OTA international : the open access journal of orthopaedic trauma最新文献

{"title":"The effect of restrictive fluid management on outcomes among geriatric hip fractures: a retrospective cohort study at five level I trauma centers.","authors":"Jordan Willis,&nbsp;Stephanie Jarvis,&nbsp;Gina M Berg,&nbsp;Chad Corrigan,&nbsp;Robert Madayag,&nbsp;Cassandra Reynolds,&nbsp;Allen Tanner,&nbsp;Gary Marshall,&nbsp;Carlos Palacio Lascano,&nbsp;David Bar-Or","doi":"10.1097/OI9.0000000000000279","DOIUrl":"https://doi.org/10.1097/OI9.0000000000000279","url":null,"abstract":"<p><p>Restrictive fluid management (RFM) for hemodynamically unstable trauma patients has reduced mortality rates. The objective was to determine whether RFM benefits geriatric hip fracture patients, who are usually hemodynamically stable.</p><p><strong>Design: </strong>Retrospective propensity-matched study.</p><p><strong>Setting: </strong>Five Level I trauma centers (January 1, 2018-December 12, 2018).</p><p><strong>Patients: </strong>Geriatric patients (65 years or older) with hip fractures were included in this study. Patients with multiple injuries, nonoperative management, and preoperative blood products were excluded.</p><p><strong>Intervention: </strong>Patients were grouped by fluid volume (normal saline, lactated Ringer, dextrose, electrolytes, and medications) received preoperatively or ≤24 hours of arrival; patients with standard fluid management (SFM) received ≥150 mL and RFM <150 mL of fluids.</p><p><strong>Main outcome measurements: </strong>The primary outcomes were length of stay (LOS), delayed ambulation (>2 days postoperatively), and mortality. Paired Student t-tests, Wilcoxon paired rank sum tests, and McNemar tests were used; an α value of < 0.05 was considered statistically significant.</p><p><strong>Results: </strong>There were 523 patients (40% RFM, 60% SFM); after matching, there were 95 patients per arm. The matched patients were well-balanced, including no difference in time from arrival to surgery. RFM and SFM patients received a median of 80 mL and 1250 mL of preoperative fluids, respectively (<i>P</i> < 0.001). Postoperative fluid volumes were 1550 versus 2000 mL, respectively, (<i>P</i> = 0.73), and LOSs were similar between the two groups (5 versus 5 days, <i>P</i> = 0.83). Mortality and complications, including acute kidney injuries, were similar. Delayed ambulation rates were similar overall. When stratified by preinjury ambulation status, SFM was associated with delayed ambulation for patients not walking independently before injury (<i>P</i> = 0.01), but RFM was not (<i>P</i> = 0.09).</p><p><strong>Conclusions: </strong>RFM seems to be safe in terms of laboratory results, complications, and disposition. SFM may lead to delayed ambulation for patients who are not walking independently before injury.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"6 3","pages":"e279"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/87/01/oi9-6-e279.PMC10356122.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9840274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of computed tomography in the detection of traumatic arthrotomies of the elbow: a cadaveric study.","authors":"Vinicius Ladeira Craveiro,&nbsp;Shasta Henderson,&nbsp;Henry Boateng,&nbsp;Matthew R Garner","doi":"10.1097/OI9.0000000000000275","DOIUrl":"https://doi.org/10.1097/OI9.0000000000000275","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the use of computed tomography (CT) imaging as a diagnostic tool for elbow arthrotomies using a standardized cadaveric arthrotomy model.</p><p><strong>Method: </strong>Nineteen intact fresh frozen cadaver elbows were CT scanned using 2 mm cuts with sagittal and coronal reformats in the plane of the joint and used as controls. An elbow arthrotomy at the posterocentral arthroscopic portal site was performed in all specimens using a 4.5 millimeter trocar. After arthrotomy, all elbows underwent a second CT scan followed by a standard saline load test (SLT). Images were randomized and reviewed by 2 blinded, independent reviewers. Bimodal scoring was performed for each specimen with regard to the presence of an arthrotomy indicated by presence of air in the joint. Regarding the SLT, saline exiting the arthrotomy wound was considered a positive test.</p><p><strong>Results: </strong>CT scans were found to have 100% sensitivity and 86% specificity for diagnosing elbow arthrotomies. Interrater reliability calculated with Cohen kappa statistic was near perfect at r = 0.89. The SLT had a sensitivity of 79% when 20 mL was injected. A total of 25 mL of saline was required to be injected for a sensitivity greater than 95%.</p><p><strong>Conclusion: </strong>This study demonstrates that CT scan is a reliable and less technically demanding method of diagnosis arthrotomies with high interrater reliability and high sensitivity and with results comparable with SLT. This technique may be useful in centers where trained providers are not readily available to perform SLT. Clinical study is required to validate our results.</p><p><strong>Level of evidence: </strong>Level II.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"6 3","pages":"e275"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/0f/f9/oi9-6-e275.PMC10278719.