literature supports early weight bearing after hip fractures in the elderly, further research is warranted to provide guidelines for management of other lower extremity fractures in this population.
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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.