Injury
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Observational Study
Fracture location impacts opioid demand in upper extremity fracture surgery.
Opioid sparing protocols should be formulated with appropriate demand. Specific fracture location has been hypothesized as an important predictor of post-operative pain. The purpose of this study is to evaluate the impact of fracture location on perioperative opioid demand after surgery with the hypothesis that this factor would be significantly associated with perioperative opioid demand in upper extremity fracture surgery. ⋯ Level III, retrospective, observational cohort study.
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To compare the Charlson Comorbidity Index (CCI) and American Society of Anesthesiologists (ASA) Physical Status Classification used in two prediction models for 30-day mortality after hip fracture surgery. ⋯ The CCI- and ASA-model had equal predictive ability of 30-day mortality after hip fracture. Considering the effort involved in calculating Charlson Comorbidity Index score, the ASA score may be the preferred tool to predict the 30-day mortality after hip fracture.
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Acute myocardial infarction (AMI) is a common cause of death following hip fracture surgery. This study aimed to determine the incidence and timing of perioperative AMI treated with percutaneous coronary intervention (PCI) in hip fracture patients, and to compare in-hospital mortality and complications between hip fracture patients who did not have an AMI, those who sustained a perioperative AMI and did not undergo PCI, and those who sustained an AMI and underwent PCI. ⋯ III.
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An external fixator is a promising medical device that could provide optimum stability and reduce the rate of complications in treating bone fracture during intervention period. It is noted that the biomechanics behaviour of device can be altered by introducing more features such as material suitability and additional components. Therefore, this study was conducted via finite element method to investigate the effects of additional hollow cylinder coated with external fixator screws in treating Type III pilon fracture. ⋯ For the micromovement, there was no difference between both models, whereby the value was 0.03 mm. The results supported previously published literature, in which high stresses are unavoidable at the interface, fortunately, those stresses did not exceed the ultimate strength of bone, which is safe for treating patients. In conclusion, if patients are allowed to bear weight bearing, the external fixator with coated screws is a more favourable option to be fixed into the bone to avoid complications at the interface.
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Preliminary results using a novel rapid-sequence MRI to diagnose ipsilateral femoral neck fractures in patients sustaining high-energy femoral shaft fractures have been favorable compared to radiographic and CT imaging alone. To evaluate and optimize this new institutional imaging protocol further, we reviewed our results one year after implementation. ⋯ The addition of rapid-sequence MRI of the pelvis in patients with high-energy femoral shaft fractures reliably increases the diagnosis of ipsilateral femoral neck fractures not identified with standard imaging. There were no cases of missed/delayed femoral neck fractures in patients with a negative MRI. This new imaging protocol effectively and safely improves the diagnosis of this injury pattern.