J Trauma
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The complication rate of periprosthetic femoral fractures above well-fixed total knee arthroplasties is high. The Less Invasive Stabilization System (LISS) was introduced to reduce surgical dissections at the fracture site. The purpose of this retrospective study was to evaluate the midterm functional outcome of a group of patients with periprosthetic fractures above well-fixed total knee arthroplasties treated with the LISS. ⋯ We found that a minimally invasive, locked plating system permitted stable fixation, early knee motion with good midterm results, and minimal complications. These techniques should be used in place of less stable and more invasive methods.
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Community-acquired methicillin-resistant Staphylococcal aureus (CA-MRSA) infection is approaching endemic proportions nationally, and it is a potential cause for early ventilator-associated pneumonia (VAP) in the acutely injured patient. We sought to determine the prevalence of early (≤4 days) and late (>4 days) MRSA pneumonia in ventilated multisystem trauma patients and to correlate findings with admission nasal swabs. ⋯ Despite an increase of MRSA nationally, we found a low incidence of early and late MRSA VAP in trauma patients, which was not identified by nasal swab screening. On the basis of our results, we question the efficacy of empiric vancomycin therapy in early (≤4 days) S. aureus VAP. Furthermore, nasal swabs were not helpful in identifying patients at risk for MRSA VAP.
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Myostatin (GDF-8) is known as a potent inhibitor of muscle growth and development, and myostatin is also expressed early in the fracture healing process. The purpose of this study was to test the hypothesis that a new myostatin inhibitor, a recombinant myostatin propeptide, can enhance the repair and regeneration of both muscle and bone in cases of deep penetrant injury. ⋯ Blocking myostatin signaling in the injured limb improves fracture healing and enhances muscle regeneration. These data suggest that myostatin inhibitors may be effective for improving wound repair in cases of orthopaedic trauma and extremity injury.
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This study was performed to determine the effects of orthopedic trauma on pregnancy outcomes in pregnant trauma patients. ⋯ Our findings indicate that traumatized pregnant women with orthopedic injuries are high-risk obstetrical patients and may benefit from referral to a medical center capable of handling both the primary injury and the potential preterm birth associated with the injury.
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Randomized Controlled Trial Multicenter Study
Results of the CONTROL trial: efficacy and safety of recombinant activated Factor VII in the management of refractory traumatic hemorrhage.
Traumatic coagulopathy contributes to early death by exsanguination and late death in multiple organ failure. Recombinant Factor VIIa (rFVIIa, NovoSeven) is a procoagulant that might limit bleeding and improve trauma outcomes. ⋯ rFVIIa reduced blood product use but did not affect mortality compared with placebo. Modern evidence-based trauma lowers mortality, paradoxically making outcomes studies increasingly difficult.