Orthopaedic traumatology: fundamental principles and current controversies for the acute care surgeon

Science.gov (United States)

Pharaon, Shad K; Schoch, Shawn; Marchand, Lucas; Mirza, Amer

2018-01-01

Multiply injured patients with fractures are co-managed by acute care surgeons and orthopaedic surgeons. In most centers, orthopaedic surgeons definitively manage fractures, but preliminary management, including washouts, splinting, reductions, and external fixations, may be performed by selected acute care surgeons. The acute care surgeon should have a working knowledge of orthopaedic terminology to communicate with colleagues effectively. They should have an understanding of the composition of bone, periosteum, and cartilage, and their reaction when there is an injury. Fractures are usually fixed urgently, but some multiply injured patients are better served with a damage control strategy. Extremity compartment syndrome should be suspected in all critically injured patients with or without fractures and a low threshold for compartment pressure measurements or empiric fasciotomy maintained. Acute care surgeons performing rib fracture fixation and other chest wall injury reconstructions should follow the principles of open fracture reduction and stabilization. PMID:29766123

Music intervention to prevent delirium among older patients admitted to a trauma intensive care unit and a trauma orthopaedic unit.

Science.gov (United States)

Johnson, Kari; Fleury, Julie; McClain, Darya

2018-08-01

Evaluate music listening for delirium prevention among patients admitted to a Trauma Intensive Care and Trauma Orthopaedic Unit. The Roy Adaptation Model provided the theoretical framework focusing on modifying contextual stimuli. Randomised controlled trial, 40 patients aged 55 and older. Participants randomly assigned to receive music listening or usual care for 60 minutes, twice a day, over three days. Pre-recorded self-selected music using an iPod and headsets, with slow tempo, low pitch and simple repetitive rhythms to alter physiologic responses. Heart rate, respiratory rate, systolic and diastolic blood pressure, confusion assessment method. Repeated measures ANOVA, F(4, 134) = 4.75, p = .001, suggested statistically significant differences in heart rate pre/post music listening, and F(1, 37) = 10.44, p = .003 in systolic blood pressure pre/post music listening. Post-hoc analysis reported changes at three time periods of statistical significance; (p = .010), (p = .005) and (p = .039) and a change in systolic blood pressure pre/post music listening; (p = .001) of statistical significance. All participants screened negative for delirium. Music addresses pathophysiologic mechanisms that contribute to delirium; neurotransmitter imbalance, inflammation and acute physiologic stressors. Music to prevent delirium is one of few that provide support in a critical care setting. Copyright © 2018 Elsevier Ltd. All rights reserved.

The available evidence on demineralised bone matrix in trauma and orthopaedic surgery : a systematic review

NARCIS (Netherlands)

van der Stok, J.; Hartholt, K.A.; Schoenmakers, D.A.L.; Arts, J.J.C.

2017-01-01

Objectives: The aim of this systematic literature review was to assess the clinical level of evidence of commercially available demineralised bone matrix (DBM) products for their use in trauma and orthopaedic related surgery. Methods: A total of 17 DBM products were used as search terms in two

[Gender-specific evaluation of student's career planning during medical study in terms of orthopaedic trauma].

Science.gov (United States)

Mooij, S C; Antony, P; Ruesseler, M; Pfeifer, R; Drescher, W; Simon, M; Pape, H-C; Knobe, M

2011-08-01

Due to recent changes in the medical licencing act as well as to the introduction of a new model-course programme for medical studies, careers in medicine have become increasingly more attractive. However, there is still a dramatic shortage in younger generation physicians, especially within the surgical fields. The goal of this cross-sectional study was the gender-specific assessment of the ideal career wishes of students during medical school, with a focus being placed in orthopaedic trauma surgery. During the winter semester of 2010/2011 an online questionnaire (www.surveymonkey.com) was created for students enrolled in their 3rd to 12th semester (n=887). The questionnaire consisted of 50 questions [Likert scale (LS); 5 = agree, 1 = disagree] along with 10 free response questions. The scope of these questions ranged from personal career goals, within the context of their learning environment, to general life goals and planning. With regard to career choice, a differentiation was made between students' ideal career choices/subjects (IS), which were based solely on personal affinity, and so-called reality-based subjects (RS), which students considered more practical and to which they were more likely to apply in the future. The response rate was 36,4% (n=323, 23,4 years, 6.3 semesters, 226 [70.0%] female [f] and 97 [30.0%] male [m]). A total of 206 students (63.8%; m=55.7% vs. f=66.7%; p=0.047) were able to pinpoint an IS, this percentage increased with increasing semester number (p=0.048). Overall, 29.1% of students indicated that their IS lay in the field of orthopaedic trauma, while 20.0% of men and 19.1% of women saw it as a realistic career path (RS). Throughout the course of their studies, from the 3rd semester to their practical year, a declining tendency was observed regarding the agreement between ideal and realistic career paths. Particularly evident was a decreasing interest in the field of orthopaedic trauma, beginning around the 9th semester and

Mental imagery and learning: a qualitative study in orthopaedic trauma surgery.

Science.gov (United States)

Ibrahim, Edward F; Richardson, Martin D; Nestel, Debra

2015-09-01

Good preparation for surgical procedures has been linked to better performance and enhanced learning in the operating theatre. Mental imagery is increasingly used to enhance performance in competitive sport and there has been recent interest in applying this in surgery. This study aims to identify the mental imagery components of preoperative preparation in orthopaedic trauma surgery and to locate these practices in existing socio-material theory in order to produce a model useful for surgical skills training. Semi-structured interviews were conducted with nine orthopaedic surgeons. Participants were identified by personal recommendation as regularly performing complex trauma operations to a high standard, and by affiliation to an international instruction course in trauma surgery. Interviews were audio-recorded and transcripts were independently analysed using thematic analysis. Analysis revealed that surgeons interact intensively with multiple colleagues and materials during their preparatory activities. Such interactions stimulate mental imagery in order to build strategy and rehearse procedures, which, in turn, stimulate preparatory interactions. Participants identified the discussion of a preoperative 'plan' as a key engagement tool for training junior surgeons and as a form of currency by which a trainee may increase his or her participation in a procedure. Preoperative preparation can be thought of as a socio-material ontology requiring a surgeon to negotiate imaginal, verbal and physical interactions with people, materials and his or her own mental imagery. Actor-network theory is useful for making sense of these interactions and for allowing surgeons to interrogate their own preparative processes. We recommend supervisors to use a form of preoperative plan as a teaching tool and to encourage trainees to develop their own preparatory skills. The ability of a trainee to demonstrate sound preparation is an indicator of readiness to perform a procedure. �

International survey among orthopaedic trauma surgeons: Lack of a definition of fracture-related infection.

Science.gov (United States)

Morgenstern, M; Moriarty, T F; Kuehl, R; Richards, R G; McNally, M A; Verhofstad, M H J; Borens, O; Zalavras, C; Raschke, M; Kates, S L; Metsemakers, W J

2018-03-01

Fracture-related infection (FRI) is one of the most challenging musculoskeletal complications in orthopaedic-trauma surgery. Although the orthopaedic community has developed and adopted a consensus definition of prosthetic joint infections (PJI), it still remains unclear how the trauma surgery community defines FRI in daily clinical practice or in performing clinical research studies. The central aim of this study was to survey the opinions of a global network of trauma surgeons on the definitions and criteria they routinely use, and their opinion on the need for a unified definition of FRI. The secondary aims were to survey their opinion on the utility of currently used definitions that may be at least partially applicable for FRI, and finally their opinion on the important clinical parameters that should be considered as diagnostic criteria for FRI. An 11-item questionnaire was developed to cover the above-mentioned aims. The questionnaire was administered by SurveyMonkey and was sent via blast email to all registered users of AO Trauma (Davos, Switzerland). Out of the 26'563 recipients who opened the email, 2'327 (8.8%) completed the questionnaire. Nearly 90% of respondents agreed that a consensus-derived definition for FRI is required and 66% of the surgeons also agreed that PJI and FRI are not equal with respect to diagnosis, treatment and outcome. Furthermore, "positive cultures from microbiology testing", "elevation of CRP", "purulent drainage" and "local clinical signs of infection" were voted the most important diagnostic parameters for FRI. This international survey infers the need for a consensus definition of FRI and provides insight into the clinical parameters seen by an international community of trauma surgeons as being critical for defining FRI. Copyright © 2018 Elsevier Ltd. All rights reserved.

Management of Acute Skin Trauma

Institute of Scientific and Technical Information of China (English)

Joel W. Beam

2010-01-01

@@ Acute skin trauma (ie, abrasions, avulsions, blisters, incisions, lacerations, and punctures) is common among individuals involved in work, recreational, and athletic activities. Appropriate management of these wounds is important to promote healing and lessen the risk of cross-contamination and infection. Wound management techniques have undergone significant changes in the past 40 years but many clinicians continue to manage acute skin trauma with long-established, traditional techniques (ie, use of hydrogen peroxide, adhesive strips/patches, sterile gauze, or no dressing) that can delay healing and increase the risk of infection. The purpose of this review is to discuss evidence-based cleansing, debridement, and dressing techniques for the management of acute skin trauma.

Acute appendicitis after blunt abdominal trauma

Directory of Open Access Journals (Sweden)

Marjan Joudi

2012-02-01

Full Text Available Appendecitis is one of the most frequent surgeries. Inflammation of appendix may be due to variable causes such as fecalit, hypertrophy of Peyer’s plaques, seeds of fruits and parasites. In this study we presented an uncommon type of appendicitis which occurred after abdominal blunt trauma. In this article three children present who involved acute appendicitis after blunt abdominal trauma. These patients were 2 boys (5 and 6-year-old and one girl (8-year-old who after blunt abdominal trauma admitted to the hospital with abdominal pain and symptoms of acute abdomen and appendectomy had been done for them.Trauma can induce intramural hematoma at appendix process and may cause appendicitis. Therefore, physicians should be aware of appendicitis after blunt abdominal trauma

Improving spinal trauma management in non-specialist centres

OpenAIRE

Magnussen, Alex; Galloway, Kate; Dinneen, Alexander

2013-01-01

Fractures of the vertebral column are increasing in incidence. Even though spinal trauma is increasingly being managed in specialist units, these patients often still initially present to district general hospitals. Due to lack of exposure to these patients, the attending Orthopaedic Senior House Officer may not always be aware of current best practice in the acute management of these patients beyond immediate Advance Trauma Life Support measures. There is concern that initiation of managemen...

Mentorship in orthopaedic and trauma residency training ...

African Journals Online (AJOL)

Background: Mentorship is important in residency training as it is necessary for personal and professional development of the resident trainees. Objectives: This study documents mentorship in orthopaedic residency training programme in Nigeria by assessing the awareness of orthopaedic residents on the role of a mentor, ...

The Use of Twitter by the Trauma and Orthopaedic Surgery Journals: Twitter Activity, Impact Factor, and Alternative Metrics.

Science.gov (United States)

Hughes, Hannah; Hughes, Andrew; Murphy, Colin

2017-12-10

Aim Social media (SoMe) platforms have become leading methods of communication and dissemination of scientific information in the medical community. They allow for immediate discussion and widespread engagement around important topics. It has been hypothesized that the activity on Twitter positively correlates with highly cited articles. The purpose of this study was to analyze the prevalence and activity of Trauma and Orthopaedic Surgery journals on Twitter, with the hypothesis that the impact factor is positively associated with the Twitter usage. Methods The top 50 Trauma and Orthopaedic Surgery journals, ranked by 2016 Impact Factor were analyzed. The Twitter profiles of each journal or affiliated society were identified. Other SoMe platforms used were also recorded. The Twitonomy software (Digonomy Pty Ltd, New South Wales, Australia) was used to analyze the Twitter profiles over a one-year period. The Twitter Klout scores were recorded for each journal to approximate the SoMe influence. The Altmetric scores (the total number of mentions via alternative metrics) were also recorded. The statistical analysis was carried out to identify correlations between journal Impact Factors, SoMe activity, Twitter Klout scores and Altmetric scores.  Results Twenty-two journals (44%) were dedicated to the Twitter profiles. Fourteen journals (28%) were associated with societies that had profiles and 14 journals (28%) had no Twitter presence. The mean Impact Factor overall was 2.16 +/- 0.14 (range, 1.07-5.16). The journals with dedicated Twitter profiles had higher Impact Factors than those without (mean 2.41 vs. 1.61; P=0.005). A greater number of Twitter followers were associated with higher Impact Factors (R2 0.317, P=0.03). The journals with higher Twitter Klout scores had higher Impact Factors (R2 0.357, P=0.016). The Altmetric score was positively associated with an Impact Factor (R2 0.310, P=0.015). The journals with higher numbers of retweets (virtual citations in

The financial impact of orthopaedic fellowship training.

Science.gov (United States)

Gaskill, Trevor; Cook, Chad; Nunley, James; Mather, R Chad

2009-07-01

Previous reports have compared the expected financial return of a medical education with those expected in other professions. However, we know of no published report estimating the financial return of orthopaedic training. The purpose of this study was to estimate the financial incentives that may influence the decision to invest an additional year of training in each of the major orthopaedic fellowships. With survey data from the American Academy of Orthopaedic Surgeons and using standard financial techniques, we calculated the estimated return on investment of an additional year of orthopaedic training over a working lifetime. The net present value, internal rate of return, and the break-even point were estimated. Eight fellowships were examined and compared with general orthopaedic practice. Investment in an orthopaedic fellowship yields variable returns. Adult spine, shoulder and elbow, sports medicine, hand, and adult arthroplasty may yield positive returns. Trauma yields a neutral return, while pediatrics and foot and ankle have negative net present values. On the basis of mean reported incomes, the break-even point was two years for spine, seven years for hand, eight years for shoulder and elbow, twelve years for adult arthroplasty, thirteen years for sports medicine, and twenty-seven years for trauma. Fellowship-trained pediatric and foot and ankle surgeons did not break even following the initial investment. When working hours were controlled for, the returns for adult arthroplasty and trauma became negative. The financial return of an orthopaedic fellowship varies on the basis of the specialty chosen. While reasons to pursue fellowship training vary widely, and many are not financial, there are positive and negative financial incentives. Therefore, the decision to pursue fellowship training is best if it is not made on the basis of financial incentives. This information may assist policy makers in analyzing medical education economics to ensure the

The evidence-based principles of negative pressure wound therapy in trauma & orthopedics.

Science.gov (United States)

A, Novak; Khan, Wasim S; J, Palmer

2014-01-01

Negative pressure wound therapy is a popular treatment for the management of both acute and chronic wounds. Its use in trauma and orthopedics is diverse and includes the acute traumatic setting as well as chronic troublesome wounds associated with pressure sores and diabetic foot surgery. Efforts have been made to provide an evidence base to guide its use however this has been limited by a lack of good quality evidence. The following review article explores the available evidence and describes future developments for its use in trauma and orthopaedic practice.

Acute coagulopathy of trauma

DEFF Research Database (Denmark)

Johansson, P I; Ostrowski, S R

2010-01-01

Acute coagulopathy of trauma predicts a poor clinical outcome. Tissue trauma activates the sympathoadrenal system resulting in high circulating levels of catecholamines that influence hemostasis dose-dependently through immediate effects on the two major compartments of hemostasis, i.......e., the circulating blood and the vascular endothelium. There appears to be a dose-dependency with regards to injury severity and the hemostatic response to trauma evaluated in whole blood by viscoelastic assays like thrombelastography (TEG), changing from normal to hypercoagulable, to hypocoagulable and finally......, is an evolutionary developed response that counterbalances the injury and catecholamine induced endothelial activation and damage. Given this, the rise in circulating catecholamines in trauma patients may favor a switch from hyper- to hypocoagulability in the blood to keep the progressively more procoagulant...

[Evaluation of radiation exposure of personnel in an orthopaedic and trauma operation theatre using the new real-time dosimetry system "dose aware"].

Science.gov (United States)

Müller, M C; Strauss, A; Pflugmacher, R; Nähle, C P; Pennekamp, P H; Burger, C; Wirtz, D C

2014-08-01

There is a positive correlation between operation time and staff exposure to radiation during intraoperative use of C-arm fluoroscopy. Due to harmful effects of exposure to long-term low-dose radiation for both the patient and the operating team it should be kept to a minimum. AIM of this study was to evaluate a novel dosimeter system called Dose Aware® (DA) enabling radiation exposure feedback of the personal in an orthopaedic and trauma operation theatre in real-time. Within a prospective study over a period of four month, DA was applied by the operation team during 104 orthopaedic and trauma operations in which the C-arm fluoroscope was used in 2D-mode. During ten operation techniques, radiation exposure of the surgeon, the first assistant, the theatre nurse and the anaesthesiologist was evaluated. Seventy-three operations were analysed. The surgeon achieved the highest radiation exposure during dorsolumbar spinal osteosynthesis, kyphoplasty and screw fixation of sacral fractures. The first assistant received a higher radiation exposure compared to the surgeon during plate osteosynthesis of distal radius fractures (157 %), intramedullary nailing of pertrochanteric fractures (143 %) and dorsolumbar spinal osteosynthesis (240 %). During external fixation of ankle fractures (68 %) and screw fixation of sacral fractures (66 %) radiation exposure of the theatre nurse exceeded 50 % of the surgeon's radiation exposure. During plate osteosynthesis of distal radius fractures (157 %) and intramedullary splinting of clavicular fractures (115 %), the anaesthesiologist received a higher radiation exposure than the surgeon. The novel dosimeter system DA provides real-time radiation exposure feedback of the personnel in an orthopaedic and trauma operation theatre for the first time. Data of this study demonstrate that radiation exposure of the personnel depends on the operation type. The first assistant, the theatre nurse and the anaesthesiologist might be

Review of MRSA screening and antibiotics prophylaxis in orthopaedic trauma patients; The risk of surgical site infection with inadequate antibiotic prophylaxis in patients colonized with MRSA.

Science.gov (United States)

Iqbal, H J; Ponniah, N; Long, S; Rath, N; Kent, M

2017-07-01

The primary aim of this study was to determine whether orthopaedic trauma patients receive appropriate antibiotic prophylaxis keeping in view the results of their MRSA screening. The secondary aim was to analyse the risk of developing MRSA surgical site infection with and without appropriate antibiotic prophylaxis in those colonized with MRSA. We reviewed 400 consecutive orthopaedic trauma patient episodes. Preoperative MRSA screening results, operative procedures, prophylactic antibiotics and postoperative course were explored. In addition to these consecutive patients, the hospital MRSA database over the previous 5 years identified 27 MRSA colonized acute trauma patients requiring surgery. Of the 400 consecutive patient episodes, 395(98.7%) had MRSA screening performed on admission. However, in 236 (59.0%) cases, the results were not available before the surgery. Seven patient episodes (1.8%) had positive MRSA colonization. Analysis of 27 MRSA colonized patients revealed that 20(74%) patients did not have the screening results available before the surgery. Only 5(18.5%) received Teicoplanin and 22(81.4%) received cefuroxime for antibiotic prophylaxis before their surgery. Of those receiving cefuroxime, five (22.73%) patients developed postoperative MRSA surgical site infection (SSI) but none of those (0%) receiving Teicoplanin had MRSA SSI. The absolute risk reduction for SSI with Teicoplanin as antibiotic prophylaxis was 22.73% (CI=5.22%-40.24%) and NNT (Number Needed to Treat) was 5 (CI=2.5-19.2) CONCLUSION: Lack of available screening results before the surgery may lead to inadequate antibiotic prophylaxis increasing the risk of MRSA surgical site infection. Glycopeptide (e.g.Teicoplanin) prophylaxis should be considered when there is history of MRSA colonization or MRSA screening results are not available before the surgery. Copyright © 2017. Published by Elsevier Ltd.

Radiation safety knowledge and practices among Irish orthopaedic trainees.

LENUS (Irish Health Repository)

Nugent, M

2014-04-23

Fluoroscopy is frequently used in orthopaedic surgery, particularly in a trauma setting. Exposure of patients and staff to ionising radiation has been studied extensively; however, little work has been done to evaluate current knowledge and practices among orthopaedic trainees.

Patient perspectives of care in a regionalised trauma system: lessons from the Victorian State Trauma System.

Science.gov (United States)

Gabbe, Belinda J; Sleney, Jude S; Gosling, Cameron M; Wilson, Krystle; Hart, Melissa J; Sutherland, Ann M; Christie, Nicola

2013-02-18

To explore injured patients' experiences of trauma care to identify areas for improvement in service delivery. Qualitative study using in-depth, semi-structured interviews, conducted from 1 April 2011 to 31 January 2012, with 120 trauma patients registered by the Victorian State Trauma Registry and the Victorian Orthopaedic Trauma Outcomes Registry and managed at the major adult trauma services (MTS) in Victoria. Emergent themes from patients' experiences of acute, rehabilitation and post-discharge care in the Victorian State Trauma System (VSTS). Patients perceived their acute hospital care as high quality, although 3s with communication and surgical management delays were common. Discharge from hospital was perceived as stressful, and many felt ill prepared for discharge. A consistent emerging theme was the sense of a lack of coordination of post-discharge care, and the absence of a consistent point of contact for ongoing management. Most patients' primary point of contact after discharge was outpatient clinics at the MTS, which were widely criticised because of substantial delays in receiving an appointment, prolonged waiting times, limited time with clinicians, lack of continuity of care and inability to see senior clinicians. This study highlights perceived 3s in the patient care pathway in the VSTS, especially those relating to communication, information provision and post-discharge care. Trauma patients perceived the need for a single point of contact for coordination of post-discharge care.

The Core Competencies for General Orthopaedic Surgeons.

Science.gov (United States)

Kellam, James F; Archibald, Douglas; Barber, James W; Christian, Eugene P; D'Ascoli, Richard J; Haynes, Richard J; Hecht, Suzanne S; Hurwitz, Shepard R; Kellam, James F; McLaren, Alexander C; Peabody, Terrance D; Southworth, Stephen R; Strauss, Robert W; Wadey, Veronica M R

2017-01-18

With the changing delivery of orthopaedic surgical care, there is a need to define the knowledge and competencies that are expected of an orthopaedist providing general and/or acute orthopaedic care. This article provides a proposal for the knowledge and competencies needed for an orthopaedist to practice general and/or acute care orthopaedic surgery. Using the modified Delphi method, the General Orthopaedic Competency Task Force consisting of stakeholders associated with general orthopaedic practice has proposed the core knowledge and competencies that should be maintained by orthopaedists who practice emergency and general orthopaedic surgery. For relevancy to clinical practice, 2 basic sets of competencies were established. The assessment competencies pertain to the general knowledge needed to evaluate, investigate, and determine an overall management plan. The management competencies are generally procedural in nature and are divided into 2 groups. For the Management 1 group, the orthopaedist should be competent to provide definitive care including assessment, investigation, initial or emergency care, operative or nonoperative care, and follow-up. For the Management 2 group, the orthopaedist should be competent to assess, investigate, and commence timely non-emergency or emergency care and then either transfer the patient to the appropriate subspecialist's care or provide definitive care based on the urgency of care, exceptional practice circumstance, or individual's higher training. This may include some higher-level procedures usually performed by a subspecialist, but are consistent with one's practice based on experience, practice environment, and/or specialty interest. These competencies are the first step in defining the practice of general orthopaedic surgery including acute orthopaedic care. Further validation and discussion among educators, general orthopaedic surgeons, and subspecialists will ensure that these are relevant to clinical practice. These

diagnostic imaging of acute head trauma

International Nuclear Information System (INIS)

Prayer, D.; Rametsteiner, C.

2001-01-01

Computed tomography (CT) is the primary modality of choice for imaging patients with acute head trauma. Lesions of the soft tissues and of the bones can be assessed more precisely than with other imaging modalities. With magnetic resonance imaging (MRI) additional information may be gained especially in subacute and chronic posttraumatic conditions. Urgent indication to perform a CT examination depends on the patient's history and on the mechanism of trauma. Imaging interpretation has been performed in the context of typical pathologic effects of trauma and with respect to potential therapy. (author)

A review of virtual reality based training simulators for orthopaedic surgery

OpenAIRE

Vaughan, Neil; Dubey, Venketesh N.; Wainwright, Tom; Middleton, Robert

2015-01-01

This review presents current virtual reality based training simulators for hip, knee and other orthopaedic surgery, including elective and trauma surgical procedures. There have not been any reviews focussing on hip and knee orthopaedic simulators. A comparison of existing simulator features is provided to identify what is missing and what is required to improve upon current simulators. In total 11 total hip replacement pre-operative planning tools were analysed, plus 9 hip trauma fracture tr...

The link between texting and motor vehicle collision frequency in the orthopaedic trauma population

Directory of Open Access Journals (Sweden)

Neil M. Issar

2013-07-01

Full Text Available BACKGROUND: This study will evaluate whether or not texting frequency while driving and/or texting frequency in general are associated with an increased risk of incurring a motor vehicle collision (MVC resulting in orthopaedic trauma injuries. METHODS: All patients who presented to the Vanderbilt University Medical Center Orthopaedic Trauma Clinic were administered a questionnaire to determine background information, mean phone use, texting frequency, texting frequency while driving, and whether or not the injury was the result of an MVC in which the patient was driving. RESULTS: 237 questionnaires were collected. 60 were excluded due to incomplete date, leaving 57 questionnaires in the MVC group and 120 from patients with non-MVC injuries. Patients who sent more than 30 texts per week (“heavy texters” were 2.22 times more likely to be involved in an MVC than those who texted less frequently. 84% of respondents claimed to never text while driving. Dividing the sample into subsets on the basis of age (25 years of age or below considered “young adult,” and above 25 years of age considered “adult”,young, heavy texters were 6.76 times more likely to be involved in an MVC than adult non-heavy texters (p = 0.000. Similarly, young adult, non-heavy texters were 6.65 (p = 0.005 times more likely to be involved in an MVC, and adult, heavy texters were 1.72 (p = 0.186 times more likely to be involved in an MVC. CONCLUSIONS: Patients injured in an MVC sent more text messages per week than non-MVC patients. Additionally, controlling for age demonstrated that young age and heavy general texting frequency combined had the highest increase in MVC risk, with the former being the variable of greatest effect

Allergies in orthopaedic and trauma surgery.

Science.gov (United States)

Lohmann, C H; Hameister, R; Singh, G

2017-02-01

Hypersensitivity reactions to implants in orthopaedic and trauma surgery are a rare but devastating complication. They are considered as a delayed-type of hypersensitivity reaction (type IV), characterized by an antigen activation of sensitized T-lymphocytes releasing various cytokines and may result in osteoclast activation and bone resorption. Potential haptens are originated from metal alloys or bone-cement. A meta-analysis has confirmed a higher probability of developing a metal hypersensitivity postoperatively and noted a greater risk of failed replacements compared to stable implants. Hypersensitivity to implants may present with a variety of symptoms such as pain, joint effusion, delayed wound/bone healing, persistent secretion, allergic dermatitis (localized or systemic), clicking noises, loss of joint function, instability and failure of the implant. Various diagnostic options have been offered, including patch testing, metal alloy patch testing, histology, lymphocyte transformation test (LTT), memory lymphocyte immunostimulation assay (MELISA), leukocyte migration inhibition test (LIF) and lymphocyte activation test (LAT). No significant differences between in vivo and in vitro methods have been found. Due to unconvincing evidence for screening methods, predictive tests are not recommended for routine performance. Infectious aetiology always needs to be excluded. As there is a lack of evidence on large-scale studies with regards to the optimal treatment option, management currently relies on individual case-by-case decisions. Several options for patients with (suspected) metal-related hypersensitivity exist and may include materials based on ceramic, titanium or oxinium or modified surfaces. Promising results have been reported, but long-term experience is lacking. More large-scaled studies are needed in this context. In patients with bone-cement hypersensitivity, the component suspected for hypersensitivity should be avoided. The development of

Does sleep deprivation impair orthopaedic surgeons' cognitive and psychomotor performance?

Science.gov (United States)

O'Brien, Michael J; O'Toole, Robert V; Newell, Mary Zadnik; Lydecker, Alison D; Nascone, Jason; Sciadini, Marcus; Pollak, Andrew; Turen, Clifford; Eglseder, W Andrew

2012-11-07

Sleep deprivation may slow reaction time, cloud judgment, and impair the ability to think. Our purpose was to study the cognitive and psychomotor performances of orthopaedic trauma surgeons on the basis of the amount of sleep that they obtained. We prospectively studied the performances of thirty-two orthopaedic trauma surgeons (residents, fellows, and attending surgeons) over two four-week periods at an urban academic trauma center. Testing sessions used handheld computers to administer validated cognitive and psychomotor function tests. We conducted a multivariate analysis to examine the independent association between test performance and multiple covariates, including the amount of sleep the night before testing. Our analysis demonstrated that orthopaedic surgeons who had slept four hours or less the night before the test had 1.43 times the odds (95% confidence interval, 1.04 to 1.95; p = 0.03) of committing at least one error on an individual test compared with orthopaedic surgeons who had slept more than four hours the previous night. The Running Memory test, which assesses sustained attention, concentration, and working memory, was most sensitive to deterioration in performance in participants who had had four hours of sleep or less; when controlling for other covariates, the test demonstrated a 72% increase in the odds of making at least one error (odds ratio, 1.72 [95% confidence interval, 1.02 to 2.90]; p = 0.04). No significant decrease in performance with sleep deprivation was shown with the other three tests. Orthopaedic trauma surgeons showed deterioration in performance on a validated cognitive task when they had slept four hours or less the previous night. It is unknown how performance on this test relates to surgical performance.

Epidemiology of acute wrist trauma

DEFF Research Database (Denmark)

Larsen, C F; Lauritsen, Jens

1993-01-01

Epidemiological data on wrist injuries in a population can be used for planning by applying them to criteria for care and thus deriving estimates of provisions for care according to currently desirable standards. In a 1-year study all patients > or = 15 years with acute wrist trauma and treated...... in the emergency room were examined according to an algorithm until a diagnosis was established. The overall incidence of wrist trauma was 69 per 10,000 inhabitants per year. Incidence of wrist trauma requiring x-ray examination was 58 per 10,000 per year. The incidence of distal radius fractures was 27 per 10...... using data from a population-based study. A completeness rate of 0.56 (95% confidence interval: 0.31-0.78) was found. An x-ray had been taken for all patients reporting a fracture thus justifying the use of fractures as an incidence measure when comparing groups of patients with wrist trauma....

Developmental orthopaedic diseases in foals

International Nuclear Information System (INIS)

Şİrİn, Özlem; Alkan, Zeki

2010-01-01

Developmental Orthopaedic Diseases (DOD) is seen frequently in horses which completed their maturity. Osteochondrosis, physitis, angular limb deformities, flexural deformities, juvenil arthritis, cervical vertebral anomalies, cuboidal bone abnormalities are problems investigated under Developmental Orthopaedic Diseases title. This diseases can develop single or some together in fast growing, heavy animals (especially Arabian and English Thoroughbreds). Multifactorial causes of this diseases etiopathogenesis can be listed as genetic predisposition, trauma, nutrition, vitamins/minerals and endocrine disorders. But the exact causes of these diseases are not known. In this review detailed information are given about the diseases mentioned above

Acute trauma-induced Budd-Chiari syndrome

International Nuclear Information System (INIS)

Izard, G.; Houri, R.; Randrianasolo, S.; Gailleton, R.

1995-01-01

The diagnosis of Budd-Chiari syndrome is based on clinical signs including liver enlargement and ascites and findings of complementary examinations: echography, echo-Doppler, cat scanning (CT-scan), magnetic resonance imaging, angiography, pressure readings, laparoscopy and biopsy. Trauma is rarely reported as a cause of acute Budd-Chiari syndrome. In some cases, the trauma is so violent the supra-hepatic veins are ruptured and the dramatic outcome leaves no time for the syndrome to develop. In others, the resulting haematomas form a compression block of the supra hepatic vessels. The mechanism of the trauma in our case appears to have been unreported to date. Four days after a violent motorcycle accident, a 33-year-old man developed an acute Budd-Chiari syndrome probably due to partial and temporary thrombosis of the left and middle supra hepatic veins. A side-to-side porto-cava anastomosis with a calibrated venous graft was performed in an emergency procedure. Outcome was quite favourable and after a 4 year follow-up, the patient is in good health. (authors). 13 refs

A preliminary RCT of a mind body skills based intervention addressing mood and coping strategies in patients with acute orthopaedic trauma.

Science.gov (United States)

Vranceanu, Ana-Maria; Hageman, Michiel; Strooker, Joost; ter Meulen, Dirk; Vrahas, Mark; Ring, David

2015-04-01

To test the acceptability and feasibility of a mind body skills-based intervention (RRCB) and estimate its preliminary effect in reducing disability and pain intensity as compared to standard care (SC) in patients with acute musculoskeletal trauma. Randomised controlled trial. Level I trauma centre. Adult patients with acute fractures at risk for chronic pain and disability based on scores on two coping with pain measures who presented to an orthopedic trauma center and met inclusion and exclusion criteria. Participants were randomied to either RRCB with SC or SC alone. Disability (short musculoskeletal functional assessment, SMFA) and pain (Numerical Analogue Scale). coping strategies (Pain Catastrophizing Scale, PCS and Pain Anxiety Scale, PAS) and mood (CESD Depression and PTSD checklist). Among the 50 patients consented, two did not complete the initial assessment. Of these, the first four received the intervention as part of an open pilot and the next 44 were randomised (24 RRCBT and 20 UC) and completed initial assessment. We combined the patients who received RRCB into one group, N=28. Of the entire sample, 34 completed time two assessments (24 RRCBT and 10 SC). The RRCB proved to be feasible and accepted (86% retention, 28 out of 24 completers). Analyses of covariance ANCOVA showed a significant (pstudy variables (.2-.5) except pain with activity where the effect size was medium (.08). Improvement for pain at rest was not significantly higher in the RRCB as compared to the control, for a small effect size (.03). The RRCB is feasible, acceptable and potentially efficacious. Level 1 prognostic. Copyright © 2014 Elsevier Ltd. All rights reserved.