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9709966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transparency films: intraoperative templating to prevent limb deformity.","authors":"Sasha Stine,&nbsp;Jonathan Daniel Joiner,&nbsp;Daniel Andersen,&nbsp;Eric Schweller,&nbsp;Rahul Vaidya","doi":"10.1097/OI9.0000000000000280","DOIUrl":"https://doi.org/10.1097/OI9.0000000000000280","url":null,"abstract":"<p><p>Operative management of fractures and malunions can be challenging when restoring native anatomy is not straightforward. Comminuted fractures and managing deformity correction in the setting of osteolysis, callus, and even complete fracture healing must include careful planning. Preoperative planning has been popularized and taught as an integral part of a surgeon's skill set, with critical evaluation and assessment of the implemented plan being the final step in the process. We present a robust, reproducible, and cost-effective technique for intraoperative fracture fixation assessment with case examples, used routinely at our institution.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"6 3","pages":"e280"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/56/e5/oi9-6-e280.PMC10438797.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10406196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mapping crisis intervention course into social work academic curricula in Lebanon","authors":"Mansour Rania","doi":"10.17352/ojt.000042","DOIUrl":"https://doi.org/10.17352/ojt.000042","url":null,"abstract":"Social work is strongly presented to support and decrease the suffering of people living in a crisis. The call to intervene professionally in such cases is highly demanded by government institutions, non-governmental organizations, international organizations, and United Nations agencies, the main umbrella that enfolded practitioner social workers in Lebanon. Although Lebanon has experienced successive crises for more than forty years, there is no national strategy for social work or for intervention during crises that must be developed by the Ministry of Social Affairs in collaboration with relevant institutions such as academia. However, considering that the Lebanese universities that graduate social workers are the most important source for developing that strategy based on evidence-based research, unfortunately, they did not do any action. The purpose of this article is to describe how these universities are preparing students and developing their capacities to deal with the crisis consequences. The focus of this article is the presence of the Crisis Intervention (CI) course in the curricula of universities. Data were collected from all Lebanese universities’ websites and catalogs with undergraduate-level social work majors (N = 6). The data were issued from reviewing the curricula of the six universities that covered the N = 290 course. Data shows that the CI course does not enclose three out of six published curricula as well and results indicate a modest appearance of the crisis and its relevant courses. Accordingly, at the end of the research, a syllabus of the crisis intervention course is proposed and will be shared with the six Lebanese concerned Universities.","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136241433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neurofilament light protein as a cerebrospinal fluid marker after whiplash trauma","authors":"Bunketorp Olof, Lindh Malin, Pujol-Calderón Fani, Rosengren Lars, Carlsson Gudrun Silverbåge, Z. Henrik","doi":"10.17352/ojt.000041","DOIUrl":"https://doi.org/10.17352/ojt.000041","url":null,"abstract":"The purpose was to investigate if a whiplash trauma may cause an increased concentration of the Neurofilament Light (NFL) protein, and if so; is this related to the injury severity and the radiological findings? Adult car occupants, with neck problems after rear-end collisions, were investigated in a study on Whiplash-Associated Disorders (WAD) in 1997-2001. The study protocol included a neurological examination, plain radiography and MRT of the cervical spine, and a lumbar puncture for Cerebrospinal Fluid (CSF) within six weeks after the accident. Similar CSF samples were also taken three and twelve months later. All CSF samples were analyzed for NFL. Of 52 subjects who entered the study, 43 completed it. The WAD grade was I in two of the 43 cases, II in 13, and III in 28. No one had radiological signs, indicating injuries to the cervical spine or spinal cord. Six subjects showed an increased NFL concentration at the primary examination. This was judged to be caused by whiplash trauma in three of them (7%). There was no relation between an increased NFL concentration and the number of pathological changes on plain radiographs or MRT. Neither was there a relation between the NFL concentration and the WAD grade. An increased NFL concentration can be found in some WAD patients. It might be difficult to relate such an increase to clinical or radiological findings. Further studies should investigate NFL as a marker for injuries to the central nervous system in whiplash trauma, including minimal traumatic brain injuries.","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73164324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preventing biological waste: Effective use of viable tissue in traumatized lower extremities.","authors":"Jefferson L Lansford, Conor F McCarthy, Jason M Souza, Ean R Saberski, Benjamin K Potter","doi":"10.1097/OI9.0000000000000242","DOIUrl":"10.1097/OI9.0000000000000242","url":null,"abstract":"<p><p>Severe open lower extremity trauma requires debridement to remove contamination and devitalized tissues. Aggressive debridement should be balanced with preservation of viable tissue. These often damaged but preserved viable tissues are \"spare parts\" that augment the options available for reconstruction. The long-term goal of reconstruction should be functional limb restoration and optimization. Injury patterns, levels, and patient factors will determine whether this endeavor is better accomplished with limb salvage or amputation. This article reviews the rationale and strategies for preserving spare parts throughout debridement and then incorporating them as opportunistic grafts in the ultimate reconstruction to facilitate healing and maximize extremity function.