Injury
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Intra-articular and comminuted fractures of the calcaneus constitute a significant orthopedic challenge. Calcaneal fracture management should primarily aim to achieve good clinical and biomechanical outcomes, pain reduction, and normal function following treatment. ⋯ We observed no significant differences between the experimental group and the healthy control group in terms of cadence, gait velocity, or stride length. Patients in experimental group showed significantly shortened stance and single support phases in the treated limb in comparison with those in the intact limb; the remaining gait parameters were similar in the treated and intact limb. We observed no significant differences between the treated limbs in the patient group and the nondominant limbs in the control group in terms of any gait parameters. In the follow-up, the average pain value on the VAS scale was 2.3. The median Böhler angle changed from 5.5° preoperatively to 28.5° postoperatively, p < 0.001. The median Gissane's angle was 119° before surgery and 143° after surgery, p < 0.001.The use of the Ilizarov method in the treatment of calcaneal fractures helps achieve sufficient normalization of most gait parameters, with their values similar to those observed in healthy volunteers. After treatment of calcaneal fractures using the Ilizarov method, radiological parameters improved. The biomechanical outcomes of calcaneal fracture treatment with the Ilizarov method are good.
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Endpoint Adjudication Committees (EACs) benefit the quality of randomized control trials (RCTs) where outcomes depend on subjective interpretations. However, assembling a committee to adjudicate large datasets is cumbersome. In a recent RCT, the primary outcome was time to union following operative fixation of scaphoid non-union, with real or placebo adjunctive ultrasound treatment. Union status was determined with computed tomography (CT) scans interpreted by treating surgeons and radiologists. An EAC was established to deliberate discrepancies between radiologists' and surgeons' interpretations of union status. ⋯ This adjudication process provides a valuable research tool for reference by other clinical investigators whose RCTs' outcomes are dependent on interpretation of radiographic images.
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Despite research linking chemical and physical restraints to negative outcomes including unplanned intubations and psychological distress, there is little guidance for their use in the care of trauma patients. We used institutional data to describe recent trends in chemical and physical restraint in the emergency department evaluation and treatment of trauma patients and to identify characteristics associated with their use. ⋯ In this institutional study, nearly one-in-twelve trauma patients were restrained during emergency department evaluation and treatment. Restraint utilization increased during the study driven primarily by increases in ketamine and restraints utilized during trauma bay evaluation and resuscitation. Future research should assess the generalizability of these findings. It is important that rigorous guidelines are established to ensure the safe and effective use of restraints in trauma.
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Fragility fractures of the pelvis (FFP) in elderly patients are an increasing concern due to their association with osteoporosis and the aging population. These fractures significantly affect patients' mobility and quality of life. This study evaluates different surgical techniques in patients suffering from FFP to provide standardized recommendations for treatment strategies. In addition, we compared therapeutic concepts and their outcome between two major trauma centers in Germany. ⋯ This study underscores the importance of minimally invasive surgical techniques in managing FFP in elderly patients, highlighting their potential to reduce the length of hospital stay and improve recovery.
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The Norwegian trauma plan was established in 2007 and renewed in 2017 defining national trauma team activation (TTA) criteria. Norwegian studies validating the performance of previous TTA protocols have found overtriage and undertriage to be out of line with the quality indicators set in the national trauma plan, but studies have not yet been published validating the new TTA protocol. ⋯ Both overtriage and undertriage are out of line with the goals set in the Norwegian trauma plan. Undertriage is often caused by older patients that do not fulfill the trauma criteria in the current TTA protocol. Mechanism of injury increases overtriage but does not reduce undertriage. The TTA protocol could be improved by changing the composition of criteria groups, removal of single criteria with low PPV, and by better compliance to the existing criteria.