Orthopaedic admissions due to sports and recreation injuries.

LENUS (Irish Health Repository)

Delaney, R A

2009-02-01

The health benefits of exercise may be attenuated by sports and recreation related injury (SRI). Though the majority of SRI are mild and self-limiting, a significant number are serious and require orthopaedic intervention. The aims of this study were to assess the burden of these serious injuries on the orthopaedic inpatient service, and to investigate potential target areas for injury prevention. All 1,590 SRI seen in the ED over a 3-month period were analysed using the Patient Information Management System to determine which patients received inpatient orthopaedic care. The medical records of those 63 patients who required inpatient care under orthopaedics were reviewed and data collected on demographic features, history, operative procedure and theatre resources, and length of hospital stay. Data were analyzed using SPSS. SRI accounted for 12.3% of all ED presentations. The principal activities resulting in injury requiring orthopaedic care were soccer, hurling and informal play e.g. trampoline. Falls made up 37% of the overall mechanism of injury but 68% of the injuries severe enough to require operative management. Most operative procedures were performed as part of a routine day trauma list but 20% were performed out of hours. This group of injuries places a significant burden on a busy trauma service. Injury prevention measures such as public education regarding falls in sport may have a role in reducing this burden.

A review of virtual reality based training simulators for orthopaedic surgery.

Science.gov (United States)

Vaughan, Neil; Dubey, Venketesh N; Wainwright, Thomas W; Middleton, Robert G

2016-02-01

This review presents current virtual reality based training simulators for hip, knee and other orthopaedic surgery, including elective and trauma surgical procedures. There have not been any reviews focussing on hip and knee orthopaedic simulators. A comparison of existing simulator features is provided to identify what is missing and what is required to improve upon current simulators. In total 11 hip replacements pre-operative planning tools were analysed, plus 9 hip trauma fracture training simulators. Additionally 9 knee arthroscopy simulators and 8 other orthopaedic simulators were included for comparison. The findings are that for orthopaedic surgery simulators in general, there is increasing use of patient-specific virtual models which reduce the learning curve. Modelling is also being used for patient-specific implant design and manufacture. Simulators are being increasingly validated for assessment as well as training. There are very few training simulators available for hip replacement, yet more advanced virtual reality is being used for other procedures such as hip trauma and drilling. Training simulators for hip replacement and orthopaedic surgery in general lag behind other surgical procedures for which virtual reality has become more common. Further developments are required to bring hip replacement training simulation up to date with other procedures. This suggests there is a gap in the market for a new high fidelity hip replacement and resurfacing training simulator. Copyright © 2015 IPEM. Published by Elsevier Ltd. All rights reserved.

Intimate partner violence in orthopaedic trauma patients

NARCIS (Netherlands)

Sprague, S.A.

2013-01-01

Intimate partner violence (IPV) or domestic violence is a common and serious public health problem around the globe. Victims of IPV frequently present to health care practitioners including orthopaedic surgeons. Substantial research has been conducted on IPV over the past few decades, but very

Surgical skills simulation in trauma and orthopaedic training.

Science.gov (United States)

Stirling, Euan R B; Lewis, Thomas L; Ferran, Nicholas A

2014-12-19

Changing patterns of health care delivery and the rapid evolution of orthopaedic surgical techniques have made it increasingly difficult for trainees to develop expertise in their craft. Working hour restrictions and a drive towards senior led care demands that proficiency be gained in a shorter period of time whilst requiring a greater skill set than that in the past. The resulting conflict between service provision and training has necessitated the development of alternative methods in order to compensate for the reduction in 'hands-on' experience. Simulation training provides the opportunity to develop surgical skills in a controlled environment whilst minimising risks to patient safety, operating theatre usage and financial expenditure. Many options for simulation exist within orthopaedics from cadaveric or prosthetic models, to arthroscopic simulators, to advanced virtual reality and three-dimensional software tools. There are limitations to this form of training, but it has significant potential for trainees to achieve competence in procedures prior to real-life practice. The evidence for its direct transferability to operating theatre performance is limited but there are clear benefits such as increasing trainee confidence and familiarity with equipment. With progressively improving methods of simulation available, it is likely to become more important in the ongoing and future training and assessment of orthopaedic surgeons.

Resources for your career in orthopaedic traumatology: what can the OTA do for you?

Science.gov (United States)

Mehta, Samir; Smith, Jeffrey M

2012-09-01

For those choosing a career in orthopaedic traumatology, several resources have been established by the Orthopaedic Trauma Association to facilitate progression from the years in training to the early years in practice. Young practitioners have access to educational programming, such as preparation for Part II of the Board Examination, web-based resources, such as on-line job postings, advocacy in health policy for the issues that will affect their ability to practice, and public relations efforts to increase their presence in the community. Ultimately, the resources set aside for the young practitioner by the Orthopaedic Trauma Association are intended to facilitate a sense of excellence, service, and community.

Disseminated intravascular coagulation or acute coagulopathy of trauma shock early after trauma? A prospective observational study

DEFF Research Database (Denmark)

Johansson, Per Ingemar; Sorensen, Anne Marie; Perner, Anders

2011-01-01

ABSTRACT: INTRODUCTION: It is debated whether the early trauma induced coagulopathy (TIC) in severely injured patients reflects disseminated intravascular coagulation (DIC) with a fibrinolytic phenotype, acute coagulopathy of trauma shock (ACoTS) or yet other entities. This study investigated the...

Development, implementation and evaluation of a patient handoff tool to improve safety in orthopaedic surgery.

Science.gov (United States)

Gagnier, Joel J; Derosier, Joseph M; Maratt, Joseph D; Hake, Mark E; Bagian, James P

2016-06-01

To develop, implement and test the effect of a handoff tool for orthopaedic trauma residents that reduces adverse events associated with the omission of critical information and the transfer of erroneous information. Components of this project included a literature review, resident surveys and observations, checklist development and refinement, implementation and evaluation of impact on adverse events through a chart review of a prospective cohort compared with a historical control group. Large teaching hospital. Findings of a literature review were presented to orthopaedic residents, epidemiologists, orthopaedic surgeons and patient safety experts in face-to-face meetings, during which we developed and refined the contents of a resident handoff tool. The tool was tested in an orthopaedic trauma service and its impact on adverse events was evaluated through a chart review. The handoff tool was developed and refined during the face-to-face meetings and a pilot implementation. Adverse event data were collected on 127 patients (n = 67 baseline period; n = 60 test period). A handoff tool for use by orthopaedic residents. Adverse events in patients handed off by orthopaedic trauma residents. After controlling for age, gender and comorbidities, testing resulted in fewer events per person (25-27% reduction; P < 0.10). Preliminary evidence suggests that our resident handoff tool may contribute to a decrease in adverse events in orthopaedic patients. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

Multicenter collaborative for orthopaedic research in India: An opportunity for global leadership

Directory of Open Access Journals (Sweden)

Mathew George

2008-01-01

Full Text Available Road traffic accidents are increasing at an alarming rate and have become a major public health concern in India. In addition, there is a lack of trauma research output and reliable data from India. There are several issues and challenges that have presented an opportunity for researchers and surgeons in India to develop a collaborative aimed at improving the quality and productivity of orthopaedic trauma research. Establishing a network of surgical researchers across India is a necessary first step towards global leadership in orthopaedic surgery trials.

Trauma care in German-speaking countries: have changes in the curricula led to changes in practice after 10 years?

Science.gov (United States)

Kuhn-Régnier, Sarah; Stickel, Michael; Link, Björn-Christian; Fischer, Henning; Babst, Reto; Beeres, Frank J P

2018-01-06

predominantly (65%) being performed by general trauma surgeons in both mono- and polytrauma patients. The majority of the respondents (80%) do not want to change the current situation and predict that in the future fracture care will still be performed by general surgeons' specialized in trauma surgery. Approximately two-thirds of the responders do not believe that emergency physicians will play a bigger role in the management of trauma patients in the future. Despite the growing importance of emergency physicians, separated in the emergency room between surgical and internal medicine fields, in the acute care of surgical patients in the emergency departments, their role in the management of the polytraumatized patients remains limited. More than 13 years after the new curricula for orthopaedic and general surgery have been implemented in Germany, fracture care is still predominantly provided by general surgeons specialized in trauma surgery. In conclusion, it seems that the general surgeon specialized in trauma surgery still plays and wants to play the key role in the management of the polytrauma patient and fracture care in German-speaking countries.

The variation of acute treatment costs of trauma in high-income countries.

Science.gov (United States)

Willenberg, Lynsey; Curtis, Kate; Taylor, Colman; Jan, Stephen; Glass, Parisa; Myburgh, John

2012-08-21

In order to assist health service planning, understanding factors that influence higher trauma treatment costs is essential. The majority of trauma costing research reports the cost of trauma from the perspective of the receiving hospital. There has been no comprehensive synthesis and little assessment of the drivers of cost variation, such as country, trauma, subgroups and methods. The aim of this review is to provide a synthesis of research reporting the trauma treatment costs and factors associated with higher treatment costs in high income countries. A systematic search for articles relating to the cost of acute trauma care was performed and included studies reporting injury severity scores (ISS), per patient cost/charge estimates; and costing methods. Cost and charge values were indexed to 2011 cost equivalents and converted to US dollars using purchasing power parities. A total of twenty-seven studies were reviewed. Eighty-one percent of these studies were conducted in high income countries including USA, Australia, Europe and UK. Studies either reported a cost (74.1%) or charge estimate (25.9%) for the acute treatment of trauma. Across studies, the median per patient cost of acute trauma treatment was $22,448 (IQR: $11,819-$33,701). However, there was variability in costing methods used with 18% of studies providing comprehensive cost methods. Sixty-three percent of studies reported cost or charge items incorporated in their cost analysis and 52% reported items excluded in their analysis. In all publications reviewed, predictors of cost included Injury Severity Score (ISS), surgical intervention, hospital and intensive care, length of stay, polytrauma and age. The acute treatment cost of trauma is higher than other disease groups. Research has been largely conducted in high income countries and variability exists in reporting costing methods as well as the actual costs. Patient populations studied and the cost methods employed are the primary drivers for the

The variation of acute treatment costs of trauma in high-income countries

Directory of Open Access Journals (Sweden)

Willenberg Lynsey

2012-08-01

Full Text Available Abstract Background In order to assist health service planning, understanding factors that influence higher trauma treatment costs is essential. The majority of trauma costing research reports the cost of trauma from the perspective of the receiving hospital. There has been no comprehensive synthesis and little assessment of the drivers of cost variation, such as country, trauma, subgroups and methods. The aim of this review is to provide a synthesis of research reporting the trauma treatment costs and factors associated with higher treatment costs in high income countries. Methods A systematic search for articles relating to the cost of acute trauma care was performed and included studies reporting injury severity scores (ISS, per patient cost/charge estimates; and costing methods. Cost and charge values were indexed to 2011 cost equivalents and converted to US dollars using purchasing power parities. Results A total of twenty-seven studies were reviewed. Eighty-one percent of these studies were conducted in high income countries including USA, Australia, Europe and UK. Studies either reported a cost (74.1% or charge estimate (25.9% for the acute treatment of trauma. Across studies, the median per patient cost of acute trauma treatment was $22,448 (IQR: $11,819-$33,701. However, there was variability in costing methods used with 18% of studies providing comprehensive cost methods. Sixty-three percent of studies reported cost or charge items incorporated in their cost analysis and 52% reported items excluded in their analysis. In all publications reviewed, predictors of cost included Injury Severity Score (ISS, surgical intervention, hospital and intensive care, length of stay, polytrauma and age. Conclusion The acute treatment cost of trauma is higher than other disease groups. Research has been largely conducted in high income countries and variability exists in reporting costing methods as well as the actual costs. Patient populations studied

Epidemiological Trends of Spine Trauma: An Australian Level 1 Trauma Centre Study

OpenAIRE

Tee, J. W.; Chan, C. H. P.; Fitzgerald, M. C. B.; Liew, S. M.; Rosenfeld, J. V.

2013-01-01

Knowledge of current epidemiology and spine trauma trends assists in public resource allocation, fine-tuning of primary prevention methods, and benchmarking purposes. Data on all patients with traumatic spine injuries admitted to the Alfred Hospital, Melbourne between May 1, 2009, and January 1, 2011, were collected from the Alfred Trauma Registry, Alfred Health medical database, and Victorian Orthopaedic Trauma Outcomes Registry. Epidemiological trends were analyzed as a general cohort, with...

[Safety culture in orthopedics and trauma surgery : Course concept: interpersonal competence by the German Society for Orthopaedics and Trauma (DGOU) and Lufthansa Aviation Training].

Science.gov (United States)

Doepfer, A-K; Seemann, R; Merschin, D; Stange, R; Egerth, M; Münzberg, M; Mutschler, M; Bouillon, B; Hoffmann, R

2017-10-01

Patient safety has become a central and measurable key factor in the routine daily medical practice. The human factor plays a decisive role in safety culture and has moved into focus regarding the reduction of treatment errors and undesired critical incidents. Nonetheless, the systematic training in communication and interpersonal competences has so far only played a minor role. The German Society of Orthopaedics and Trauma (DGOU) in cooperation with the Lufthansa Aviation Training initiated a course system for interpersonal competence. Several studies confirmed the reduction of critical incidents and costs after implementation of a regular and targeted human factor training. The interpersonal competence should be an essential component of specialist training within the framework of a 3‑column model.

An interobserver reliability comparison between the Orthopaedic Trauma Association's open fracture classification and the Gustilo and Anderson classification.

Science.gov (United States)

Ghoshal, A; Enninghorst, N; Sisak, K; Balogh, Z J

2018-02-01

To evaluate interobserver reliability of the Orthopaedic Trauma Association's open fracture classification system (OTA-OFC). Patients of any age with a first presentation of an open long bone fracture were included. Standard radiographs, wound photographs, and a short clinical description were given to eight orthopaedic surgeons, who independently evaluated the injury using both the Gustilo and Anderson (GA) and OTA-OFC classifications. The responses were compared for variability using Cohen's kappa. The overall interobserver agreement was ĸ = 0.44 for the GA classification and ĸ = 0.49 for OTA-OFC, which reflects moderate agreement (0.41 to 0.60) for both classifications. The agreement in the five categories of OTA-OFC was: for skin, ĸ = 0.55 (moderate); for muscle, ĸ = 0.44 (moderate); for arterial injury, ĸ = 0.74 (substantial); for contamination, ĸ = 0.35 (fair); and for bone loss, ĸ = 0.41 (moderate). Although the OTA-OFC, with similar interobserver agreement to GA, offers a more detailed description of open fractures, further development may be needed to make it a reliable and robust tool. Cite this article: Bone Joint J 2018;100-B:242-6. ©2018 The British Editorial Society of Bone & Joint Surgery.

Acute appendicitis following blunt abdominal trauma. Coincidence or causality?

Directory of Open Access Journals (Sweden)

Sergio Iván Latorre

2017-01-01

Full Text Available Acute appendicitis is a common disease in clinical practice; some well-defined causes include luminal obstruction by fecoliths, lymphoid hyperplasia, foreign bodies and intestinal parasites. Closed abdominal trauma has been associated as an etiological factor, although, their causal relationship is still unclear. This paper presents the case of a patient with appendicitis after a closed abdominal trauma.

Antibiotic-Impregnated Bone Grafts in Orthopaedic and Trauma Surgery: A Systematic Review of the Literature

Directory of Open Access Journals (Sweden)

Konstantinos Anagnostakos

2012-01-01

Full Text Available There exist several options for local antibiotic therapy in orthopaedic and trauma surgery. Over the past years, the use of antibiotic-impregnated bone grafts (AIBGs has become a popular procedure in the treatment of bone and joint infections. A major advantage of AIBGs involves the possibility of impregnation of various antibiotics depending on the sensitivity profile of the causative organism, whereas an additional surgery with removal of the antibiotic carrier is not necessary, as in the use of antibiotic-loaded bone cement. However, generalized conclusions cannot be clearly drawn from the existing literature due to differences of bone used, impregnation method, antibiotics, their doses, laboratory circumstances, or clinical indications. The present work reviews the literature regarding this topic and sheds some light onto the choice of bone and antibiotics, manufacturing details, and clinical experience.

Orthopaedic Timing in Polytrauma in a Second Level Emergency Hospital. An Overrated Problem?

Science.gov (United States)

V, Dei Giudici; N, Giampaolini; A, Panfighi; M, Marinelli; R, Procaccini; A, Gigante

2015-01-01

The main concern for orthopaedic treatment in polytrauma has always been the same for almost forty years, which also regards “where” and “when” to proceed; correct surgical timing and correct interpretation of the DCO concept are still being debated. In the last few years, several attempts have been made to classify patients based on their clinical presentation and by trying to figure out which vital parameters are able to predict the patient’s outcome. This study evaluated all patients who presented with code red at the Emergency Department of our Hospital, a level II trauma center. For every patient, the following characteristics were noted: sex, age, day of hospitalization, orthopaedic trauma, time to surgery, presence of an associated surgical condition in the fields of general surgery, thoracic surgery, neurosurgery and vascular surgery, cardiac frequency, blood pressure, oxygen saturation, Glasgow Coma Scale and laboratory data. All patients included were divided into subgroups based on orthopaedic surgical timing. Two other subgroups were also identified and analyzed in detail: deceased and weekend traumas. A total of 208 patients were included. Our primary goal was to identify a correlation between the mortality and surgical timing of the orthopaedic procedures; our secondary goal was to recognize, if present, a statistically relevant association between historical, clinical and laboratory data, and mortality rate, defining any possible risk factor. A correlation between mortality and orthopaedic surgical timing was not found. Analyzing laboratory data revealed an interesting correlation between mortality and: blood pressure, platelet count, cardiac frequency, hematocrit, hemoglobin and age. PMID:26312113

Video-assisted thoracoscopic surgery for acute thoracic trauma

Directory of Open Access Journals (Sweden)

Michael Goodman

2013-01-01

Full Text Available Background: Operative intervention for thoracic trauma typically requires thoracotomy. We hypothesized that thoracoscopy may be safely and effectively utilized for the acute management of thoracic injuries. Materials and Methods: The Trauma Registry of a Level I trauma center was queried from 1999 through 2010 for all video-assisted thoracic procedures within 24 h of admission. Data collected included initial vital signs, operative indication, intraoperative course, and postoperative outcome. Results: Twenty-three patients met inclusion criteria: 3 (13% following blunt injury and 20 (87% after penetrating trauma. Indications for urgent thoracoscopy included diaphragmatic/esophageal injury, retained hemothorax, ongoing hemorrhage, and open/persistent pneumothorax. No conversions to thoracotomy were required and no patient required re-operation. Mean postoperative chest tube duration was 2.9 days and mean length of stay was 5.6 days. Conclusion: Video-assisted thoracoscopic surgery is safe and effective for managing thoracic trauma in hemodynamically stable patients within the first 24 h post-injury.

Clinical practice guidelines for the management of acute limb compartment syndrome following trauma.

Science.gov (United States)

Wall, Christopher J; Lynch, Joan; Harris, Ian A; Richardson, Martin D; Brand, Caroline; Lowe, Adrian J; Sugrue, Michael

2010-03-01

Acute compartment syndrome is a serious and not uncommon complication of limb trauma. The condition is a surgical emergency, and is associated with significant morbidity if not managed appropriately. There is variation in management of acute limb compartment syndrome in Australia. Clinical practice guidelines for the management of acute limb compartment syndrome following trauma were developed in accordance with Australian National Health and Medical Research Council recommendations. The guidelines were based on critically appraised literature evidence and the consensus opinion of a multidisciplinary team involved in trauma management who met in a nominal panel process. Recommendations were developed for key decision nodes in the patient care pathway, including methods of diagnosis in alert and unconscious patients, appropriate assessment of compartment pressure, timing and technique of fasciotomy, fasciotomy wound management, and prevention of compartment syndrome in patients with limb injuries. The recommendations were largely consensus based in the absence of well-designed clinical trial evidence. Clinical practice guidelines for the management of acute limb compartment syndrome following trauma have been developed that will support consistency in management and optimize patient health outcomes.

Acute pain from the perspective of minor trauma patients treated at the emergency unit

Directory of Open Access Journals (Sweden)

Andrea Regina Martin

Full Text Available OBJECTIVE: To study the factors that influence the perception of acute pain and the consequences of this experience in patients suffering from mild trauma. METHOD: Descriptive qualitative study conducted in an emergency service in southern Brazil. Data was collected in October 2013, through semi-structured interviews with 29 individuals who reported pain after physical trauma, regardless of the triggering factor. To process the data, we used a Content Analysis technique, subject modality. RESULTS: Two categories emerged: Factors that influence the perception of pain resulting from trauma and, Consequences of acute pain due to trauma. The acute pain sensation was influenced by biological, emotional, spiritual and socio-cultural factors and induced biological and emotional consequences for individuals. CONCLUSION: The health professionals need to consider the factors that influence soreness and its consequences for the proper assessment and management of pain resulting from trauma.

An Osteoconductive, Osteoinductive, and Osteogenic Tissue-Engineered Product for Trauma and Orthopaedic Surgery: How Far Are We?

Directory of Open Access Journals (Sweden)

Wasim S. Khan

2012-01-01

Full Text Available The management of large bone defects due to trauma, degenerative disease, congenital deformities, and tumor resection remains a complex issue for the orthopaedic reconstructive surgeons. The requirement is for an ideal bone replacement which is osteoconductive, osteoinductive, and osteogenic. Autologous bone grafts are still considered the gold standard for reconstruction of bone defects, but donor site morbidity and size limitations are major concern. The use of bioartificial bone tissues may help to overcome these problems. The reconstruction of large volume defects remains a challenge despite the success of reconstruction of small-to-moderate-sized bone defects using engineered bone tissues. The aim of this paper is to understand the principles of tissue engineering of bone and its clinical applications in reconstructive surgery.

An osteoconductive, osteoinductive, and osteogenic tissue-engineered product for trauma and orthopaedic surgery: how far are we?

Science.gov (United States)

Khan, Wasim S; Rayan, Faizal; Dhinsa, Baljinder S; Marsh, David

2012-01-01

The management of large bone defects due to trauma, degenerative disease, congenital deformities, and tumor resection remains a complex issue for the orthopaedic reconstructive surgeons. The requirement is for an ideal bone replacement which is osteoconductive, osteoinductive, and osteogenic. Autologous bone grafts are still considered the gold standard for reconstruction of bone defects, but donor site morbidity and size limitations are major concern. The use of bioartificial bone tissues may help to overcome these problems. The reconstruction of large volume defects remains a challenge despite the success of reconstruction of small-to-moderate-sized bone defects using engineered bone tissues. The aim of this paper is to understand the principles of tissue engineering of bone and its clinical applications in reconstructive surgery.

Identifying and exploring physical and psychological morbidity and patient and family caregiver resilience following acute wound development and/or wound blistering post orthopaedic surgery: a systematic review.

Science.gov (United States)

Ousey, Karen; Edward, Karen-Leigh; Lui, Steve

2015-02-01

The aim of this article was to identify the literature that examined and explored physical and psychological morbidity and patient and family caregiver resilience following acute wound development and/or wound blistering post orthopaedic surgery. A systematic review of the literature using the databases MEDLINE, CINAHL and EMBASE was undertaken. The papers were examined using title and abstract for relevance to the primary and secondary outcomes. The primary outcome of interest was family caregiver resilience following acute wound development and/or wound blistering post orthopaedic surgery. The search yielded 275 records after removing any duplicates; eight studies were considered eligible and were reviewed as full text. Following full review, none of the studies was included in this article. To conclude, there were no papers that investigated or examined the concept of resilience in relation to the management of acute post-surgical orthopaedic wounds. Four of the papers identified, following the review process, did discuss quality of life outcomes and how these may be improved following wound development; most papers focused on the management of chronic wounds. It is apparent from the review that there is no evidence currently available that explores patient and family caregiver resilience following acute wound development and/or wound blistering post orthopaedic surgery. © 2013 The Authors. International Wound Journal © 2013 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

Orthopaedic Implants And Prosthesis: Economic Costs Of Post ...

African Journals Online (AJOL)

OBJECTIVE: To assess the economic impact of post-operative wound infection in trauma patients who had open reduction and internal fixation with implants and prostheses following fractures of the femur. METHOD: This is a 2-year case controlled prospective study carried out at the National Orthopaedic Hospital, Lagos.

Re-estimation of acute subdural hematoma in children caused by trivial household head trauma

International Nuclear Information System (INIS)

Nishimoto, Hiroshi; Kurihara, Jun

2006-01-01

The objective of this study was to identify characteristics of acute subdural hematoma in children caused by a trivial household head trauma from a modem neurosurgical and medicolegal standpoint. We performed a retrospective study of 25 children younger than 48 months hospitalized for acute subdural hematoma from December 1, 1993, through February 28, 2003. Inclusion criteria were as follows: acute subdural hematoma caused by trivial household trauma and a history of trauma corroborated by a caretaker, absence of physical injuries consistent with child abuse, fundoscopic examinations performed by a pediatric ophthalmologist, absence of fractures on general bone survey, and child abuse ruled out by long-term follow-up (more than 5 years). Twenty-one of the patients were boys, and 4 were girls. The patients ranged in age from 6 to 17 months, with an average age of 8.5 months. In 17 of 25 patients trauma had been caused by falls to the floor while standing with support or while sitting. Most of the patients were admitted to the hospital because of generalized convulsions or seizures that had developed soon after a trivial household trauma. Fifteen of the 25 (60%) patients had retinal or preretinal hemorrhage and 9 patients had bilateral retinal hemorrhage. Computed tomography showed fluid-type acute subdural hematomas at the frontal convexity or in the interhemispheric fissure in 18 of 25 (72%) patients. Fourteen of 25 (56%) patients had pre-existing external hydrocephalus (enlargements of the subarachnoid space). The long-term outcomes included normal mental development (IQ≥80) in 18 cases, mild mental retardation (IQ<80) in 7 cases, and epilepsy in 3 cases. Acute subdural hematoma in children caused by trivial household trauma is a clinical entity distinct from acute subdural hematoma caused by child abuse or shaken-baby syndrome. (author)

Orthopaedic injuries in children: Federal Medical Centre, Umuahia ...

African Journals Online (AJOL)

Background: Worldwide, trauma is a recognized leading cause of childhood morbidity, mortality and disability. Aim: To review the causes and consequences of orthopaedic injuries in children. Methods: A retrospective study of all injuries in children 14 years and below seen at the Federal Medical Centre Umuahia from 1st ...

Analysis the findings of chest radiograph and CT scan in 217 acute thoracic trauma

International Nuclear Information System (INIS)

Huang Shaoying

2005-01-01

Objective: To evaluate chest radiograph and CT scan in assessing acute thoracic trauma. Methods: Retrospectively analyzed the findings of chest radiograph and CT scan in 217 cases of acute thoracic trauma and positive rate of each modality was compared. Results: The positive rate of rib and clavicle fracture was higher in chest radiograph than these in CT scan. But the positive rate of chest wall hematoma, mediastinum and subcutaneous emphysema, pneumothorax, hydropneumothorax, damage of lung parenchyma and traumatic pulmonary atelectasis was higher in CT scan than those in chest radiograph. Conclusion: The application of the combined imaging modalities improves assessing of acute thoracic trauma, because the imaging manifestation of the lesion is various. (authors)

Measuring acute rehabilitation needs in trauma: preliminary evaluation of the Rehabilitation Complexity Scale.

Science.gov (United States)

Hoffman, Karen; West, Anita; Nott, Philippa; Cole, Elaine; Playford, Diane; Liu, Clarence; Brohi, Karim

2013-01-01

Injury severity, disability and care dependency are frequently used as surrogate measures for rehabilitation requirements following trauma. The true rehabilitation needs of patients may be different but there are no validated tools for the measurement of rehabilitation complexity in acute trauma care. The aim of the study was to evaluate the potential utility of the Rehabilitation Complexity Scale (RCS) version 2 in measuring acute rehabilitation needs in trauma patients. A prospective observation study of 103 patients with traumatic injuries in a Major Trauma Centre. Rehabilitation complexity was measured using the RCS and disability was measured using the Barthel Index. Demographic information and injury characteristics were obtained from the trauma database. The RCS was closely correlated with injury severity (r=0.69, p<0.001) and the Barthel Index (r=0.91, p<0.001). However the Barthel was poor at discriminating between patients rehabilitation needs, especially for patients with higher injury severities. Of 58 patients classified as 'very dependent' by the Barthel, 21 (36%) had low or moderate rehabilitation complexity. The RCS correlated with acute hospital length of stay (r=0.64, p=<0.001) and patients with a low RCS were more likely to be discharged home. The Barthel which had a flooring effect (56% of patients classified as very dependent were discharged home) and lacked discrimination despite close statistical correlation. The RCS outperformed the ISS and the Barthel in its ability to identify rehabilitation requirements in relation to injury severity, rehabilitation complexity, length of stay and discharge destination. The RCS is potentially a feasible and useful tool for the assessment of rehabilitation complexity in acute trauma care by providing specific measurement of patients' rehabilitation requirements. A larger longitudinal study is needed to evaluate the RCS in the assessment of patient need, service provision and trauma system performance

The Nature of Trauma Memories in Acute Stress Disorder in Children and Adolescents

Science.gov (United States)

Salmond, C. H.; Meiser-Stedman, R.; Glucksman, E.; Thompson, P.; Dalgleish, T.; Smith, P.

2011-01-01

Background: There is increasing theoretical, clinical and research evidence for the role of trauma memory in the aetiology of acute pathological stress responses in adults. However, research into the phenomenology of trauma memories in young people is currently scarce. Methods: This study compared the nature of trauma narratives to narratives of…

Radiation exposure to the eye lens of orthopaedic surgeons during various orthopaedic procedures

International Nuclear Information System (INIS)

Romanova, K.; Alyakov, M.; Vassileva, J.

2015-01-01

The aim of the present study was to assess the radiation dose to the eye lens of orthopaedic surgeons during various orthopaedic procedures and to make efforts to ensure that radiation protection is optimised. The study was performed for Fractura femoris and Fractura cruris procedures performed in orthopaedic operating theatres, as well as for fractures of wrist, ankle and hand/ shoulder performed in the emergency trauma room. The highest mean value of the eye lens dose of 47.2 μSv and higher mean fluoroscopy time of 3 min, as well as the corresponding highest maximum values of 77.1 μSv and 5.0 min were observed for the Fractura femoris procedure performed with the Biplanar 500e fluoroscopy systems. At a normal workload, the estimated mean annual dose values do not exceed the annual occupational dose limit for the lens of eye, but at a heavy workload in the department, this dose limit could be achieved or exceeded. The use of protective lead glasses is recommended as they could reduce the radiation exposure of the lens of the eye. The phantom measurements demonstrated that the use of half-dose mode could additionally reduce dose to the operator's eye lens. (authors)

Open Tibia Shaft Fractures and Soft-Tissue Coverage: The Effects of Management by an Orthopaedic Microsurgical Team.

Science.gov (United States)

VandenBerg, James; Osei, Daniel; Boyer, Martin I; Gardner, Michael J; Ricci, William M; Spraggs-Hughes, Amanda; McAndrew, Christopher M

2017-06-01

To compare the timing of soft-tissue (flap) coverage and occurrence of complications before and after the establishment of an integrated orthopaedic trauma/microsurgical team. Retrospective cohort study. A single level 1 trauma center. Twenty-eight subjects (13 pre- and 15 post-integration) with open tibia shaft fractures (OTA/AO 42A, 42B, and 42C) treated with flap coverage between January 2009 and March 2015. Flap coverage for open tibia shaft fractures treated before ("preintegration") and after ("postintegration") implementation of an integrated orthopaedic trauma/microsurgical team. Time from index injury to flap coverage. The unadjusted median time to coverage was 7 days (95% confidence interval, 5.9-8.1) preintegration, and 6 days (95% confidence interval, 4.6-7.4) postintegration (P = 0.48). For preintegration, 9 (69%) of the patients experienced complications, compared with 7 (47%) postintegration (P = 0.23). After formation of an integrated orthopaedic trauma/microsurgery team, we observed a 1-day decrease in median days to coverage from index injury. Complications overall were lowered in the postintegration group, although statistically insignificant. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Non-Steroidal Anti Inflammatory Drugs Usage In Orthopaedics And ...

African Journals Online (AJOL)

Background: Non steroidal anti-inflammatory drugs NSAIDs) are a group of heterogeneous compounds with nti inflammatory, analgesic and often times anti pyretic roperties. They are weak organic acids and are the most commonly used drugs in Orthopaedic/Trauma practice. hey provide mild to moderate pain relief.

