Injury
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During revision surgery for the management of patients presenting with long-bone upper extremity nonunion, it is crucial to rule out fracture-related infection (FRI). This is especially true if there are clinical signs suggestive of FRI, or if there is a history of prior FRI, open wound fracture, or surgery. This study aimed to determine the efficacy of frozen section analysis (FSA) in providing real-time diagnosis of FRI in patients with upper-limb long-bone nonunion undergoing revision surgery. ⋯ FSA showed high sensitivity and specificity for the detection of active infection during revision surgery for nonunion of the upper limb. Owing to its high negative predictive value, it can reliably rule out active infections during revision surgery. Since the results are obtained immediately during revision surgery, this approach offers the significant advantage of enabling real-time decision-making.
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Severe metaphyseal comminution and sizable bone defect of the distal femur are high risks of fixation failure. To date, no exact magnitude of comminution and bone loss is determined as an indication for augmentation of fixation construct. The present study aimed to investigate the influence of metaphyseal gap width, working length, and screw distribution on the stability of the fixation construct. ⋯ The 30-mm and wider metaphyseal gap width with a long working length presented a risk of varus collapse and fixation failure. Short working length with spreading screw provided low EQV stress, low bone stress, and high fracture stability.
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Fracture-related infection (FRI) is a feared complication in orthopaedic trauma surgery. They are associated with multiple surgical interventions and prolonged antibiotic treatment duration, and hence, increased costs. The objective of this study was to assess the costs of FRI treatment in a Tertiary Swiss Trauma Center and to identify the variables associated with increased costs. ⋯ This study illustrates the financial burden of FRI in a DRG system and identifies potential drivers for these costs. Since repeated surgeries or unplanned surgical revisions are drivers of costs, optimal pre-operative planning and coordination between the involved disciplines is key to minimize costs. Management in multidisciplinary teams that are specialized in the treatment of these complex and cost-intensive patients may therefore reduce the financial burden.
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Several concerns regarding gender equality in orthopedic surgery do exists. The aim of this study was to (1) compare operative times, (2) compare mortality rates, (3) investigate gender disparities in hip fracture surgeries, and (4) analyze gender distribution among attending and resident surgeons performing Closed Reduction Internal Fixation (CRIF) and Hemiarthroplasty (HA) METHODS: All patients >75 years old treated for proximal femur fractures in a level-one trauma center in a four-year timeframe were retrospectively enrolled. Exclusion criteria were follow-up <3 years, incomplete data, active patients treated with total hip arthroplasty (THA) and other surgeries performed during the same anesthesia. Patients were grouped according to procedure: 1) Closed Reduction Internal Fixation (CRIF) and 2) Hemiarthroplasty (HA). Gender and level of expertise (residents or attending surgeon) of leading surgeons (male (M), female (F) and non-binary (NB)) was extracted from medical records. Operative time, mortality rates, and the likelihood of performing either CRIF or HA were compared across genders. ⋯ Despite orthopedics still being a male-dominated field, gender does not affect surgical outcomes or the likelihood of performing CRIF or HA. However, the focus should shift towards improving inclusivity in surgical education and practice by providing equal opportunities and removing social and educational barriers based on gender.
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Traumatic injury poses significant physical and psychological challenges, often resulting in psychological distress, encompassing symptoms of anxiety, depression and post-traumatic stress. Despite the recognised need for psychological care in trauma rehabilitation, there is limited empirical evidence of effective interventions tailored specifically for individuals with traumatic injuries, leading to a practice-evidence gap. ⋯ The review findings highlight the preliminary evidence supporting CBT as a viable option for reducing psychological distress following traumatic injury. However, this may be explained by the dominance of CBT in the literature due to its structured nature, availability and suitability for research, potentially limiting the visibility of alternative therapeutic approaches. Further, these findings are constrained by study limitations, including small sample sizes, heterogeneity of injury types and severity, reliance on self-reported outcomes, and limited follow-up data. Future research should aim to include longitudinal follow-up assessments and explore alternative therapeutic approaches to contribute to our understanding of meaningful trauma rehabilitation methods.