European journal of trauma and emergency surgery : official publication of the European Trauma Society
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Eur J Trauma Emerg Surg · Oct 2020
Masquelet technique for open tibia fractures in a military setting.
The induced membrane technique (IMT) is a two-stage procedure dedicated to reconstruction of bone defects of the limbs. The objective of this report was to evaluate employment of the IMT for the treatment of open tibia fractures managed in a military trauma center treating both wartime and peacetime injuries. ⋯ This series is the first to report IMT use in a military setting. The prior eradication of infection constitutes a major challenge in tibial bone defects, especially in high-energy, multi-tissue injuries. An inter-tibiofibular bone reconstruction approach is required when external fixation is chosen.
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Eur J Trauma Emerg Surg · Oct 2020
Outcomes after unstable pertrochanteric femur fracture: intermediate versus long cephalomedullary nails.
Optimal cephalomedullary nail (CMN) length for unstable pertrochanteric femur fractures is controversial. Long CMNs (L-CMNs) are currently recommended; however, intermediate-length CMNs (I-CMNs) may provide stable fixation without the additional surgical steps required by L-CMNs. We analyzed outcomes after unstable pertrochanteric femur fractures treated with L-CMNs or I-CMNs to determine whether functional outcomes, perioperative measures, complications, and mortality and reoperation rates differ by CMN length. ⋯ Level IV, Retrospective case series study.
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Eur J Trauma Emerg Surg · Oct 2020
Reduced complication rates for unstable trochanteric fractures managed with third-generation nails: Gamma 3 nail versus PFNA.
Third-generation nails for the management of unstable trochanteric fractures were evaluated with regard to outcomes. ⋯ The Gamma 3 nail and the PFNA yielded comparable clinical results and significantly improved outcomes for unstable trochanteric fractures compared to older nail generations.
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Eur J Trauma Emerg Surg · Oct 2020
A differentiated approach to repeat small-bowel anastomoses in patients with postoperative peritonitis: a prospective cohort study.
Postoperative peritonitis still remains the cause of a high mortality rate in emergency abdominal surgery. Here we aimed to evaluate the efficacy of different surgical strategies for small-bowel perforations that resulted in postoperative peritonitis. ⋯ The differentiated surgical approach undertaken herein using delayed small-bowel anastomosis in more serious patients with postoperative peritonitis was able to mitigate the risk of recurrent anastomotic leaks and was not accompanied by a considerable rise in mortality. The mortality for primary repair and delayed primary closure was basically the same (17.0% and 18.8%, p = 0.03); however, delayed anastomosis in the patients with postoperative peritonitis at higher APACHE-II and MPI scores for severity of illness showed 15.1% less complications in the form of anastomotic leaks (p = 0.04).
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Eur J Trauma Emerg Surg · Oct 2020
Randomized Controlled TrialThe effectiveness of preoperative colon cleansing on post-operative surgical site infection after hip hemiarthroplasty.
This study aimed to evaluate the effectiveness of prophylactic mechanical bowel preparation in elderly patients undergoing hip hemiarthroplasty in a single training institution over a period of 2 years. ⋯ Although preoperative colon cleansing did not reduce the overall incidence of post-operative infections, our study suggested that it may reduce polymicrobial infections after hip hemiarthroplasty. Polymicrobial infections after hip hemiarthroplasty seem to have worse prognosis. Therefore, the effectiveness of preoperative colon cleansing in remediating such infections must be investigated in a larger number of patients.