Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Sep 2015
Review Meta AnalysisAre Volar Locking Plates Superior to Percutaneous K-wires for Distal Radius Fractures? A Meta-analysis.
Distal radius fractures are common, costly, and increasing in incidence. Percutaneous K-wire fixation and volar locking plates are two of the most commonly used surgical treatments for unstable dorsally displaced distal radius fractures. However, there is uncertainty regarding which of these treatments is superior. ⋯ Level I, therapeutic study.
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Clin. Orthop. Relat. Res. · Sep 2015
Can Cytoprotective Cobalt Protoporphyrin Protect Skeletal Muscle and Muscle-derived Stem Cells From Ischemic Injury?
Extremity trauma is the most common injury seen in combat hospitals as well as in civilian trauma centers. Major skeletal muscle injuries that are complicated by ischemia often result in substantial muscle loss, residual disability, or even amputation, yet few treatment options are available. A therapy that would increase skeletal muscle tolerance to hypoxic damage could reduce acute myocyte loss and enhance preservation of muscle mass in these situations. ⋯ Pharmacotherapy with HO-1 inducers, delivered in the field, on hospital arrival, or during trauma surgery, may improve preservation of muscle mass and muscle-inherent stem cells after severe ischemic limb injury.
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Clin. Orthop. Relat. Res. · Sep 2015
Review Meta AnalysisWhat Are the Prognostic Factors for Radiographic Progression of Knee Osteoarthritis? A Meta-analysis.
A previous systematic review on prognostic factors for knee osteoarthritis (OA) progression showed associations for generalized OA and hyaluronic acid levels. Knee pain, radiographic severity, sex, quadriceps strength, knee injury, and regular sport activities were not associated. It has been a decade since the literature search of that review and many studies have been performed since then investigating prognostic factors for radiographic knee OA progression. ⋯ Baseline knee pain, presence of Heberden nodes, varus alignment, and high levels of serum markers hyaluronic acid and tumor necrosis factor-α predict knee OA progression. Sex, knee injury, and quadriceps strength, among others, did not predict knee OA progression. Large variation remains in definitions of knee OA and knee OA progression. Clinical studies should use more consistent definitions of these factors to facilitate data pooling by future meta-analyses.
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Clin. Orthop. Relat. Res. · Sep 2015
Review Comparative StudyBlast Injury in the Spine: Dynamic Response Index Is Not an Appropriate Model for Predicting Injury.
Improvised explosive devices are a common feature of recent asymmetric conflicts and there is a persistent landmine threat to military and humanitarian personnel. Assessment of injury risk to the spine in vehicles subjected to explosions was conducted using a standardized model, the Dynamic Response Index (DRI). However, the DRI was intended for evaluating aircraft ejection seats and has not been validated in blast conditions. ⋯ A new model needs to be developed to aid in the design of mine-protected vehicles for future conflicts.
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Clin. Orthop. Relat. Res. · Sep 2015
ReviewWhat Is the Magnitude and Long-term Economic Cost of Care of the British Military Afghanistan Amputee Cohort?
Personal protection equipment, improved early medical care, and rapid extraction of the casualty have resulted in more injured service members who served in Afghanistan surviving after severe military trauma. Many of those who survive the initial trauma are faced with complex wounds such as multiple amputations. Although costs of care can be high, they have not been well quantified before. This is required to budget for the needs of the injured beyond their service in the armed forces. ⋯ Estimates here should be taken as the start of a challenge to develop sustained rehabilitation and recovery funding and provision.