Eur J Trauma Emerg S
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Due to the demographic developments worldwide, fragility fractures represent an increasing problem for the public health system. The risk of developing osteoporosis increases with age and is relatively higher in women and in the Caucasian population. The stability of bone is reduced because of accentuation of the normal loss of bone mass in ageing, leading to an increased susceptibility to fracture with an increased rate of complications after surgical stabilization. ⋯ At this stage, the trauma surgeon should initiate diagnostic procedures, treatment of osteoporosis and tertiary prevention according to the European guidelines. Ultimately, all female patients older than 50 years and all male patients older than 60 years with fractures should be assessed and treated for bone quality. Orthogeriatric specialists or interdisciplinary orthogeriatric teams should initiate a specific surgical treatment followed by early rehabilitation in order to allow the elderly patient to return to daily living as soon as possible.
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Eur J Trauma Emerg S · Dec 2008
Quantification of Reaming Debris at the Fracture Gap of Diaphyseal A2 and A3 Fractures After Reamed Intramedullary Nailing of the Sheep Tibia.
The aim of this study was to visualize the intramedullary bone debris after reamed nailing of long bones. To date, there is no protocol to quantify bone debris in the fracture gap. The hypothesis was to show if there are differences between A2 and A3 fractures. ⋯ The results show reaming produces intramedullary bonegrafting. Despite different fracture planes of A2 and A3 fractures, no significant differences in the amount of reaming debris located at the fracture gap could be found. However the percental rate of reaming debris at the fracture gap of plain fractures is negligible. This research shows that there is potential for reaming debris to be applied effectively as a prophylactic and osteogenetic autograft. Together with the high stability of the intramedullary nail an all embracing concept of osteosynthesis could be established.
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Eur J Trauma Emerg S · Dec 2008
Helsinki Trauma Outcome Study 2005: Audit on Outcome in Trauma Management in Adult Patients in Southern Part of Finland.
The outcome performance of the adult patients trauma care in Helsinki University Hospital was compared with a sample of English hospitals. This was a first time such an audit on trauma care was conducted in Finland. Helsinki University Hospital submitted the Trauma Audit and Research Network (TARN, UK) data of adult trauma patients during 1 year period (from 1 September 2004 to 31 August 2005). ⋯ The patients were older and the mean ISS was higher in Helsinki (mean ISS in Helsinki 14 vs. 11 in England). The standardized W statistic (a measure of survival variation from the expected mean, per 100 patients) was + 3.0 (confidence intervals + 2.3 to + 3.8) for Helsinki University Hospital and + 0.2 (confidence intervals -0.1 to 0.4) for English hospitals. These results suggest that the organization of trauma care in Helsinki University Hospital area is more effective in preventing death after trauma in adults than that covering the present sample of English hospitals.
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Eur J Trauma Emerg S · Dec 2008
Postoperative Protocol in the Prevention of Fragility Fractures in Patients with Osteoporosis-Related Fractures.
Osteoporosis is a multifactorial disorder that requires advanced diagnostic evaluation tools. It should not be considered to be an inevitable disease entity or as a logical consequence of the physiological ageing process. Osteoporosis can be diagnosed and - more importantly - properly treated. ⋯ Basic measures for fracture prevention, including dietary supplements of calcium and vitamin D, should be recommended and implemented for all patients, whereas only those patients with the diagnosis of a manifest osteoporosis should receive a specific pharmacotherapy. Antiresorptive and anabolic drugs that are licensed for the treatment of men or postmenopausal women with osteoporosis have been shown to effectively reduce the incidence of vertebral and non-vertebral fractures. An evaluation of the treatment efficiency should also be performed, such as routine clinical re-evaluation and the measuring of the bone mineral density by dual X-ray absortiometry, every 18-24 months after the initiation of the pharmacotherapy.
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Eur J Trauma Emerg S · Dec 2008
The Second Most Common Bone Disease: A Review on Paget's Disease of Bone.
Paget disease of bone (PDB) is the second most common metabolic bone disease. It is a chronic disease with a mono- or polyostotic appearance that is characterized by an increased bone turnover. The orthopedic surgeon is often confronted with such symptoms and complications as bone pain, skeletal deformities, and pathologic fractures caused by the "out-of-balance bone remodeling process". ⋯ Patients with PDB are at increased risk for surgical complications, such as blood loss and heterotopic bone formation, if operative treatment is necessary. However, advances in surgical techniques and accompanying medical treatment could potentially improve the overall outcome of these patients. To achieve that goal, careful perioperative interdisciplinary management and monitoring are essential.