Injury
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The incidence of distal radius fractures (DRFs) is reported, with conflicting results. To ensure evidence-based practice, the variation in treatment over time should be monitored. Treatment in the elderly population is particularly interesting because newer guidelines find little indication for surgery. Our primary aim was to assess the incidence and treatment of DRFs in the adult population. Secondly, we assessed the treatment stratified on non-elderly (aged 18-64 years) and elderly (aged 65+ years) patients. ⋯ We found a 31% increase in DRFs over a 22-year period, mostly driven by an increase in the size of the elderly population. The surgical rate increased markedly even in the elderly group. There is a lack of evidence on how beneficial surgery is for elderly patients, and similar surgical rate between the elderly and non-elderly calls for hospitals to re-evaluate their treatment strategies.
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Intraoperative 3D fluoroscopy (3DRX) is increasingly used in fracture management instead of conventional fluoroscopy (RX), but its effect on the treatment and outcome of tibial plateau fractures (TFs) is not well known. This study aims to evaluate whether the use of 3DRX in the treatment of tibial plateau fractures reduces the number of revision surgeries. ⋯ Implementing 3DRX in treating TFs improves the assessment of fracture alignment and implant position perioperatively, resulting in more intraoperative corrections and no revision surgeries within 6 weeks postoperatively. However, using 3DRX significantly increases perioperative radiation exposure and surgery duration without a significant rise in postoperative infections and a shorter hospital length of stay.
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This network meta-analysis aims to compare functional outcomes and complications between conservative treatment and surgery for distal radius fractures in patients aged 60 years and over. ⋯ Evidence to date demonstrates that VLP provides measurable benefits in grip strength and fewer complications to those 60 years of age and over, and that benefit is not reflected in current practice guidelines. There is a subgroup of patients where K-wire fixation outcomes are similar to those of VLP; defining this subgroup may yield substantial societal benefits.
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Review
Digitalising patient reported outcome collection tools in orthopaedic trauma-A scoping review.
The aim of this study was to provide a scoping review to the role of digital technology in the collection of orthopaedic trauma related patient reported outcome measures (PROMs) METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews and Arksey and O'Malley frameworks were followed. A search strategy identified relevant literature, with the identified criteria screened for acceptability for inclusion. Data was extracted to form a descriptive analysis. ⋯ This paper has demonstrated the dearth of ePROM implementation in the orthopaedic trauma setting, however its use has proved successful and therefore further evidence is needed to demonstrate its effectiveness. Furthermore, the types of PROMs in orthopaedic trauma varies significantly, and efforts to standardise the type of digital trauma PROMs used are recommended.
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The STUMBL Score clinical prediction model was originally developed and externally validated to support clinical decision-making of patients with blunt chest wall trauma in the Emergency Department. The aim of this scoping review was to understand the extent and type of evidence in relation to the STUMBL Score clinical prediction model as a component of the management of patients with blunt chest wall trauma managed in the Emergency Care setting. ⋯ This review demonstrates how the STUMBL Score has evolved from solely predicting risk of respiratory complications to a measure which supports clinical decision making for the use of complex analgesic modes and as a guide for eligibility in chest wall injury trauma research studies. Despite external validation of the STUMBL Score, there is a need for further calibration and evaluation, particularly relating to these repurposed functions of the score. Overall, the clinical benefit of the score remains clear and its wide usage demonstrates the impact it has on clinical care, patient experience and clinician decision making.