Eur J Trauma Emerg S
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Eur J Trauma Emerg S · Feb 2008
Evaluation of Factors Delaying Discharge in Acute Orthopedic Wards: a Prospective Study.
Prolonged hospitalization due to delayed discharge not only increases cost, it also increases the risk of medical complications e.g., hospital acquired infections. Length of stay (LOS) is one of the indicators that reflect total cost of care during hospitalization. The study was planned to evaluate the factors affecting delay in discharges from hospital and whether these factors are avoidable. ⋯ Older patients with co-morbidities are more prone to long stay due to de-conditioning requiring social input and nosocomial infection. The study thus proved the hypothesis and suggested that early identification of social issues and prompt discharge planning helps to avoid delay in discharge.
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Eur J Trauma Emerg S · Dec 2007
Osteitis and Septic Arthritis after Tibial Head Fracture: Results of a Radical Treatment Regime.
We report a series of 37 consecutive patients with both bone infection and septic arthritis of the knee following fracture of the proximal tibia. Aim of this study is to evaluate treatment results using a standardized treatment regime. The treatment regime consisted of an aggressive surgical approach to both the bone and the joint. In 61% the joint function was preserved, in the reminder an arthrodesis was required, there were no amputations. The difficulties in dealing with this condition are described as well as the clinical, radiological and occupational results. ⋯ The reported treatment regime gives reliable results for the treatment of combined bone and joint infection of the knee after fracture. In a large group of cases it was possible to salvage joint function. Comparison to other forms of treatment is not possible as there are no reported results so far.
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Eur J Trauma Emerg S · Dec 2007
Ischemia-Reperfusion Injury : Pathophysiology and Clinical Implications.
The term ischemia-reperfusion injury describes the experimentally and clinically prevalent finding that tissue ischemia with inadequate oxygen supply followed by successful reperfusion initiates a wide and complex array of inflammatory responses that may both aggravate local injury as well as induce impairment of remote organ function. Conditions under which ischemia-reperfusion injury is encountered include the different forms of acute vascular occlusions (stroke, myocardial infarction, limb ischemia) with the respective reperfusion strategies (thrombolytic therapy, angioplasty, operative revascularization) but also routine surgical procedures (organ transplantation, free-tissue-transfer, cardiopulmonary bypass, vascular surgery) and major trauma/shock. Since the first recognition of ischemia-reperfusion injury during the 1970s, significant knowledge has accumulated and the purpose of this review is to present an overview over the current literature on the molecular and cellular basis of ischemia-reperfusion injury, to outline the clinical manifestations and to compile contemporary treatment and prevention strategies. Although the concept of reperfusion injury is still a matter of debate, it is corroborated by recent and ongoing clinical trials that demonstrated ischemic preconditioning, inhibition of sodium-hydrogen-exchange and administration of adenosine to be effective in attenuating ischemia-reperfusion injury.
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Eur J Trauma Emerg S · Dec 2007
Plating of Femoral Shaft Fractures: the Experience in an African Teaching Hospital.
Femoral shaft fractures are common presentation in our trauma units. It is obvious that all these fractures cannot be treated conservatively due to the pressure on trauma beds and thus a suitable method of internal fixation that is feasible in the environment has had to be adopted. ⋯ Femoral shaft plating gives good result if the principles of fixation is carefully followed and in developing countries where initial cost of procurement of equipments for closed nailing may not be forth coming, it thus provide a safe efficient and low cost method of fixation of femoral shaft fracture.
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Eur J Trauma Emerg S · Dec 2007
Planning Analysis of Knee-Adjacent Deformities : I. Frontal Plane Deformities.
The planning analysis of leg deformities around the knee joint is based on a standardized clinical examination and on long leg standing anteroposterior (AP) radiographs, which may be complemented by spot-film radiographs and stress radiographs. The principles of true-nominal analysis in six steps are used to characterize the deformity and plan the corrective osteotomy:1. Drawing in the anatomic points of reference.2. ⋯ Deciding on the osteosynthesis technique and the osteotomy level.6. Measuring the angle of correction. All the steps are exemplified on a valgus deformity and a varus deformity.