Clinical orthopaedics and related research
-
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.
-
Clin. Orthop. Relat. Res. · Sep 2015
Percutaneous Distraction Pinning for Metacarpophalangeal Joint Stabilization After Blast or Crush Injuries of the Hand.
Unstable, severely comminuted fractures of the metacarpophalangeal (MCP) joint are difficult to treat. Closed treatment and casting of these fractures often fail to maintain proper alignment and impede wound care where concomitant open injuries such as gunshot wounds are present. Conventional pinning or plating techniques are not feasible if extensive bone loss and comminution are present. A distraction pinning technique represents a potential alternative, but results with this approach, to our knowledge, have not been reported. ⋯ Level IV, therapeutic study.
-
Clin. Orthop. Relat. Res. · Sep 2015
Comparative StudyHydrogel-based Delivery of rhBMP-2 Improves Healing of Large Bone Defects Compared With Autograft.
Autologous bone grafting remains the gold standard in the treatment of large bone defects but is limited by tissue availability and donor site morbidity. Recombinant human bone morphogenetic protein-2 (rhBMP-2), delivered with a collagen sponge, is clinically used to treat large bone defects and complications such as delayed healing or nonunion. For the same dose of rhBMP-2, we have shown that a hybrid nanofiber mesh-alginate (NMA-rhBMP-2) delivery system provides longer-term release and increases functional bone regeneration in critically sized rat femoral bone defects compared with a collagen sponge. However, no comparisons of healing efficiencies have been made thus far between this hybrid delivery system and the gold standard of using autograft. ⋯ Delivery systems that allow prolonged availability of BMP may provide an effective clinical alternative to autograft treatment for repair of segmental bone defects. Future studies in a large animal model comparing mixed cortical-trabecular autograft and the NMA-rhBMP-2 hybrid delivery system are the next step toward clinical translation of this approach.
-
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.