Injury
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Review Meta Analysis
The local soft tissue status and the prediction of local complications following fractures of the ankle region.
Well-known risk factors (RF) for soft tissue complications following surgical treatment of fracture of the ankle region include diabetes, smoking, and the local soft tissue status. A weighted analysis might provide a risk profile that guides the surgical treatment strategy. The aim of this meta-analysis was to provide a risk profile for soft tissue complications following closed fractures of the ankle region. ⋯ Among all RFs for regional soft tissue complications, the most predictive is the local soft tissue status, while additional injuries or NPS RF were less predictive. The soft tissue damage can be quantified and outweighs the cofactors described in previous publications. The soft tissue status appears to have a more important role in the decision making of the treatment strategy when compared with comorbidities such as diabetes.
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Extensor mechanism (EM) disruption after total knee arthroplasty (TKA) is rare, but can result in devastating outcomes for patients including inability to ambulate. Disruption can occur at the quadriceps tendon, patella, or patellar tendon. This complication can be traumatic, but is often atraumatic from an iatrogenic or degenerative etiology. ⋯ However, to date, there is still no consensus for the optimal EM reconstructive technique due to the heterogeneity and small sample sizes of published studies. The need to identify a consistent and effective surgical technique is paramount to restore quality of life to patients who suffer from EM disruption after TKA. The purpose of this review is to describe the osteology, vasculature, and EM of the knee, identify risk factors associated with EM disruption after TKA, outline the considerations for surgical management, as well as compare and analyze the latest contributions to the literature, in particular allograft versus synthetic mesh, in the reconstruction of the EM after TKA.
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Cryoprecipitate is frequently administered as an adjunct to balanced transfusion in the setting of traumatic hemorrhage. However, civilian studies have not demonstrated a clear survival advantage, and prior observational studies noted selection bias when analyzing cryoprecipitate use. Additionally, due to the logistics involved in cryoprecipitate administration, it is inconsistently implemented alongside standardized massive transfusion protocols. This study aims to evaluate the effects of early cryoprecipitate administration on inpatient mortality in the setting of massive transfusion for exsanguinating trauma and to use propensity score analysis to minimize selection bias. ⋯ Patients receiving cryoprecipitate within 4 h of presentation were more severely injured at presentation and had increased inpatient mortality. Multivariable logistic regression and propensity score analysis failed to show that early administration of cryoprecipitate was associated with survival benefit for exsanguinating trauma patients. The prospect of definitively assessing the utility of cryoprecipitate in exsanguinating hemorrhage warrants prospective investigation.
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Multicenter Study
Validation of the diagnostic criteria of the consensus definition of fracture-related infection.
The recently developed fracture-related infection (FRI) consensus definition, which is based on specific diagnostic criteria, has not been fully validated in clinical studies. We aimed to determine the diagnostic performance of the criteria of the FRI consensus definition and evaluated the effect of the combination of certain suggestive and confirmatory criteria on the diagnostic performance. ⋯ The presence of at least one confirmatory criterion identifies the vast majority of patients with an FRI and was associated with an excellent diagnostic discriminatory value. Therefore, our study validates the confirmatory criteria of the FRI consensus definition. Infection is highly likely in case of the presence of a single positive culture with a virulent pathogen. When certain clinical suggestive signs (e.g., wound drainage) are observed (individually or in combination and even without a confirmatory criterion), it is more likely than not, that an infection is present.
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Multicenter Study
Lisfranc injury: Refined diagnostic methodology using weightbearing and non-weightbearing radiographs.
To compare diagnostic parameters for Lisfranc instability on WB and NWB radiographs and to assess the inter-observer reliability of a standardized diagnostic protocol. ⋯ Using WB imaging for diagnosing subtle Lisfranc instability reveals larger diastasis in the tarsometatarsal joint and has a higher interobserver reliability compared to NWB imaging. Clinical concern for subtle or occult Lisfranc instability in any patient should therefore trigger WB radiographic assessment since such injuries may be missed on NWB views.