Injury-International Journal of the Care of the Injured最新文献

{"title":"Effects of major trauma care organisation on mortality in a European level 1 trauma centre: A retrospective analysis of 2016-2023","authors":"Philip Verdonck ,&nbsp;Matthew Peters ,&nbsp;Tom Stroobants ,&nbsp;Johan Gillebeert ,&nbsp;Eva Janssens ,&nbsp;Sebastian Schnaubelt ,&nbsp;Suresh Krishan Yogeswaran ,&nbsp;Sabine Lemoyne ,&nbsp;Anouk Wittock ,&nbsp;Lore Sypré ,&nbsp;Dominique Robert ,&nbsp;Philippe G Jorens ,&nbsp;Dennis Brouwers ,&nbsp;Stijn Slootmans ,&nbsp;Koenraad Monsieurs","doi":"10.1016/j.injury.2024.112022","DOIUrl":"10.1016/j.injury.2024.112022","url":null,"abstract":"<div><h3>Introduction</h3><div>The centralisation of care for trauma patients in trauma centres, alongside the creation of inclusive trauma networks, has proven to reduce mortality. In Europe, such structured trauma programs and trauma networks are in development.</div></div><div><h3>Objective</h3><div>To describe the aetiology and evolution of in-hospital mortality in a developing European level 1 trauma centre, to determine the early effect of trauma care reorganisation on mortality and to identify the areas for future investments in trauma care.</div></div><div><h3>Materials and methods</h3><div>This retrospective analysis included the calculation of the standardised mortality ratio (SMR), the time to in-hospital death and the cause of in-hospital death of all primary major trauma admissions to the Antwerp University Hospital from 2016 to 2023.</div></div><div><h3>Results</h3><div>A total of 1470 patients was included with a crude mortality of 16.4 %, a median Revised Injury Severity Classification II (RISC II) adjusted mortality of 1.47 %, and a SMR of 1.12. A limitation of care directive was registered for 18.1 % of the patients. The causes of in-hospital death were traumatic brain injury (TBI) in 60 %, haemorrhagic shock in 15 %, organ failure in 10 %, miscellaneous in 14 % and unknown in 1 %. Sixty percent died in the first 48 h of hospital admission (mainly due to TBI and haemorrhagic shock) and 27 % died after more than seven days (mainly due to organ failure and TBI). In 24 % of the deceased patients with severe TBI, a non-TBI related cause of death was found. Overall, the SMR showed a nonsignificant decreasing trend, with a significant decrease of the SMR in the highest risk group (RISCII &gt; 75 %) and a nonsignificant increase in the lowest risk group (RISC II &lt;15 %).</div></div><div><h3>Conclusion</h3><div>The standardised mortality ratio declined over a period of 8 years, even though the SMR increased nonsignificantly in the lowest risk-adjusted mortality group. Future analysis of this subgroup could clarify whether this trend is due to an increase of limitation of care directives and if these deaths could have been prevented with improved trauma care. There might be opportunities to increase the survival of patients with severe TBI who have a non-TBI cause of death.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"55 12","pages":"Article 112022"},"PeriodicalIF":2.2,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142645280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-effectiveness and budget impact of cement augmentation for the fixation of unstable trochanteric fractures from a European perspective","authors":"Graham Radcliffe ,&nbsp;Jean-Baptiste Trouiller ,&nbsp;Suzanne Battaglia ,&nbsp;Ricardo Larrainzar-Garijo","doi":"10.1016/j.injury.2024.111999","DOIUrl":"10.1016/j.injury.2024.111999","url":null,"abstract":"<div><h3>Introduction</h3><div>Hip fractures have a high patient burden and mortality rate, particularly following revision surgery. Cement augmentation of cephalomedullary nails has been shown to lower the risk of cut-out, aiming to reduce the need and expense of revision surgeries. The aim of this study was to assess the economic impact of cement augmentation for the fixation of trochanteric hip fractures in fragile, elderly patients, across a range of European countries (UK, Spain, Italy, Germany, and France), from both a provider (hospital) and a payer perspective.</div></div><div><h3>Method</h3><div>The budget impact (hospital perspective) and cost-effectiveness (payer perspective) analyses were informed by clinical outcomes from a meta-analysis published in 2021, additional published literature, registries, and clinical experts. Economic inputs included length of stay and operating time for the hospital perspective, revision surgery, outpatient, and rehabilitation days costs for the payer perspective. Outcomes included the breakeven cost below which using cement augmentation would begin to generate cost savings for the hospital, and potential cost savings for the payer with incremental costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs). Deterministic and probabilistic sensitivity analyses were conducted to assess model uncertainty.