Injury
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As our population ages and increasing numbers of older patients experience major trauma it is important to understand factors that influence outcomes in this patient cohort. The aim of this study is to assess the impact of frailty in older patients who experience major trauma (Injury Severity Score (ISS) greater than 15). A retrospective cohort review using the national trauma registry data (Trauma Audit and Research Network) and an institutional database was carried out on all patients aged 60 years or older with an ISS> 15 who were treated at the regional Major Trauma Centre from 2014 to 2017 following major trauma. ⋯ Increasing frailty was also associated with an increased risk of serious complications including unplanned intubation, infection and progressive renal failure, and discharge to a destination other than home. This is the first study that has delineated the impact of frailty in older patients who experience major trauma and provides important information for patients, their families and healthcare providers. Future studies should focus on identifying care pathways that counteract the impact of frailty in this setting.
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In the last decade, the sinus tarsi approach (STA) has gained interest over the extensile lateral approach (ELA) in the operative treatment of displaced intra-articular calcaneal fractures (DIACF's), mainly because of the lower rate of surgical site infections (SSIs). However, most studies are small and retrospective. The aim of this study was to evaluate the rate of SSIs of the STA in a large, prospective series of patients and to identify predictors for SSIs. ⋯ This study confirms the low risk of SSI in DIACFs treated via STA. Significant predictors for SSIs were surgery within one week after injury, ASA of 2 or higher and blood loss > 150cc.
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The paper presents an innovative osteofixation system designed for bone fracture stabilization. Its special feature, which makes it different from other similar systems, is the possibility to precisely adjust the implant to the shape of the bone. Such a precise adjustment is particularly important in the case of multiple fractures, where proper stabilization is a condition for restoring bone geometry and thus obtaining the biomechanical function of a given segment of the body lost due to fracture. ⋯ Numerical tests were performed for three different fracture models: unilateral double fracture of the body of mandible, unilateral double fracture of the body and the angle of mandible, and bilateral fracture of the mandible at the angle and body of the mandible. The results indicate that the proposed system may be used to stabilize broken bone fragments successfully, and the obtained stabilization would allow unrestricted use of the chewing function during bone healing and remodeling. The authors point out the advantages of the proposed implantation method thanks to which it is possible to obtain any shape of the implant and thus stabilize bone fragments in any case.
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Complications related to treatment of long bone fractures still stand as a major challenge for orthopaedic surgeons. Elucidation of the mechanisms of bone healing and development, and the subsequent alteration of these mechanisms to improve outcomes, typically requires animal models as an intermediary between in vitro and human clinical studies. ⋯ We lay out the general procedure for execution of each model, evaluate the practical implications and important advantages/disadvantages of each and describe recent innovations. Furthermore, we explore the applications that each model is best adapted for in the context of the current state of murine orthopaedic research.