Does virtual reality simulation have a role in training trauma and orthopaedic surgeons?

Science.gov (United States)

Bartlett, J D; Lawrence, J E; Stewart, M E; Nakano, N; Khanduja, V

2018-05-01

Aims The aim of this study was to assess the current evidence relating to the benefits of virtual reality (VR) simulation in orthopaedic surgical training, and to identify areas of future research. Materials and Methods A literature search using the MEDLINE, Embase, and Google Scholar databases was performed. The results' titles, abstracts, and references were examined for relevance. Results A total of 31 articles published between 2004 and 2016 and relating to the objective validity and efficacy of specific virtual reality orthopaedic surgical simulators were identified. We found 18 studies demonstrating the construct validity of 16 different orthopaedic virtual reality simulators by comparing expert and novice performance. Eight studies have demonstrated skill acquisition on a simulator by showing improvements in performance with repeated use. A further five studies have demonstrated measurable improvements in operating theatre performance following a period of virtual reality simulator training. Conclusion The demonstration of 'real-world' benefits from the use of VR simulation in knee and shoulder arthroscopy is promising. However, evidence supporting its utility in other forms of orthopaedic surgery is lacking. Further studies of validity and utility should be combined with robust analyses of the cost efficiency of validated simulators to justify the financial investment required for their use in orthopaedic training. Cite this article: Bone Joint J 2018;100-B:559-65.

A Systematic Review of Early Prognostic Factors for Persistent Pain Following Acute Orthopedic Trauma

Directory of Open Access Journals (Sweden)

Fiona J Clay

2012-01-01

Full Text Available Persistent or chronic pain is prevalent in many developed countries, with estimates ranging from 10% to higher than 50%, and is a major economic burden to individuals and societies. However, the variation in pain outcomes after acute orthopedic trauma and treatment confronts treating physicians with uncertainty in providing prognostic advice regarding long-term recovery. Although several previous reviews have addressed the determinants of chronic pain outcomes secondary to acute trauma, they have primarily focused on specific injury samples and, furthermore, lack consistency with respect to the important prognostic factors, which limits the generalizability of findings. This review, however, aimed specifically to identify the early prognostic factors associated with variation in persistent pain outcomes following acute orthopedic trauma presenting with a spectrum of pathologies.

Cumulative exposure to prior collective trauma and acute stress responses to the Boston marathon bombings.

Science.gov (United States)

Garfin, Dana Rose; Holman, E Alison; Silver, Roxane Cohen

2015-06-01

The role of repeated exposure to collective trauma in explaining response to subsequent community-wide trauma is poorly understood. We examined the relationship between acute stress response to the 2013 Boston Marathon bombings and prior direct and indirect media-based exposure to three collective traumatic events: the September 11, 2001 (9/11) terrorist attacks, Superstorm Sandy, and the Sandy Hook Elementary School shooting. Representative samples of residents of metropolitan Boston (n = 846) and New York City (n = 941) completed Internet-based surveys shortly after the Boston Marathon bombings. Cumulative direct exposure and indirect exposure to prior community trauma and acute stress symptoms were assessed. Acute stress levels did not differ between Boston and New York metropolitan residents. Cumulative direct and indirect, live-media-based exposure to 9/11, Superstorm Sandy, and the Sandy Hook shooting were positively associated with acute stress responses in the covariate-adjusted model. People who experience multiple community-based traumas may be sensitized to the negative impact of subsequent events, especially in communities previously exposed to similar disasters. © The Author(s) 2015.

Surgical skills simulation in trauma and orthopaedic training

OpenAIRE

Stirling, Euan RB; Lewis, Thomas L; Ferran, Nicholas A

2014-01-01

Changing patterns of health care delivery and the rapid evolution of orthopaedic surgical techniques have made it increasingly difficult for trainees to develop expertise in their craft. Working hour restrictions and a drive towards senior led care demands that proficiency be gained in a shorter period of time whilst requiring a greater skill set than that in the past. The resulting conflict between service provision and training has necessitated the development of alternative methods in orde...

Is trauma in Switzerland any different? epidemiology and patterns of injury in major trauma - a 5-year review from a Swiss trauma centre.

Science.gov (United States)

Heim, C; Bosisio, F; Roth, A; Bloch, J; Borens, O; Daniel, R T; Denys, A; Oddo, M; Pasquier, M; Schmidt, S; Schoettker, P; Zingg, T; Wasserfallen, J B

2014-01-01

Switzerland, the country with the highest health expenditure per capita, is lacking data on trauma care and system planning. Recently, 12 trauma centres were designated to be reassessed through a future national trauma registry by 2015. Lausanne University Hospital launched the first Swiss trauma registry in 2008, which contains the largest database on trauma activity nationwide. Prospective analysis of data from consecutively admitted shock room patients from 1 January 2008 to 31 December 2012. Shock room admission is based on physiology and mechanism of injury, assessed by prehospital physicians. Management follows a surgeon-led multidisciplinary approach. Injuries are coded by Association for the Advancement of Automotive Medicine (AAAM) certified coders. Over the 5 years, 1,599 trauma patients were admitted, predominantly males with a median age of 41.4 years and median injury severity score (ISS) of 13. Rate of ISS >15 was 42%. Principal mechanisms of injury were road traffic (40.4%) and falls (34.4%), with 91.5% blunt trauma. Principal patterns were brain (64.4%), chest (59.8%) and extremity/pelvic girdle (52.9%) injuries. Severe (abbreviated injury scale [AIS] score ≥ 3) orthopaedic injuries, defined as extremity and spine injuries together, accounted for 67.1%. Overall, 29.1% underwent immediate intervention, mainly by orthopaedics (27.3%), neurosurgeons (26.3 %) and visceral surgeons (13.9%); 43.8% underwent a surgical intervention within the first 24 hours and 59.1% during their hospitalisation. In-hospital mortality for patients with ISS >15 was 26.2%. This is the first 5-year report on trauma in Switzerland. Trauma workload was similar to other European countries. Despite high levels of healthcare, mortality exceeds published rates by >50%. Regardless of the importance of a multidisciplinary approach, trauma remains a surgical disease and needs dedicated surgical resources.

The relation of appraisal, coping efforts, and acuteness of trauma to PTS symptoms among former political prisoners.

Science.gov (United States)

Kanninen, Katri; Punamäki, Raija-Leena; Qouta, Samir

2002-06-01

We examined how trauma-specific appraisals and coping efforts mediate between traumatic experiences, acuteness of trauma, and length of imprisonment and posttraumatic stress symptoms (PTS) among 103 Palestinian former political prisoners. The findings provide support for both direct and mediated models of trauma. The acuteness of trauma (time since release), appraisal of prison experience as harmful and involving loss, and use of both emotion- and problem-focused coping efforts were associated with high levels of PTS symptoms. Torture and ill-treatment had a direct association with intrusion, and recent release from prison with avoidance symptoms. Acuteness of trauma turned out to be important in the coping and symptom association: emotion-focused coping was associated with a low level of PTS symptoms in the long run, whereas problem-focused coping was associated with a low level of PTS symptoms in the short run.

Chronic resuscitation after trauma-hemorrhage and acute fluid replacement improves hepatocellular function and cardiac output.

Science.gov (United States)

Remmers, D E; Wang, P; Cioffi, W G; Bland, K I; Chaudry, I H

1998-01-01

To determine whether prolonged (chronic) resuscitation has any beneficial effects on cardiac output and hepatocellular function after trauma-hemorrhage and acute fluid replacement. Acute fluid resuscitation after trauma-hemorrhage restores but does not maintain the depressed hepatocellular function and cardiac output. Male Sprague-Dawley rats underwent a 5-cm laparotomy (i.e., trauma was induced) and were bled to and maintained at a mean arterial pressure of 40 mmHg until 40% of maximal bleed-out volume was returned in the form of Ringer's lactate (RL). The animals were acutely resuscitated with RL using 4 times the volume of maximum bleed-out over 60 minutes, followed by chronic resuscitation of 0, 5, or 10 mL/kg/hr RL for 20 hours. Hepatocellular function was determined by an in vivo indocyanine green clearance technique. Hepatic microvascular blood flow was assessed by laser Doppler flowmetry. Plasma levels of interleukin-6 (IL-6) were determined by bioassay. Chronic resuscitation with 5 mL/kg/hr RL, but not with 0 or 10 mL/kg/hr RL, restored cardiac output, hepatocellular function, and hepatic microvascular blood flow at 20 hours after hemorrhage. The regimen above also reduced plasma IL-6 levels. Because chronic resuscitation with 5 mL/kg/hr RL after trauma-hemorrhage and acute fluid replacement restored hepatocellular function and hepatic microvascular blood flow and decreased plasma levels of IL-6, we propose that chronic fluid resuscitation in addition to acute fluid replacement should be routinely used in experimental studies of trauma-hemorrhage.

Geriatric resources in acute care hospitals and trauma centers: a scarce commodity.

Science.gov (United States)

Maxwell, Cathy A; Mion, Lorraine C; Minnick, Ann

2013-12-01

The number of older adults admitted to acute care hospitals with traumatic injury is rising. The purpose of this study was to examine the location of five prominent geriatric resource programs in U.S. acute care hospitals and trauma centers (N = 4,865). As of 2010, 5.8% of all U.S. hospitals had at least one of these programs. Only 8.8% of trauma centers were served by at least one program; the majorities were in level I trauma centers. Slow adoption of geriatric resource programs in hospitals may be due to lack of champions who will advocate for these programs, lack of evidence of their impact on outcomes, or lack of a business plan to support adoption. Future studies should focus on the benefits of geriatric resource programs from patients' perspectives, as well as from business case and outcomes perspectives. Copyright 2013, SLACK Incorporated.

Acute Stress Symptoms in Seriously Injured Patients: Precipitating Versus Cumulative Trauma and the Contribution of Peritraumatic Distress.

Science.gov (United States)

Briere, John; Dias, Colin P; Semple, Randye J; Scott, Catherine; Bigras, Noémie; Godbout, Natacha

2017-08-01

The relationship between type of trauma exposure, cumulative trauma, peritraumatic distress, and subsequent acute stress disorder (ASD) symptoms was examined prospectively in 96 individuals presenting with acute medical injuries to a Level 1 emergency/trauma department. Common precipitating traumas included motor vehicle-related events, stabbings, shootings, and physical assaults. At 2 to 3 weeks follow-up, 22.9% of participants had developed ASD. Univariate analysis revealed no relationship between type of precipitating trauma and ASD symptoms, whereas robust path analysis indicated direct effects of gender, lifetime cumulative trauma exposure, and peritraumatic distress. Peritraumatic distress did not mediate the association between cumulative trauma and symptoms, but did mediate the association between gender and symptomatology. These results, which account for 23.1% of the variance in ASD symptoms, suggest that ASD may be more due to cumulative trauma exposure than the nature of the precipitating trauma, but that cumulative trauma does not exert its primary effect by increasing peritraumatic distress to the most recent trauma. Copyright © 2017 International Society for Traumatic Stress Studies.

A Prospective, Randomized Investigation of Plasma First Resuscitation for Traumatic Hemorrhage and Attenuation of Acute Coagulopathy of Trauma

Science.gov (United States)

2016-05-01

COMBAT study staff was made aware of a code 10 trauma return of a male patient who sustained an anterior left- chest stab wound. Paramedics enrolled the...Attenuation of Acute Coagulopathy of Trauma . PRINCIPAL INVESTIGATOR: Ernest E. Moore, MD CONTRACTING ORGANIZATION: University of Colorado Denver...Randomized Investigation of “Plasma First Resuscitation” for Traumatic Hemorrhage and Attenuation of Acute Coagulopathy of Trauma . 5b. GRANT NUMBER

Acute care nurse practitioners in trauma care: results of a role survey and implications for the future of health care delivery.

Science.gov (United States)

Noffsinger, Dana L

2014-01-01

The role of acute care nurse practitioners (ACNPs) in trauma care has evolved over time. A survey was performed with the aim of describing the role across the United States. There were 68 respondents who depicted the typical trauma ACNP as being a 42-year-old woman who works full-time at a level I American College of Surgeons verified trauma center. Trauma ACNPs typically practice with 80% of their time for clinical care and are based on a trauma and acute care surgery service. They are acute care certified and hold several advanced certifications to supplement their nursing license.

Trauma indices for prediction of acute respiratory distress syndrome.

Science.gov (United States)

Afshar, Majid; Smith, Gordon S; Cooper, Richard S; Murthi, Sarah; Netzer, Giora

2016-04-01

A myriad of trauma indices has been validated to predict probability of trauma survival. We aimed to compare the performance of commonly used indices for the development of the acute respiratory distress syndrome (ARDS). Historic, observational cohort study of 27,385 consecutive patients admitted to a statewide referral trauma center between July 11, 2003 and October 31, 2011. A validated algorithm was adapted to identify patients with ARDS. Each trauma index was evaluated in logistic regression using the area under the receiver operating characteristic curve. The case rate for ARDS development was 5.8% (1594). The receiver operating characteristics for injury severity score (ISS) had the best discrimination and had an area under the curve of 0.88 (95% confidence interval [CI] = 0.87-0.89). Glasgow coma score (0.71, 95% CI = 0.70-0.73), A Severity Characterization of Trauma (0.86, 95% CI = 0.85-0.87), Revised Trauma Score (0.71, 95% CI = 0.70-0.72) and thorax Abbreviated Injury Score (0.73, 95% CI = 0.72-0.74) performed worse (P < 0.001) and Trauma and Injury Severity Score (0.88, 95% CI = 0.87-0.88) performed equivocally (P = 0.51) in comparison to ISS. Using a cutoff point ISS ≥16, sensitivity and specificity were 84.9% (95% CI = 83.0%-86.6%) and 75.6% (95% CI = 75.1%-76.2%), respectively. Among commonly used trauma indices, ISS has superior or equivocal discriminative ability for development of ARDS. A cutoff point of ISS ≥16 provided good sensitivity and specificity. The use of ISS ≥16 is a simple method to evaluate ARDS in trauma epidemiology and outcomes research. Copyright © 2016 Elsevier Inc. All rights reserved.

The Relationship of Obesity to Increasing Health-Care Burden in the Setting of Orthopaedic Polytrauma.

Science.gov (United States)

Licht, Heather; Murray, Mark; Vassaur, John; Jupiter, Daniel C; Regner, Justin L; Chaput, Christopher D

2015-11-18

With the rise of obesity in the American population, there has been a proportionate increase of obesity in the trauma population. The purpose of this study was to use a computed tomography-based measurement of adiposity to determine if obesity is associated with an increased burden to the health-care system in patients with orthopaedic polytrauma. A prospective comprehensive trauma database at a level-I trauma center was utilized to identify 301 patients with polytrauma who had orthopaedic injuries and intensive care unit admission from 2006 to 2011. Routine thoracoabdominal computed tomographic scans allowed for measurement of the truncal adiposity volume. The truncal three-dimensional reconstruction body mass index was calculated from the computed tomography-based volumes based on a previously validated algorithm. A truncal three-dimensional reconstruction body mass index of obese patients and ≥ 30 kg/m(2) denoted obese patients. The need for orthopaedic surgical procedure, in-hospital mortality, length of stay, hospital charges, and discharge disposition were compared between the two groups. Of the 301 patients, 21.6% were classified as obese (truncal three-dimensional reconstruction body mass index of ≥ 30 kg/m(2)). Higher truncal three-dimensional reconstruction body mass index was associated with longer hospital length of stay (p = 0.02), more days spent in the intensive care unit (p = 0.03), more frequent discharge to a long-term care facility (p obesity on patients with polytrauma. Obese patients were found to have higher total hospital charges, longer hospital stays, discharge to a continuing-care facility, and a higher rate of orthopaedic surgical intervention. Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.

Incidence, clinical predictors and outcome of acute renal failure among North Indian trauma patients

Science.gov (United States)

Medha; Subramanian, Arulselvi; Pandey, Ravindra Mohan; Sawhney, Chhavi; Upadhayay, Ashish Dutt; Albert, Venencia

2013-01-01

Context: There is a need for identifying risk factors aggravating development of acute renal failure after attaining trauma and defining new parameters for better assessment and management. Aim of the study was to determine the incidence of acute renal failure among trauma patients, and its correlation with various laboratory and clinical parameters recorded at the time of admission and in-hospital mortality. Subjects and Methods: The retrospective cohort study included admitted 208 trauma patients over a period of one year. 135 trauma patients at the serum creatinine level >2.0 mg/dL were enrolled in under the group of acute renal failure. 73 patients who had normal creatinine level made the control group. They were further assessed with clinical details and laboratory investigations. Results: Incidence of acute renal failure was 3.1%. There were 118 (87.4%) males and average length of stay was 9 (1, 83) days. Severity of injury (ISS, GCS) was relatively more among the renal failure group. Renal failure was transient in 35 (25.9%) patients. They had higher incidence of bone fracture (54.0%) (P= 0.04). Statistically significant association was observed between patients with head trauma and mortality 72 (59.0%) (P= 0.001). Prevalence of septic 24 (59.7%) and hemorrhagic 9 (7.4%) shock affected the renal failure group. Conclusion: Trauma patients at the urea level >50 mg/dL, ISS >24 on the first day of admission had 23 times and 7 times the risk of developing renal failure. Similarly, patients with hepatic dysfunction and pulmonary dysfunction were 12 times and 6 times. Patients who developed cardiovascular dysfunction, hematological dysfunction and post-trauma renal failure during the hospital stay had risk for mortality 29, 7 and 8 times, respectively. The final prognostic score obtained was: 14*hepatic dysfunction + 11*cISS + 18*cUrea + 12*cGlucose + 10*pulmonary dysfunction. Optimal score cut-off for prediction of renal failure was found to be ≥25 with

Incidence, clinical predictors and outcome of acute renal failure among North Indian trauma patients

Directory of Open Access Journals (Sweden)

Medha

2013-01-01

Full Text Available Context: There is a need for identifying risk factors aggravating development of acute renal failure after attaining trauma and defining new parameters for better assessment and management. Aim of the study was to determine the incidence of acute renal failure among trauma patients, and its correlation with various laboratory and clinical parameters recorded at the time of admission and in-hospital mortality. Subjects and Methods: The retrospective cohort study included admitted 208 trauma patients over a period of one year. 135 trauma patients at the serum creatinine level >2.0 mg/dL were enrolled in under the group of acute renal failure. 73 patients who had normal creatinine level made the control group. They were further assessed with clinical details and laboratory investigations. Results: Incidence of acute renal failure was 3.1%. There were 118 (87.4% males and average length of stay was 9 (1, 83 days. Severity of injury (ISS, GCS was relatively more among the renal failure group. Renal failure was transient in 35 (25.9% patients. They had higher incidence of bone fracture (54.0% (P = 0.04. Statistically significant association was observed between patients with head trauma and mortality 72 (59.0% (P = 0.001. Prevalence of septic 24 (59.7% and hemorrhagic 9 (7.4% shock affected the renal failure group. Conclusion: Trauma patients at the urea level >50 mg/dL, ISS >24 on the first day of admission had 23 times and 7 times the risk of developing renal failure. Similarly, patients with hepatic dysfunction and pulmonary dysfunction were 12 times and 6 times. Patients who developed cardiovascular dysfunction, hematological dysfunction and post-trauma renal failure during the hospital stay had risk for mortality 29, 7 and 8 times, respectively. The final prognostic score obtained was: 14FNx01hepatic dysfunction + 11FNx01cISS + 18FNx01cUrea + 12FNx01cGlucose + 10FNx01pulmonary dysfunction. Optimal score cut-off for prediction of renal failure was

The pharmacokinetics of meperidine in acute trauma patients.

Science.gov (United States)

Kirkwood, C F; Edwards, D J; Lalka, D; Lasezkay, G; Hassett, J M; Slaughter, R L

1986-12-01

Traumatic injury has the potential to alter the hepatic clearance and hence the efficacy and toxicity of drugs by a variety of mechanisms. These include changes in hepatic microsomal enzyme activity, hepatic blood flow rate, and plasma protein binding. Unfortunately, there have been few pharmacokinetic studies in trauma patients. Thus, few data are available to provide guidance in drug regimen design for these individuals. Meperidine clearance was therefore evaluated in patients with traumatic injury and an effort was made to identify physiologic and/or clinical predictors of clearance which could facilitate initial dosage selection. Meperidine total body clearance (TBC) was determined on 12 occasions at steady state following IM administration of meperidine to nine severely injured nonseptic trauma patients with normal renal and hepatic function. TBC of this drug averaged 684 +/- 206 ml/min (mean +/- SD) and was highly correlated with ideal body weight (IBW) (r2 = 0.735; F = 27.75; n = 12; p less than 0.01). The serum concentration of the acute phase reactant protein, alpha 1 acid glycoprotein (AGP), which binds meperidine and many other basic drugs increased strikingly in an apparent linear manner at a rate of 27 mg/dl/day up to 9 days after the traumatic event (r2 = 0.828; F = 42.30; n = 12; p less than 0.01). However, this increase in binding protein concentration was not associated with an alteration in meperidine TBC as has been reported for other drugs. It is concluded that IBW may be a useful guide initial dosage selection of meperidine in acute trauma patients.(ABSTRACT TRUNCATED AT 250 WORDS)

A VACUUM ASSISTED CLOSURE (VAC THERAPY IN ORTHOPAEDIC TRAUMA : A PROSPECTIVE STUDY

Directory of Open Access Journals (Sweden)

Suresh

2015-10-01

Full Text Available BACKGROUND: Management of open fractures and massive soft tissue injuries around leg ankle, foot and hand requires multi - disciplinary approach. VAC therapy is an innovative approach to the treatment of these wounds. VAC therapy facilitates granulation tissue formation, promotes healing, reduces infection and allows early skin grafting or flap closure. AIM: To describe our experience with VAC therapy for orthopaedics trauma around leg ankle, foot and hand. MATERIALS AND METHODS : 41 patients were included in Prospective Study performed at Preethi hospital, Madurai in years 2011 - 12. Only patients having t raumatic wound of leg, ankle, foot and hand were i ncluded. Patients with bleeding disorders were not included. VAC therapy was used as adjuvant to debridement in wound care. RESULTS: In 39 patients lower limb and in 2 patient hands was involved. The mean age was 39.3 years and 38 pateints were male 3 were female. Mean wound grade after VAC therapy decrease by 1 grade. Average wound area reduction was 10%. The mean duration of VAC therapy was 5.2 days. Plastic surgery was done in mean 6 days after removal of VAC dressing. Local flap was required in only 39% of patients. After VAC therapy all 10 patients having heel injury showed good granulation tissue. Complications like infection, bleeding and skin irritation were not seen in our study. CONCLUSION : VAC therapy is a viable adjuvant in the management of trau matic open wounds. It facilitates the rapid granulation tissue formation and wound healing. It reduces the duration of treatment, hospital stay and need of extensive plastic surgery

"Osteoporosis and orthopods" incidences of osteoporosis in distal radius fracture from low energy trauma.

LENUS (Irish Health Repository)

Bahari, Syah

2007-07-01

Fracture of the distal radius from low energy trauma is a common presentation to orthopaedic trauma services. This fragility type fracture is associated with underlying osteoporosis. Osteoporosis is a \\'silent disease\\' where fragility fracture is a common presentation. Orthopaedic surgeons may be the only physician that these patients encounter. We found a high percentage of female patients who sustained a fragility fracture of the distal radius have an underlying osteoporosis. Further management of osteoporosis is important to prevent future fragility fractures.

Dual-energy computed tomography of cruciate ligament injuries in acute knee trauma

Energy Technology Data Exchange (ETDEWEB)

Peltola, Erno K. [Helsinki University Hospital, Toeoeloe Trauma Center, Department of Radiology, Helsinki Medical Imaging Center, Helsinki (Finland); Koskinen, Seppo K. [Karolinska Universitetssjukhuset, Department of Clinical Science, Intervention and Technology (CLINTEC), Stockholm (Sweden)

2015-09-15

To examine dual-energy computed tomography (DECT) in evaluating cruciate ligament injuries. More specifically, the purpose was to assess the optimal keV level in DECT gemstone spectral imaging (GSI) images and to examine the usefulness of collagen-specific color mapping and dual-energy bone removal in the evaluation of cruciate ligaments and the popliteus tendon. At a level 1 trauma center, a 29-month period of emergency department DECT examinations for acute knee trauma was reviewed by two radiologists for presence of cruciate ligament injuries, visualization of the popliteus tendon and the optimal keV level in GSI images. Three different evaluating protocols (GSI, bone removal and collagen-specific color mapping) were rated. Subsequent MRI served as a reference standard for intraarticular injuries. A total of 18 patients who had an acute knee trauma, DECT and MRI were found. On MRI, six patients had an ACL rupture. DECT's sensitivity and specificity to detect ACL rupture were 79 % and 100 %, respectively. The DECT vs. MRI intra- and interobserver proportions of agreement for ACL rupture were excellent or good (kappa values 0.72-0.87). Only one patient had a PCL rupture. In GSI images, the optimal keV level was 63 keV. GSI of 40-140 keV was considered to be the best evaluation protocol in the majority of cases. DECT is a usable method to evaluate ACL in acute knee trauma patients with rather good sensitivity and high specificity. GSI is generally a better evaluation protocol than bone removal or collagen-specific color mapping in the evaluation of cruciate ligaments and popliteus tendon. (orig.)

Use of the emotional Stroop to assess psychological trauma following traumatic brain injury.

Science.gov (United States)

Coates, Richard C

2008-04-01

A modified Stroop task was used to investigate the hypothesis that implicit memory may be a possible mechanism for the development of acute stress disorder (ASD) in patients who have suffered a closed head injury. Three groups of hospital patients were compared within 1 month post-trauma: road traffic accident (RTA) patients with a brain injury (n = 15), RTA patients without a brain injury (n = 13) and a control group of orthopaedic and plastics patients (n = 15). Participants named colours of five types of words: RTA-related words, words related to hospitalization, obsessive-compulsive disorder (OCD) words, positive words and neutral words. Participants were also administered the Acute Stress Disorder Interview and the State-Trait Anxiety Inventory. Both RTA patients with and without a brain injury demonstrated significant interference on words related to an RTA. Significant interference was unexpectedly observed for OCD words in RTA patients. Control patients did not display significant interference effects. Findings suggested that patients, both with and without explicit recall for an RTA, responded similarly on a task involving implicit memory for trauma. Possible implications for ASD and Post-traumatic Stress Disorder are discussed.

The burden of gunshot injuries on orthopaedic healthcare resources in South Africa.

Science.gov (United States)

Martin, Case; Thiart, Gerhard; McCollum, Graham; Roche, Stephen; Maqungo, Sithombo

2017-06-30

cost USD2 940, used just over 3 hours of theatre time per operation, and necessitated a hospital bed for an average period of 9.75 days. Improved understanding of the high incidence of orthopaedic GSWs treated in an SA tertiary care trauma centre and the costs incurred will help the state healthcare system better prioritise orthopaedic trauma funding and training opportunities, while also supporting cost-saving measures, including redirection of financial resources to primary prevention initiatives.

Surgical advances during the First World War: the birth of modern orthopaedics.

Science.gov (United States)

Ramasamy, Arul; Eardley, W G P; Edwards, D S; Clasper, J C; Stewart, M P M

2016-02-01

The First World War (1914-1918) was the first truly industrial conflict in human history. Never before had rifle fire and artillery barrage been employed on a global scale. It was a conflict that over 4 years would leave over 750,000 British troops dead with a further 1.6 million injured, the majority with orthopaedic injuries. Against this backdrop, the skills of the orthopaedic surgeon were brought to the fore. Many of those techniques and systems form the foundation of modern orthopaedic trauma management. On the centenary of 'the War to end all Wars', we review the significant advances in wound management, fracture treatment, nerve injury and rehabilitation that were developed during that conflict. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Health resource utilisation costs in acute patients with persistent midline cervical tenderness following road trauma.

Science.gov (United States)

Ackland, Helen M; Wolfe, Rory; Cameron, Peter A; Cooper, D James; Malham, Gregory M; Varma, Dinesh K; Fitt, Gregory J; Rosenfeld, Jeffrey V; Liew, Susan M

2012-11-01

The costs associated with patients discharged with isolated clinician-elicited persistent midline tenderness and negative computed tomography (CT) findings have not been reported. Our aim was to determine the association of acute and post-acute patient and injury characteristics with health resource costs in such patients following road trauma. In a prospective cohort study, road trauma patients presenting with isolated persistent midline cervical tenderness and negative CT, who underwent additional acute imaging with MRI, were recruited. Patients were reviewed in the outpatient spine clinic following discharge, and were followed up at 6 and 12 months post-trauma. Multivariate linear regression was used to assess the association of injury mechanism, clinical assessment, socioeconomic factors and outcome findings with health resource costs generated in the acute hospital and post-acute periods. There were 64 patients recruited, of whom 24 (38%) had cervical spine injury detected on MRI. Of these, 2 patients were managed operatively, 6 were treated in cervical collars and 16 had the cervical spine cleared and were discharged. At 12 months, there were 25 patients (44%) with residual neck pain, and 22 (39%) with neck-related disability. The mean total cost was AUD $10,153 (SD=10,791) and the median was $4015 (IQR: 3044-6709). Transient neurologic deficit, which fully resolved early in the emergency department, was independently associated with higher marginal mean acute costs (represented in the analysis by the β coefficient) by $3521 (95% CI: 50-6880). Low education standard (β coefficient: $5988, 95% CI: 822-13,317), neck pain at 6 months (β coefficient: $4017, 95% CI: 426-9254) and history of transient neurologic deficit (β coefficient: $8471, 95% CI: 1766-18,334) were associated with increased post-acute costs. In a homogeneous group of road trauma patients with non fracture-related persistent midline cervical tenderness, health resource costs varied

SCINTIGRAPHY IN URGENT CONDITIONS AND COMPLICATIONS OF ACUTE DISEASES AND TRAUMAS

Directory of Open Access Journals (Sweden)

N. Ye. Kudryashova

2014-01-01

Full Text Available ABSTRACT. The data generalized in the review characterize radionuclide method as a high informative technique in diagnosis of the row of acute diseases and traumas and complications of them. It was shown that each radionuclide technique decides the concrete clinical tests and has a strictly definite place in the diagnostic algorithm. Urgent radionuclide techniques give the important information for the choice of the treatment’s policy or operation’s volume in such acute diseases as tromboembolism, arterial occlusions, small bowel obstruction, acute cholecystitis and cholelithiasis, acute myocardial infarct, rhabdomyolysis, differentiation of acute urological and acute abdominal surgical diseases and so on. The main aim of the work of our radionuclide department is to perfect, modificate of urgent radionuclide techniques and to correct the place of them in urgent conditions’s diagnostic algorithm for increasing of the quality and the rapidity in diagnosis. 

Analysis of scientific articles published in two general orthopaedic journals.

Science.gov (United States)

Holzer, Lukas A; Holzer, Gerold

2013-01-01

To give an overview of the behaviour and scientific contributions of the Journal of Bone and Joint Surgery American (JBJS-A) and British Volume (JBJS-B). 480 original articles published in 2009 were identified through a combined comprehensive computer and manual library search. Articles were assigned to 11 orthopaedic categories and by country, type and specialty of the institution. Possible grants and citations were analysed. USA led all countries in published articles (36,87%), followed by UK (20,62%) and South Korea (5,83%). Most studies published were performed at academic institutions (65,83 %), only 4,16% at private practices. Almost half of the articles (46,24%) were published in three categories: hip (19.16%), knee (13.75%) and trauma (13.33%). In both journals 47.15% articles had at least one funding source. A review of articles published in major journals allows to show how research in orthopaedics is distributed worldwide. This study shows that a variety of different journals is neccessary to reflect the broad spectrum of orthopaedics in depth. Level of Evidence III, Retrospective Comparative Study.

The influence of psychosocial factors on recovery following acute whiplash trauma.

Science.gov (United States)

Carstensen, Tina Birgitte Wisbech

2012-12-01

Persistent pain and disability after whiplash trauma has become an increasingly significant problem in many industrialized countries entailing comprehensive individual as well as social costs. The dissertation includes two areas of research within whiplash trauma. The first part contains two empirical articles focusing on risk factors for poor recovery. The second part contains a systematic review and an empirical article and concerns the influence of coping strategies on recovery with a special emphasis on possible gender differences. All empirical articles in the dissertation are based on self-reported questionnaire data on a patient cohort of whiplash-exposed. Patients are consecutively included in the study within the first ten days of collision recruited from emergency departments and general practitioners in four counties in Denmark from April 2001 to June 2003. One of the empirical articles in the dissertation is supplemented with data from a social register of transfer benefits on the patient cohort as well as on a matched register control cohort in the general population. In this dissertation we wish to answer the following questions: 1) Do self-reported pre-collision health-related and socio-demographic factors affect self-reported work capability and neck pain one year after acute whiplash trauma? 2) Do transfer benefits before the accident predict negative change in future health-related provisional situation and future neck pain? 3) Do persons with acute whiplash trauma experience more negative change in future health-related provisional situation compared to a matched register control group? 4) Does research in the use of coping strategies after whiplash trauma show that these predict poor restitution and is there any research on gender differences in the use of coping strategies in whiplash-exposed? 5) Do gender and coping strategies interact in the prediction of future neck pain following acute whiplash trauma? Self-reported unspecified pain, female

Readability of Trauma-Related Patient Education Materials From the American Academy of Orthopaedic Surgeons.

