Injury
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Pulled elbow (PE) is one of the most common injury in children under the age of five years. Diagnosis of PE is usually based on the typical anamnesis and clinical symptoms. A simple reduction maneuver without the need of any imaging modality can eliminate the problem. Certain fractures however can mimic the physical findings of PE and in this cases reduction should not be attempted. The aim of our prospective diagnostic study was to evaluate the accuracy of a sonographic testing method in the differential diagnosis of PE. ⋯ The two plane sonographic point of care method is an effective tool for confirming the diagnosis of PE and excluding the presence of fractures. It is an easy, standard and objective procedure which can be used as a fast diagnostic test before reduction attempts.
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Multicenter Study
Avoiding Cribari gridlock 2: The standardized triage assessment tool outperforms the Cribari matrix method in 38 adult and pediatric trauma centers.
The Cribari Matrix Method (CMM) is the current standard to identify over/undertriage but requires manual trauma triage reviews to address its inadequacies. The Standardized Triage Assessment Tool (STAT) partially emulates triage review by combining CMM with the Need For Trauma Intervention, an indicator of major trauma. This study aimed to validate STAT in a multicenter sample. ⋯ This multicenter study strongly indicates STAT safely and accurately flags fewer cases for triage reviews, thereby reducing the subjectivity introduced by manual triage determinations. This may enable better refinement of activation criteria and reduced workload.
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According to the classification of Judet and Letournel, all double column acetabular fractures will certainly involve the disruption of the quadrilateral plate (QLP). Accurate reduction and reliable fixation of QLP is the key to obtain a normal congruent hip joint and avoid postoperative arthritis. The aims of this study were to assess the biomechanical properties of a novel dynamic anterior plate-screw system (named DAPSQ) and to compare its biomechanical stability with buttress-plate construct. ⋯ In this in vitro biomechanical study, DAPSQ plate and quadrilateral screws fixation of a double column acetabular fracture involving the QLP resulted in a better fixation construct than the traditional suprapectineal pelvic reconstruction plate and 1/3 tube buttress plate fixation.
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Randomized Controlled Trial
Preoperative nerve blocks for hip fracture patients: A pilot randomized trial.
To determine the: 1) impact of pre-operative femoral nerve block(PreopFNB) on: a) pain; b) opioid use; and c) early post-operative mobilization relative to usual care(CONTROL) and 2) feasibility of a definitive randomized clinical trial(RCT). ⋯ We found similar reported pain between groups. Although not significant, opioid use was higher and more variable in CONTROL and more PreopFNB patients mobilized day 1 post-operatively. Participants with cognitive impairment were not frequently enrolled. With modification, a definitive RCT is feasible and would inform pain management after hip fracture.
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Periprosthetic fractures (PPFx) occur more and more often following joint replacement. The aim of this study was to investigate the functional outcome of patients treated with lower limb periprosthetic fractures in our institution. ⋯ In this series of patients, fixation of lower limb periprosthetic fractures was found to be associated with good results despite the different fracture patterns studied. Larger studies with subgroup analysis of different fracture patterns are desirable to throw more light in this complex group of patients.