</div></div><div><h3>Results</h3><div>From a hospital perspective, the breakeven cost below which the hospital would start saving money using cement augmentation was £491 (UK), €1490 (Spain), €1075 (Italy), €852 (Germany), and €834 (France) per patient, driven by reduced length of hospital stay. From a payer perspective, cost savings were £1675 (UK), €2202 (Spain), €993 (Italy), €944 (Germany), and €892 (France) per patient, mainly driven by fewer revision surgeries. Payer cost savings, coupled with incremental QALY gain of 0.004 across all regions, led to cement augmentation being the dominant strategy. These budget impact and cost-effectiveness results were rigorously tested in sensitivity analyses and were found to be robust.</div></div><div><h3>Conclusion</h3><div>These models support the wider adoption of cement augmentation to reduce the healthcare system costs associated with length of stay and revision surgery. These results provide useful information to providers, payers, and policymakers to ultimately influence choice surrounding the ‘gold-standard’ treatment of an unstable trochanteric fracture following low energy trauma.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"55 12","pages":"Article 111999"},"PeriodicalIF":2.2,"publicationDate":"2024-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142650439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A finite element analysis of the trapezoidal plate. How to get a stable fixation at different fracture lines?","authors":"Paris Liokatis ,&nbsp;Georgios Tzortzinis ,&nbsp;Carl Peter Cornelius ,&nbsp;Yoana Malenova ,&nbsp;Katharina Theresa Obermeier ,&nbsp;Wenko Smolka","doi":"10.1016/j.injury.2024.112020","DOIUrl":"10.1016/j.injury.2024.112020","url":null,"abstract":"<div><div>The fractures in the condylar area are a challenge for every surgeon, for the treatment of which trapezoidal condylar plate is used in most cases. However, it is not possible to position the plate in the ideal osteosynthesis lines according to Meyer et al. in every clinical situation. In many cases, the fracture line is also not in the centre of the trapezoidal plate. The aim of this study is to investigate the osteosynthesis rigidity and the effect of plate localisation relative to the fracture line.</div><div>In a simulation model in the first group the plate was positioned in the ideal position in the middle of the condylar base, in the second group the plate position was changed - the plate was shifted upwards until the fracture passed underneath the centre of the plate again and in the last group the plate was moved further down so that the fracture passes underneath the middle of the plate. Heterogeneity of the bone was simulated using different sets of biomechanical properties.</div><div>In the experiment, the joints were fully constrained and a force of 500 N was applied to the opposite side. An interaction between bone and plate was completely excluded and the stability of the plates as well as the mobility of the bone fragments was analysed.</div><div>The results have shown that an inferior position of the fracture line leads to greater mobility of the fragments if the position of the osteosynthesis material is the same. With a deep fracture line, a more cranial positioning of the plate leads to better stabilisation. This study needs to be experimentally validated.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"55 12","pages":"Article 112020"},"PeriodicalIF":2.2,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142645279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Avoiding “a piece of paper on the wall that everyone ignores”: A qualitative study on the barriers for implementing open fracture guidelines","authors":"Juan Enrique Berner ,&nbsp;Adele Pope ,&nbsp;David Winston Hamilton ,&nbsp;Jagdeep Nanchahal ,&nbsp;Abhilash Jain","doi":"10.1016/j.injury.2024.112018","DOIUrl":"10.1016/j.injury.2024.112018","url":null,"abstract":"<div><h3>Background</h3><div>Ortho-plastic evidence-based clinical guidelines for open fractures have demonstrated to standardise care and improve outcomes for patients admitted following lower extremity trauma. Despite its benefits, very few countries have introduced such guidance. The aim of this study was to explore the attitudes, barriers and limitations to the development and implementation of guidelines for lower limb open fractures</div></div><div><h3>Methods</h3><div>Twelve renowned orthopaedic and plastic surgeons, based in countries with no guidelines at present, underwent semi-structured interviews. A qualitative appraisal was conducted using reflexive thematic analysis methodology. Systematic coding led to the development and refinement of themes to address the research question.