Science.gov (United States)

Eltorai, Adam E M; P Thomas, Nathan; Yang, Heejae; Daniels, Alan H; Born, Christopher T

2016-02-01

According to the american medical association (AMA) and the national institutes of health (NIH), the recommended readability of patient education materials should be no greater than a sixth-grade reading level. The online patient education information produced by the american academy of orthopaedic surgeons (AAOS) may be too complicated for some patients to understand. This study evaluated whether the AAOS's online trauma-related patient education materials meet recommended readability guidelines for medical information. Ninety-nine articles from the "Broken Bones and Injuries" section of the AAOS-produced patient education website, orthoinfo.org, were analyzed for grade level readability using the Flesch-Kincaid formula, a widely-used and validated tool to evaluate the text reading level. Results for each webpage were compared to the AMA/NIH recommended sixth-grade reading level and the average reading level of U.S. adults (eighth-grade). The mean (SD) grade level readability for all patient education articles was 8.8 (1.1). All but three of the articles had a readability score above the sixth-grade level. The readability of the articles exceeded this level by an average of 2.8 grade levels (95% confidence interval, 2.6 - 3.0; P reading skill level of U.S. adults (eighth grade) by nearly an entire grade level (95% confidence interval, 0.6-1.0; P education website have readability levels that may make comprehension difficult for a substantial portion of the patient population.

Multishot diffusion-weighted MR imaging features in acute trauma of spinal cord

International Nuclear Information System (INIS)

Zhang, Jin Song; Huan, Yi

2014-01-01

To analyse diffusion-weighted MRI of acute spinal cord trauma and evaluate its diagnostic value. Conventional MRI and multishot, navigator-corrected DWI were performed in 20 patients with acute spinal cord trauma using 1.5-T MR within 72 h after the onset of trauma. Twenty cases were classified into four categories according to the characteristics of DWI: (1) Oedema type: ten cases presented with variable hyperintense areas within the spinal cord. There were significant differences in the apparent diffusion coefficients (ADCs) between lesions and unaffected regions (t = -7.621, P < 0.01). ADC values of lesions were markedly lower than those of normal areas. (2) Mixed type: six cases showed heterogeneously hyperintense areas due to a mixture of haemorrhage and oedema. (3) Haemorrhage type: two cases showed lesions as marked hypointensity due to intramedullary haemorrhage. (4) Compressed type (by epidural haemorrhage): one of the two cases showed an area of mild hyperintensity in the markedly compressed cord due to epidural haematoma. Muti-shot DWI of the spinal cord can help visualise and evaluate the injured spinal cord in the early stage, especially in distinguishing the cytotoxic oedema from vasogenic oedema. It can assist in detecting intramedullary haemorrhage and may have a potential role in the evaluation of compressed spinal cord. (orig.)

Demographics, nature and treatment of orthopaedic trauma injuries occurring in an agricultural context in the West of Ireland.

LENUS (Irish Health Repository)

Byrne, F J

2011-03-01

Farming is a major industry in the West of Ireland. This prospective study examined the age profile, nature and treatment of orthopaedic injuries occurring in agricultural surroundings presenting at the Orthopaedic Unit of Merlin Park Hospital, Galway.

A Systematic Review of the Usefulness of Glial Fibrillary Acidic Protein for Predicting Acute Intracranial Lesions following Head Trauma

Directory of Open Access Journals (Sweden)

Teemu M. Luoto

2017-12-01

Full Text Available BackgroundThe extensive use of computed tomography (CT after acute head injury is costly and carries potential iatrogenic risk. This systematic review examined the usefulness of blood-based glial fibrillary acidic protein (GFAP for predicting acute trauma-related CT-positive intracranial lesions following head trauma. The main objective was to summarize the current evidence on blood-based GFAP as a potential screening test for acute CT-positive intracranial lesions following head trauma.MethodsWe screened MEDLINE, EMBASE, PsychInfo, CINAHL, Web of Science, the Cochrane Database, Scopus, Clinical Trials, OpenGrey, ResearchGate, and the reference lists of eligible publications for original contributions published between January 1980 and January 2017. Eligibility criteria included: (i population: human head and brain injuries of all severities and ages; (ii intervention: blood-based GFAP measurement ≤24 h post-injury; and (iii outcome: acute traumatic lesion on non-contrast head CT ≤24 h post-injury. Three authors completed the publication screening, data extraction, and quality assessment of eligible articles.ResultsThe initial search identified 4,706 articles, with 51 eligible for subsequent full-text assessment. Twenty-seven articles were ultimately included. Twenty-four (89% studies reported a positive association between GFAP level and acute trauma-related intracranial lesions on head CT. The area under the receiver operating characteristic curve for GFAP prediction of intracranial pathology ranged from 0.74 to 0.98 indicating good to excellent discrimination. GFAP seemed to discriminate mass lesions and diffuse injury, with mass lesions having significantly higher GFAP levels. There was considerable variability between the measured GFAP averages between studies and assays. No well-designed diagnostic studies with specific GFAP cutoff values predictive of acute traumatic intracranial lesions have been published

Clinical features of anaerobic orthopaedic infections.

Science.gov (United States)

Lebowitz, Dan; Kressmann, Benjamin; Gjoni, Shpresa; Zenelaj, Besa; Grosgurin, Olivier; Marti, Christophe; Zingg, Matthieu; Uçkay, Ilker

2017-02-01

Some patient populations and types of orthopaedic surgery could be at particular risk for anaerobic infections. In this retrospective cohort study of operated adult patients with infections from 2004 to 2014, we assessed obligate anaerobes and considered first clinical infection episodes. Anaerobes, isolated from intra-operative samples, were identified in 2.4% of 2740 surgical procedures, of which half (33/65; 51%) were anaerobic monomicrobial infections. Propionibacterium acnes, a penicillin and vancomycin susceptible pathogen, was the predominantly isolated anaerobe. By multivariate analysis, the presence of fracture fixation plates was the variable most strongly associated with anaerobic infection (odds ratio: 2.1, 95% CI: 1.3-3.5). Anaerobes were also associated with spondylodesis and polymicrobial infections. In contrast, it revealed less likely in native bone or prosthetic joint infections and was not related to prior antibiotic use. In conclusion, obligate anaerobes in our case series of orthopaedic infections were rare, and mostly encountered in infections related to trauma with open-fracture fixation devices rather than clean surgical site infection. Anaerobes were often co-pathogens, and cultures most frequently recovered P. acnes. These observations thus do not support changes in current practices such as broader anaerobe coverage for perioperative prophylaxis.

The profile of CT scan findings in acute head trauma in Orotta ...

African Journals Online (AJOL)

The use of investigation modalities are influenced by socioeconomic and cost effectiveness of the tests. Objective and methods: The purpose of the present five months observational study was to describe the profile of cranial computed tomography (CT) scan findings of 110 cases of acute head trauma in Orotta Hospital.

The Effects of Acute Stress-Induced Sleep Disturbance on Acoustic Trauma-Induced Tinnitus in Rats

Directory of Open Access Journals (Sweden)

Yiwen Zheng

2014-01-01

Full Text Available Chronic tinnitus is a debilitating condition and often accompanied by anxiety, depression, and sleep disturbance. It has been suggested that sleep disturbance, such as insomnia, may be a risk factor/predictor for tinnitus-related distress and the two conditions may share common neurobiological mechanisms. This study investigated whether acute stress-induced sleep disturbance could increase the susceptibility to acoustic trauma-induced tinnitus in rats. The animals were exposed to unilateral acoustic trauma 24 h before sleep disturbance being induced using the cage exchange method. Tinnitus perception was assessed behaviourally using a conditioned lick suppression paradigm 3 weeks after the acoustic trauma. Changes in the orexin system in the hypothalamus, which plays an important role in maintaining long-lasting arousal, were also examined using immunohistochemistry. Cage exchange resulted in a significant reduction in the number of sleep episodes and acoustic trauma-induced tinnitus with acoustic features similar to a 32 kHz tone at 100 dB. However, sleep disturbance did not exacerbate the perception of tinnitus in rats. Neither tinnitus alone nor tinnitus plus sleep disturbance altered the number of orexin-expressing neurons. The results suggest that acute sleep disturbance does not cause long-term changes in the number of orexin neurons and does not change the perception of tinnitus induced by acoustic trauma in rats.

Functional survival after acute care for severe head injury at a designated trauma center in Hong Kong.

Science.gov (United States)

Taw, Benedict B T; Lam, Alan C S; Ho, Faith L Y; Hung, K N; Lui, W M; Leung, Gilberto K K

2012-07-01

Severe head injury is known to be a major cause of early mortalities and morbidities. Patients' long-term outcome after acute care, however, has not been widely studied. We aim to review the outcome of severely head-injured patients after discharge from acute care at a designated trauma center in Hong Kong. This is a retrospective study of prospectively collected data of patients admitted with severe head injuries between 2004 and 2008. Patients' functional status post-discharge was assessed using the Extended Glasgow Outcome Score (GOSE). Of a total of 1565 trauma patients, 116 had severe head injuries and 41 of them survived acute hospital care. Upon the last follow-up, 23 (56.1%) of the acute-care survivors had improvements in their GOSE, six (11.8%) experienced deteriorations, and 12 (23.5%) did not exhibit any change. The greatest improvement was observed in patients with GOSE of 5 and 6 upon discharge, but two of the 16 patients with GOSE 2 or 3 also had a good recovery. On logistic regression analysis, old age and prolonged acute hospital stay were found to be independent predictors of poor functional outcome after a mean follow-up duration of 42 months. Multidisciplinary neurorehabilitation service is an important component of comprehensive trauma care. Despite significant early mortalities, a proportion of severely head-injured patients who survive acute care may achieve good long-term functional recovery. Copyright © 2012, Asian Surgical Association. Published by Elsevier Taiwan LLC. All rights reserved.

The evaluation of fat saturation fast spin-echo T2WI for patients with acute spinal trauma

International Nuclear Information System (INIS)

Kim, Sung Gyu; Lee, Chang Jun; Lee, Myung Joon; Kang, Ik Won; Yoo, Jeong Hyun

2002-01-01

To determine the usefulness of fat saturation fast spin-echo T2WI for patients with mild acute trauma of the spine. Between July 1998 and June 2002, 36 patients with acute spinal trauma underwent MRI within four months of injury. One, whose clinal symptoms indicated neurological paralysis, was excluded form our study. A superconductive 1.0-T MRI scanner was used, and conventional T1W1, T2W1, and additional fat-saturation fast spin-echo T2W1 were performed. Two radiologists compared conventional T2-weighted sagittal imaging and fat-saturation T2-weighted sagittal imaging in terms of the extension of increased high signal intensities in soft tissue and vertebral bodies, bone marrow signal change, disk herniation, and signal change of the disk. The detection rate of focal high signal intensities in soft tissue and bone marrow was significantly higher at fat-saturation fast spin-echo T2W1 is useful the evaluation of patients with mild acute spinal trauma without neurological impairment

Distribution of emergency operations and trauma in a Swedish hospital: need for reorganisation of acute surgical care?

Directory of Open Access Journals (Sweden)

al-Ayoubi Fawzi

2012-09-01

Full Text Available Abstract Background Subspecialisation within general surgery has today reached further than ever. However, on-call time, an unchanged need for broad surgical skills are required to meet the demands of acute surgical disease and trauma. The introduction of a new subspecialty in North America that deals solely with acute care surgery and trauma is an attempt to offer properly trained surgeons also during on-call time. To find out whether such a subspecialty could be helpful in Sweden we analyzed our workload for emergency surgery and trauma. Methods Linköping University Hospital serves a population of 257 000. Data from 2010 for all patients, diagnoses, times and types of operations, surgeons involved, duration of stay, types of injury and deaths regarding emergency procedures were extracted from a prospectively-collected database and analyzed. Results There were 2362 admissions, 1559 emergency interventions; 835 were mainly abdominal operations, and 724 diagnostic or therapeutic endoscopies. Of the 1559 emergency interventions, 641 (41.1% were made outside office hours, and of 453 minor or intermediate procedures (including appendicectomy, cholecystectomy, or proctological procedures 276 (60.9% were done during the evenings or at night. Two hundred and fifty-four patients were admitted with trauma and 29 (11.4% required operation, of whom general surgeons operated on eight (3.1%. Thirteen consultants and 11 senior registrars were involved in 138 bowel resections and 164 cholecystectomies chosen as index operations for standard emergency surgery. The median (range number of such operations done by each consultant was 6 (3–17 and 6 (1–22. Corresponding figures for senior registrars were 7 (0–11 and 8 (1–39. Conclusion There was an uneven distribution of exposure to acute surgical problems and trauma among general surgeons. Some were exposed to only a few standard emergency interventions and most surgeons did not operate on a single patient

Cognitive activity limitations one year post-trauma in patients admitted to sub-acute rehabilitation after severe traumatic brain injury

DEFF Research Database (Denmark)

Sommer, Jens Bak; Norup, Anne; Poulsen, Ingrid

2013-01-01

Objective: To examine cognitive activity limitations and predictors of outcome 1 year post-trauma in patients admitted to sub-acute rehabilitation after severe traumatic brain injury. Subjects: The study included 119 patients with severe traumatic brain injury admitted to centralized sub-acute re......Objective: To examine cognitive activity limitations and predictors of outcome 1 year post-trauma in patients admitted to sub-acute rehabilitation after severe traumatic brain injury. Subjects: The study included 119 patients with severe traumatic brain injury admitted to centralized sub......-acute rehabilitation in the Eastern part of Denmark during a 5-year period from 2005 to 2009. Methods: Level of consciousness was assessed consecutively during rehabilitation and at 1 year post-trauma. Severity of traumatic brain injury was classified according to duration of post-traumatic amnesia. The cognitive...... subscale of Functional Independence MeasureTM (Cog-FIM) was used to assess cognitive activity limitations. Multivariate logistic regression analyses were performed to identify predictors of an independent level of functioning. Results: The majority of patients progressed to a post-confusional level...

Thrombelastography and biomarker profiles in acute coagulopathy of trauma: a prospective study

Directory of Open Access Journals (Sweden)

Larsen Claus F

2011-10-01

Full Text Available Abstract Background Severe injury induces an acute coagulopathy associated with increased mortality. This study compared the Thrombelastography (TEG and biomarker profiles upon admission in trauma patients. Methods Prospective observational study of 80 trauma patients admitted to a Level I Trauma Centre. Data on demography, biochemistry including standard coagulation tests, hematology, transfusions, Injury Severity Score (ISS and TEG were recorded. Retrospective analysis of thawed plasma/serum for biomarkers reflecting tissue injury (histone-complexed DNA fragments, sympathoadrenal activation (adrenaline, noradrenaline, coagulation activation/inhibition and fibrinolysis (sCD40L, protein C, activated Protein C, tissue-type plasminogen activator, plasminogen activator inhibitor-1, D-dimer, prothrombinfragment 1+2, plasmin/α2-antiplasmin complex, thrombin/antithrombin complex, tissue factor pathway inhibitor, antithrombin, von willebrand factor, factor XIII. Comparison of patients stratified according to ISS/TEG maximum clot strength. Linear regression analysis of variables associated with clot strength. Results Trauma patients had normal (86%, hypercoagulable (11% or hypocoagulable (1% TEG clot strength; one had primary hyperfibrinolysis. Hypercoagulable patients had higher age, fibrinogen and platelet count (all p 10 red blood cells the initial 24 h. Patients with normal or hypercoagulable TEG clot strength had comparable biomarker profiles, but the few patients with hypocoagulable TEG clot strength and/or hyperfibrinolysis had very different biomarker profiles. Increasing ISS was associated with higher levels of catecholamines, histone-complexed DNA fragments, sCD40L, activated protein C and D-dimer and reduced levels of non-activated protein C, antithrombin, fibrinogen and factor XIII (all p 26. In patients with ISS > 26, adrenaline and sCD40L were independently negatively associated with clot strength. Conclusions Trauma patients displayed

Use of the WHO surgical safety checklist in trauma and orthopaedic patients.

Science.gov (United States)

Sewell, Mathew; Adebibe, Miriam; Jayakumar, Prakash; Jowett, Charlie; Kong, Kin; Vemulapalli, Krishna; Levack, Brian

2011-06-01

The World Health Organisation (WHO) recommends routine use of a surgical safety checklist prior to all surgical operations. The aim of this study was to prospectively audit checklist use in orthopaedic patients before and after implementation of an educational programme designed to increase use and correlate this with early complications, mortality and staff perceptions. Data was collected on 480 patients before the educational program and 485 patients after. Pre-training checklist use was 7.9%. The rates of early complications and mortality were 8.5% and 1.9%, respectively. Forty-seven percent thought the checklist improved team communication. Following an educational program, checklist use significantly increased to 96.9% (RR12.2; 95% CI 9.0-16.6). The rate of early complications and mortality was 7.6% (RR 0.89; 95% CI 0.58-1.37) and 1.6% (RR 0.88; 95% CI 0.34-2.26), respectively. Seventy-seven percent thought the checklist improved team communication. Checklist use was not associated with a significant reduction in early complications and mortality in patients undergoing orthopaedic surgery. Education programs can significantly increase accurate use and staff perceptions following implementation.

Cumulative Exposure to Prior Collective Trauma and Acute Stress Responses to the Boston Marathon Bombings

OpenAIRE

Garfin, DR; Holman, EA; Silver, RC

2015-01-01

© The Author(s) 2015 The role of repeated exposure to collective trauma in explaining response to subsequent community-wide trauma is poorly understood. We examined the relationship between acute stress response to the 2013 Boston Marathon bombings and prior direct and indirect media-based exposure to three collective traumatic events: the September 11, 2001 (9/11) terrorist attacks, Superstorm Sandy, and the Sandy Hook Elementary School shooting. Representative samples of residents of metrop...

Acute transfusion-related abdominal injury in trauma patients: a case report.

Science.gov (United States)

Michel, P; Wähnert, D; Freistühler, M; Laukoetter, M G; Rehberg, S; Raschke, M J; Garcia, P

2016-10-19

Secondary abdominal compartment syndrome is well known as a life-threatening complication in critically ill patients in an intensive care unit. Massive crystalloid fluid resuscitation has been identified as the most important risk factor. The time interval from hospital admittance to the development of manifest abdominal compartment syndrome is usually greater than 24 hours. In the absence of any direct abdominal trauma, we observed a rapidly evolving secondary abdominal compartment syndrome shortly after hospital admittance associated with massive transfusion of blood products and only moderate crystalloid resuscitation. We report the case of an acute secondary abdominal compartment syndrome developing within 3 to 4 hours in a 74-year-old polytraumatized white woman. Although multiple fractures of her extremities and a B-type pelvic ring fracture were diagnosed by a full body computed tomography scan, no intra-abdominal injury could be detected. Hemorrhagic shock with a drop in her hemoglobin level to 5.7 g/dl was treated by massive transfusion of blood products and high doses of catecholamines. Shortly afterwards, her pulmonary gas exchange progressively deteriorated and mechanical ventilation became almost impossible with peak airway pressures of up to 60 cmH 2 O. Her abdomen appeared rigid and tense accompanied by a progressive hemodynamic decompensation necessitating mechanic cardiopulmonary resuscitation. Although preoperative computed tomography scans showed no signs of intra-abdominal fluid, a decompressive laparotomy under cardiopulmonary resuscitation conditions was performed and 2 liters of ascites-like fluid disgorged. Her hemodynamics and pulmonary ventilation improved immediately. This case report describes for the first time acute secondary abdominal compartment syndrome in a trauma patient, evolving in a very short time period. We hypothesize that the massive transfusion of blood products along with high doses of catecholamines triggered the acute

The First World War and its influence on the development of orthopaedic surgery.

Science.gov (United States)

Scotland, T

2014-01-01

By December 1914, overwhelming numbers of soldiers with infected musculoskeletal wounds had filled hospitals in France and Britain. Frequently initial management had been inadequate. In 1915, patients with orthopaedic wounds were segregated for the first time when Robert Jones established an experimental orthopaedic unit in Alder Hey Hospital, Liverpool. In 1916 he opened the first of 17 orthopaedic centres in Britain to surgically treat and rehabilitate patients. Henry Gray from Aberdeen emerged as the leading authority in the management of acute musculoskeletal wounds in casualty clearing stations in France and Flanders. Gray had particular expertise in dealing with compound fractures of the femur for which he documented an 80% mortality rate in 1914-15.

Quantification of facial contamination with blood during orthopaedic procedures.

LENUS (Irish Health Repository)

Collins, D

2012-02-03

Operative surgery exposes the surgeon to possible blood-borne infections. Risks include pen-etrating injuries and conjunctival contact with infected blood. Visor masks worn during orthopaedic trauma procedures were assessed for blood contamination using computer analysis. This was found to be present on 86% of masks, of which only 15% was recognized by the surgeon intraoperatively. Of the blood splashes 80% were less than 0.6mm in diameter. We conclude that power instrumentation produces a blood particulate mist causing considerable microscopic, facial contamination which is a significant risk to the surgeon.

A review of the use of common antiplatelet agents in orthopaedic practice.

LENUS (Irish Health Repository)

Dineen, P F

2010-09-01

Antiplatelet agents are widely prescribed for the primary and secondary prevention of cardiovascular events. A common clinical problem facing orthopaedic and trauma surgeons is how to manage patients receiving these agents who require surgery, either electively or following trauma. The dilemma is to balance the risk of increased blood loss if the antiplatelet agents are continued peri-operatively against the risk of coronary artery\\/stent thrombosis and\\/or other vascular event if the drugs are stopped. The traditional approach of stopping these medications up to two weeks before surgery appears to pose significant danger to patients and may require review. This paper covers the important aspects regarding the two most commonly prescribed antiplatelet agents, aspirin and clopidogrel.

Acute pulmonary injury induced by experimental muscle trauma Lesão pulmonar aguda induzida por trauma muscular experimental

Directory of Open Access Journals (Sweden)

Márcia Andréa da Silva Carvalho Sombra

2011-01-01

Full Text Available PURPOSE: To develop an easily reproducible model of acute lung injury due to experimental muscle trauma in healthy rats. METHODS: Eighteen adult Wistar rats were randomized in 3 groups (n=6: G-1- control, G-2 - saline+trauma and G-3 - dexamethasone+trauma. Groups G-1 and G-2 were treated with saline 2,0ml i.p; G-3 rats were treated with dexamethasone (DE (2 mg/kg body weight i.p.. Saline and DE were applied 2h before trauma and 12h later. Trauma was induced in G-2 and G-3 anesthetized (tribromoethanol 97% 100 ml/kg i.p. rats by sharp section of anterior thigh muscles just above the knee, preserving major vessels and nerves. Tissue samples (lung were collected for myeloperoxidase (MPO assay and histopathological evaluation. RESULTS: Twenty-four hours after muscle injury there was a significant increase in lung neutrophil infiltration, myeloperoxidase activity and edema, all reversed by dexamethasone in G-3. CONCLUSION: Trauma by severance of thigh muscles in healthy rats is a simple and efficient model to induce distant lung lesions.OBJETIVO: Desenvolver um modelo facilmente reprodutível de lesão pulmonar aguda decorrente de trauma muscular experimental em ratos sadios. MÉTODOS: Dezoito ratos Wistar adultos foram randomizados em 3 grupos (n=6: G-1-controle, G-2 - trauma+salina e G-3 - trauma+dexametasona. Grupos G-1 e G-2 foram tratados com salina 2,0 ml ip, G-3 ratos foram tratados com dexametasona (DE (2 mg/kg peso corporal ip. Salina e DE foram aplicadas 2h antes e 12h depois do trauma. Trauma foi induzido em ratos G-2 e G-3 anestesiados (tribromoetanol 97% de 100 ml/kg, i.p. por secção da musculatura anterior da coxa logo acima da articulação do joelho, preservando os grandes vasos e nervos. Amostras de tecido (pulmão foram coletadas para avaliação da mieloperoxidase (MPO, e exames histopatológicos. RESULTADOS: Vinte e quatro horas após a indução da lesão muscular houve um aumento significativo na infiltração de neutr

Obesity Is Associated With More Complications and Longer Hospital Stays After Orthopaedic Trauma.

Science.gov (United States)

Childs, Benjamin R; Nahm, Nickolas J; Dolenc, Andrea J; Vallier, Heather A

2015-11-01

The objective of this study was to characterize relationships between obesity and initial hospital stay, including complications, in patients with multiple system trauma and surgically treated fractures. Prospective, observational. Level 1 trauma center. Three hundred seventy-six patients with an Injury Severity Score greater than 16 and mechanically unstable high-energy fractures of the femur, pelvic ring, acetabulum, or spine requiring stabilization. Data for obese (body mass index ≥ 30) versus nonobese patients included presence of pneumonia, deep vein thrombosis, pulmonary embolism, infection, organ failure, and mortality. Days in ICU and hospital, days on ventilator, transfusions, and surgical details were documented. Complications occurred more often in obese patients (38.0% vs. 28.4%, P = 0.03), with more acute renal failure (5.70% vs. 1.38%, P = 0.02) and infection (11.4% vs. 5.50%, P = 0.04). Days in ICU and mechanical ventilation times were longer for obese patients (7.06 vs. 5.25 days, P = 0.05 and 4.92 vs. 2.90 days, P = 0.007, respectively). Mean total hospital stay was also longer for obese patients (12.3 vs. 9.79 days, P = 0.009). No significant differences in rates of mortality, multiple organ failure, or pulmonary complications were noted. Medically stable obese patients were almost twice as likely to experience delayed fracture fixation due to preference of the surgeon and were more likely to experience delay overall (26.0% vs. 16.1%; P = 0.02). Mean time from injury to fixation was 34.9 hours in obese patients versus 23.7 hours in nonobese patients (P = 0.03). Obesity was noted among 42% of our trauma patients. In obese patients, complications occurred more often and hospital and ICU stays were significantly longer. These increases are likely to be associated with greater hospital costs. Surgeon decision to delay procedures in medically stable obese patients may have contributed to these findings; definitive fixation was more likely to be

Building a successful trauma practice in a community setting.

Science.gov (United States)

Althausen, Peter L

2011-12-01

The development of a busy community-based trauma practice is a multifaceted endeavor that requires good clinical judgment, business acumen, interpersonal skills, and negotiation tactics. Private practice is a world in which perfect outcomes are expected and efficiency is paramount. Successful operative outcomes are dependent on solid clinical training, good preoperative planning, and communication with mentors when necessary. Private practitioners must display confidence, polite behavior, and promptness. Maintaining availability for consultation from emergency room physicians, private practice physicians, and local orthopaedic surgeons is a powerful marketing tool. Orthopaedic trauma surgery has been shown to be a profitable field for hospitals and private practitioners. However, physician success depends on a sound understanding of hospital finance, marketing skills, and knowledge of billing and coding. As the financial pressures of medical care increase, hospital negotiation will be paramount, and private practitioners must combine clinical and business skills to provide good patient care while maintaining independence and financial security.

The Experience and Effectiveness of Nurse Practitioners in Orthopaedic Settings: A Comprehensive Systematic Review.

Science.gov (United States)

Taylor, Anita; Staruchowicz, Lynda

nurse practitioners in Australia. In order for the nurse practitioner to be endorsed by the Australian Health Practitioner Regulation Agency (AHPRA) to practise as a nurse practitioner they must have met the competency standards and be endorsed to practise by the Nursing and Midwifery Board of Australia (NMBA) as a nurse practitioner under section 95 of the National Law. The nurse practitioner's endorsement in Australia is contextualised by their scope of practice, as is the case internationally.At September 2011, 450 endorsed nurse practitioners were nationally registered with AHPRA; 54 of these were endorsed to practise in South Australia. The first orthopaedic nurse practitioner was authorised in South Australia in 2005. To date there are eight endorsed orthopaedic nurse practitioners in Australia authorised to practise in a diverse range of orthopaedic settings that include acute care, community care, outpatient settings, rehabilitation, private practice and rural settings. The current scope of practice for Australian orthopaedic nurse practitioners spans the clinical range of trauma, arthroplasty, fragility fracture and ortho-geriatric care, surgical care: spinal/neurology and paediatric care. Orthopaedic nurse practitioners work within contemporary orthopaedic/musculoskeletal client disease models. These clinical models of care articulate the health care needs of populations living with musculoskeletal conditions, disorders and disease. Osteoarthritis and osteoporosis are 'highly prevalent long term [musculoskeletal] conditions known to predominantly affect the elderly and comprise the most common cause of disability in Australia'. Musculoskeletal trauma or injury as a result of an 'external force' such as vehicle accident, a fall, industrial or home environment accident or assault comprises a leading cause of hospital admission that requires orthopaedic management and care.There is some evidence to suggest that orthopaedic nursing is a 'specialty under threat' as

Acute unilateral foot drop as a result of direct blunt trauma to the ...

African Journals Online (AJOL)

This is a case report of an acute unilateral foot drop which occurred during a professional mixed martial arts (MMA) contest, specifically as a result of direct blunt trauma to the left peroneal nerve, without an accompanying fracture of the fibula. Keywords: foot extensor weakness, gait abnormality, contact sports, mixed martial ...

[The Summer School of the German Society for Orthopaedics and Traumatology - A Success Story].

Science.gov (United States)

Merschin, D; Mutschler, M; Stange, R; Kopschina, C; Schüttrumpf, J P; Doepfer, A K; Achatz, G; Niethard, M; Hoffmann, R; Kladny, B; Perl, M; Münzberg, M

2016-10-01

Background: It has been known for several years that orthopaedic and trauma clinics suffer from a shortage of young people, due to the substantial loss in attractiveness. The Youth Forum OU has been addressing this problem for many years, by initiating many projects such as the Summer School to counteract this trend. The purpose of this research is to evaluate the success of Summer Schools since 2009. Methods: The Youth Forum OU performed a survey in December 2014 to answer the research question on the basis of an internet-based poll of the student participants in all Summer Schools between 2009 and 2014. Following data cleansing, 121 students and former students were included in the survey. Results: Seventy-two completed questionnaires were collected and included in the evaluation. The survey included 40 % of Summer School participants, with a mean age of 27.3 years (SD ± 2.95); 50 % were female. Participation in the Summer School helped 50 % of the respondents to decide to start advanced study in orthopaedics and/or traumatology (OU). One third of these Summer School participants had already finished a university degree; 100 % are now residents in orthopaedics and/or traumatology. Regardless of prior plans, 87.2 % of participants are now residents in OU. Thirty-three are still students: 78.8 % have already decided to work in OU. The survey also served to identify the factors positively and negatively associated with OU. Unfavourable factors included the reputation of OU, and the difficulty of reconciling family and work. Favourable factors included surgical work and personal experience during university studies. Discussion: The aim of this study was to evaluate whether the efforts of the Youth Forum OU, the German Society for Orthopaedics and Traumatology (DGOU) and the local hospitals lead to increased interest in OU. The answer to this question is positive. This is particularly true for those students who did not plan to become an orthopaedic or

[Orthopaedics' megalomania - myth or mobbing?

Science.gov (United States)

Gundtoft, Per Hviid; Brand, Eske; Klit, Jakob; Weisskirchner, Kristoffer Barfod

2016-12-12

It is a general impression in the world of medicine that orthopaedic surgeons differ from doctors of other specialities in terms of intellect and self-confidence. The purpose of this study was to evaluate the self-confidence of orthopaedics. We asked doctors from 30 different specialities to fill out a questionnaire. In addition to this, the participating orthopaedics were asked to rate their self-perceived surgical skills. In all, 120 orthopaedics and 416 non-orthopaedic doctors completed the questionnaire. There was no difference in GSE scores between orthopaedics and other doctors (p = 0.58). 98% of young orthopaedics estimated that their surgical talent was average or above average when compared with their colleagues on the same level of education. 72% believed that they were "equally talented", "more talented", or "far more talented" than their colleagues on a higher level of education. 76% believed that when assisting a senior surgeon the patients would "sometimes" (60%), "often" (14%) or "always" (2%) be better off if they were the ones performing the operation. More orthopaedics than non-orthopaedics believed that their speciality was regarded as one of the least important specialities in the world of medicine (p = 0.001). Orthopaedic surgeons in general are not more self-confident than other doctors or the average population, but young orthopaedic surgeons have a very high level of confidence in their own operation skills. none. none.