</p><p><strong>Level of evidence: </strong>5.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"6 4 Suppl","pages":"e242"},"PeriodicalIF":0.0,"publicationDate":"2023-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10337847/pdf/oi9-6-e242.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9825839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Soft tissue coverage: techniques for the orthopaedic trauma surgeon","authors":"D. Stinner, J. Hsu, J. Blair","doi":"10.1097/oi9.0000000000000271","DOIUrl":"https://doi.org/10.1097/oi9.0000000000000271","url":null,"abstract":"","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47225961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Negative pressure wound therapy: Where are we in 2022?","authors":"Michael A Quacinella,&nbsp;Taylor M Yong,&nbsp;William T Obremskey,&nbsp;Daniel J Stinner","doi":"10.1097/OI9.0000000000000247","DOIUrl":"https://doi.org/10.1097/OI9.0000000000000247","url":null,"abstract":"<p><p>The use of negative pressure wound therapy (NPWT) continues to be an important tool for surgeons. As the use and general acceptance of NPWT have grown, so have the indications for its use. These indications have expanded to include soft tissue defects in trauma, infection, surgical wound management, and soft tissue grafting procedures. Many adjuvants have been engineered into newer generations of NPWT devices such as wound instillation of fluid or antibiotics allowing surgeons to further optimize the wound healing environment or aid in the eradication of infection. This review discusses the recent relevant literature on the proposed mechanisms of action, available adjuvants, and the required components needed to safely apply NPWT. The supporting evidence for the use of NPWT in traumatic extremity injuries, infection control, and wound care is also reviewed. Although NPWT has a low rate of complication, the surgeon should be aware of the potential risks associated with its use. Furthermore, the expanding indications for the use of NPWT are explored, and areas for future innovation and research are discussed.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"6 4 Suppl","pages":"e247"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/8f/6e/oi9-6-e247.PMC10337842.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10180908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How to get the most out of your gastrocnemius and soleus flaps.","authors":"Paul E Matuszewski,&nbsp;Gary L Ulrich","doi":"10.1097/OI9.0000000000000255","DOIUrl":"https://doi.org/10.1097/OI9.0000000000000255","url":null,"abstract":"<p><p>Gastrocnemius and soleus flaps represent the workhorse local flaps to cover soft tissue defects of the proximal 1/3 and middle 1/3 of the leg, respectively. An important consideration before conducting a local flap is whether the flap can provide adequate coverage. The utility of the gastrocnemius flap can be increased using multiple techniques to increase the arc of rotation including the posterior midline approach, dissection at the pes anserinus and medial femoral condyle origin, scoring the fascia, and inclusion of a skin paddle. Concerning the soleus flap, the hemisoleus flap represents a technique to increase the arc of rotation. With a soleus flap, one must consider the soft tissue defect location, size, and perforator blood supply because these factors influence what soleus flap technique to use. This article discusses how to make the most out of gastrocnemius flaps and soleus flaps regarding maximizing coverage and ensuring successful flap outcome.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"6 4 Suppl","pages":"e255"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/2e/dd/oi9-6-e255.PMC10337844.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9877683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute shortening and angulation for complex open fractures: an updated perspective.","authors":"Sarah N Pierrie,&nbsp;Michael J Beltran","doi":"10.1097/OI9.0000000000000245","DOIUrl":"https://doi.org/10.1097/OI9.0000000000000245","url":null,"abstract":"<p><p>Reestablishing an intact, healthy soft tissue envelope is a critical step in managing lower extremity injuries, particularly high-grade open tibia fractures. Acute shortening and angulation can be used independently or together to address complex soft tissue injuries, particularly when bone loss is present. These techniques facilitate management of difficult wounds and can be combined with local soft tissue rearrangement or pedicled flaps as needed, avoiding the need for free tissue transfer. After angular deformity correction, adjacent bone loss can be addressed with bone grafting or distraction histogenesis. This article discusses the indications for, surgical technique for, and limitations of acute shortening and angulation for management of open lower extremity fractures.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"6 4 Suppl","pages":"e245"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e1/fc/oi9-6-e245.PMC10337845.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9877688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}