Injury
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Soft tissue management and fracture fixation including initial external fixation in Gustilo-Anderson type II and type III open fractures are cornerstones in the treatment but details on timing and type of wound closure, irrigation and debridement, systemic and local antibiotics, antimicrobial-coated implants and the use of Bone Morphogenetic Protein-2 remain controversial. This article looks at current clinical evidence of these items for the management of open fractures. Timing of debridement and wound closure remains critical. ⋯ Recombinant human bone morphogenetic proteins (rhBMP)-2 showed promising data in Gustilo-Anderson type III open tibial shaft fractures with lower rates of invasive secondary procedures. In conclusion, there is evidence for thorough debridement and irrigation with saline, early soft tissue coverage and the use of systemic and local antibiotics. Except for a short-term soft tissue coverage VAC seems not to be beneficial and rhBMP-2 is an additional tool in Gustilo-Anderson type III open fractures.
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Review
Is PROMIS the new standard for patient-reported outcomes measures in orthopaedic trauma research?
This review describes some of the benefits of the Patient-Reported Outcomes Measurement Information System (PROMIS) architecture, determined how frequently PROMIS measures were used in the current orthopaedic trauma literature, and compared the features of PROMIS instruments with other frequently used patient-reported outcomes measures (PROMs). PROMIS instruments have several unique elements to their architecture, such as item response theory, computerized adaptive testing options, and scaling using T-scores, that differentiate the instruments from many other PROMs. ⋯ PROMIS measures were found to be comparable to other more common PROMs with respect to respondent burden, administration options, and psychometric assessments specific to fracture patients. Likely, the limited familiarity and interpretability of PROMIS measures in the fracture population remain the most substantial barriers to broader adoption in orthopaedic trauma research.
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Trauma is a major cause of mortality globally, with post-traumatic hemorrhage being the leading cause of death amongst trauma patients. In this paper, the authors review the underlying pathophysiology of trauma-related hemorrhagic shock, specifically the factors which contribute to the development of the acute coagulopathy of trauma shock (ACoTS). We then review the best available evidence for treatment strategies in the pre-hospital setting, as well as the in-hospital setting. ⋯ Targeted resuscitation is an evolving field, with use of thromboelastography to guide resuscitation being a particularly promising area. Special trauma populations at particularly high risk are also reviewed, including the geriatric population, as well as unstable pelvic fractures, which are each at increased risk for poor outcomes, and deserve special attention. Major advances have been made in this important area, and ongoing research into the understanding and correction of ACoTS will continue to guide practice.
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The use of patient-reported outcome measures (PROs) in research and clinical use in orthopedic trauma surgery has increased dramatically over the past decades, and this trend will continue in the future. This review aimed to provide insight into the way PROs can best be identified, reviewed, selected, and used in orthopedic trauma studies and patient care. Selection of instruments for a specific (research) question starts with a systematic literature review for identifying the mostly used instruments. ⋯ Reporting guidelines like the SPIRIT-PRO and CONSORT-PRO are available in order to guide the reporting of PROs in study protocol and outcome reports, respectively. Using Core Outcome Sets improves the validity of results of clinical research and increases the feasibility of conducting meta-analyses. If the standards and procedures as outlined above are used, the use of PROs will contribute to improved patient care and clinical research.
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Outcome measures are the indispensable mean through which different interventions are compared in research. The increase in volume that orthopaedic research has experienced in the last years has provided an extensive list of outcomes to choose from. Historically, attention has been focused mainly in morbidity as well as physician reported clinical outcomes, however there is a trend towards the use of patient reported outcomes. We intent to review the inherent characteristics and current applicability of two of the most representative physical outcome measures used in orthopaedics: Range of Motion (ROM) and Strength.