Injury
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Multicenter Study
Risk factors for infection in severe open tibial shaft fractures.
To evaluate risk factors for infection in severe open tibial shaft fractures. ⋯ Surgeons can now counsel patients with these risk factors that they are at a markedly higher risk of infection. The identification of these risk factors may direct future research aimed at mitigating the risk of deep surgical site infection in this patient population.
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Multicenter Study Observational Study
Wound infection rate after skin closure of damage control laparotomy with wicks or incisional negative wound therapy: An EAST multi-center trial.
Damage control laparotomy (DCL) has a high risk of SSI and as an attempt to mitigate this, surgeons often leave the skin open to heal by secondary intention. A recent retrospective study showed that DCL wounds could be closed with the addition of wicks or incisional wound vacs with acceptable rates of wound infection. The aim of this prospective trial was to corroborate these results. ⋯ Most of the patients' skin was closed with wicks in place (68.9 %). There was a 9.8 % infection rate in patient's skin closed with wicks versus 16.2 % closed with an incisional wound vac (p = 0.361). Although the wick group had a higher proportion of class III and IV wound types, patients primarily treated with wicks had a lower risk of wound infection compared to those treated with incisional wound VACs; however, this difference was not statistically significant.
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Multicenter Study
Etiologies of non-traumatic extremity compartment syndrome: A multi-center retrospective review.
Determine the etiologies of non-traumatic extremity compartment syndrome (NTECS), understand the demographics of NTECS patients, describe their diagnostic workup and treatment, and establish their rate and cause of in-hospital mortality. This is a retrospective cohort study of all patients diagnosed with NTECS at two level 1 trauma centers between January 2006 and December 2019. Data pertaining to the etiology of NTECS, patient demographics, diagnostic and treatment modalities, and in-hospital mortality were collected from electronic medical records. ⋯ While uncommon, many etiologies of NTECS exist and often manifest insidiously. 13% of patients who develop NTECS will require a skin graft / flap, or extremity amputation. 20 % of patients who develop NTECS die during their hospitalization. High clinical suspicion and future research in this field are necessary to improve clinical outcomes for these patients. Level IV: Retrospective review.
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Multicenter Study
Prevalence of pelvic CT angiography (CTA) and angiographic embolization in geriatric patients with pelvic ring fractures presenting to two level I trauma centers.
Hemorrhage in osteoporotic pelvic ring fractures is a rare, but serious complication. Most bleeding comes from the bone or venous plexuses, but arterial injury does occur. The purpose of this study was to characterize a large geriatric pelvic fracture cohort and determine the prevalence of pelvic CT angiography (CTA) and subsequent need for arterial embolization. ⋯ Bleeding events in geriatric pelvic ring injuries is a previously under researched area of orthopedic trauma. Further research is needed to elucidate the exact pathomechanisms of arterial injury and what patients or injury patterns are most significantly associated. Specifically, larger cohort sizes and evaluating our existing cohort with different injury classification systems may yield useful results.
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Animal models are essential for orthopedic infectious research. However, only few models are currently able to capture the complex and multidisciplinary treatment approach for osteomyelitis. ⋯ Herein, we review a well-characterized and reproducible porcine model of human-scale one-stage revision of implant-associated osteomyelitis that can be used for robust preclinical testing of operative and post-operative interventions. The pros and cons of the model are discussed in the context of existing literature on large animal revision models.