Journal of orthopaedic trauma
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Meta Analysis
Complex limb salvage or early amputation for severe lower-limb injury: a meta-analysis of observational studies.
Leg threatening injuries present patients and clinicians with a difficult decision: whether to pursue primary amputation or limb salvage? The purpose of our study was to review the literature in an effort to inform this management decision. ⋯ Functional outcome among patients who present with leg-threatening injuries are not significantly different, at least up to 7 years, whether they are managed with limb salvage or primary amputation. Research to optimize triage decisions to avoid failed limb salvage as well as on interventions targeting important psychosocial prognostic variables should be considered a priority.
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Randomized Controlled Trial
Prolonged thromboprophylaxis with dalteparin after surgical treatment of achilles tendon rupture: a randomized, placebo-controlled study.
Prophylaxis against thromboembolic complications has become routine after major orthopedic surgery. In contrast, it remains an issue for debate whether prophylaxis after minor surgery and immobilization is necessary, even though these treatments are well-known risk factors for deep-vein thrombosis (DVT). The objective of this study was to evaluate the efficacy of dalteparin during lower-limb immobilization after surgical treatment of Achilles tendon rupture. DESIGN SETTING, AND PATIENTS: Randomized, placebo-controlled, double-blind study of 105 consecutive patients surgically treated for Achilles tendon rupture in a trauma hospital. DVT screening with color duplex sonography was conducted 3 weeks and 6 weeks after surgery. All DVTs were confirmed with phlebography. Intervention was placebo or dalteparin (5000 U) given subcutaneously once daily for 6 weeks postoperatively. ⋯ DVT is common after surgical treatment of Achilles tendon rupture, and therefore effective thromboprophylaxis is desirable. In our study, thromboprophylaxis with dalteparin, however, does not affect the incidence of DVT during immobilization after Achilles tendon rupture surgery. Long-term effects of immobilization, such as the risk for postthrombotic syndrome, need to be investigated further.
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To analyze the long-term (5-27 years) functional and radiologic results of surgically treated fractures of the tibial plateau. ⋯ Long-term results after open reduction and internal fixation for tibial plateau fractures are excellent, independent of the patient's age.
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To determine reliable, early indicators of mortality and causes of death in hemodynamically unstable patients with pelvic ring injuries. ⋯ Predictors of mortality in pelvis fracture patients should be available early in the course of treatment in order to be useful. Death within 24 hours was most often a result of acute blood loss while death after 24 hours was most often caused by MOF. Improved survival will depend upon the evolution of early hemorrhage control and resuscitative strategies in patients at high mortality risk.