European journal of trauma and emergency surgery : official publication of the European Trauma Society
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Lower extremity fractures are very common in victims of falls. These fractures are usually associated with other bodily injuries and can lead to permanent disability if appropriate management is not provided. The aim of this study was to evaluate the incidence and outcomes of associated injuries in victims of falls with lower extremity fractures. ⋯ Patients with a combination of femur and tibia fractures have a significantly higher risk of associated injuries compared to patients with either a femur or a tibia fracture. Elderly patients (≥65 years of age) have higher morbidity and mortality compared to younger patients after falls. Clinicians evaluating these patients should be aware of these injury patterns. Further studies assessing the impact of age and pattern of injury in patients following falls are warranted.
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Eur J Trauma Emerg Surg · Jun 2014
A holistic hip fracture approach: individualized diagnosis and treatment after surgery.
Secondary fracture prevention is of paramount importance in the clinical management of patients with hip fractures. However, in contrast to the excellent surgical care provided to these patients in the Western hemisphere and despite good medical options, causative treatment of the underlying osteopathy causing skeletal fragility remains an unmet medical need that urgently needs to be improved. This calls for a concerted action between orthopedic/trauma surgeons and osteologists, as outstanding hospitals not only treat fragility fractures, but also prevent fractures from recurring. Aiming for a holistic hip fracture approach, in this work we highlight aspects of (a) improved risk assessment and differential diagnosis, (b) optimized basic medical care, and
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Extramedullary fixation with a sliding hip screw remains the treatment of choice for the majority of trochanteric hip fractures. Attention to surgical detail is far more important that the actual choice of implant. The fracture must be reduced to an anatomical or slight valgus position using the fracture table. ⋯ A four-hole plate should suffice for most fractures. After surgery, weight bearing as able should be allowed. For fractures fixed correctly, wound or fracture healing complication should be rare, occurring in <5 % of cases.
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Eur J Trauma Emerg Surg · Jun 2014
The exponential function transforms the Abbreviated Injury Scale, which both improves accuracy and simplifies scoring.
We present here the exponential function which transforms the Abbreviated Injury Scale (AIS). It is called the Exponential Injury Severity Score (EISS), and significantly outperforms the venerable but dated New Injury Severity Score (NISS) and Injury Severity Score (ISS) as a predictor of mortality. ⋯ The EISS may be used as the standard summary measure of human trauma.
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Eur J Trauma Emerg Surg · Jun 2014
Primary prosthetic replacement in per- and intertrochanteric fractures.
Hip arthroplasty is rarely indicated in the treatment of per- and intertrochanteric femur fractures. Although the majority of fractures are amenable to closed- or open reduction and internal fixation (CRIF/ORIF), in some patients the complexity of the fracture or other patient-related factors may cause the orthopaedic surgeon to consider arthroplasty as the treatment of choice. Decision-making is challenging, and a reliable score has not yet been established. ⋯ CRIF/ORIF remain the workhorses in per- and intertrochanteric fracture management. Arthroplasty offers an advantageous treatment option for a well-defined patient and fracture collective. The HPIFS might support the decision-making process.