Injury
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Studies have demonstrated successful outcomes with early weightbearing following open reduction internal fixation (ORIF) of specific ankle fractures. The external validity of an early weightbearing protocol and its effects on patient-reported outcome information scores (PROMIS) has yet to be investigated. This study aimed to investigate the effects of an early weightbearing protocol for all operatively treated ankle fractures and its impact on clinical outcomes and complications. ⋯ This study found that early weightbearing after ORIF of unstable ankle fractures leads to similar PROMIS scores and ankle ROM without increased complications. In addition, smokers were found to have worse ankle ROM when compared to nonsmokers at final follow-up.
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Intertrochanteric fractures are common in older adults and pose significant challenges in terms of morbidity and mortality. Accurate reduction and optimal implant positioning during operative stabilisation of these fractures reduce the rates of complications and reoperations while improving functional outcomes in this population. This study aimed to assess the effects of a structured educational intervention on the radiographic outcomes, reduction quality, and revision rates of intertrochanteric fractures. ⋯ Implementation of the structured training program led to better radiographic outcomes for intertrochanteric fractures, especially among less experienced surgeons. The observed improvements in reduction quality and decrease in revision rates underscore the potential benefits of incorporating educational interventions in orthopaedic trauma treatment.
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Frame configuration for the management of complex tibial fractures is highly variable and is dependent upon both fracture pattern and surgeon preference. The optimal number of rings to use when designing a frame remains uncertain. Traditionally larger, multi-ring-per-segment constructs have been assumed to offer optimal stability and therefore favourable conditions for fracture healing but there is little in-vivo evidence for this and the recent concept of reverse dynamisation challenges this approach. ⋯ No significant differences were found in the rate of malunion or the requirement for secondary surgical intervention to achieve union. The groups were evenly matched for age, co-morbidities, energy of injury mechanism, post-treatment alignment and presence of an open fracture. This study finds that 2-ring frame constructs are a reliable option associated with shorter duration of treatment and no increase in rates of adverse outcomes compared with larger, more complex frame configurations.
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The purpose of this study was to establish typical dose values at orthopaedic operating rooms of the Larnaca General Hospital (LGH). Kerma area product (KAP), fluoroscopy time (FT) and cumulative air-kerma (Ka,r) measurements were collected for 821 patients who underwent common and reproducible trauma surgery over a five-year period, with three mobile C-arm systems; two equipped with an image-intensifier and one with a flat-panel detector. Dose indices were automatically extracted from radiation dose structured reports or DICOM meta-data files archived in the PACS, using custom-made software. ⋯ Additionally, when comparing surgical operations, only femur/trochanter long/short and tibia intramedullary nailing demonstrated a significant increase in median KAP, FT and Ka,r values compared to dynamic hip screw and fixation with a locking plate, respectively. The typical dose values reported could be used as a guide to appropriate levels of intra-operative fluoroscopy in orthopaedic trauma surgery at LGH, and to encourage further optimisation by providing a baseline for audit of local practice in the absence of national reference doses. These values could also contribute to the establishment of the first national DRLs for orthopaedic trauma surgery.
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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.