</div></div><div><h3>Results</h3><div>Individualistic decision-making, reliance on multidisciplinary interpersonal relationships, and the presence of immobile determinants of open fracture care emerged as three themes that define how patients are currently managed in settings with no guidelines in place. Although guidelines can potentially improve care by presenting evidence-based recommendations, introducing audit practices, establishing pathways for multidisciplinary collaboration, and enhancing effective leadership; if barriers to the implementation are not considered, they may end up as a “piece of paper on the wall that everyone ignores”</div></div><div><h3>Conclusions</h3><div>This study is the first to explore the challenges of introducing ortho-plastic guidelines for open extremity trauma. The themes presented describe the status quo in settings with no such protocols in place, establishing the foundation for future initiatives aiming to provide a practical strategy to aid the development and introduction of clinical guidelines for open lower limb fractures.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"55 12","pages":"Article 112018"},"PeriodicalIF":2.2,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142635134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"“Utility of social vulnerability index in trauma: A systematic review”","authors":"Anthony J. Duncan ,&nbsp;Samuel J. Bloomsburg ,&nbsp;Mentor Ahmeti","doi":"10.1016/j.injury.2024.112016","DOIUrl":"10.1016/j.injury.2024.112016","url":null,"abstract":"<div><h3>Introduction</h3><div>Traumatic injuries remain a leading cause of mortality across age groups. Despite advancements in medical care, addressing the broader determinants of health is essential. Social determinants of health (SDOH), including socioeconomic factors, play a crucial role in patient outcomes. The Social Vulnerability Index (SVI), developed by the CDC, integrates various indicators, providing a comprehensive framework for assessing community vulnerability. The objective of this study is to evaluate the connection between SVI and trauma patient outcomes.</div></div><div><h3>Methods</h3><div>A systematic literature search was conducted using PubMed, EMBASE and Web of Science. Inclusion criteria consisted of studies that were peer reviewed, obtainable in English, used SVI as a measurement and involved blunt or penetrating trauma. Of the initial 623 papers 12 studies met inclusion criteria.</div></div><div><h3>Results</h3><div>In adult studies, high SVI correlated with increased trauma mortality, especially in specific domains like Household Composition and Disability. For gunshot injuries, residents of high SVI communities had a higher likelihood of recurrent injuries. Readmission rates showed mixed results, with potential associations in younger patients. Long-term outcomes, such as functional limitations and PTSD, were more prevalent in higher SVI quartiles. Pediatric studies indicated associations between SVI and outcomes like firearm injuries, intentional injuries, and rehabilitation admission rates.</div></div><div><h3>Discussion</h3><div>In summary, these studies collectively demonstrate that there is a predictive value that SVI carries as it relates to trauma outcomes, underscoring that targeted interventions and policies to address social vulnerabilities can be done using this index. Further research is imperative to delve into the intricate interactions between SVI and specific trauma outcomes, considering demographic variations and exploring the potential implications for public health interventions.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"55 12","pages":"Article 112016"},"PeriodicalIF":2.2,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142650438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors contributing to disparities in trauma care between urban vs rural trauma centers: Towards improving trauma care access and quality of care delivery","authors":"Nickolas Hernandez ,&nbsp;Ruth Zagales ,&nbsp;Muhammad Usman Awan ,&nbsp;Sarthak Kumar ,&nbsp;Francis Cruz ,&nbsp;Kelsey Evans ,&nbsp;Kathleen Heller ,&nbsp;Tracy Zito ,&nbsp;Adel Elkbuli","doi":"10.1016/j.injury.2024.112017","DOIUrl":"10.1016/j.injury.2024.112017","url":null,"abstract":"<div><h3>Background</h3><div>We aim to explore and target factors contributing to disparities in trauma-care outcomes between urban vs rural trauma centers including EMS protocols, trauma centers’ (TC) distribution, infrastructure, and hospital resources.