Injury
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The centralisation of care for trauma patients in trauma centres, alongside the creation of inclusive trauma networks, has proven to reduce mortality. In Europe, such structured trauma programs and trauma networks are in development. ⋯ The standardised mortality ratio declined over a period of 8 years, even though the SMR increased nonsignificantly in the lowest risk-adjusted mortality group. Future analysis of this subgroup could clarify whether this trend is due to an increase of limitation of care directives and if these deaths could have been prevented with improved trauma care. There might be opportunities to increase the survival of patients with severe TBI who have a non-TBI cause of death.
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Hip fractures have a high patient burden and mortality rate, particularly following revision surgery. Cement augmentation of cephalomedullary nails has been shown to lower the risk of cut-out, aiming to reduce the need and expense of revision surgeries. The aim of this study was to assess the economic impact of cement augmentation for the fixation of trochanteric hip fractures in fragile, elderly patients, across a range of European countries (UK, Spain, Italy, Germany, and France), from both a provider (hospital) and a payer perspective. ⋯ These models support the wider adoption of cement augmentation to reduce the healthcare system costs associated with length of stay and revision surgery. These results provide useful information to providers, payers, and policymakers to ultimately influence choice surrounding the 'gold-standard' treatment of an unstable trochanteric fracture following low energy trauma.
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Traumatic injuries remain a leading cause of mortality across age groups. Despite advancements in medical care, addressing the broader determinants of health is essential. Social determinants of health (SDOH), including socioeconomic factors, play a crucial role in patient outcomes. The Social Vulnerability Index (SVI), developed by the CDC, integrates various indicators, providing a comprehensive framework for assessing community vulnerability. The objective of this study is to evaluate the connection between SVI and trauma patient outcomes. ⋯ In summary, these studies collectively demonstrate that there is a predictive value that SVI carries as it relates to trauma outcomes, underscoring that targeted interventions and policies to address social vulnerabilities can be done using this index. Further research is imperative to delve into the intricate interactions between SVI and specific trauma outcomes, considering demographic variations and exploring the potential implications for public health interventions.
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Ortho-plastic evidence-based clinical guidelines for open fractures have demonstrated to standardise care and improve outcomes for patients admitted following lower extremity trauma. Despite its benefits, very few countries have introduced such guidance. The aim of this study was to explore the attitudes, barriers and limitations to the development and implementation of guidelines for lower limb open fractures METHODS: Twelve renowned orthopaedic and plastic surgeons, based in countries with no guidelines at present, underwent semi-structured interviews. A qualitative appraisal was conducted using reflexive thematic analysis methodology. Systematic coding led to the development and refinement of themes to address the research question. ⋯ Individualistic decision-making, reliance on multidisciplinary interpersonal relationships, and the presence of immobile determinants of open fracture care emerged as three themes that define how patients are currently managed in settings with no guidelines in place. Although guidelines can potentially improve care by presenting evidence-based recommendations, introducing audit practices, establishing pathways for multidisciplinary collaboration, and enhancing effective leadership; if barriers to the implementation are not considered, they may end up as a "piece of paper on the wall that everyone ignores" CONCLUSIONS: This study is the first to explore the challenges of introducing ortho-plastic guidelines for open extremity trauma. The themes presented describe the status quo in settings with no such protocols in place, establishing the foundation for future initiatives aiming to provide a practical strategy to aid the development and introduction of clinical guidelines for open lower limb fractures.
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The fractures in the condylar area are a challenge for every surgeon, for the treatment of which trapezoidal condylar plate is used in most cases. However, it is not possible to position the plate in the ideal osteosynthesis lines according to Meyer et al. in every clinical situation. In many cases, the fracture line is also not in the centre of the trapezoidal plate. ⋯ The results have shown that an inferior position of the fracture line leads to greater mobility of the fragments if the position of the osteosynthesis material is the same. With a deep fracture line, a more cranial positioning of the plate leads to better stabilisation. This study needs to be experimentally validated.