Survey of 2582 Cases of Acute Orthopedic Trauma

Science.gov (United States)

Soleymanha, Mehran; Mobayen, Mohammadreza; Asadi, Kamran; Adeli, Alborz; Haghparast-Ghadim-Limudahi, Zahra

2014-01-01

Background: Orthopedic injuries are among the most common causes of mortality, morbidity, hospitalization, and economic burden in societies. Objectives: In this research, we study the prevalence of different types of trauma requiring orthopedic surgery. Patients and Methods: We conducted a cross-sectional study on 2582 patients with acute orthopedic injuries admitted to the orthopedic emergency ward at the Poursina Hospital (a referral center in Guilan province (northern Iran), during December 2010 through September 2011. Patients were examined and the data collection form was filled for each patient. Data were analyzed by SPSS software version 19 and were listed in tables. Results: Of 2582 included cases, 1940 were male and 642 were female, with a mean age of 34.5 years. Most injuries were seen in the 25 to 44 year age group from rural areas. The highest frequency of trauma related to falls. On the other hand, bicycling and shooting had the lowest frequencies. There were 18 cases with limb amputation. Overall, 66.5% of patients had fractures, 5% had soft tissue lacerations, and 10% had dislocations. Conclusions: Identification of risk factors and methods of prevention is one of the most important duties of healthcare systems. Devising plans to minimize these risk factors and familiarizing people with them is prudent. PMID:25717444

The evaluation of fat saturation fast spin-echo T2W1 for patients with acute spinal trauma

International Nuclear Information System (INIS)

Kim, Sung Gyu; Lee, Chang Jun; Lee, Myung Joon; Kang, Ik Won; Yoo, Jeong Hyun

2002-01-01

To determine the usefulness of fat saturation fast spin-echo T2W1 for patients with mild acute trauma of the spine. Between July 1998 and June 2002, 36 patients with acute spinal trauma underwent MRI within four months of injury. One, whose clinal symptoms indicated neurological paralysis, was excluded form our study. A superconductive 1.0-T MRI scanner was used, and conventional T1W1, T2W1, and additional fat-saturation fast spin-echo T2W1 were performed. Two radiologists compared conventional T2-weighted sagittal imaging and fat-saturation T2-weighted sagittal imaging in terms of the extension of increased high signal intensities in soft tissue and vertebral bodies, bone marrow signal change, disk herniation, and signal change of the disk. The detection rate of focal high signal intensities in soft tissue and bone marrow was significantly higher at fat-saturation fast spin-echo T2W1 than at conventional T2W1. Fat-saturation fast spin-echo T2W1 is useful for the evaluation of patients with mild acute spinal trauma without neurological impairment

The Torg-Pavlov ratio for the prediction of acute spinal cord injury after a minor trauma to the cervical spine.

Science.gov (United States)

Aebli, Nikolaus; Wicki, Anina G; Rüegg, Tabea B; Petrou, Nassos; Eisenlohr, Heidrun; Krebs, Jörg

2013-06-01

Acute cervical spinal cord injury (SCI) has been observed in some patients after a minor trauma to the cervical spine. The discrepancy between the severity of the trauma and the clinical symptoms has been attributed to spinal canal stenosis. However, to date, there is no universally established radiological parameter for identifying critical spinal stenosis in these patients. The spinal canal-to-vertebral body ratio (Torg-Pavlov ratio) has been proposed for assessing developmental spinal canal stenosis. The relevance of the Torg-Pavlov ratio for predicting the occurrence and severity of acute cervical SCI after a minor trauma to the cervical spine has not yet been established. To investigate the Torg-Pavlov ratio values of the cervical spine in patients suffering from acute cervical SCI after a minor trauma to the cervical spine and the use of the Torg-Pavlov ratio for identifying patients at risk of cervical SCI and predicting the severity and course of symptoms. Retrospective radiological study of consecutive patients. Forty-five patients suffering from acute cervical SCI and 68 patients showing no neurologic symptoms after a minor trauma to the cervical spine. Midvertebral sagittal cervical spinal canal diameter and the sagittal vertebral body diameter. Calculation of the Torg-Pavlov ratio values. Conventional lateral radiographs of the cervical spine (C3-C7) were analyzed to determine the Torg-Pavlov ratio values. Receiver operating characteristic curves were calculated for evaluating the classification accuracy of the Torg-Pavlov ratio for predicting SCI. The Torg-Pavlov ratio values in the SCI group were significantly (pPavlov ratio cutoff value of 0.7 yielded the greatest positive likelihood ratio for predicting the occurrence of SCI. However, there were no significant differences in the Torg-Pavlov ratio values between the different American Spinal Injury Association Impairment Score groups and between patients with complete, partial, and no recovery of

The 2016 American Orthopaedic Association-Japanese Orthopaedic Association Traveling Fellowship.

Science.gov (United States)

Nandi, Sumon; Cho, Samuel K; Freedman, Brett A; Firoozabadi, Reza

2017-06-07

The American Orthopaedic Association-Japanese Orthopaedic Association (AOA-JOA) Traveling Fellowship, which began in 1992 as a collaborative effort between the 2 orthopaedic communities, is aimed at fostering leadership among early-career surgeons through clinical, academic, and cultural exchange. Over 3 weeks, we experienced an extraordinary journey that led us across nearly 800 miles of the picturesque Japanese countryside, with stops at 6 distinguished academic centers. The opportunity to become personally acquainted with orthopaedic leaders in Japan, learn from their experiences, and immerse ourselves in the ancient and storied culture of a beautiful country was one that we will not soon forget. Along the way, we accumulated a wealth of information while enjoying the legendary hospitality of the Japanese people. There is a ubiquitous challenge in delivering cost-effective, accessible health care while maintaining a commitment to education and research. The U.S. orthopaedic community may take solace in the fact that our Japanese colleagues stand with us as partners in this pursuit, and our relationship with them continues to grow stronger through endeavors such as the AOA-JOA Traveling Fellowship. We look forward to honoring our Japanese colleagues in 2017 when we host them in the United States.

Professional liability in orthopaedics and traumatology in Italy.

Science.gov (United States)

Tarantino, Umberto; Giai Via, Alessio; Macrì, Ernesto; Eramo, Alessandro; Marino, Valeria; Marsella, Luigi Tonino

2013-10-01

Interest in medical errors has increased during the last few years owing to the number of medical malpractice claims. Reasons for the increasing number of claims may be related to patients' higher expectations, iatrogenic injury, and the growth of the legal services industry. Claims analysis provides helpful information in specialties in which a higher number of errors occur, highlighting areas where orthopaedic care might be improved. We determined: (1) the number of claims involving orthopaedics and traumatology in Rome; (2) the risk of litigation in elective and trauma surgery; (3) the most common surgical procedures involved in claims and indemnity payments; (4) the time between the adverse medical event and the judgment date; and (5) issues related to informed consent. We analyzed 1925 malpractice judgments decided in the Civil Court of Rome between 2004 and 2010. In total, 243 orthopaedics claims were filed, and in 75% of these cases surgeons were found liable; 149 (61%) of these resulted from elective surgery. Surgical teams were sued in 30 claims and found liable in 22. The total indemnity payment ordered was more than €12,350,000 (USD 16,190,000). THA and spinal surgery were the most common surgical procedures involved. Inadequate informed consent was reported in 5.3% of cases. Our study shows that careful medical examination, accurate documentation in medical records, and adequate informed consent might reduce the number of claims. We suggest monitoring of court judgments would be useful to develop prevention strategies to reduce claims.

[Management of war orthopaedic injuries in recent armed conflicts].

Science.gov (United States)

Frank, M; Mathieu, L

2013-01-01

The extremities continue to be the most frequent sites of wounding during armed conflicts despite the change of combat tactics, soldier armour and battlefield medical support. Due to the advances in prehospital care and timely transport to the hospital, orthopaedic surgeons deal with severe and challenging injuries of the limbs. In contrast to civilian extremity trauma, the most combat-related injuries are open wounds that often have infection-related complications. Data from two recent large armed conflicts (Iraq, Afghanistan) show that extremity injuries are associated with a high complication rate, morbidity and healthcare utilization. A systematic approach that consists of sequential surgical care and good transport capabilities can reduce the complication rate of these injuries. New medical technologies have been implemented in the treatment strategy during the last decade. This article reviews the published scientific data and current opinions on combat-related extremity injuries. Key words: extremity, combat, trauma, medical support system.

Incidence and predictors of new-onset constipation during acute hospitalisation after stroke.

Science.gov (United States)

Lim, S-F; Ong, S Y; Tan, Y L; Ng, Y S; Chan, Y H; Childs, C

2015-04-01

We investigated new-onset constipation in patients with stroke compared with orthopaedic conditions and explored the predictors associated with constipation during acute hospitalisation. This was a prospective matched cohort study of 110 patients comparing stroke patients (n = 55) with orthopaedic patients (n = 55) admitted to a large tertiary acute hospital. Both cohorts were matched by age and sex. The incidence of new-onset constipation which occurred during a patient's acute hospitalisation was determined. Demographics, comorbidity, clinical factors, laboratory parameters and medications were evaluated as possible predictors of constipation. The incidence of new-onset constipation was high for both stroke (33%) and orthopaedic patients (27%; p = 0.66). Seven stroke patients (39%) and four orthopaedic patients (27%) developed their first onset of constipation on day 2 of admission. Mobility gains (RR 0.741, p constipation. Bedpan use (RR 2.058, p constipation. New-onset constipation is common among patients admitted for stroke and orthopaedic conditions during acute hospitalisation. The early occurrence, on day 2 of admission, calls for prompt preventive intervention for constipation. © 2015 John Wiley & Sons Ltd.

Assessing the gap between the acute trauma workload and the capacity of a single rural health district in South Africa. What are the implications for systems planning?

Science.gov (United States)

Clarke, D L; Aldous, C; Thomson, S R

2014-06-01

This study focuses on a single rural health district in South Africa, and attempts to establish the burden of disease and to review the capacity of the district hospitals to deal with this load. Ethical approval to undertake this study was obtained from both the University of Kwa-Zulu Natal and the Department of Health. The audit was performed over a 6-month period in the four district hospitals of rural Sisonke District. There were four components to this audit. 1. Information on the hospital incidence of acute trauma in Sisonke was also sourced from the epidemiology unit of the Department of Health in Pietermaritzburg 2. Each of the district hospitals was visited and the medical manager was interviewed. The medical manager was asked to complete the World Health Organization's Tool for Situational Analysis to Assess Emergency and Essential Surgical Care. (SAT). 3. The operative registers were reviewed to determine the number of index cases for trauma. This information was used to determine the unmet need of acute trauma in the district. 4. Each hospital was classified according to the Trauma Society of South Africa (TSSA) guidelines for levels of trauma care. The annual incidence of trauma in the Sisonke District is estimated to be 1,590 per 100,000 population. Although there appeared to be adequate infrastructure in the district hospitals, the SAT revealed significant deficits in terms of capacity of staff to adequately treat and triage acute trauma patients. There is a significant unmet need for trauma care in Sisonke. The four district hospitals can best be classified as Level IV centers of trauma care. There is a significant burden of trauma in the Sisonke District, yet the capacity to deal with this burden is inadequate. Although the physical infrastructure is adequate, the deficits relate to human resources. The strategic choices are between enhancing the district hospitals' capacity to deal with acute trauma, or deciding to bypass them completely and

Pattern of surgical procedures performed in the orthopaedic units of a tertiary hospital in South West Nigeria

Directory of Open Access Journals (Sweden)

Thomas O Adekoya-Cole

2016-01-01

Full Text Available Background: Lagos University Teaching Hospital (LUTH is one of the foremost teaching institutions in Nigeria. It is a recognized training institution for residency training in Nigeria. However, a thorough evaluation of the procedures being undertaken by the orthopaedic teams in this centre and the impact on the type of training being passed on to the resident doctors in training is the focus of this paper. Objectives: To determine the pattern of procedures performed by the orthopaedic units of the Department of Surgery, LUTH with a view to import the findings in re-organizing its structure based on service requirement, manpower allocation and to make recommendation. Methods: We retrospectively reviewed data including age, sex, procedures and leading surgeons retrieved from all our operating theatres over a period from 1st January 2010 to 31st December 2011. The data retrieved was analyzed. Results: A total 741 procedures were performed over the 2 year period. More male patients (58.5% had procedures performed on them than the female patients. The mean age of patients treated was 37.2±15.5 years. Trauma related procedures accounted for 68.8% of the total procedures. Open reduction and internal fixation surgical operations were the most common trauma related procedure while ablative surgical operations following Diabetic Mellitus foot syndrome were the most common non-trauma related procedure performed. Conclusion: Trauma related surgery remains the most common procedures in our teaching hospital. Efforts should be made to increase the number of elective operations like Arthroplasties, Arthroscopic operations and Spinal axis correction operations being performed.

Evaluation of Pediatric Questions on the Orthopaedic In-Training Examination-An Update.

Science.gov (United States)

Murphy, Robert F; Nunez, Leah; Barfield, William R; Mooney, James F

2017-09-01

Pediatric orthopaedics is tested frequently on the Orthopaedic In-Training Examination (OITE). The most recent data on the pediatrics section of the OITE were generated from content 10 years old. The purpose of this study is to assess the pediatric orthopaedic questions on the 2011 to 2014 OITE, and to compare question categories and cognitive taxonomy with previous data. Four years (2011 to 2014) of OITE questions, answers, and references were reviewed. The number of pediatric questions per year was recorded, as well as presence of a clinical photo or imaging modality. Each question was categorized and assigned a cognitive taxonomy level. Categories included: knowledge; knowledge-treatment modalities; diagnosis; diagnosis/recognition of associated conditions; diagnosis/further studies; and diagnosis/treatment. Cognitive taxonomy levels included: simple recall, interpretation of data, and advanced problem-solving. The 3 most commonly covered topics were upper extremity trauma (17.4%), scoliosis (10.1%), and developmental dysplasia of the hip (5.7%). Compared with previous data, the percentage of pediatric questions was constant (13% vs. 14%). Categorically, the more recent OITE examinations contained significantly fewer questions testing simple knowledge (19% vs. 39%, P=0.0047), and significantly more questions testing knowledge of treatment modalities (17% vs. 9%, P=0.016) and diagnosis with associated conditions (19% vs. 9%, P=0.0034). Regarding cognitive taxonomy, there was a significant increase in the average number of questions that required advanced problem-solving (57% vs. 46%, P=0.048). Significantly more questions utilized clinical photographs and imaging studies (62% vs. 48%, P=0.012). The most common reference materials provided to support correct responses included Lovell and Winter's Pediatric Orthopaedics (25.7%) and the Journal of Pediatric Orthopaedics (23.4%). Although the percentage of pediatric questions on the OITE has remained essentially

Functional survival after acute care for severe head injury at a designated trauma center in Hong Kong

Directory of Open Access Journals (Sweden)

Benedict B.T. Taw

2012-07-01

Conclusion: Multidisciplinary neurorehabilitation service is an important component of comprehensive trauma care. Despite significant early mortalities, a proportion of severely head-injured patients who survive acute care may achieve good long-term functional recovery.

A clinical study of multiple trauma combined with acute lung injury

Directory of Open Access Journals (Sweden)

Tao Liang

2016-11-01

Full Text Available Objective: To study the changes of the contents of inflammatory mediators in serum of polytrauma patients with acute lung injury (ALI and their correlation with the disease. Methods: Patients suffering from multiple trauma combined with ALI were selected as ALI group (n = 54. Patients suffering from multiple trauma without ALI were considered as the control group (n = 117. The severity of the disease of patients in the two groups was assessed. Arterial blood was extracted for blood gas analysis. Venous blood was extracted to detect the contents of inflammatory mediators tumor necrosis factor-a, interleukin-1b (IL-1b, IL-10, granulocyte-macrophage colony stimulating factor, NO, endothelin-1. Results: The scores of injury severity score [(25.42 ± 3.58 vs. (17.03 ± 2.25], systemic inflammatory response syndrome [(3.85 ± 0.52 vs. (2.20 ± 0.36] and acute physiology and chronic health evaluation II [(92.63 ± 11.04 vs. (60.46 ± 8.87] in patients in ALI group were all significantly higher than those in the control group and its correcting shock time [(8.39 ± 1.05 vs. (5.15 ± 0.72 h] was longer than that of the control group. The amount of blood transfusion [(674.69 ± 93.52 vs. (402.55 ± 57.65 mL] was greater than that in the control group. The contents of the arterial partial pressure of oxygen [(76.65 ± 9.68 vs. (86.51 ± 10.56 mmHg], arterial blood pressure of carbon dioxide [(27.76 ± 4.82 vs. (36.78 ± 5.82 mmHg] and arterial partial pressure of oxygen/fraction of inspired oxygen [(236.94 ± 36.49 vs. (353.95 ± 47.76] were all significantly lower than those in the control group. The contents of serum tumor necrosis factor-a, IL-1b, IL- 10, granulocyte-macrophage colony stimulating factor, NO and endothelin-1 were obviously higher than those of control group and also positively correlated with the scores of injury severity score, systemic inflammatory response syndrome and acute physiology and chronic health evaluation II. Conclusions

Acute Knee Trauma: Analysis of Multidetector Computed Tomography Findings and Comparison with Conventional Radiography

International Nuclear Information System (INIS)

Mustonen, A.O.T.; Kiuru, M.J.

2005-01-01

Purpose: To evaluate the multidetector computed tomography (MDCT) findings of acute knee trauma and to compare radiography with MDCT in patients referred ta level 1 trauma center. Material and Methods: During a 5-year period, a total of 415 MDCT examinations were performed on 409 patients with acute knee trauma to reveal complex fracture anatomy or rule out a fracture. MDCT and primary radiographs were re-evaluated with respect to fracture location and trauma mechanism. Tibial plateau fractures were further analyzed depending on anatomical location: anterior-medial, anterior-lateral, posterior-lateral, and posterior-medial regions. Maximal depression of the tibial articular surface was measured. Findings on the primary knee radiographs were compared with MDCT findings. Results: Of the 409 patients, 356 (87%) had a knee fracture. A total of 451 fractures were found in all anatomic regions: distal femur ( n = 49), proximal tibia ( n 307), patella ( n = 23), and proximal fibula ( n = 72). Primary radiographs were available in 316 (76%) cases. Of these, 225 (71%) had MDCT in order to reveal the fracture anatomy better, and 91 (29%) had a subsequent MDCT after negative plain radiographs. Overall sensitivity of radiography was 83%, while negative predictive value was 49%. On radiography, tibial plateau articular depression was underestimated in all regions except when the fracture consisted of the whole half of the anterior or posterior plateau. The three main injury mechanisms were traffic accident, a simple fall, and sport. In 49 cases (15%), primary radiographs were suboptimal due to positioning. Conclusion: In severely injured patients, diagnostically sufficient radiographs are difficult to obtain, and therefore a negative radiograph is not reliable in ruling out a fracture. In these patients, MDCT is a fast and accurate examination and is also recommended in patients with tibial plateau fractures or complex knee injuries in order to evaluate the fracture adequately

SUBSPECIALIZATION IN THE FIELD OF ORTHOPAEDIC SURGERY

African Journals Online (AJOL)

provide comprehensive care of acutely injured patients. ... total hip replacement surgery, that focus on one body part can achieve ... like malnutrition, communicable diseases and trauma. ... for children treated for closed femoral shaft fractures.

X-ray signs of traumas of the cervical region of the spinal cord in the acute period

International Nuclear Information System (INIS)

Brodskaya, Z.L.

1983-01-01

The results are analyzed of an X-ray examination of 208 patients with traumas of the cervical region of the spinal column and spinal cord in the acute period of trauma. The authors proposed a scheme that included telespondylography in standard and oblique projections, flebospondylography, discography and pneumomyelography in the Schantz collar with a patient lying on the back. Four types of the spinal cord traumas were diagnosed: compression with osseous elements (76.92%), with sharp discs and strained epidural hematomas (3.85%), isolated contusion of the spinal cord (10.1%) and disorder of the spinal circulation (9.13%). Special emphasis was laid on clinicospondylographic correlations, a critical distance, congenital narrowing of the vertebral canal. The concept of traumatic decompression of the spinal cord was stressed. Symptoms of its contusion and trauma of the spinal circulation were indicated

Acute costs and predictors of higher treatment costs of trauma in New South Wales, Australia.

Science.gov (United States)

Curtis, Kate; Lam, Mary; Mitchell, Rebecca; Black, Deborah; Taylor, Colman; Dickson, Cara; Jan, Stephen; Palmer, Cameron S; Langcake, Mary; Myburgh, John

2014-01-01

Accurate economic data are fundamental for improving current funding models and ultimately in promoting the efficient delivery of services. The financial burden of a high trauma casemix to designated trauma centres in Australia has not been previously determined, and there is some evidence that the episode funding model used in Australia results in the underfunding of trauma. To describe the costs of acute trauma admissions in trauma centres, identify predictors of higher treatment costs and cost variance in New South Wales (NSW), Australia. Data linkage of admitted trauma patient and financial data provided by 12 Level 1 NSW trauma centres for the 08/09 financial year was performed. Demographic, injury details and injury scores were obtained from trauma registries. Individual patient general ledger costs (actual trauma patient costs), Australian Refined Diagnostic Related Groups (AR-DRG) and state-wide average costs (which form the basis of funding) were obtained. The actual costs incurred by the hospital were then compared with the state-wide AR-DRG average costs. Multivariable multiple linear regression was used for identifying predictors of costs. There were 17,522 patients, the average per patient cost was $10,603 and the median was $4628 (interquartile range: $2179-10,148). The actual costs incurred by trauma centres were on average $134 per bed day above AR-DRG costs-determined costs. Falls, road trauma and violence were the highest causes of total cost. Motor cyclists and pedestrians had higher median costs than motor vehicle occupants. As a result of greater numbers, patients with minor injury had comparable total costs with those generated by patients with severe injury. However the median cost of severely injured patients was nearly four times greater. The count of body regions injured, sex, length of stay, serious traumatic brain injury and admission to the Intensive Care Unit were significantly associated with increased costs (p<0.001). This

[Financing of inpatient orthopaedics and trauma surgery in the 2011 G-DRG System].

Science.gov (United States)

Franz, D; Schemmann, F; Roeder, N; Siebert, H; Mahlke, L

2011-09-01

The German DRG system forms the basis for billing inpatient hospital services. It includes not only the case groups (G-DRGs), but also copayments. This paper analyses and evaluates the relevant developments of the 2011 G-DRG system for orthopaedics and traumatology from the medical and classificatory perspective. An analysis was performed of relevant diagnoses, medical procedures and G-DRGs in the 2010 and 2011 versions based on the publications of the German DRG Institute (InEK) and the German Institute of Medical Documentation and Information (DIMDI). A number of codes for surgical measures have been newly established or modified - above all in foot surgery, arthroscopic surgery and wound surgery. Here, the identification and the correct and performance-based mapping of complex and elaborate scenarios was again the focus of the restructuring of the G-DRG system. The G-DRG structure in orthopaedics and traumatology is changed, especially for polytraumata. The allocation of common cases with a standardized treatment pattern appears to be appropriate and the reimbursement adequate. For the less common and more complex cases the 2011 G-DRG system still shows need for further modification (e.g. polytraumata, joint replacement, spine surgery). The proper integration of the modified OPS classification for foot surgery to the appropriate G-DRGs will be essential to maintain the high quality of the reimbursement structure for the future.

East African Orthopaedic Journal: Submissions

African Journals Online (AJOL)

Author Guidelines. The East African Orthopaedic Journal is published biannually by the Kenya Orthopaedics Association. Its primary objective is to give researchers in orthopaedics and ... Format should be as follows; Details of authors as for original articles, summary of not more than 200 words, introduction, case report,

The older orthopaedic patient: general considerations.

Science.gov (United States)

Potter, Jane F

2004-08-01

People older than 65 years are more likely to need elective and emergent orthopaedic surgery compared with younger persons. They also experience significant benefits. Although age-related changes increase the risk of perioperative complications, understanding those changes allows prevention or at least early recognition and treatment when problems arise. Because of comorbidities, older persons take more medications that need to be managed in the perioperative period. Care could be simplified if patients were to bring their medications to the preoperative evaluation. Central nervous system sensitivity to certain pain medications (meperidine and propoxyphene) means that these drugs are best avoided as good alternatives exist (morphine and oxycodone). Adverse reactions to drugs are an important cause of acute confusion (delirium) that often complicates orthopaedic care. Early mobilization after surgery, avoiding certain drugs, avoiding restraints (including Foley catheters), attending to hydration, promoting normal sleep, compensating for sensory disorders, and stimulating daytime activities can prevent delirium. Patients with dementia are more likely to have delirium develop and, like many older people, will present special challenges in communication and decision making. Including family members in discussions may be helpful in ensuring truly informed consent.

Blunt abdominal trauma with handlebar injury: A rare cause of traumatic amputation of the appendix associated with acute appendicitis

Directory of Open Access Journals (Sweden)

Amanda Jensen

2016-04-01

Full Text Available We describe traumatic appendicitis in a 7-year-old boy who presented after sustaining blunt abdominal trauma to his right lower abdomen secondary to bicycle handlebar injury. With diffuse abdominal pain following injury, he was admitted for observation. Computed axial tomography (CT obtained at an outside hospital demonstrated moderate stranding of the abdomen in the right lower quadrant. The CT was non-contrasted and therefore significant appendiceal distention could not be confirmed. However, there was a calcified structure in the right pelvis with trace amount of free fluid. Patient was observed with conservative management and over the course of 15 h his abdominal pain continued to intensify. With his worsening symptoms, we elected to take him for diagnostic laparoscopy. In the operating room we found an inflamed traumatically amputated appendix with the mesoappendix intact. We therefore proceeded with laparoscopic appendectomy. Pathology demonstrated acute appendicitis with fecalith. It was unclear as to whether the patient's appendicitis and perforation were secondary to fecalith obstruction, his blunt abdominal trauma or if they concurrently caused his appendicitis. Acute appendicitis is a common acute surgical condition in the pediatric population and continues to be a rare and unique cause of operative intervention in the trauma population.

The iliotibial band in acute knee trauma: patterns of injury on MR imaging

Energy Technology Data Exchange (ETDEWEB)

Mansour, Ramy; Yoong, Philip; McKean, David; Teh, James L. [Oxford University Hospitals NHS Trust, Department of Radiology, Nuffield Orthopaedic Centre, Oxford (United Kingdom)

2014-10-15

To delineate the spectrum of knee injuries associated with sprains and tears of the distal iliotibial band (ITB). A retrospective review of 200 random MRI scans undertaken for acute knee trauma was performed. Scans were excluded if there was a history of injury over 4 weeks from the time of the scan, septic arthritis, inflammatory arthropathy, previous knee surgery, or significant artefact. In each scan, the ITB was scored as normal, minor sprain (grade 1), severe sprain (grade 2), and torn (grade 3). The menisci, ligaments, and tendons of each knee were also assessed. The mean age was 27.4 years (range, 9-69 years) and 71.5 % (n = 143) of the patients were male. The ITB was injured in 115 cases (57.5 %). The next most common soft tissue structure injured was the anterior cruciate ligament (ACL) in 53.5 % of cases (n = 107). Grade 1 ITB injury was seen in 90 of these 115 cases (45 %), grade 2 injury in 20 cases, and grade 3 injury in only five cases. There is a significant association between ITB injury and ACL rupture (p < 0.05), as well as acute patellar dislocation (p < 0.05). There were ten cases of significant posterolateral corner injury, and all were associated with ITB injury, including four ITB tears. Only two cases of isolated ITB injury were seen (1 %). ITB injury is common in acute knee trauma and is associated with significant internal derangement of the knee, especially cruciate ligament rupture, posterolateral corner injury, and patellar dislocation. (orig.)

Barriers and strategies for the clinical translation of advanced orthopaedic tissue engineering protocols.

Science.gov (United States)

Madry, H; Alini, M; Stoddart, M J; Evans, C; Miclau, T; Steiner, S

2014-05-06

Research in orthopaedic tissue engineering has intensified over the last decade and new protocols continue to emerge. The clinical translation of these new applications, however, remains associated with a number of obstacles. This report highlights the major issues that impede the clinical translation of advanced tissue engineering concepts, discusses strategies to overcome these barriers, and examines the need to increase incentives for translational strategies. The statements are based on presentations and discussions held at the AO Foundation-sponsored symposium "Where Science meets Clinics 2013" held at the Congress Center in Davos, Switzerland, in September, 2013. The event organisers convened a diverse group of over one hundred stakeholders involved in clinical translation of orthopaedic tissue engineering, including scientists, clinicians, healthcare industry professionals and regulatory agency representatives. A major point that emerged from the discussions was that there continues to be a critical need for early trans-disciplinary communication and collaboration in the development and execution of research approaches. Equally importantly was the need to address the shortage of sustained funding programs for multidisciplinary teams conducting translational research. Such detailed discussions between experts contribute towards the development of a roadmap to more successfully advance the clinical translation of novel tissue engineering concepts and ultimately improve patient care in orthopaedic and trauma surgery.

Barriers and strategies for the clinical translation of advanced orthopaedic tissue engineering protocols

Directory of Open Access Journals (Sweden)

H Madry

2014-05-01

Full Text Available Research in orthopaedic tissue engineering has intensified over the last decade and new protocols continue to emerge. The clinical translation of these new applications, however, remains associated with a number of obstacles. This report highlights the major issues that impede the clinical translation of advanced tissue engineering concepts, discusses strategies to overcome these barriers, and examines the need to increase incentives for translational strategies. The statements are based on presentations and discussions held at the AO Foundation-sponsored symposium "Where Science meets Clinics 2013" held at the Congress Center in Davos, Switzerland, in September, 2013. The event organisers convened a diverse group of over one hundred stakeholders involved in clinical translation of orthopaedic tissue engineering, including scientists, clinicians, healthcare industry professionals and regulatory agency representatives. A major point that emerged from the discussions was that there continues to be a critical need for early trans-disciplinary communication and collaboration in the development and execution of research approaches. Equally importantly was the need to address the shortage of sustained funding programs for multidisciplinary teams conducting translational research. Such detailed discussions between experts contribute towards the development of a roadmap to more successfully advance the clinical translation of novel tissue engineering concepts and ultimately improve patient care in orthopaedic and trauma surgery.

Computed tomography in trauma

International Nuclear Information System (INIS)

Toombs, B.D.; Sandler, C.M.

1987-01-01

This book begins with a chapter dealing with the epidemiology and mechanisms of trauma. Trauma accounts for more lives lost in the United States than cancer and heart disease. The fact that 30%-40% of trauma-related deaths are caused by improper or delayed diagnoses or treatment emphasizes the importance of rapid and accurate methods to establish a diagnosis. Acute thoracic, abdominal, and pelvic trauma and their complications are discussed. A chapter on high-resolution CT of spinal and facial trauma and the role of three-dimensional reconstruction images is presented

Computed tomography in trauma

Energy Technology Data Exchange (ETDEWEB)

Toombs, B.D.; Sandler, C.M.

1987-01-01

This book begins with a chapter dealing with the epidemiology and mechanisms of trauma. Trauma accounts for more lives lost in the United States than cancer and heart disease. The fact that 30%-40% of trauma-related deaths are caused by improper or delayed diagnoses or treatment emphasizes the importance of rapid and accurate methods to establish a diagnosis. Acute thoracic, abdominal, and pelvic trauma and their complications are discussed. A chapter on high-resolution CT of spinal and facial trauma and the role of three-dimensional reconstruction images is presented.

International Combined Orthopaedic Research Societies: A model for international collaboration to promote orthopaedic and musculoskeletal research

Directory of Open Access Journals (Sweden)

Theodore Miclau

2014-10-01

Full Text Available In October 2013, the International Combined Orthopaedic Research Societies (ICORS; http://i-cors.org was founded with inaugural member organisations from the previous Combined Orthopaedic Research Society, which had sponsored combined meetings for more than 2 decades. The ICORS is dedicated to the stimulation of orthopaedic and musculoskeletal research in fields such as biomedical engineering, biology, chemistry, and veterinary and human clinical research. The ICORS seeks to facilitate communication with member organisations to enhance international research collaborations and to promote the development of new international orthopaedic and musculoskeletal research organisations. Through new categories of membership, the ICORS represents the broadest coalition of orthopaedic research organisations globally.

Trauma in Auckland: an overview.

Science.gov (United States)

Streat, S J; Donaldson, M L; Judson, J A

1987-07-22

Data are presented on all 569 subjects who, as a result of trauma, either died or were admitted to hospital in Auckland over a four week period. Median age was 23 with an overall 3:2 male:female ratio. Median injury severity score (ISS) was five with 9% of subjects having an ISS of 16 or more (major trauma). Blunt trauma accounted for 84% of all injuries. Life threatening injuries were most commonly to the head, thorax and abdomen while the largest number of less severe injuries were to the extremities. Eight subjects died before admission to hospital and a further six in hospital. Definitive care was given to 98% of patients at Middlemore and Auckland hospitals (including the onsite Princess Mary paediatric facility) but 26% had presented first to other hospitals and 43% of all patients were transferred from one hospital to another. The 561 patients used 6380 hospital days (including 314 intensive care days) and the following services--operating room 63%, orthopaedic ward 45%, plastic surgical ward 17%, paediatric ward 15%, neurosurgical ward 10%, general surgical ward 5%, intensive care 5% and CT scanner 4%. Only one hospital death was judged potentially preventable. This study reveals areas where trauma care could be improved, demonstrates the large amount of hospital resources required to treat trauma and particularly highlights the urgent need for studies into strategies for trauma prevention in New Zealand.

Pseudofracture: an acute peripheral tissue trauma model.