</div></div><div><h3>Methods</h3><div>A comprehensive literature review was conducted from January 1988 through April 1st, 2024, using Google Scholar, Embase, Cochrane, ProQuest, and PubMed. Included studies evaluated prehospital and in-hospital factors impacting trauma outcomes in urban and rural care settings. Key outcomes of interest were EMS transport times, TC access, inter-hospital transfers, trauma system utilization, and workforce infrastructure.</div></div><div><h3>Results</h3><div>A review of 29 studies demonstrated prolonged EMS on-scene and transport times, higher undertriage rates, and lower geospatial access to TCs in rural compared to urban settings. Transferring from rural to urban TCs was associated with increased mortality and designating rural TCs as Level III TCs reduced mortality (32 % decrease, <em>p</em> &lt; 0.0001). The unregulated expansion of TCs did not improve patient access or outcomes. Rural hospitals lacked specialized providers, had more hospitalizations (x̄ rural = 685.4 vs x̄ urban = 566.3; <em>p</em> = 0.005), ICU admissions (20.2% vs 11.6 %, <em>p</em> = 0.042), and ventilation requirements (37.8% vs 20.7 %, <em>p</em> = 0.001) among trauma patients.</div></div><div><h3>Conclusions</h3><div>Rural trauma patients often experience worse outcomes than their urban counterparts, possibly due to longer prehospital times, reduced TC access, and less specialized care. The designation of targeted Level III TCs in rural areas has been associated with improved outcomes. In contrast, unregulated TC expansion has not necessarily enhanced access or outcomes for rural patients.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"55 12","pages":"Article 112017"},"PeriodicalIF":2.2,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142635232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health related outcomes of patients with serious traumatic injury: Results of a longitudinal follow-up program delivered by trauma clinicians","authors":"Kate Dale ,&nbsp;Charlotte Winkleman ,&nbsp;Ian Hughes ,&nbsp;Katharine Heathcote ,&nbsp;Elizabeth Wake","doi":"10.1016/j.injury.2024.112012","DOIUrl":"10.1016/j.injury.2024.112012","url":null,"abstract":"<div><h3>Introduction</h3><div>The routine collection of long-term patient health outcomes after serious traumatic injury at the health service level is uncommon. In 2019, we implemented the longitudinal Trauma Service Follow Up (TSFU) program at a level I trauma centre. Delivered by the trauma service clinicians involved in inpatient care, it assesses quality of life and disability. This study reports the 6- and 12-month outcomes of the first two years of operation of the TSFU program.</div></div><div><h3>Methods</h3><div>This is a prospective cohort study of seriously injured adult trauma patients admitted to a level I trauma centre with 6- and 12-months post-discharge outcome assessments. Outcomes were quality of life and function/disability as measured using the EQ-5D-5L and WHODAS 2.0 validated instruments. Changes from 6 to 12 months were assessed using generalised estimating equations methods. Logistic regression models were used to identify factors associated with ongoing problems at each time point.</div></div><div><h3>Results</h3><div>Five-hundred and eight seriously injured patients were eligible for the TSFU program with follow-up rates over 80 % at both 6- and 12-month timepoints. At six months, ongoing problems with pain (69.9 %), anxiety and depression (49 %) and carrying out usual activities (57.5 %) were highly prevalent; at 12 months problems with pain (61.4 %) and anxiety and depression (43.8 %) persisted. Lower extremity and/or pelvic surgery was associated with ongoing pain, odds ratio (OR) = 3.77 (95 % CI 1.54–9.21, <em>p</em>=0.01), anxiety and depression (OR 1.95, 95 % CI 1.09–3.48, <em>p</em>=0.02) and problems carrying out their usual activities (OR 3.19, 95 % CI 0.75–13.5, <em>p</em>=0.11) at six months. These patterns mostly persisted at 12 months. Similar associations between surgical intervention and high levels of disability were evident at both time points.</div></div><div><h3>Conclusion</h3><div>Persistent impairments in physical and emotional health continues to affect many people following serious traumatic injury. The collection of longitudinal health outcomes by trauma clinicians enables identification of factors that contribute to disability and a reduction in quality of life. This in turn can drive quality improvement initiatives within the hospital trauma system. Longitudinal follow-up programs may provide a platform to provide ongoing specialist trauma-informed care after hospital discharge.