Journal of orthopaedic trauma
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Randomized Controlled Trial
Femoral Medialization, Fixation Failures, and Functional Outcome in Trochanteric Hip Fractures Treated With Either a Sliding Hip Screw or an Intramedullary Nail From Within a Randomized Trial.
The aim of this study was to determine if femoral medialization influences residual pain and mobility and to determine if fixation method or fracture pattern influences the tendency to medialize. ⋯ Prognostic level II. See Instructions for Authors for a complete description of levels of evidence.
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The Bundled Payments for Care Improvement (BPCI) initiative is the latest cost-saving program developed by the Center for Medicare and Medicaid Innovation. This model is intended to create a system for higher quality and more coordinated care at a lower cost to Medicare. It is currently an optional program for physician groups, hospitals and post-acute care providers to benefit financially from improved care models and cost containment measures. ⋯ Keys for success include appropriate patient selection for elective surgery, implant pricing control, adherence to preoperative and postoperative protocols, diligent postcare care management, and appropriate choice of metrics to maximize gainsharing potential. Ultimately, the BPCI program has been a successful venture, saving our hospitals over $1.6 million in 2015. In the process, this provided an additional revenue stream for our physicians while decreasing the overall cost of care.
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The traumatic loss of muscle tissue, defined as volumetric muscle loss (VML) injury, has no definitive therapy. The purposes of this study were: (1) to develop a porcine model of VML and (2) to investigate autologous minced muscle grafts (1-mm pieces of muscle) as a potential therapeutic. Minced grafts were evaluated because they have promoted fiber regeneration and functional recovery in rat VML models and do not require US Food and Drug Administration approval for clinical use. ⋯ Autologous minced muscle grafts partially restored neuromuscular strength in a novel porcine model of VML.
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Comparative Study
Buttress Plating Versus Anterior-to-Posterior Lag Screws for Fixation of the Posterior Malleolus: A Biomechanical Study.
The preferred method of fixation for posterior malleolus fractures remains controversial, and practices vary widely among surgeons. The purpose of this study was to compare anterior-to-posterior (AP) lag screws with posterior buttress plating for fixation of posterior malleolus fractures in a human cadaveric model. ⋯ Posterior malleolus fractures treated with posterior buttress plating showed significantly less displacement during cyclical loading compared with fractures fixed with AP lag screws. Surgeons should consider these findings when selecting a fixation strategy for these common fractures. Further research is warranted to investigate the clinical implications of these biomechanical findings.
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Prothrombin complex concentrate (PCC) is being increasingly used for reversing induced coagulopathy of trauma. However, the use of PCC for reversing coagulopathy in multiply injured patients with pelvic and/or lower extremity fractures remains unclear. The aim of our study was to assess the efficacy of PCC for reversing coagulopathy in this group of patients. ⋯ Therapeutic level III. See Instructions for Authors for a complete description of levels of evidence.