Science.gov (United States)

Darwiche, Sophie S; Kobbe, Philipp; Pfeifer, Roman; Kohut, Lauryn; Pape, Hans-Christoph; Billiar, Timothy

2011-04-18

Following trauma there is an early hyper-reactive inflammatory response that can lead to multiple organ dysfunction and high mortality in trauma patients; this response is often accompanied by a delayed immunosuppression that adds the clinical complications of infection and can also increase mortality. Many studies have begun to assess these changes in the reactivity of the immune system following trauma. Immunologic studies are greatly supported through the wide variety of transgenic and knockout mice available for in vivo modeling; these strains aid in detailed investigations to assess the molecular pathways involved in the immunologic responses. The challenge in experimental murine trauma modeling is long term investigation, as fracture fixation techniques in mice, can be complex and not easily reproducible. This pseudofracture model, an easily reproduced trauma model, overcomes these difficulties by immunologically mimicking an extremity fracture environment, while allowing freedom of movement in the animals and long term survival without the continual, prolonged use of anaesthesia. The intent is to recreate the features of long bone fracture; injured muscle and soft tissue are exposed to damaged bone and bone marrow without breaking the native bone. The pseudofracture model consists of two parts: a bilateral muscle crush injury to the hindlimbs, followed by injection of a bone solution into these injured muscles. The bone solution is prepared by harvesting the long bones from both hindlimbs of an age- and weight-matched syngeneic donor. These bones are then crushed and resuspended in phosphate buffered saline to create the bone solution. Bilateral femur fracture is a commonly used and well-established model of extremity trauma, and was the comparative model during the development of the pseudofracture model. Among the variety of available fracture models, we chose to use a closed method of fracture with soft tissue injury as our comparison to the

Prognosis of venous thromboembolism in orthopaedic surgery or trauma patients and use of thromboprophylaxis.

Science.gov (United States)

Gutiérrez Guisado, J; Trujillo-Santos, J; Arcelus, J I; Bertoletti, L; Fernandez-Capitán, C; Valle, R; Hernandez-Hermoso, J A; Erice Calvo-Sotelo, A; Nieto, J A; Monreal, M

2018-06-18

There is scarce evidence about the prognosis of venous thromboembolism in patients undergoing orthopedic surgery and in patients suffering non-surgical trauma. We used the RIETE database (Registro Informatizado de pacientes con Enfermedad Trombo Embólica) to compare the prognosis of venous thromboembolism and the use of thromboprophylaxis in patients undergoing different orthopedic procedures and in trauma patients not requiring surgery. From March 2001 to March 2015, a total of 61,789 patients were enrolled in RIETE database. Of these, 943 (1.52%) developed venous thromboembolism after elective arthroplasty, 445 (0.72%) after hip fracture, 1,045 (1.69%) after non-major orthopedic surgery and 2,136 (3.46%) after non-surgical trauma. Overall, 2,283 patients (50%) initially presented with pulmonary embolism. Within the first 90 days of therapy, 30 patients (0.66%; 95% CI 0.45-0.93) died from pulmonary embolism. The rate of fatal pulmonary embolism was significantly higher after hip fracture surgery (n = 9 [2.02%]) than after elective arthroplasty (n = 5 [0.53%]), non-major orthopedic surgery (n = 5 [0.48%]) or non surgical trauma (n = 11 [0.48%]). Thromboprophylaxis was more commonly used for hip fracture (93%) or elective arthroplasty (94%) than for non-major orthopedic surgery (71%) or non-surgical trauma (32%). Major bleeding was significantly higher after hip fracture surgery (4%) than that observed after elective arthroplasty (1.6%), non-major orthopedic surgery (1.5%) or non-surgical trauma (1.4%). Thromboprophylaxis was less frequently used in lower risk procedures despite the absolute number of fatal pulmonary embolism after non-major orthopedic surgery or non-surgical trauma, exceeded that observed after high risk procedures. Copyright © 2018 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

Utilisation of a trauma meeting handover proforma to improve trauma patient pathway.

Science.gov (United States)

Smyth, Rachel; Parton, Felicity; Trikha, Paul

2015-01-01

Decision making within orthopaedic centres predominantly occurs at the trauma meeting, where all decisions are made as a part of the multidisciplinary process. This is an essential handover process. Difficulties occur when teaching and detailed case discussions detract from the actual decision making process, leading to failure in documentation and implementing treatment plans. An audit was carried out in a busy district general hospital (DGH), assessing the quality of trauma meeting documentation in patient records, and assessing whether the introduction of a proforma document would improve this. Prospective clinical reviews were performed on all patients discussed in the trauma meeting over a one month period. Following the initial audit cycle a proforma was introduced, and the audit process was repeated at a two month and six month interval. The quality of the entries were assessed and compared to the Academy of Medical Royal Colleges Standards for the clinical structure and content of patient records, and The Royal College of Surgeons (RCS) of England Guidelines for Clinicians on Medical Records and Notes. Sixty three patient records during a one month period from 1 August 2014 found that only 16% had any documentation of the trauma meeting, none of which met the standard set at the beginning of the audit. Following the introduction of the proforma, 102 patient records were reviewed from October 2014, showing 70% had documentation of the trauma meeting. This improved further to 84% in February 2015. The proforma has provided an effective means of documenting and communicating management plans, and in turn also improved the trauma patient pathway to theatre or discharge.

Integrating technical and non-technical skills coaching in an acute trauma surgery team training: Is it too much?

Science.gov (United States)

Alken, Alexander; Luursema, Jan-Maarten; Weenk, Mariska; Yauw, Simon; Fluit, Cornelia; van Goor, Harry

2017-08-25

Research on effective integration of technical and non-technical skills in surgery team training is sparse. In a previous study we found that surgical teachers predominantly coached on technical and hardly on non-technical skills during the Definitive Surgical and Anesthetic Trauma Care (DSATC) integrated acute trauma surgery team training. This study aims to investigate whether the priming of teachers could increase the amount of non-technical skills coaching during such a training. Coaching activities of 12 surgical teachers were recorded on audio and video. Six teachers were primed on non-technical skills coaching prior to the training. Six others received no priming and served as controls. Blind observers reviewed the recordings of 2 training scenario's and scored whether the observed behaviors were directed on technical or non-technical skills. We compared the frequency of the non-technical skills coaching between the primed and the non-primed teachers and analyzed for differences according to the trainees' level of experience. Surgical teachers coached trainees during the highly realistic DSATC integrated acute trauma surgery team training. Trainees performed damage control surgery in operating teams on anesthetized porcine models during 6 training scenario's. Twelve experienced surgical teachers participated in this study. Coaching on non-technical skills was limited to about 5%. The primed teachers did not coach more often on non-technical skills than the non-primed teachers. We found no differences in the frequency of non-technical skills coaching based on the trainees' level of experience. Priming experienced surgical teachers does not increase the coaching on non-technical skills. The current DSATC acute trauma surgery team training seems too complex for integrating training on technical and non-technical skills. Patient care, Practice based learning and improvement. Copyright © 2017 Elsevier Inc. All rights reserved.

The role of social support in the relationship between mental health and posttraumatic stress disorder amongst orthopaedic patients

Directory of Open Access Journals (Sweden)

Vhuhwavho M. Maselesele

2013-05-01

Full Text Available Background: Some life-event experiences such as injuries in car accidents, gun shots and the like, can be life changing and traumatic. Objectives: The article investigated the relationship between mental health and posttraumatic stress disorder (PTSD symptoms after orthopaedic trauma, and attempted to understand whether social support moderates the relationship between mental health and PTSD. Method: A cross-sectional research model was used. Two hundred participants were selected using simple randomisation within a hospital complex in Gauteng, South Africa. The sample consisted of 110 men and 90 women (x̄ = 37.8 years, s.d. = 12.9 years. Data were collected using the Revised Civilian Mississippi Scale for PTSD, the Multidimensional Scale of Perceived Social Support (MSPSS, and the General Health Questionnaire version 28. Results: The findings of the study indicated that there is a statistically significant relationship between mental health and PTSD after orthopaedic trauma, and a positive correlation between poor mental health and PTSD (r = 0.52, n = 200, p < 0.05. However, perceived social support did not moderate mental health or PTSD, indicating that perceived social support did not significantly influence mental health or PTSD, (MSPSS B = 0.07, p = 0.66. Those with high scores on social support had a lower regression coefficient (B = 0.19 for mental health and PTSD than those who reported low social support (B = 0.26.Conclusion: There is a significant relationship between mental health and PTSD of orthopaedic patients, and social support did not moderate the relationship between mental health and PTSD.

The role of social support in the relationship between mental health and posttraumatic stress disorder amongst orthopaedic patients

Directory of Open Access Journals (Sweden)

Vhuhwavho M. Maselesele

2013-05-01

Full Text Available Background: Some life-event experiences such as injuries in car accidents, gun shots and the like, can be life changing and traumatic. Objectives: The article investigated the relationship between mental health and posttraumatic stress disorder (PTSD symptoms after orthopaedic trauma, and attempted to understand whether social support moderates the relationship between mental health and PTSD. Method: A cross-sectional research model was used. Two hundred participants were selected using simple randomisation within a hospital complex in Gauteng, South Africa. The sample consisted of 110 men and 90 women (x̄ = 37.8 years, s.d. = 12.9 years. Data were collected using the Revised Civilian Mississippi Scale for PTSD, the Multidimensional Scale of Perceived Social Support (MSPSS, and the General Health Questionnaire version 28. Results: The findings of the study indicated that there is a statistically significant relationship between mental health and PTSD after orthopaedic trauma, and a positive correlation between poor mental health and PTSD (r = 0.52, n = 200, p < 0.05. However, perceived social support did not moderate mental health or PTSD, indicating that perceived social support did not significantly influence mental health or PTSD, (MSPSS B = 0.07, p = 0.66. Those with high scores on social support had a lower regression coefficient (B = 0.19 for mental health and PTSD than those who reported low social support (B = 0.26. Conclusion: There is a significant relationship between mental health and PTSD of orthopaedic patients, and social support did not moderate the relationship between mental health and PTSD.

Acute diagnosis of spinal trauma; Akutdiagnostik des Wirbelsaeulentraumas

Energy Technology Data Exchange (ETDEWEB)

Rieger, M.; Mallouhi, A.; Jaschke, W. [Medizinische Universitaet, Universitaetsklinik fuer Radiodiagnostik, Innsbruck (Austria); El Attal, R.; Kathrein, A.; Knop, C.; Blauth, M. [Medizinische Universitaet, Universitaetsklinik fuer Unfallchirurgie, Innsbruck (Austria)

2006-06-15

Most traumatic spinal injuries result from a high-energy process and are accompanied by other injuries. Following the CCSPR study, the presence of all low-risk factors (simple trauma mechanism, fully conscious, ambulatory at any time since trauma, neck rotation exceeding 45 bilaterally) obviates the need to acutely image the cervical spine. Imaging is indicated in all other patients. Emergency spiral CT should be performed as the first imaging method in high-risk and moderate-risk patients; only in low-risk patients should conventional radiography be performed and trusted as the sole modality. The AO classification according to Magerl et al. is used for the subaxial spine, whereas the upper cervical spine should be classified separately because the anatomy is different at each level. Radiological evaluation of traumatic spinal injuries should be done systematically using the ''ABCS'' scheme. (orig.) [German] Wirbelsaeulentraumen entstehen zumeist infolge hochenergetischer Mechanismen und sind haeufig von weiteren Verletzungen begleitet. Auf eine Diagnostik der Wirbelsaeule kann laut CCSPR-Studie nur dann verzichtet werden, wenn alle Niedrigrisikofaktoren (bewusstseinsklar, gehfaehig, ausreichender Bewegungsumfang, einfacher Unfallmechanismus) erfuellt sind. Alle anderen Patienten muessen radiologisch abgeklaert werden. Dabei sollten Patienten mit einer hohen und mittleren Verletzungswahrscheinlichkeit primaer computertomographisch untersucht werden, nur bei einer geringen Verletzungswahrscheinlichkeit kann der konventionellen Diagnostik vertraut werden. Die Frakturen der subaxialen Wirbelsaeule werden nach der Magerl-AO-Klassifikation eingeteilt, wohingegen fuer die obere HWS separate Einteilungen angewandt werden. Die radiologische Beurteilung des Wirbelsaeulentraumas sollte systematisch anhand des ''ABCS''-Schemas erfolgen. (orig.)

History of orthopaedics in China: a brief review.

Science.gov (United States)

Li, Jia; Zhang, Yingze

2018-03-01

Chinese orthopaedic surgeons have made a substantial contribution to the development of orthopaedics worldwide, and traditional Chinese medicine (TCM) in orthopaedics has a very long history in China. We make a brief review of the development of orthopaedics in China, intending to pave the way for further understanding of Chinese orthopaedics for scholars all over the world. The description of fractures firstly appeared in 3600 years ago in China, and the theories, experience, and treatment strategies of TCM still play important roles in clinical diagnosis and treatment of orthopaedic disorders in our country. Western orthopaedics was first introduced into China in the early twentieth century. After decades of development, Chinese scholars have made some gratifying achievements in orthopaedics. Orthopaedics is constantly evolving, and we need to strengthen the ability of independent innovation to achieve orthopaedic surgeons' Chinese dream, and better serve our patients.

Trauma memory characteristics and the development of acute stress disorder and post-traumatic stress disorder in youth.

Science.gov (United States)

McKinnon, A; Brewer, N; Meiser-Stedman, R; Nixon, R D V

2017-03-01

The present study addresses gaps in knowledge regarding the association between trauma memory processes and posttraumatic stress responses in youth. Our primary goal was to explore the relative contribution of perceptions of trauma memory quality versus narrative trauma memory characteristics to explain overall adjustment. Children (N = 67) were interviewed within four weeks (T1) of an injury leading to hospital treatment and then again eight weeks later (T2). In each interview, the child told a trauma narrative (which were later coded), and answered the Trauma Memory Quality Questionnaire (Meiser-Stedman, Smith, Yule, & Dalgleish, 2007a), a self-report measure indexing the sensory, fragmented, and disorganised characteristics of trauma memory. They then completed measures of Acute Stress Disorder (ASD) symptoms and associated psychopathology at T1 and measures of Posttraumatic Stress (PTS) symptoms and associated psychopathology at T2. Self-reported trauma memory characteristics predicted ASD symptoms cross-sectionally at T1 and PTS symptoms prospectively over time. At both time points, self-reported trauma memory characteristics accounted for all of the unique variance in symptoms initially explained by narrative characteristics. A reduction in self-report ratings, but not the hypothesised narrative features (e.g., disorganised or lexical elements of the narrative), significantly predicted a reduction in PTS symptoms over time. The small sample size and the absence of a within-subjects narrative control were the main limitations of the study. These findings underscore the importance of self-reported trauma memory characteristics to the aetiology of PTSD. Copyright © 2016 Elsevier Ltd. All rights reserved.

Effect of painless diabetic neuropathy on pressure pain hypersensitivity (hyperalgesia after acute foot trauma

Directory of Open Access Journals (Sweden)

Tobias Wienemann

2014-11-01

Full Text Available Introduction and objective: Acute injury transiently lowers local mechanical pain thresholds at a limb. To elucidate the impact of painless (diabetic neuropathy on this post-traumatic hyperalgesia, pressure pain perception thresholds after a skeletal foot trauma were studied in consecutive persons without and with neuropathy (i.e. history of foot ulcer or Charcot arthropathy. Design and methods: A case–control study was done on 25 unselected clinical routine patients with acute unilateral foot trauma (cases: elective bone surgery; controls: sprain, toe fracture. Cases were 12 patients (11 diabetic subjects with severe painless neuropathy and chronic foot pathology. Controls were 13 non-neuropathic persons. Over 1 week after the trauma, cutaneous pressure pain perception threshold (CPPPT and deep pressure pain perception threshold (DPPPT were measured repeatedly, adjacent to the injury and at the opposite foot (pinprick stimulators, Algometer II®. Results: In the control group, post-traumatic DPPPT (but not CPPPT at the injured foot was reduced by about 15–25%. In the case group, pre- and post-operative CPPPT and DPPPT were supranormal. Although DPPPT fell post-operatively by about 15–20%, it remained always higher than the post-traumatic DPPPT in the control group: over musculus abductor hallucis 615 kPa (kilopascal versus 422 kPa, and over metatarsophalangeal joint 518 kPa versus 375 kPa (medians; case vs. control group; CPPPT did not decrease post-operatively. Conclusion: Physiological nociception and post-traumatic hyperalgesia to pressure are diminished at the foot with severe painless (diabetic neuropathy. A degree of post-traumatic hypersensitivity required to ‘pull away’ from any one, even innocuous, mechanical impact in order to avoid additional damage is, therefore, lacking.

Effect of painless diabetic neuropathy on pressure pain hypersensitivity (hyperalgesia) after acute foot trauma

Science.gov (United States)

Wienemann, Tobias; Chantelau, Ernst A.; Koller, Armin

2014-01-01

Introduction and objective Acute injury transiently lowers local mechanical pain thresholds at a limb. To elucidate the impact of painless (diabetic) neuropathy on this post-traumatic hyperalgesia, pressure pain perception thresholds after a skeletal foot trauma were studied in consecutive persons without and with neuropathy (i.e. history of foot ulcer or Charcot arthropathy). Design and methods A case–control study was done on 25 unselected clinical routine patients with acute unilateral foot trauma (cases: elective bone surgery; controls: sprain, toe fracture). Cases were 12 patients (11 diabetic subjects) with severe painless neuropathy and chronic foot pathology. Controls were 13 non-neuropathic persons. Over 1 week after the trauma, cutaneous pressure pain perception threshold (CPPPT) and deep pressure pain perception threshold (DPPPT) were measured repeatedly, adjacent to the injury and at the opposite foot (pinprick stimulators, Algometer II®). Results In the control group, post-traumatic DPPPT (but not CPPPT) at the injured foot was reduced by about 15–25%. In the case group, pre- and post-operative CPPPT and DPPPT were supranormal. Although DPPPT fell post-operatively by about 15–20%, it remained always higher than the post-traumatic DPPPT in the control group: over musculus abductor hallucis 615 kPa (kilopascal) versus 422 kPa, and over metatarsophalangeal joint 518 kPa versus 375 kPa (medians; case vs. control group); CPPPT did not decrease post-operatively. Conclusion Physiological nociception and post-traumatic hyperalgesia to pressure are diminished at the foot with severe painless (diabetic) neuropathy. A degree of post-traumatic hypersensitivity required to ‘pull away’ from any one, even innocuous, mechanical impact in order to avoid additional damage is, therefore, lacking. PMID:25397867

Effect of painless diabetic neuropathy on pressure pain hypersensitivity (hyperalgesia) after acute foot trauma.

Science.gov (United States)

Wienemann, Tobias; Chantelau, Ernst A; Koller, Armin

2014-01-01

Acute injury transiently lowers local mechanical pain thresholds at a limb. To elucidate the impact of painless (diabetic) neuropathy on this post-traumatic hyperalgesia, pressure pain perception thresholds after a skeletal foot trauma were studied in consecutive persons without and with neuropathy (i.e. history of foot ulcer or Charcot arthropathy). A case-control study was done on 25 unselected clinical routine patients with acute unilateral foot trauma (cases: elective bone surgery; controls: sprain, toe fracture). Cases were 12 patients (11 diabetic subjects) with severe painless neuropathy and chronic foot pathology. Controls were 13 non-neuropathic persons. Over 1 week after the trauma, cutaneous pressure pain perception threshold (CPPPT) and deep pressure pain perception threshold (DPPPT) were measured repeatedly, adjacent to the injury and at the opposite foot (pinprick stimulators, Algometer II(®)). In the control group, post-traumatic DPPPT (but not CPPPT) at the injured foot was reduced by about 15-25%. In the case group, pre- and post-operative CPPPT and DPPPT were supranormal. Although DPPPT fell post-operatively by about 15-20%, it remained always higher than the post-traumatic DPPPT in the control group: over musculus abductor hallucis 615 kPa (kilopascal) versus 422 kPa, and over metatarsophalangeal joint 518 kPa versus 375 kPa (medians; case vs. control group); CPPPT did not decrease post-operatively. Physiological nociception and post-traumatic hyperalgesia to pressure are diminished at the foot with severe painless (diabetic) neuropathy. A degree of post-traumatic hypersensitivity required to 'pull away' from any one, even innocuous, mechanical impact in order to avoid additional damage is, therefore, lacking.

Evaluation of SOCOM Wireless Monitor in Trauma Patients

Science.gov (United States)

2016-02-01

justified in polytrauma patients? Presented at 2014 American College of Surgeons Florida Committee on Trauma Paper Competition Jacksonville, FL Oct...Model of Polytrauma , Hemorrhage and Traumatic Brain Injury” J Trauma Acute Care Surg 2013 Dec 75(6):974-975 4) Thorson CM, Dubose JJ, Rhee P, Knuth TE...injury increase the risk for venous thromboembolism in polytrauma patients? J Trauma Acute Care Surg 2014 Aug;77(2):243-50. 26) Ryan ML, Van Haren RM

Post-traumatic acute kidney injury: a cross-sectional study of trauma patients.

Science.gov (United States)

Lai, Wei-Hung; Rau, Cheng-Shyuan; Wu, Shao-Chun; Chen, Yi-Chun; Kuo, Pao-Jen; Hsu, Shiun-Yuan; Hsieh, Ching-Hua; Hsieh, Hsiao-Yun

2016-11-22

The causes of post-traumatic acute kidney injury (AKI) are multifactorial, and shock associated with major trauma has been proposed to result in inadequate renal perfusion and subsequent AKI in trauma patients. This study aimed to investigate the true incidence and clinical presentation of post-traumatic AKI in hospitalized adult patients and its association with shock at a Level I trauma center. Detailed data of 78 trauma patients with AKI and 14,504 patients without AKI between January 1, 2009 and December 31, 2014 were retrieved from the Trauma Registry System. Patients with direct renal trauma were excluded from this study. Two-sided Fisher's exact or Pearson's chi-square tests were used to compare categorical data, unpaired Student's t-test was used to analyze normally distributed continuous data, and Mann-Whitney's U test was used to compare non-normally distributed data. Propensity score matching with a 1:1 ratio with logistic regression was used to evaluate the effect of shock on AKI. Patients with AKI presented with significantly older age, higher incidence rates of pre-existing comorbidities, higher odds of associated injures (subdural hematoma, intracerebral hematoma, intra-abdominal injury, and hepatic injury), and higher injury severity than patients without AKI. In addition, patients with AKI had a longer hospital stay (18.3 days vs. 9.8 days, respectively; P < 0.001) and intensive care unit (ICU) stay (18.8 days vs. 8.6 days, respectively; P < 0. 001), higher proportion of admission into the ICU (57.7% vs. 19.0%, respectively; P < 0.001), and a higher odds ratio (OR) of short-term mortality (OR 39.0; 95% confidence interval, 24.59-61.82; P < 0.001). However, logistic regression analysis of well-matched pairs after propensity score matching did not show a significant influence of shock on the occurrence of AKI. We believe that early and aggressive resuscitation, to avoid prolonged untreated shock, may help to prevent the occurrence

Acute Pancreatitis as a Model to Predict Transition of Systemic Inflammation to Organ Failure in Trauma and Critical Illness

Science.gov (United States)

2017-10-01

models ); • clinical interventions; • new business creation; and • other. Nothing to report. Nothing to report. Nothing to report. 17...AWARD NUMBER: W81XWH-14-1-0376 TITLE: Acute Pancreatitis as a Model to Predict Transition of Systemic Inflammation to Organ Failgure in Trauma...COVERED 22 Sep 2016 - 21 Sep 2017 4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER Acute Pancreatitis as a Model to Predict Transition of Systemic

Orthopaedic complications of osteogenesis imperfecta

International Nuclear Information System (INIS)

Azrak, S.; Ksyar, R.; Ben Rais, N.

2009-01-01

Osteogenesis imperfecta is a genetic disease characterized by bone frailty. It is generally caused by an abnormal production of collagen, which is the main fibrous protein of the bone. Collagen is also present in the skin, tendons, the sclera of the eye and dentin. The most frequent manifestation of osteogenesis imperfecta is the occurrence of multiple fractures without major trauma. Severity and timing of the attack varies widely: some patients sustain a significant number of fractures during early childhood which may have a serious impact on growth, while others will have some fractures separated by a few years. In all cases, the bone strength improves in adulthood. The bone fractures cause pain and bone deformities sometimes result in a smaller size. Scoliosis is frequent and associated with painful vertebral collapses. We present a case of osteogenesis imperfecta in a 40-year-old adult and we describe the various orthopaedic complications of the disease, stressing the role of bone scintigraphy in the diagnosis and monitoring of these complications. (authors)

Post-trauma ratings of pre-collision pain and psychological distress predict poor outcome following acute whiplash trauma: A 12-month follow-up study

DEFF Research Database (Denmark)

Carstensen, Tina; Frostholm, Lisbeth; Ørnbøl, Eva

2008-01-01

emergency departments or primary care after car accidents in four counties in Denmark. After the collision patients received a questionnaire on psychological distress, unspecified pain and socio-demographics and 12 months later a follow-up on work capability and neck pain was performed. Risk factors were......Patients with acute whiplash trauma were followed to examine if post-trauma ratings of pre-collision pain and psychological distress were associated with reduced work capability and neck pain at 12 months follow-up. The study included 740 consecutive patients (474 females, 266 males) referred from...... identified by multiple logistic regression analysis. Factors associated with affected work capacity at the 12-month follow-up were pre-collision unspecified pain condition (OR = 2.4, p = 0.002) and socio-demographic characteristics: female gender, low educational level, unemployment and blue collar worker...

Surgical simulation in orthopaedic skills training.

Science.gov (United States)

Atesok, Kivanc; Mabrey, Jay D; Jazrawi, Laith M; Egol, Kenneth A

2012-07-01

Mastering rapidly evolving orthopaedic surgical techniques requires a lengthy period of training. Current work-hour restrictions and cost pressures force trainees to face the challenge of acquiring more complex surgical skills in a shorter amount of time. As a result, alternative methods to improve the surgical skills of orthopaedic trainees outside the operating room have been developed. These methods include hands-on training in a laboratory setting using synthetic bones or cadaver models as well as software tools and computerized simulators that enable trainees to plan and simulate orthopaedic operations in a three-dimensional virtual environment. Laboratory-based training offers potential benefits in the development of basic surgical skills, such as using surgical tools and implants appropriately, achieving competency in procedures that have a steep learning curve, and assessing already acquired skills while minimizing concerns for patient safety, operating room time, and financial constraints. Current evidence supporting the educational advantages of surgical simulation in orthopaedic skills training is limited. Despite this, positive effects on the overall education of orthopaedic residents, and on maintaining the proficiency of practicing orthopaedic surgeons, are anticipated.

American Academy of Orthopaedic Surgeons

Science.gov (United States)

... Research Research Tools Research Roadmap Facts and Figures Unified Orthopaedic Research Agenda Sex and Gender in Research ... Career Center Clinician Scholar Career Development Clinician-Patient Communication Leadership Fellows Program Medical Student Resources Postgraduate Orthopaedic ...

Where Are the Women in Orthopaedic Surgery?

Science.gov (United States)

Rohde, Rachel S; Wolf, Jennifer Moriatis; Adams, Julie E

2016-09-01

Although women account for approximately half of the medical students in the United States, they represent only 13% of orthopaedic surgery residents and 4% of members of the American Academy of Orthopaedic Surgeons (AAOS). Furthermore, a smaller relative percentage of women pursue careers in orthopaedic surgery than in any other subspecialty. Formal investigations regarding the gender discrepancy in choice of orthopaedic surgery are lacking. (1) What reasons do women orthopaedic surgeons cite for why they chose this specialty? (2) What perceptions do women orthopaedic surgeons think might deter other women from pursuing this field? (3) What role does early exposure to orthopaedics and mentorship play in this choice? (4) What professional and personal choices do women in orthopaedics make, and how might this inform students who are choosing a career path? A 21-question survey was emailed to all active, candidate, and resident members of the Ruth Jackson Orthopaedic Society (RJOS, n = 556). RJOS is the oldest surgical women's organization incorporated in the United States. An independent orthopaedic specialty society, RJOS supports leadership training, mentorship, grant opportunities, and advocacy for its members and promotes sex-related musculoskeletal research. Although not all women in orthopaedic practice or training belong to RJOS, it is estimated that 42% of women AAOS fellows are RJOS members. Questions were formulated to determine demographics, practice patterns, and lifestyle choices of women who chose orthopaedic surgery as a specialty. Specifically, we evaluated the respondents' decisions about their careers and their opinions of why more women do not choose this field. For the purpose of this analysis, the influences and dissuaders were divided into three major categories: personal attributes, experience/exposure, and work/life considerations. The most common reasons cited for having chosen orthopaedic surgery were enjoyment of manual tasks (165 of 232

A CASE OF SELF-INDUCED ACUTE HYDROPS IN A PATIENT WITH IMPULSE CONTROL DISORDER ASSOCIATED WITH COMPULSIVE EYE TRAUMA

OpenAIRE

Bindu Madhavi; Soumya

2016-01-01

PURPOSE To describe acute hydrops in a patient with impulse control disorder (not otherwise specified) secondary to self-induced repetitive eye trauma. METHODS A 22-year-old male patient was referred from a psychiatrist with a diagnosis of impulse control disorder not otherwise specified (compulsive impulse self-mutilating behaviour) for opacity and watering of both eyes (left eye more than right eye). Left eye showed features of acute hydrops with Descemet’s tear and rig...

Critical roles of orthopaedic surgeon leadership in healthcare systems to improve orthopaedic surgical patient safety.

Science.gov (United States)

Kuo, Calvin C; Robb, William J

2013-06-01

The prevention of medical and surgical harm remains an important public health problem despite increased awareness and implementation of safety programs. Successful introduction and maintenance of surgical safety programs require both surgeon leadership and collaborative surgeon-hospital alignment. Documentation of success of such surgical safety programs in orthopaedic practice is limited. We describe the scope of orthopaedic surgical patient safety issues, define critical elements of orthopaedic surgical safety, and outline leadership roles for orthopaedic surgeons needed to establish and sustain a culture of safety in contemporary healthcare systems. We identified the most common causes of preventable surgical harm based on adverse and sentinel surgical events reported to The Joint Commission. A comprehensive literature review through a MEDLINE(®) database search (January 1982 through April 2012) to identify pertinent orthopaedic surgical safety articles found 14 articles. Where gaps in orthopaedic literature were identified, the review was supplemented by 22 nonorthopaedic surgical references. Our final review included 36 articles. Six important surgical safety program elements needed to eliminate preventable surgical harm were identified: (1) effective surgical team communication, (2) proper informed consent, (3) implementation and regular use of surgical checklists, (4) proper surgical site/procedure identification, (5) reduction of surgical team distractions, and (6) routine surgical data collection and analysis to improve the safety and quality of surgical patient care. Successful surgical safety programs require a culture of safety supported by all six key surgical safety program elements, active surgeon champions, and collaborative hospital and/or administrative support designed to enhance surgical safety and improve surgical patient outcomes. Further research measuring improvements from such surgical safety systems in orthopaedic care is needed.

Epidemiological Trends of Spine Trauma: An Australian Level 1 Trauma Centre Study

Science.gov (United States)

Tee, J. W.; Chan, C. H. P.; Fitzgerald, M. C. B.; Liew, S. M.; Rosenfeld, J. V.

2013-01-01

Knowledge of current epidemiology and spine trauma trends assists in public resource allocation, fine-tuning of primary prevention methods, and benchmarking purposes. Data on all patients with traumatic spine injuries admitted to the Alfred Hospital, Melbourne between May 1, 2009, and January 1, 2011, were collected from the Alfred Trauma Registry, Alfred Health medical database, and Victorian Orthopaedic Trauma Outcomes Registry. Epidemiological trends were analyzed as a general cohort, with comparison cohorts of nonsurvivors versus survivors and elderly versus nonelderly. Linear regression analysis was utilized to demonstrate trends with statistical significance. There were 965 patients with traumatic spine injuries with 2,333 spine trauma levels. The general cohort showed a trimodal age distribution, male-to-female ratio of 2:2, motor vehicle accidents as the primary spine trauma mechanism, 47.7% patients with severe polytrauma as graded using the Injury Severity Score (ISS), 17.3% with traumatic brain injury (TBI), the majority of patients with one spine injury level, 7% neurological deficit rate, 12.8% spine trauma operative rate, and 5.2% mortality rate. Variables with statistical significance trending toward mortality were the elderly, motor vehicle occupants, severe ISS, TBI, C1–2 dissociations, and American Spinal Injury Association (ASIA) A, B, and C neurological grades. Variables with statistical significance trending toward the elderly were females; low falls; one spine injury level; type 2 odontoid fractures; subaxial cervical spine distraction injuries; ASIA A, B, and C neurological grades; and patients without neurological deficits. Of the general cohort, 50.3% of spine trauma survivors were discharged home, and 48.1% were discharged to rehabilitation facilities. This study provides baseline spine trauma epidemiological data. The trimodal age distribution of patients with traumatic spine injuries calls for further studies and intervention targeted

Pharmacist's impact on acute pain management during trauma resuscitation.