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"55 12","pages":"Article 112012"},"PeriodicalIF":2.2,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142635239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do scoring scales work for determining salvage of extremities with severe trauma?","authors":"Kaja Matovinovic ,&nbsp;Michael Leslie ,&nbsp;Richard Buckley","doi":"10.1016/j.injury.2024.112015","DOIUrl":"10.1016/j.injury.2024.112015","url":null,"abstract":"","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"55 12","pages":"Article 112015"},"PeriodicalIF":2.2,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142640245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of elective implant removal and complication rates between mini and small fragment implants for lateral malleolar fixation","authors":"Riley Swenson ,&nbsp;Thomas Z. Paull ,&nbsp;Zachary A. Rockov ,&nbsp;Kevin Huang ,&nbsp;Gaonhia Moua ,&nbsp;Milton T.M. Little ,&nbsp;Mai P. Nguyen","doi":"10.1016/j.injury.2024.112014","DOIUrl":"10.1016/j.injury.2024.112014","url":null,"abstract":"<div><h3>Introduction</h3><div>Implant removal after open reduction and internal fixation (ORIF) of ankle fractures is common. Mini-fragment implants have gained popularity for their smaller size, with studies showing similar load to failure to small-fragment implants. We hypothesized mini-fragment implant use for ORIF of the distal fibula is associated with a lower implant removal rate and without an increase in implant failure.</div></div><div><h3>Methods</h3><div>In this retrospective review study at two level-one trauma centers, adult patients (&gt;18 years) with a lateral malleolar or bimalleolar fracture were included. Chart review was performed to determine if patients received ORIF of the distal fibula with mini-fragment implants or small-fragment implants. The primary outcome was elective implant removal of the fibular plate. Secondary outcomes included complications requiring reoperation.</div></div><div><h3>Results</h3><div>Five-hundred and five patients were included with a mean age of 50.6 ± 17.8 years old with a mean follow-up of was 75.7 ± 61.0 weeks. Sixty patients (11.9 %) received mini-fragment fixation. The rate of elective distal fibula implant removal for the mini-fragment group was 8.3 % (5 of 60) compared to 10.8 % (48 of 445) in the small-fragment group (<em>p</em> = .66). The complication rate was 6.7 % (4 of 60) for the mini fragment group versus 6.5 % (29 of 445) for the small fragment group (<em>p</em> = 1.00). Logistic regression demonstrated that each additional week of follow-up increased the implant removal rate with the observed odd ratio (OR) of 1.007 (95 % CI 1.002–1.012).</div></div><div><h3>Conclusion</h3><div>Elective implant removal rates and complications requiring reoperation were similar between mini-fragment and small-fragment fixation of distal fibula fractures. The hypothetical benefit of low-profile mini-fragment implants should be balanced with the higher implant cost.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"55 12","pages":"Article 112014"},"PeriodicalIF":2.2,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142635218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of mechanical stability of osteosynthesis on infection rates: Timing of temporary and definitive fixation","authors":"Emmanuele Santolini ,&nbsp;Vincenzo Giordano ,&nbsp;Peter V. Giannoudis","doi":"10.1016/j.injury.2024.111845","DOIUrl":"10.1016/j.injury.2024.111845","url":null,"abstract":"<div><div>Fracture related infection (FRI) remains one of the most challenging complications of orthopaedic trauma surgery. Several factors contribute to FRI development but, among those, particularly interesting from the orthopaedic surgeon's perspective is the contribution of mechanical stability and timing of fracture fixation. These are indeed crucial factors both in prevention and treatment of FRI and are directly influenced by the surgeon's work. While the role of stability has been studied and discussed, the pathophysiological process regulating such role and how this influences surgeon's treatment decision making is still debated. The same applies to the ideal timing of temporary or definitive fixation which varies according to the clinical scenario considered.</div><div>In the present narrative review, we described the influence of mechanical stability on both FRI pathophysiology and on the decision making of FRI treatment. In addition, we analysed the impact of the timing of fracture fixation on the risk of FRI development particularly in those clinical scenarios where it has been shown to be specifically relevant, such as fractures affecting segments with poor soft tissue envelope, open fractures, damage control orthopaedics, and the need for soft tissue coverage.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"55 ","pages":"Article 111845"},"PeriodicalIF":2.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142553686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}