Journal of orthopaedic trauma
-
To assess the results of a standardized staged treatment strategy for displaced open calcaneal fractures with medial wounds. ⋯ Open Type II and IIA wounds associated with displaced OTA Type 73 B or C calcaneal fractures represent high-energy injuries with potential increased risk for wound complications. In our series, a staged treatment strategy consisting of urgent débridement, provisional internal stabilization, and late definitive reconstruction offers a protocol that may reduce infections associated with open calcaneal fractures.
-
To examine the cost and efficacy of methods of general and regional anesthetic for postoperative pain control after open repair of intra-articular calcaneal fractures. We compared single-injection popliteal fossa blocks and continuous infusion popliteal fossa blocks with drug delivered through a catheter from an infusion pump (CPNB) to general or spinal anesthetic alone in terms of hospital charges, length of hospital stay, and postoperative oral and intravenous narcotic use, antiemetic use, and safety. ⋯ CPNB through an infusion pump may allow patients undergoing open treatment of calcaneal fractures to be safely discharged within 24 hours with a concomitant decrease in healthcare costs. These data suggest that this method of postoperative pain management might be applied to other patients with major foot and ankle trauma and/or reconstructive procedures and that wider use of continuous peripheral nerve blocks may lead to a reduction in healthcare costs.
-
Low-intensity pulsed ultrasound (LIPUS) is a relatively new technique for the acceleration of fracture healing in fresh fractures and nonunions. It has a frequency of 1.5 MHz, a signal burst width of 200 micros, a signal repetition frequency of 1 kHz, and an intensity of 30 mW/cm2. In 1994 and 1997, two milestone double-blind randomized controlled trials revealed the benefits of LIPUS for the acceleration of fracture healing in the tibia and radius. ⋯ For delayed union and nonunion, the overall success rate of LIPUS therapy is approximately 67% (humerus), 90% (radius/radius-ulna), 82% (femur), and 87% (tibia/tibia-fibula). LIPUS likely has the ability to enhance maturation of the callus in distraction osteogenesis and reduce the healing index. The critical role of LIPUS for fracture healing is still unknown because of the heterogeneity of results in clinical trials for fresh fractures and the lack of controlled trials for delayed unions and nonunions.
-
The measurement of clinical outcomes in trauma research is often problematic in that it is subjective and currently no feasible gold standard evaluation is available. Consequently, observed trial results are partly dependent on which outcome measure is used. Precise and useful estimates of treatment effects can only be obtained when using reliable, valid, and responsive instruments for measuring fracture healing. ⋯ In contrast, patient-assessed measures have been designed specifically for investigational purposes and measure health on various domains. Some of them have been validated extensively. Critically evaluating established clinician-based assessments and integrating those found to be valid with patient-assessed outcomes into a composite measure of fracture healing constitute major future challenges.
-
Selecting the most appropriate outcome measures can be especially burdensome in trials studying fracture healing, because the process of fracture healing is subjective and without a gold standard. Although a wide variety of radiographic modalities are available, plain radiography remains the most common approach for healing assessment. ⋯ In this article, we provide an overview of the most commonly used radiographic and clinical criteria for defining fracture healing. The validity and reliability of alternative approaches is also discussed.