Science.gov (United States)

Montgomery, Kayla; Hall, A Brad; Keriazes, Georgia

2015-01-01

The timely administration of analgesics is crucial to the comprehensive management of trauma patients. When an emergency department (ED) pharmacist participates in trauma resuscitation, the pharmacist acts as a medication resource for trauma team members and facilitates the timely administration of analgesics. This study measured the impact of a pharmacist on time to first analgesic dose administered during trauma resuscitation. All adult (>18 years) patients who presented to this level II trauma center via activation of the trauma response system between January 1, 2009, and May 31, 2013, were screened for eligibility. For inclusion, patients must have received intravenous fentanyl, morphine, or hydromorphone in the trauma bay. The time to medication administration was defined as the elapsed time from ED arrival to administration of first analgesic. There were 1328 trauma response system activations during the study period; of which 340 patients were included. The most common analgesic administered was fentanyl (62% in both groups). When a pharmacist was participating, the mean time to first analgesic administered was decreased (17 vs 21 minutes; P = .03). Among the 78% of patients with documented pain scores, the overall mean reduction in pain scores from ED arrival to ED discharge was similar between the 2 groups. There was a 2.4 point reduction with a pharmacist versus 2.7 without a pharmacist, using a 0 to 10 numeric pain rating scale. The participation of a clinical pharmacist during trauma resuscitation significantly decreased the time to first analgesic administration in trauma patients. The results of this study supplement the literature supporting the integration of clinical ED pharmacists on trauma teams.

Joint Distraction Treatments of Intra-Articular Fracture-Induced Posttraumatic Osteoarthritis in a Large Animal Model

Science.gov (United States)

2016-10-01

amounts for those were based on a 60 kg animal. We have identified another approved vendor of Yucatan minipigs who offers animals at an intermediate ...Activity in Acute Cartilage Injury Sponsor Agency: Orthopaedic Trauma Association 9400 W. Higgins Road, Suite 305 Rosemont IL 60018-4226 01/01...Orthopaedic Foot & Ankle Society 9400 West Higgins Road, Suite 220 Rosemont IL 60018 05/12/2015 – 10/31/2016, $20,000 Total Costs Nathan A

Acute cervical spine injuries: prospective MR imaging assessment at a level 1 trauma center.

Science.gov (United States)

Katzberg, R W; Benedetti, P F; Drake, C M; Ivanovic, M; Levine, R A; Beatty, C S; Nemzek, W R; McFall, R A; Ontell, F K; Bishop, D M; Poirier, V C; Chong, B W

1999-10-01

To determine the weighted average sensitivity of magnetic resonance (MR) imaging in the prospective detection of acute neck injury and to compare these findings with those of a comprehensive conventional radiographic assessment. Conventional radiography and MR imaging were performed in 199 patients presenting to a level 1 trauma center with suspected cervical spine injury. Weighted sensitivities and specificities were calculated, and a weighted average across eight vertebral levels from C1 to T1 was formed. Fourteen parameters indicative of acute injury were tabulated. Fifty-eight patients had 172 acute cervical injuries. MR imaging depicted 136 (79%) acute abnormalities and conventional radiography depicted 39 (23%). For assessment of acute fractures, MR images (weighted average sensitivity, 43%; CI: 21%, 66%) were comparable to conventional radiographs (weighted average sensitivity, 48%; CI: 30%, 65%). MR imaging was superior to conventional radiography in the evaluation of pre- or paravertebral hemorrhage or edema, anterior or posterior longitudinal ligament injury, traumatic disk herniation, cord edema, and cord compression. Cord injuries were associated with cervical spine spondylosis (P < .05), acute fracture (P < .001), and canal stenosis (P < .001). MR imaging is more accurate than radiography in the detection of a wide spectrum of neck injuries, and further study is warranted of its potential effect on medical decision making, clinical outcome, and cost-effectiveness.

Advanced practice physiotherapy-led triage in Irish orthopaedic and rheumatology services: national data audit.

LENUS (Irish Health Repository)

Fennelly, Orna

2018-06-01

Many people with musculoskeletal (MSK) disorders wait several months or years for Consultant Doctor appointments, despite often not requiring medical or surgical interventions. To allow earlier patient access to orthopaedic and rheumatology services in Ireland, Advanced Practice Physiotherapists (APPs) were introduced at 16 major acute hospitals. This study performed the first national evaluation of APP triage services.

Patient compliance and effect of orthopaedic shoes

DEFF Research Database (Denmark)

Philipsen, A B; Ellitsgaard, N; Krogsgaard, M R

1999-01-01

Orthopaedic shoes are individually handmade after a prescription from an orthopaedic surgeon, hence relatively expensive. Bad compliance is mentioned in the literature but not investigated. In order to evaluate patient compliance and the effect of orthopaedic shoes, 85 patients who were prescribed...

Disseminated intravascular coagulation or acute coagulopathy of trauma shock early after trauma? A prospective observational study

DEFF Research Database (Denmark)

Johansson, Per Ingemar; Sorensen, Anne Marie; Perner, Anders

2011-01-01

the prevalence of overt DIC and ACoTS in trauma patients and characterized these conditions based on their biomarker profiles. METHODS: Observational study at a single Level I Trauma Centre. Inclusion of 80 adult trauma patients ([greater than or equal to]18 years) who met criteria for full trauma team...

Appendicitis following blunt abdominal trauma.

Science.gov (United States)

Cobb, Travis

2017-09-01

Appendicitis is a frequently encountered surgical problem in the Emergency Department (ED). Appendicitis typically results from obstruction of the appendiceal lumen, although trauma has been reported as an infrequent cause of acute appendicitis. Intestinal injury and hollow viscus injury following blunt abdominal trauma are well reported in the literature but traumatic appendicitis is much less common. The pathophysiology is uncertain but likely results from several mechanisms, either in isolation or combination. These include direct compression/crush injury, shearing injury, or from indirect obstruction of the appendiceal lumen by an ileocecal hematoma or traumatic impaction of stool into the appendix. Presentation typically mirrors that of non-traumatic appendicitis with nausea, anorexia, fever, and right lower quadrant abdominal tenderness and/or peritonitis. Evaluation for traumatic appendicitis requires a careful history and physical exam. Imaging with ultrasound or computed tomography is recommended if the history and physical do not reveal an acute surgical indication. Treatment includes intravenous antibiotics and surgical consultation for appendectomy. This case highlights a patient who developed acute appendicitis following blunt trauma to the abdomen sustained during a motor vehicle accident. Appendicitis must be considered as part of the differential diagnosis in any patient who presents to the ED with abdominal pain, including those whose pain begins after sustaining blunt trauma to the abdomen. Because appendicitis following trauma is uncommon, timely diagnosis requires a high index of suspicion. Copyright © 2017 Elsevier Inc. All rights reserved.

(Mis)perceptions about intimate partner violence in women presenting for orthopaedic care: a survey of Canadian orthopaedic surgeons.

Science.gov (United States)

Bhandari, Mohit; Sprague, Sheila; Tornetta, Paul; D'Aurora, Valerie; Schemitsch, Emil; Shearer, Heather; Brink, Ole; Mathews, David; Dosanjh, Sonia

2008-07-01

Domestic violence is the most common cause of nonfatal injury to women in North America. In a review of 144 such injuries, the second most common manifestation of intimate partner violence was musculoskeletal injuries (28%). The American Academy of Orthopaedic Surgeons is explicit that orthopaedic surgeons should play a role in the screening and appropriate identification of victims. We aimed to identify the perceptions, attitudes, and knowledge of Canadian orthopaedic surgeons with regard to intimate partner violence. We surveyed members of the Canadian Orthopaedic Association to identify attitudes toward intimate partner violence. With use of a systematic random sample, 362 surgeons were mailed questionnaires. The questionnaire consisted of three sections: (1) the general attitude of the orthopaedic surgeon toward intimate partner violence, (2) the attitude of the orthopaedic surgeon toward victims and batterers, and (3) the clinical relevance of intimate partner violence in orthopaedic surgery. Up to three follow-up mailings were performed to enhance response rates. A total of 186 orthopaedic surgeons responded (a response rate of 51%), and 167 (91%) of them were men. Most orthopaedic surgeons (95%) estimated that <10% of their patients were victims of intimate partner violence, and most respondents (80%) believed that it was exceedingly rare (a prevalence of <1%). The concept of mandatory screening for intimate partner violence was met with uncertainty by 116 surgeons (64%). Misconceptions were perpetuated by surgeons who believed that inquiring about intimate partner violence was an invasion of the victim's privacy, that investigating intimate partner violence was not part of their duty, that victims choose to be a victim, and that victims play a proactive role in causing their abuse. By the completion of the survey, the majority of surgeons (91%) believed that knowledge about intimate partner violence was relevant to their surgical practice. Discomfort with

Do surgeon interviewers have human factor-related issues during the long day UK National Trauma and Orthopaedic specialty recruitment process?

Science.gov (United States)

Scrimgeour, D S G; Higgins, J; Bucknall, V; Arnett, R; Featherstone, C R; Cleland, J; Lee, A J; Brennan, P A

2018-03-05

The role that human factors (HF) play in contributing to medical error is increasingly being recognised by healthcare professionals. Surprisingly, much less is known about the possible effects of HF including boredom, fatigue and organisational influences, on performance outside of the clinical environment such as examining or assessing candidates in other high stakes situations. The authors used a validated 38 response questionnaire based around the HF analysis and classification system (HFACS) to assess factors including stress and pressure, care and support and working within the rules for surgeon interviewers at the UK national trainee selection process in Trauma and Orthopaedic surgery. 121 completed questionnaires were analysed (86% response rate). No statistically significant differences were found between interviewer experience, grade or role at the interview and the mean scores obtained for all four factor items. Overall interviewers had a positive experience during national selection with mean factor scores ranging from 3.80 to 3.98 (out of a maximum satisfaction score of 5). Careful planning by organisations and recognising the importance of the human element are essential to ensure assessors are looked after properly during high stakes assessment processes. Our data suggests that a positive experience for examiners is likely to benefit candidate performance and contribute to a fair and reliable recruitment process. The relationship between examiner experience and candidate performance merits further investigation. Crown Copyright © 2018. Published by Elsevier Ltd. All rights reserved.

Radiology in chest trauma

International Nuclear Information System (INIS)

Wenz, W.; Kloehn, I.; Wolfart, W.; Freiburg Univ.

1979-01-01

In chest trauma, a routine chest film, preferably in the lateral as well as the frontal projection, is the basic part of the work-up. Occasionally valuable additional methods are fluoroscopy, tomography, bronchography, contrast studies of the GI Tract and angiography and angiocardiography. In 679 chest trauma patients, traffic accidents and falls were the main reason for the trauma. There were 248 fractures; then - in order of frequency - hemopneumothorax (76), lung contusion (58), subcutaneous emphysema (33) cardiac (16) and vascular trauma (12) and damage to other organs. While 20-30% mistakes are made in diagnosing rib fractures in acute trauma, there is high accuracy in the diagnosis of the other injuries. Many cases are shown to demonstrate the value of diagnostic radiology. (orig.) [de

Improving the quality of orthopaedic elective and trauma operative notes: A completed audit loop study

Directory of Open Access Journals (Sweden)

Parth Arvind Shah

2016-01-01

Discussion: This study showed that the quality of elective operative notes was improved through surgeon education and the circulation of a guideline based electronic operative note. We have further plans to implement procedure specific notes for the most common types of trauma cases to help improve the quality of trauma operative notes.

Current status and progress of digital orthopaedics in China

Directory of Open Access Journals (Sweden)

Guo-Xian Pei

2014-07-01

Full Text Available Based on the development of digital medicine and digital anatomy, the concept of “digital orthopaedics” was raised by Pei Guo-Xian in China in 2006. The most striking feature of digital orthopaedics is the combination of basic and clinical orthopaedic knowledge with digital technology. In this review, we summarised the development of digital orthopaedics in China in recent years with respect to: the foundation of the Chinese Association of Digital Orthopedics, virtual human project (VHP, three-dimensional (3D reconstruction, finite element simulation, navigation in orthopaedic operations, and robot-assisted orthopaedic operations. In addition, we briefly reviewed digital orthopaedics in world leading institutes. We also looked into the future of digital orthopaedics in China and proposed the major challenges in digital technology and application in orthopaedics.

Do Orthopaedic Surgeons Acknowledge Uncertainty?

Science.gov (United States)

Teunis, Teun; Janssen, Stein; Guitton, Thierry G; Ring, David; Parisien, Robert

2016-06-01

Much of the decision-making in orthopaedics rests on uncertain evidence. Uncertainty is therefore part of our normal daily practice, and yet physician uncertainty regarding treatment could diminish patients' health. It is not known if physician uncertainty is a function of the evidence alone or if other factors are involved. With added experience, uncertainty could be expected to diminish, but perhaps more influential are things like physician confidence, belief in the veracity of what is published, and even one's religious beliefs. In addition, it is plausible that the kind of practice a physician works in can affect the experience of uncertainty. Practicing physicians may not be immediately aware of these effects on how uncertainty is experienced in their clinical decision-making. We asked: (1) Does uncertainty and overconfidence bias decrease with years of practice? (2) What sociodemographic factors are independently associated with less recognition of uncertainty, in particular belief in God or other deity or deities, and how is atheism associated with recognition of uncertainty? (3) Do confidence bias (confidence that one's skill is greater than it actually is), degree of trust in the orthopaedic evidence, and degree of statistical sophistication correlate independently with recognition of uncertainty? We created a survey to establish an overall recognition of uncertainty score (four questions), trust in the orthopaedic evidence base (four questions), confidence bias (three questions), and statistical understanding (six questions). Seven hundred six members of the Science of Variation Group, a collaboration that aims to study variation in the definition and treatment of human illness, were approached to complete our survey. This group represents mainly orthopaedic surgeons specializing in trauma or hand and wrist surgery, practicing in Europe and North America, of whom the majority is involved in teaching. Approximately half of the group has more than 10 years

Trauma team activation criteria in managing trauma patients at an emergency room in Thailand.

Science.gov (United States)

Wuthisuthimethawee, P

2017-02-01

Trauma team activation (TTA) criteria were first implemented in the Emergency Department (ED) of Songklanagarind Hospital in 2009 to treat severe trauma patients. To determine the efficacy of the TTA criteria on the acute trauma care process in the ED and the 28-day mortality rate. A 1-year prospective cohort study was conducted at the ED. Trauma patients who were 18 years old and over who met the TTA criteria were enrolled. Demographic data, physiologic parameters, ED length of stay (EDLOS), and the injury severity score (ISS) were recorded. Multiple logistic regression was used to determine the factors affecting 28-day mortality. Institutional review board approval was obtained from the Prince of Songkla University. A total of 80 patients (74 male and 6 female) were eligible with a mean age of 34.3 years old. Shock, penetrating torso injury, and pulse rate >120 beats per minute were the three most common criteria for trauma team consultation. At the ED, 9 patients (11.3 %) were non-survivors, 30 patients (37.5 %) needed immediate operation, and 41 patients (51.2 %) were admitted. All of the arrest patients died (p team activation criteria improved acute trauma care in the ED which was demonstrated by the decreased EDLOS and mortality rate. A high ISS is the sole parameter predicting mortality.

Orthopaedic research and education foundation and industry.

Science.gov (United States)

Wurth, Gene R; Sherr, Judy H; Coffman, Thomas M

2003-07-01

Members of orthopaedic industry commit a significant amount of funds each year to support research and education programs that are directly related to their product(s). In addition, industry supports organizations such as the Orthopaedic Research and Education Foundation. The relationship between the Orthopaedic Research and Education Foundation and industry began in the early 1980s. The support to the Orthopaedic Research and Education Foundation from industry primarily has come in the form of unrestricted grants. These grants best can be looked at as an investment rather than a contribution. This form of giving, once called corporate philanthropy is more accurately referred to as strategic philanthropy. Members of industry make these investments to enhance their reputations, build brand awareness, market their products and services, improve employee morale, increase customer loyalty, and establish strategic alliances. The specialty of orthopaedics is among the leaders in medicine in the amount of funding raised within the specialty for research and education programs. This is because of the amount of support from members of industry and the surgeons. During the past 15 years, 40% of the annual support to the Orthopaedic Research and Education Foundation has come from industry and the balance has come from surgeons and members of lay public. Future industry support of the Orthopaedic Research and Education Foundation and other organizations within the specialty of orthopaedics will be dependent on the continued demonstration of tangible returns in areas described.

Endovascular treatment of peripheral and visceral arterial injuries in patients with acute trauma.

Science.gov (United States)

Erbahçeci Salık, Aysun; Saçan İslim, Filiz; Çil, Barbaros Erhan

2016-11-01

The present study is an evaluation of the efficacy of endovascular treatment in emergency setting for patients with acute peripheral and visceral arterial injury secondary to penetrating or blunt trauma. Twelve patients (11 men) aged 35.8±11.3 years (range: 18-56 years) with penetrating or blunt trauma who underwent endovascular treatment in our department between March 2010 and June 2014 for peripheral and visceral arterial injury were retrospectively reviewed. Selective coil embolization was performed on 11 patients and particle embolization of the injured vessel was performed on 1 patient. Criteria for endovascular treatment included active extravasation or pseudoaneurysm on contrast-enhanced computed tomography and decrease in hemoglobin level or temporary hemodynamic instability. Arterial injuries were secondary to penetrating injury due to gunshot wound in 4 patients and stab wound in 5, and blunt abdominal injury as result of traffic accident in 3 patients. Traumatic lesions were in the right hepatic artery (n=3), left hepatic (n=2), right hepatic and right renal (n=1), left inferior epigastric (n=2), left facial (n=1), anterior tibial (n=1), and deep femoral (n=1) arteries. Technical success with no procedural complications was seen in all cases. Two patients died due to coexisting injuries on 29th and 43rd days of hospitalization. Median hospitalization period was 6.0 days (range: 1-43 days) and mean intensive care unit hospitalization was 7.7 days (range: 0-43 days). In our experience, endovascular treatment was a safe and effective option for acute traumatic peripheral and visceral arterial lesions.

Hand dominance in orthopaedic surgeons.

LENUS (Irish Health Repository)

Lui, Darren F

2012-08-01

Handedness is perhaps the most studied human asymmetry. Laterality is the preference shown for one side and it has been studied in many aspects of medicine. Studies have shown that some orthopaedic procedures had poorer outcomes and identified laterality as a contributing factor. We developed a questionnaire to assess laterality in orthopaedic surgery and compared this to an established scoring system. Sixty-two orthopaedic surgeons surveyed with the validated Waterloo Handedness Questionnaire (WHQ) were compared with the self developed Orthopaedic Handedness Questionnaire (OHQ). Fifty-eight were found to be right hand dominant (RHD) and 4 left hand dominant (LHD). In RHD surgeons, the average WHQ score was 44.9% and OHQ 15%. For LHD surgeons the WHQ score was 30.2% and OHQ 9.4%. This represents a significant amount of time using the non dominant hand but does not necessarily determine satisfactory or successful dexterity transferable to the operating room. Training may be required for the non dominant side.

Origins of eponymous orthopaedic equipment.

Science.gov (United States)

Meals, Clifton; Wang, Jeffrey

2010-06-01

Orthopaedists make great use of eponymous equipment, however the origins of these tools are unknown to many users. This history enriches, enlightens, and enhances surgical education, and may inspire modern innovation. We explored the origins of common and eponymous orthopaedic equipment. We selected pieces of equipment named for their inventors and in the broadest use by modern orthopaedists. We do not describe specialized orthopaedic implants and instruments owing to the overwhelming number of these devices. The history of this equipment reflects the coevolution of orthopaedics and battlefield medicine. Additionally, these stories evidence the primacy of elegant design and suggest that innovation is often a process of revision and refinement rather than sudden inspiration. Their history exposes surgical innovators as brilliant, lucky, hardworking, and sometimes odd. These stories amuse, enlighten, and may inspire modern orthopaedists to develop creative solutions of their own. The rich history of the field's eponymous instruments informs an ongoing tradition of innovation in orthopaedics.

MR imaging of spinal trauma

International Nuclear Information System (INIS)

Buchberger, W.; Springer, P.; Birbamer, G.; Judmaier, W.; Kathrein, A.; Daniaux, H.

1995-01-01

To assess the value of MR imaging in the acute and chronic stages of spinal trauma. 126 MR examinations of 120 patients were evaluated retrospectively. In 15 cases of acute spinal cord injury, correlation of MR findings with the degree of neurological deficit and eventual recovery was undertaken. Cord anomalies in the acute stage were seen in 16 patients. Intramedullary haemorrhage (n=6) and cord transection (n=2) were associated with complete injuries and poor prognosis, whereas patients with cord oedema (n=7) had incomplete injuries and recovered significant neurological function. In the chronic stage, MR findings included persistent cord compression in 8 patients, syringomyelia or post-traumatic cyst in 12, myelomalacia in 6, cord atrophy in 9, and cord transection in 7 patients. In acute spinal trauma, MR proved useful in assessing spinal cord compression and instability. In addition, direct visualisation and characterisation of posttraumatic changes within the spinal cord may offer new possibilities in establishing the prognosis for neurological recovery. In the later stages, potentially remediable causes of persistent or progressive symptoms, such as chronic spinal cord compression or syringomyelia can be distinguished from other sequelae of spinal trauma, such as myelomalacia, cord transection or atrophy. (orig.) [de

Fibrinogen depletion in trauma: early, easy to estimate and central to trauma-induced coagulopathy.

Science.gov (United States)

Davenport, Ross; Brohi, Karim

2013-09-24

Fibrinogen is fundamental to hemostasis and falls rapidly in trauma hemorrhage, although levels are not routinely measured in the acute bleeding episode. Prompt identification of critically low levels of fibrinogen and early supplementation has the potential to correct trauma-induced coagulation and improve outcomes. Early estimation of hypofibrinogenemia is possible using surrogate markers of shock and hemorrhage; for example, hemoglobin and base excess. Rapid replacement with fibrinogen concentrate or cryoprecipitate should be considered a clinical priority in major trauma hemorrhage.

Trauma quality improvement: The Pietermaritzburg Metropolitan Trauma Service experience with the development of a comprehensive structure to facilitate quality improvement in rural trauma and acute care in KwaZulu-Natal, South Africa.

Science.gov (United States)

Clarke, Damian Luiz

2015-01-03

Improving the delivery of efficient and effective surgical care in rural South Africa is a mammoth task bedevilled by conflict between the stakeholders, who include rural doctors, surgeons, ancillary staff, researchers, educators and administrators. Management training is not part of most medical school curricula, yet as they progress in their careers, many clinicians are required to manage a health system and find the shift from caring for individual patients to managing a complex system difficult. Conflict arises when management-type interventions are imposed in a top-down manner on surgical staff suspicious of an unfamiliar field of study. Another area of conflict concerns the place of surgical research. Researchers are often accused of not being sufficiently focused on or concerned about the tasks of service delivery. This article provides an overview of management theory and describes a comprehensive management structure that integrates a model for health systems with a strategic planning process, strategic planning tools and appropriate quality metrics, and shows how the Pietermaritzburg Metropolitan Trauma Service in KwaZulu-Natal Province, South Africa, successfully used this structure to facilitate and contextualise a diverse number of quality improvement programmes and research initiatives in the realm of rural acute surgery and trauma. We have found this structure to be useful, and hope that it may be applied to other acute healthcare systems.

April 2006. 32 Major Orthopaedic Procedures

African Journals Online (AJOL)

user

2006-04-01

Apr 1, 2006 ... Major Orthopaedic Procedures: 17 Year Trends. Biruk Lambisso Wamisho1 ... financial and logistic constraints with poor compliance of ... Modern orthopaedic surgery is very expensive. A highly ..... Case management. Tribury.

Orthopaedic Footwear Design

Science.gov (United States)

1992-01-01

Although the need for orthopaedic shoes is increasing, the number of skilled shoemakers has declined. This has led to the development of a CAD/CAM system to design and fabricate, orthopaedic footwear. The NASA-developed RIM database management system is the central repository for CUSTOMLAST's information storage. Several other modules also comprise the system. The project was initiated by Langley Research Center and Research Triangle Institute in cooperation with the Veterans Administration and the National Institute for Disability and Rehabilitation Research. Later development was done by North Carolina State University and the University of Missouri-Columbia. The software is licensed by both universities.

Endovascular Treatment of Acute Arterial Hemorrhage in Trauma Patients Using Ethylene Vinyl Alcohol Copolymer (Onyx)

International Nuclear Information System (INIS)

Müller-Wille, R.; Heiss, P.; Herold, T.; Jung, E. M.; Schreyer, A. G.; Hamer, O. W.; Rennert, J.; Hoffstetter, P.; Stroszczynski, C.; Zorger, N.

2012-01-01

Purpose: This study was designed to determine the feasibility and efficacy of endovascular embolization with liquid embolic agent ethylene vinyl alcohol copolymer (Onyx) in patients with acute traumatic arterial bleeding. Methods: This is a retrospective review of 13 patients (9 men and 4 women; mean age 45 years) with severe trauma who underwent embolotherapy using Onyx from November 2003 to February 2009. Bleeding was located in the pelvis (5 patients), kidney (3 patients), mesenteric region (2 patients), retroperitoneal space (2 patients), neck (1 patient), and thigh (1 patient). In three cases (23.1%), Onyx was used in conjunction with coils. We evaluate the technical and clinical success, procedural and embolization time, occurrence of rebleeding, and embolotherapy-related complications, such as necrosis or migration of Onyx into nontarget vessels. Results: In all patients, embolotherapy was technically and clinically successful on the first attempt. Control of bleeding could be reached with a mean time of 19 (range, 4–63) min after correct placement of the microcatheter in the feeding artery. No recurrent bleeding was detected. No unintended necrosis or migration of Onyx into a nontarget region was observed. During the follow-up period, three patients (23.1%) died due to severe intracranial hemorrhage, cardiac arrest, and sepsis. Conclusions: Transcatheter embolization with new liquid embolic agent Onyx is technically feasible and effective in trauma patients with acute arterial hemorrhage.

Imaging of laryngeal trauma

Energy Technology Data Exchange (ETDEWEB)

Becker, Minerva, E-mail: Minerva.Becker@hcuge.ch [Department of Radiology, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14 (Switzerland); Leuchter, Igor, E-mail: Igor.Leuchter@hcuge.ch [Department of Otorhinolaryngology and Cervico-facial Surgery, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14 (Switzerland); Platon, Alexandra, E-mail: Alexandra.Platon@hcuge.ch [Department of Radiology, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14 (Switzerland); Becker, Christoph D., E-mail: Christoph.Becker@hcuge.ch [Department of Radiology, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14 (Switzerland); Dulguerov, Pavel, E-mail: Pavel.Dulguerov@hcuge.ch [Department of Otorhinolaryngology and Cervico-facial Surgery, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14 (Switzerland); Varoquaux, Arthur, E-mail: Arthur.Varoquaux@hcuge.ch [Department of Radiology, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14 (Switzerland)

2014-01-15

External laryngeal trauma is a rare but potentially life-threatening situation in the acutely injured patient. Trauma mechanism and magnitude, maximum focus of the applied force, and patient related factors, such as age and ossification of the laryngeal cartilages influence the spectrum of observed injuries. Their correct diagnosis and prompt management are paramount in order to avoid patient death or long-term impairment of breathing, swallowing and speaking. The current review provides a comprehensive approach to the radiologic interpretation of imaging studies performed in patients with suspected laryngeal injury. It describes the key anatomic structures that are relevant in laryngeal trauma and discusses the clinical role of multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) in the acute emergency situation. The added value of two-dimensional multiplanar reconstructions (2D MPR), three-dimensional volume rendering (3D VR) and virtual endoscopy (VE) for the non-invasive evaluation of laryngeal injuries and for treatment planning is discussed. The clinical presentation, biomechanics of injury, diagnostic pitfalls and pearls, common and uncommon findings are reviewed with emphasis of fracture patterns, involvement of laryngeal joints, intra- and extralaryngeal soft tissue injuries, and complications seen in the acute emergency situation. The radiologic appearance of common and less common long-term sequelae, as well as treatment options are equally addressed.

Imaging of laryngeal trauma

International Nuclear Information System (INIS)

Becker, Minerva; Leuchter, Igor; Platon, Alexandra; Becker, Christoph D.; Dulguerov, Pavel; Varoquaux, Arthur

2014-01-01

External laryngeal trauma is a rare but potentially life-threatening situation in the acutely injured patient. Trauma mechanism and magnitude, maximum focus of the applied force, and patient related factors, such as age and ossification of the laryngeal cartilages influence the spectrum of observed injuries. Their correct diagnosis and prompt management are paramount in order to avoid patient death or long-term impairment of breathing, swallowing and speaking. The current review provides a comprehensive approach to the radiologic interpretation of imaging studies performed in patients with suspected laryngeal injury. It describes the key anatomic structures that are relevant in laryngeal trauma and discusses the clinical role of multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) in the acute emergency situation. The added value of two-dimensional multiplanar reconstructions (2D MPR), three-dimensional volume rendering (3D VR) and virtual endoscopy (VE) for the non-invasive evaluation of laryngeal injuries and for treatment planning is discussed. The clinical presentation, biomechanics of injury, diagnostic pitfalls and pearls, common and uncommon findings are reviewed with emphasis of fracture patterns, involvement of laryngeal joints, intra- and extralaryngeal soft tissue injuries, and complications seen in the acute emergency situation. The radiologic appearance of common and less common long-term sequelae, as well as treatment options are equally addressed

Comparison of health literacy in privately insured and public hospital orthopaedic patients.

Science.gov (United States)

Cosic, Filip; Porter, Tabitha; Norsworthy, Cameron; Price, Rohan; Bedi, Harvinder

2018-05-14

increased mortality and chronic disease morbidity. It has also been associated with an increased rate of hospitalisation and use of healthcare resources. Previous work in the orthopaedic trauma setting has found poor levels of health literacy and poor understanding of diagnosis, management and prognosis in the Australian public health system. Promisingly, it has been shown that simple, targeted interventions can improve patient health literacy. What does this paper add? This study further highlights that health literacy exhibited by orthopaedic patients is poor, particularly among patients in the public healthcare system. The present study is the first to have demonstrated that health literacy is poor among patients in both the public and private healthcare systems, despite these patients having distinctly different demographics. Promisingly, the present study shows that, unlike public orthopaedic out-patient review, private orthopaedic out-patient review appears to be effective in increasing patient health literacy regarding their orthopaedic condition and its management. What are the implications for practitioners? Health literacy is essential for patients to effectively communicate with doctors and achieve good health outcomes. Healthcare professionals need to be aware that a large proportion of patients have poor health literacy and difficulty understanding health-related information, particularly pertaining to that surrounding diagnosis, management and prognosis. This study highlights the need for healthcare professionals to ensure that they communicate with patients at an appropriate level to ensure patient understanding during the pre-, peri- and postoperative stages of management. Further, healthcare professionals should be aware that there is potential to improve patient health literacy at routine out-patient review, provided that this opportunity is used as an educational resource.

Leadership and business education in orthopaedic residency training programs.

Science.gov (United States)

Kiesau, Carter D; Heim, Kathryn A; Parekh, Selene G

2011-01-01

Leadership and business challenges have become increasingly present in the practice of medicine. Orthopaedic residency programs are at the forefront of educating and preparing orthopaedic surgeons. This study attempts to quantify the number of orthopaedic residency programs in the United States that include leadership or business topics in resident education program and to determine which topics are being taught and rate the importance of various leadership characteristics and business topics. A survey was sent to all orthopaedic department chairpersons and residency program directors in the United States via e-mail. The survey responses were collected using a survey collection website. The respondents rated the importance of leadership training for residents as somewhat important. The quality of character, integrity, and honesty received the highest average rating among 19 different qualities of good leaders in orthopaedics. The inclusion of business training in resident education was also rated as somewhat important. The topic of billing and coding received the highest average rating among 14 different orthopaedically relevant business topics. A variety of topics beyond the scope of clinical practice must be included in orthopaedic residency educational curricula. The decreased participation of newly trained orthopaedic surgeons in leadership positions and national and state orthopaedic organizations is concerning for the future of orthopaedic surgery. Increased inclusion of leadership and business training in resident education is important to better prepare trainees for the future.

Spontaneous Recanalization of the Obstructed Right Coronary Artery Caused by Blunt Chest Trauma.

Science.gov (United States)

Haraguchi, Yumiko; Sakakura, Kenichi; Yamamoto, Kei; Taniguchi, Yousuke; Nakashima, Ikue; Wada, Hiroshi; Sanui, Masamitsu; Momomura, Shin-Ichi; Fujita, Hideo

2018-03-30

Blunt chest trauma can cause a wide variety of injuries including acute myocardial infarction (AMI). Although AMI due to coronary artery dissection caused by blunt chest trauma is very rare, it is associated with high morbidity and mortality. In the vast majority of patients with AMI, primary percutaneous coronary interventions (PCI) are performed to recanalize obstructed arteries, but PCI carries a substantial risk of hemorrhagic complications in the acute phase of trauma. We report a case of AMI due to right coronary artery (RCA) dissection caused by blunt chest trauma. The totally obstructed RCA was spontaneously recanalized with medical therapy. We could avoid primary PCI in the acute phase of blunt chest trauma because electrocardiogram showed early reperfusion signs. We performed an elective PCI in the subacute phase when the risk of bleeding subsided. Since the risk of severe hemorrhagic complications is greater in the acute phase of blunt chest trauma as compared with the late phase, deferring emergency PCI is reasonable if signs of recanalization are observed.

Reduced butyrylcholinesterase activity is an early indicator of trauma-induced acute systemic inflammatory response

Directory of Open Access Journals (Sweden)

Zivkovic AR

2016-11-01

Full Text Available Aleksandar R Zivkovic, Jochen Bender, Thorsten Brenner, Stefan Hofer,* Karsten Schmidt* Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany *These authors contributed equally to this work Purpose: Early diagnosis of systemic inflammatory response syndrome is fundamentally important for an effective and a goal-directed therapy. Various inflammation biomarkers have been used in clinical and experimental practice. However, a definitive diagnostic tool for an early detection of systemic inflammation remains to be identified. Acetylcholine (Ach has been shown to play an important role in the inflammatory response. Serum cholinesterase (butyrylcholinesterase [BChE] is the major Ach hydrolyzing enzyme in blood. The role of this enzyme during inflammation has not yet been fully understood. This study tests whether a reduction in the BChE activity could indicate the onset of the systemic inflammatory response upon traumatic injury. Patients and methods: This observational study measured BChE activity in patients with traumatic injury admitted to the emergency room by using point-of-care-test system (POCT. In addition, the levels of routine inflammation biomarkers during the initial treatment period were measured. Injury Severity Score was used to assess the trauma severity. Results: Altered BChE activity was correlated with trauma severity, resulting in systemic inflammation. Reduction in the BChE activity was detected significantly earlier compared to those of routinely measured inflammatory biomarkers. Conclusion: This study suggests that the BChE activity reduction might serve as an early indicator of acute systemic inflammation. Furthermore, BChE activity, measured using a POCT system, might play an important role in the early diagnosis of the trauma-induced systemic inflammation. Keywords: trauma, injury, early diagnostics, cholinergic, pseudocholinesterase, SIRS

Radiologic examination of orthopaedics. Methods and techniques

International Nuclear Information System (INIS)

Hafner, E.; Meuli, H.C.

1976-01-01

This volume describes in detail radiological examinations of the skeleton modern procedures in orthopaedic surgery. Special emphasis is given to functional examination techniques based upon the authors' extensive work on standardized radiological examinations best suited to the needs of orthopaedic surgeons. These techniques were developed at the Radiodiagnostic Department of the Central Radiological Clinic, Bern University, in cooperation with the University Clinic of Orthopaedics and Surgery of the Locomotor System. Exposure techniques are explained concisely, yet with extraordinary precision and attention to detail. They have proved highly successful in teaching programs for X-ray technicians and as standard examination techniques for many hospitals, X-ray departments, orthopaedic units, and private clinics. Recommended for orthopaedic surgeons, radiologists, general surgeons, and X-ray technicians, this definitive treatise, with its superb X-ray reproductions and complementary line drawings, explains how to achieve improved diagnoses and standardized control with the least possible radiation exposure to the patient

Reappraising the concept of massive transfusion in trauma

DEFF Research Database (Denmark)

Stanworth, Simon J; Morris, Timothy P; Gaarder, Christine

2010-01-01

ABSTRACT : INTRODUCTION : The massive-transfusion concept was introduced to recognize the dilutional complications resulting from large volumes of packed red blood cells (PRBCs). Definitions of massive transfusion vary and lack supporting clinical evidence. Damage-control resuscitation regimens...... of modern trauma care are targeted to the early correction of acute traumatic coagulopathy. The aim of this study was to identify a clinically relevant definition of trauma massive transfusion based on clinical outcomes. We also examined whether the concept was useful in that early prediction of massive...... transfusion as a concept in trauma has limited utility, and emphasis should be placed on identifying patients with massive hemorrhage and acute traumatic coagulopathy....

The value of trauma registries.

Science.gov (United States)

Moore, Lynne; Clark, David E

2008-06-01

Trauma registries are databases that document acute care delivered to patients hospitalised with injuries. They are designed to provide information that can be used to improve the efficiency and quality of trauma care. Indeed, the combination of trauma registry data at regional or national levels can produce very large databases that allow unprecedented opportunities for the evaluation of patient outcomes and inter-hospital comparisons. However, the creation and upkeep of trauma registries requires a substantial investment of money, time and effort, data quality is an important challenge and aggregated trauma data sets rarely represent a population-based sample of trauma. In addition, trauma hospitalisations are already routinely documented in administrative hospital discharge databases. The present review aims to provide evidence that trauma registry data can be used to improve the care dispensed to victims of injury in ways that could not be achieved with information from administrative databases alone. In addition, we will define the structure and purpose of contemporary trauma registries, acknowledge their limitations, and discuss possible ways to make them more useful.

The popliteal fibular ligament in acute knee trauma: patterns of injury on MR imaging

Energy Technology Data Exchange (ETDEWEB)

McKean, D.; Thomee, E.; Grant, D.; Teh, J.L.; Mansour, R. [Oxford University Hospitals NHS Trust, Nuffield Orthopaedic Centre, Headington, Oxford (United Kingdom); Yoong, P. [Royal Berkshire NHS Foundation Trust, Royal Berkshire Hospital, Reading (United Kingdom); Yanny, S. [Buckinghamshire Healthcare NHS Trust, Stoke Mandeville Hospital, Aylesbury (United Kingdom)

2015-10-15

To describe the patterns of injury associated with injury to the popliteofibular ligament injury. A retrospective review was performed of 180 MRI scans undertaken for acute knee trauma. Scans were excluded if the time of injury was over 4 weeks from the time of the scan, or if there was a history of septic arthritis, inflammatory arthropathy, previous knee surgery, or significant artefact. An agreed criterion for assessing the structures of the posterolateral ligamentous complex was defined and in each scan, the popliteofibular ligament (PFL) was scored as normal or injured. The menisci, ligaments, and tendons of each knee were also assessed. The mean age was 25.7 years (range, 9-65 years) and 72.2 % (n = 130) patients were male. The PFL was injured in 36 cases (20 %). There is a significant association between PFL injury and ACL rupture (p = 0.0001), ITB injury (p = 0.0001), PCL injury (p = 0.0373), in addition to associations with injury to other posterolateral corner structures including the lateral collateral ligament (p = 0.0001), biceps femoris tendon (p = 0.0014), and popliteus tendon (p = 0.0014). Of our series of PFL injuries, nine cases (25 %) were associated with further injuries of posterolateral corner structures and in 27 cases (75 %) the PFL was the only posterolateral corner structure torn. PFL injury is not uncommon in acute knee trauma and is associated with significant internal derangement of the knee, especially anterior cruciate ligament rupture, ITB sprain, and injury to other structures within the posterolateral corner. (orig.)

Orthopaedic training in Kenya | Mulimba | East African Orthopaedic ...

African Journals Online (AJOL)

Objective: To do a survey of the current orthopaedic specialists in Kenya's training since their first medical degrees. Determine the duration, facilities and methods of training. Methods: A number of doctors trained under different arrangements were identified, interviewed and where curriculum was available this was read.

Effect of the systemic inflammatory response, as provoked by elective orthopaedic surgery, on HbA1c.

Science.gov (United States)

Chadburn, Andrew J; Garman, Elizabeth; Abbas, Raad; Modupe, Anu; Ford, Clare; Thomas, Osmond L; Chugh, Sanjiv; Deshpande, Shreeram; Gama, Rousseau

2017-07-01

Background In acutely ill patients with new onset hyperglycaemia, plasma glucose cannot reliably distinguish between stress hyperglycaemia and undiagnosed diabetes mellitus. We, therefore, investigated the diagnostic reliability of glycated haemoglobin (HbA1c) in acute illness by prospectively evaluating the effect of the systemic inflammatory response, as provoked by elective orthopaedic surgery, on HbA 1c . Methods HbA 1c and serum C-reactive protein concentrations were compared before and two days after elective knee or hip surgery in 30 patients without diabetes. C-reactive protein was used to assess the systemic inflammatory response. Results The mean (standard deviation) serum C-reactive protein increased following surgery (4.8 [7.5] vs. 179.7 [61.9] mg/L; P<0.0001). HbA 1c was similar before and after surgery (39.2 [5.4] vs. 38.1 [5.1] mmol/moL, respectively; P = 0.4363). Conclusions HbA 1c is unaffected within two days of a systemic inflammatory response as provoked by elective orthopaedic surgery. This suggests that HbA 1c may be able to differentiate newly presenting type 2 diabetes mellitus from stress hyperglycaemia in acutely ill patients with new onset hyperglycaemia.

1 venous thromboembolism in orthopaedics references

African Journals Online (AJOL)

2008-05-23

2004; 126: 338-400S. 3. American Academy of Orthopaedic Surgeons. American Academy of orthopaedic Surgeons clinical guidelines on prevention of symptomatic pulmonary embolism in patients undergoing total hip or knee arthroplasty.www.aaos.org/Research/ guidelines/PE_guideline. Pdf (accessed May 23, 2008). 4.

Using Trauma and Injury Severity Score (TRISS)-based analysis in the development of regional risk adjustment tools to trend quality in a voluntary trauma system: the experience of the Trauma Foundation of Northeast Ohio.

Science.gov (United States)

Mancuso, C; Barnoski, A; Tinnell, C; Fallon, W

2000-04-01

Presently, no trauma system exists in Ohio. Since 1993, all hospitals in Cuyahoga County (CUY), northeast Ohio (n = 22) provide data to a trauma registry. In return, each received hospital-specific data, comparison data by trauma care level and a county-wide aggregate summary. This report describes the results of this approach in our region. All cases were entered by paper abstract or electronic download. Interrater reliability audits and z score analysis was performed by using the Major Trauma Outcome Study and the CUY 1994 baseline groups. Risk adjustment of mortality data was performed using statistical modeling and logistic regression (Trauma and Injury Severity Score, Major Trauma Outcome Study, CUY). Trauma severity measures were defined. In 1995, 3,375 patients were entered. Two hundred ninety-one died (8.6%). Severity measures differed by level of trauma care, indicating differences in case mix. Probability of survival was lowest in the Level I centers, highest in the acute care hospitals. Outcomes z scores demonstrated survival differences for all levels. In a functioning trauma system, the most severely injured patients should be cared for at the trauma centers. A low volume at acute care hospitals is desirable. By using Trauma and Injury Severity Score with community-specific constants, NE Ohio is accomplishing these goals. The Level I performance data are an interesting finding compared with the data from the Level II centers in the region

Advanced practice physiotherapy-led triage in Irish orthopaedic and rheumatology services: national data audit.

Science.gov (United States)

Fennelly, Orna; Blake, Catherine; FitzGerald, Oliver; Breen, Roisin; Ashton, Jennifer; Brennan, Aisling; Caffrey, Aoife; Desmeules, François; Cunningham, Caitriona

2018-06-01

Many people with musculoskeletal (MSK) disorders wait several months or years for Consultant Doctor appointments, despite often not requiring medical or surgical interventions. To allow earlier patient access to orthopaedic and rheumatology services in Ireland, Advanced Practice Physiotherapists (APPs) were introduced at 16 major acute hospitals. This study performed the first national evaluation of APP triage services. Throughout 2014, APPs (n = 22) entered clinical data on a national database. Analysis of these data using descriptive statistics determined patient wait times, Consultant Doctor involvement in clinical decisions, and patient clinical outcomes. Chi square tests were used to compare patient clinical outcomes across orthopaedic and rheumatology clinics. A pilot study at one site identified re-referral rates to orthopaedic/rheumatology services of patients managed by the APPs. In one year, 13,981 new patients accessed specialist orthopaedic and rheumatology consultations via the APP. Median wait time for an appointment was 5.6 months. Patients most commonly presented with knee (23%), lower back (22%) and shoulder (15%) disorders. APPs made autonomous clinical decisions regarding patient management at 77% of appointments, and managed patient care pathways without onward referral to Consultant Doctors in more than 80% of cases. Other onward clinical pathways recommended by APPs were: physiotherapy referrals (42%); clinical investigations (29%); injections administered (4%); and surgical listing (2%). Of those managed by the APP, the pilot study identified that only 6.5% of patients were re-referred within one year. This national evaluation of APP services demonstrated that the majority of patients assessed by an APP did not require onward referral for a Consultant Doctor appointment. Therefore, patients gained earlier access to orthopaedic and rheumatology consultations in secondary care, with most patients conservatively managed.

Facilitators and barriers to doing workplace mental health research: Case study of acute psychological trauma in a public transit system.

Science.gov (United States)

Links, Paul S; Bender, Ash; Eynan, Rahel; O'Grady, John; Shah, Ravi

2016-03-10

The Acute Psychological Trauma (APT) Study was a collaboration between an acute care hospital, a specialized multidisciplinary program designed to meet the mental health needs of injured workers, and a large urban public transit system. The overall purpose was to evaluate a Best Practices Intervention (BPI) for employees affected by acute psychological trauma compared to a Treatment as Usual (TAU) group. The specific purpose is to discuss facilitators and barriers that were recognized in implementing and carrying out mental health research in a workplace setting. Over the course of the APT study, a joint implementation committee was responsible for day-to-day study operations and made regular observations on the facilitators and barriers that arose throughout the study. The facilitators to this study included the longstanding relationships among the partners, increased recognition for the need of mental health research in the workplace, and the existence of a community advisory committee. The significant barriers to doing this study of mental health research in the workplace included differences in organizational culture, inconsistent union support, co-interventions, and stigma. Researchers and funding agencies need to be flexible and provide additional resources in order to overcome the barriers that can exist doing workplace mental health research.

Biomaterials in orthopaedics

Science.gov (United States)

Navarro, M; Michiardi, A; Castaño, O; Planell, J.A

2008-01-01

At present, strong requirements in orthopaedics are still to be met, both in bone and joint substitution and in the repair and regeneration of bone defects. In this framework, tremendous advances in the biomaterials field have been made in the last 50 years where materials intended for biomedical purposes have evolved through three different generations, namely first generation (bioinert materials), second generation (bioactive and biodegradable materials) and third generation (materials designed to stimulate specific responses at the molecular level). In this review, the evolution of different metals, ceramics and polymers most commonly used in orthopaedic applications is discussed, as well as the different approaches used to fulfil the challenges faced by this medical field. PMID:18667387

Publication Productivity of Early-Career Orthopedic Trauma Surgeons.

Science.gov (United States)

Hake, Mark E; Lee, John J; Goulet, James A

2016-01-01

The goals of this study were to: (1) define the publication productivity of early-career orthopedic trauma surgeons over time; (2) compare the early-career publication productivity of recent orthopedic trauma fellowship graduates vs their more senior colleagues; and (3) determine the proportion of fellowship graduates who meet the Orthopaedic Trauma Association (OTA) publication criteria for active membership early in their careers. Orthopedic trauma fellowship graduates from 1982 to 2007 were analyzed. A literature search was performed for each fellow's publications for the 6-year period beginning the year of fellowship graduation. Publication productivity was compared between early and recent groups of graduates, 1987 to 1991 and 2003 to 2007, respectively. Fulfillment of OTA publication criteria was determined. Seventy-nine percent of graduates contributed to 1 or more publications. The recent group produced more total publications per graduate (4.06 vs 3.29, P=.01) and more coauthor publications (2.60 vs 2.04, P=.019) than the early group. The number of first-author publications did not differ between groups (1.46 vs 1.25, P=.26). A greater percentage of the recent group met current OTA publication criteria compared with the early group (51% vs 35%, P=.04). The findings showed that recent orthopedic trauma graduates had increased publication productivity compared with their more senior colleagues, although a proportion had not qualified for active OTA membership 6 years into their career. Overall, these data are encouraging and suggest that young orthopedic trauma surgeons remain committed to sustaining a high level of academic excellence. Copyright 2016, SLACK Incorporated.

Fibrinogen depletion in trauma: early, easy to estimate and central to trauma-induced coagulopathy

OpenAIRE

Davenport, Ross; Brohi, Karim

2013-01-01

Fibrinogen is fundamental to hemostasis and falls rapidly in trauma hemorrhage, although levels are not routinely measured in the acute bleeding episode. Prompt identification of critically low levels of fibrinogen and early supplementation has the potential to correct trauma-induced coagulation and improve outcomes. Early estimation of hypofibrinogenemia is possible using surrogate markers of shock and hemorrhage; for example, hemoglobin and base excess. Rapid replacement with fibrinogen con...

Inappropriately Timed Pediatric Orthopaedic Referrals From the Emergency Department Result in Unnecessary Appointments and Financial Burden for Patients.

Science.gov (United States)

Jackson, Taylor J; Blumberg, Todd J; Shah, Apurva S; Sankar, Wudbhav N

2018-03-01

Musculoskeletal injuries are among the most common reasons for emergency department (ED) visits in the pediatric population. Many such injuries can be managed with a single follow-up outpatient visit. However, untimely (ie, premature) referrals by emergency physicians to orthopaedic surgeons are common and may inadvertently create need for a second visit, generating unnecessary expenditures. We sought to elucidate the cost of premature musculoskeletal follow-up visits to the patients, families, and the health care system. We performed a retrospective review of pediatric patients with acute musculoskeletal injuries referred from our ED (without a formal orthopaedic consult) to our outpatient clinic. Patients were retrospectively reviewed in a consecutive fashion. The appropriateness of the recommended follow-up time interval was determined for each patient, and the direct and indirect cost of the inappropriate services were calculated utilizing a combination of traditional cost accounting techniques and time-driven activity-based costing. The characteristics of patients with appropriate and untimely follow-up referrals were compared. Two hundred consecutive referrals from the ED were reviewed. Overall, 96.5% of the follow-up visits recommended by the ED were premature, which led 106 (53%) patients to require a second visit to complete their clinical care. Patients who required a second visit were significantly younger (P=0.005), more likely to be male (P=0.042), more likely to have a fracture (Pcost of $342.93 per patient. Untimely referrals for follow-up of acute pediatric musculoskeletal conditions are very common and represent a significant financial burden to patients, families, and the health care system. Over 40% of unnecessary visits resulted from just 3 diagnoses. Improved orthopaedic follow-up guidelines, particularly for these readily recognizable conditions, and feedback to referring providers may reduce poorly timed clinic visits and decrease costs in

Dual-phase CT for the assessment of acute vascular injuries in high-energy blunt trauma: the imaging findings and management implications.

Science.gov (United States)

Iacobellis, Francesca; Ierardi, Anna M; Mazzei, Maria A; Magenta Biasina, Alberto; Carrafiello, Gianpaolo; Nicola, Refky; Scaglione, Mariano

2016-01-01

Acute vascular injuries are the second most common cause of fatalities in patients with multiple traumatic injuries; thus, prompt identification and management is essential for patient survival. Over the past few years, multidetector CT (MDCT) using dual-phase scanning protocol has become the imaging modality of choice in high-energy deceleration traumas. The objective of this article was to review the role of dual-phase MDCT in the identification and management of acute vascular injuries, particularly in the chest and abdomen following multiple traumatic injuries. In addition, this article will provide examples of MDCT features of acute vascular injuries with correlative surgical and interventional findings.

Quality of life during orthopaedic training and academic practice. Part 1: orthopaedic surgery residents and faculty.

Science.gov (United States)

Sargent, M Catherine; Sotile, Wayne; Sotile, Mary O; Rubash, Harry; Barrack, Robert L

2009-10-01

A pilot study of two academic training programs revealed concerning levels of resident burnout and psychological dysfunction. The purpose of the present study was to determine the quality of life of orthopaedic residents and faculty on a national scale and to identify risk factors for decompensation. Three hundred and eighty-four orthopaedic residents and 264 full-time orthopaedic faculty members completed a voluntary, anonymous survey consisting of three validated instruments (the Maslach Burnout Inventory, the General Health Questionnaire-12, and the Revised Dyadic Adjustment Scale) and question sets assessing demographic information, relationship issues, stress reactions/management, and work/life balance. High levels of burnout were seen in 56% of the residents and 28% of the faculty members. Burnout risk was greatest among second-postgraduate-year residents and residents in training programs with six or more residents per postgraduate year. Sixteen percent of residents and 19% of faculty members reported symptoms of psychological distress. Sleep deprivation was common among the residents and correlated positively with every distress measure. Faculty reported greater levels of stress but greater satisfaction with work and work/life balance. A number of factors, such as making time for hobbies and limiting alcohol use, correlated with decreased dysfunction for both residents and faculty. Despite reporting high levels of job satisfaction, orthopaedic residents and faculty are at risk for burnout and distress. Identification of protective factors and risk factors may provide guidance to improve the quality of life of academic orthopaedic surgeons in training and beyond.

[Managment of acute low back pain without trauma - an algorithm].

Science.gov (United States)

Melcher, Carolin; Wegener, Bernd; Jansson, Volkmar; Mutschler, Wolf; Kanz, Karl-Georg; Birkenmaier, Christof

2018-05-14

Low back pain is a common problem for primary care providers, outpatient clinics and A&E departments. The predominant symptoms are those of so-called "unspecific back pain", but serious pathologies can be concealed by the clinical signs. Especially less experienced colleagues have problems in treating these patients, as - despite the multitude of recommendations and guidelines - there is no generally accepted algorithm. After a literature search (Medline/Cochrane), 158 articles were selected from 15,000 papers and classified according to their level of evidence. These were attuned to the clinical guidelines of the orthopaedic and pain-physician associations in Europe, North America and overseas and the experience of specialists at LMU Munich, in order to achieve consistency with literature recommendations, as well as feasibility in everyday clinical work and optimised with practical relevance. An algorithm was formed to provide the crucial differential diagnosis of lumbar back pain according to its clinical relevance and to provide a plan of action offering reasonable diagnostic and therapeutic steps. As a consequence of distinct binary decisions, low back patients should be treated at any given time according to the guidelines, with emergencies detected, unnecessary diagnostic testing and interventions averted and reasonable treatment initiated pursuant to the underlying pathology. In the context of the available evidence, a clinical algorithm has been developed that translates the complex diagnostic testing of acute low back pain into a transparent, structured and systematic guideline. Georg Thieme Verlag KG Stuttgart · New York.

Communication skills training in orthopaedics.

Science.gov (United States)

Lundine, Kristopher; Buckley, Richard; Hutchison, Carol; Lockyer, Jocelyn

2008-06-01

Communication skills play a key role in many aspects of both medical education and clinical patient care. The objectives of this study were to identify the key components of communication skills from the perspectives of both orthopaedic residents and their program directors and to understand how these skills are currently taught. This study utilized a mixed methods design. Quantitative data were collected with use of a thirty-item questionnaire distributed to all Canadian orthopaedic residents. Qualitative data were collected through focus groups with orthopaedic residents and semistructured interviews with orthopaedic program directors. One hundred and nineteen (37%) of 325 questionnaires were completed, twelve residents participated in two focus groups, and nine of sixteen program directors from across the country were interviewed. Both program directors and residents identified communication skills as being the accurate and appropriate use of language (i.e., content skills), not how the communication was presented (i.e., process skills). Perceived barriers to effective communication included time constraints and the need to adapt to the many personalities and types of people encountered daily in the hospital. Residents rarely have explicit training in communication skills. They rely on communication training implicitly taught through observation of their preceptors and clinical experience interacting with patients, peers, and other health-care professionals. Orthopaedic residents and program directors focus on content and flexibility within communication skills as well as on the importance of being concise. They value the development of communication skills in the clinical environment through experiential learning and role modeling. Education should focus on developing residents' process skills in communication. Care should be taken to avoid large-group didactic teaching sessions, which are perceived as ineffective.

Trauma Center Staffing, Infrastructure, and Patient Characteristics that Influence Trauma Center Need

Directory of Open Access Journals (Sweden)

Faul, Mark

2014-11-01

Full Text Available Introduction: The most effective use of trauma center resources helps reduce morbidity and mortality, while saving costs. Identifying critical infrastructure characteristics, patient characteristics and staffing components of a trauma center associated with the proportion of patients needing major trauma care will help planners create better systems for patient care.   Methods: We used the 2009 National Trauma Data Bank-Research Dataset to determine the proportion of critically injured patients requiring the resources of a trauma center within each Level I-IV trauma center (n=443. The outcome variable was defined as the portion of treated patients who were critically injured. We defined the need for critical trauma resources and interventions (“trauma center need” as death prior to hospital discharge, admission to the intensive care unit, or admission to the operating room from the emergency department as a result of acute traumatic injury. Generalized Linear Modeling (GLM was used to determine how hospital infrastructure, staffing Levels, and patient characteristics contributed to trauma center need.     Results: Nonprofit Level I and II trauma centers were significantly associated with higher levels of trauma center need. Trauma centers that had a higher percentage of transferred patients or a lower percentage of insured patients were associated with a higher proportion of trauma center need.  Hospital infrastructure characteristics, such as bed capacity and intensive care unit capacity, were not associated with trauma center need. A GLM for Level III and IV trauma centers showed that the number of trauma surgeons on staff was associated with trauma center need. Conclusion: Because the proportion of trauma center need is predominantly influenced by hospital type, transfer frequency, and insurance status, it is important for administrators to consider patient population characteristics of the catchment area when planning the

Proceedings of scientific instructional conference on local antibiotic therapy on prevention and treatment of infections in orthopaedics and traumatology.

Science.gov (United States)

Okapa, Robert; Marczyński, Wojciech; Kolbuszewski, Andrzej

2013-06-13

Proceedings of scientific instructional conference which was held on 7th July 2012 in Józefów near Warsaw. Dring the Conference the cectures were presented by leading experts - Dr. David Jenkins, clinical microbiology consultant from the University Hospital in Leicester, Professor Harald Knaepler, head of the Department of Trauma and Orthopaedics in Wetzlar, Germany, Dr. David Jahoda, head of the department of orthopedic infections, Motol University Hospital, Prague, and Professor Wojciech Marczyński, head of the Department of Orthopaedics, The Centre of Postgraduate Medical Education, Professor Adam Gruca Teaching Hospital in Otwock, who was also the Conference moderator. The meeting was the opportunity to clarify the indications and contraindications to the use of local antibiotic therapy in the treatment of infectious complications after surgical procedures  and focus on practical aspects of clinical microbiology and its important contribution to the identification and resolution of problems with infectious complications in orthopedics and traumatology.  

Computational radiology for orthopaedic interventions

CERN Document Server

Li, Shuo

2016-01-01

This book provides a cohesive overview of the current technological advances in computational radiology, and their applications in orthopaedic interventions. Contributed by the leading researchers in the field, this volume covers not only basic computational radiology techniques such as statistical shape modeling, CT/MRI segmentation, augmented reality and micro-CT image processing, but also the applications of these techniques to various orthopaedic interventional tasks. Details about following important state-of-the-art development are featured: 3D preoperative planning and patient-specific instrumentation for surgical treatment of long-bone deformities, computer assisted diagnosis and planning of periacetabular osteotomy and femoroacetabular impingement, 2D-3D reconstruction-based planning of total hip arthroplasty, image fusion for  computer-assisted bone tumor surgery, intra-operative three-dimensional imaging in fracture treatment, augmented reality based orthopaedic interventions and education, medica...

The horror of wrong-site surgery continues: report of two cases in a regional trauma centre in Nigeria.

Science.gov (United States)

Nwosu, Arinze

2015-01-01

Wrong- site surgeries are iatrogenic errors encountered in the course of surgical patient management. Despite the 'never do harm' pledge in the 'Hippocratic Oath' drafted in 5(th) century BC, man is after all human, with this limitation manifesting in the physician's art despite his best intention. Beyond the catastrophic consequences of wrong- site surgery on the patient and surgeon, and the opprobrium on the art of medicine, the incidents have come to be regarded as a quality-of-care indicator. Orthopaedic surgery is a specialty with a preponderance of this phenomenon and the attendant medico-legal issues relating to malpractice claims. Consequently the specialty had pioneered institutional initiatives at preventing these 'friendly-fires'. Awareness and implementation of these initiatives however remain low in many parts of the world, hampered by a culture of denial and shame. This report presents two cases of wrong-site surgery following trauma from road-traffic accident. The first case was a closed reduction of the 'wrong' dislocated hip in the trauma/emergency unit under the care of senior residents, while the second case was attempted wrong-site surgery on the right leg in a patient with fracture of the left tibia, in conjunction with bilateral femoral fracture and right radio-ulnar fracture; by an experienced Chief Consultant Orthopaedic Surgeon operating elective list. Both are orthopaedic cases, each with some trauma to both lower extremeties. Neither of the cases was formally mentioned anywhere in clinical discourse in the hospital, much less a formal report or audit. There was no formal, institutionalized process to prevent wrong-site surgery in the health institution and this could have been largely responsible for these incidents. An open, mandatory process of reporting such incidents for relevant audit and awareness is necessary, as a mechanism for prevention rather than blame or punishment.

Gunshot induced injuries in orthopaedic trauma research. A bibliometric analysis of the most influential literature.

Science.gov (United States)

Held, M; Engelmann, E; Dunn, R; Ahmad, S S; Laubscher, M; Keel, M J B; Maqungo, S; Hoppe, S

2017-09-01

A growing burden of gunshot injuries demands evidence-based ballistic trauma management. No comprehensive systematic overview of the current knowledge is available to date. This study aims to identify and analyze the most influential publications in the field of orthopedic ballistic trauma research. All databases available in the Thomson Reuters Web of Knowledge were searched to conduct this bibliometrical study. The most cited orthopedic ballistic trauma articles published between 1950 and 2015 were identified by use of a multi-step approach. Publications with ten citations and more were analyzed for citations, journal, authorship, geographic origin, area of research, anatomical site, study type, study category, and level of evidence. Citations of the 128 included studies ranged from 113 to 10. These were published in fifty different journals between 1953 and 2011. Most publications (n=106; 83%) originated from the USA, were retrospective (n=85; 66.4%), level IV studies (n=90; 70.3%), reported on spinal gunshot injuries (n=49; 38.33%) and were published between 1980 and 2000 (n=111; 86.7%). This bibliometric study provides the first comprehensive overview of influential publications in the field of orthopedic ballistic trauma research. More prospective studies and high-quality systematic reviews are needed. Centres with a high burden of gunshot injuries from the developing world need to share their experience in form of international publications, to provide a more comprehensive picture of the global gun-related orthopedic injury burden. bibliometric analysis: level III. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Imaging of blunt chest trauma

International Nuclear Information System (INIS)

Prosch, H.; Negrin, L.

2014-01-01

Blunt chest trauma is associated with high morbidity and mortality. Consequently, all patients should be evaluated radiologically after blunt chest trauma to allow timely and appropriate treatment. Conventional chest radiographs and computed tomography (CT) are proven modalities with which to evaluate patients after blunt chest trauma. Over the last several years extended focused assessment with sonography for trauma (eFAST) has gained increasing importance for the initial assessment of seriously injured patients. In the acute phase of severely injured patients eFAST examinations are helpful to exclude pneumothorax, hemothorax and hemopericardium. Chest radiographs may also be used to diagnose a pneumothorax or hemothorax; however, the sensitivity is limited and CT is the diagnostic modality of choice to evaluate severely injured patients. (orig.) [de

Mortality after acute trauma: Progressive decreasing rather than a trimodal distribution

Directory of Open Access Journals (Sweden)

Ionut Negoi

2015-08-01

Conclusions: The trimodal time distribution of mortality remains a milestone in trauma education and research. Nevertheless, it must be questioned in the modern and very efficient trauma systems, but still very actual for developing trauma care systems. In conclusion, the pattern of mortality due to major trauma seems decreasing continuously with time rather than presenting high peaks of frequency at some moments.

The trauma ecosystem: The impact and economics of new trauma centers on a mature statewide trauma system.

Science.gov (United States)

Ciesla, David J; Pracht, Etienne E; Leitz, Pablo T; Spain, David A; Staudenmayer, Kristan L; Tepas, Joseph J

2017-06-01

Florida serves as a model for the study of trauma system performance. Between 2010 and 2104, 5 new trauma centers were opened alongside 20 existing centers. The purpose of this study was to explore the impact of trauma system expansion on system triage performance and trauma center patients' profiles. A statewide data set was queried for all injury-related discharges from adult acute care hospitals using International Classification of Diseases, Ninth Revision (ICD-9) codes for 2010 and 2014. The data set, inclusion criteria, and definitions of high-risk injury were chosen to match those used by the Florida Department of Health in its trauma registry. Hospitals were classified as existing Level I (E1) or Level II (E2) trauma centers and new E2 (N2) centers. Five N2 centers were established 11.6 to 85.3 miles from existing centers. Field and overall trauma system triage of high-risk patients was less accurate with increased overtriage and no change in undertriage. Annual volume at N2 centers increased but did not change at E1 and E2 centers. In 2014, Patients at E1 and E2 centers were slightly older and less severely injured, while those at N2 centers were substantially younger and more severely injured than in 2010. The injured patient-payer mix changed with a decrease in self-pay and commercial patients and an increase in government-sponsored patients at E1 and E2 centers and an increase in self-pay and commercial patients with a decrease in government-sponsored patients at N2 centers. Designation of new trauma centers in a mature system was associated with a change in established trauma center demographics and economics without an improvement in trauma system triage performance. These findings suggest that the health of an entire trauma system network must be considered in the design and implementation of a regional trauma system. Therapeutic/care management study, level IV; epidemiological, level IV.

An information revolution in orthopaedics.

Science.gov (United States)

Goldberg, A J; MacGregor, A; Spencer, S A

2012-04-01

With the established success of the National Joint Registry and the emergence of a range of new national initiatives for the capture of electronic data in the National Health Service, orthopaedic surgery in the United Kingdom has found itself thrust to the forefront of an information revolution. In this review we consider the benefits and threats that this revolution poses, and how orthopaedic surgeons should marshal their resources to ensure that this is a force for good.

Irish (Republic) versus British (North West) orthopaedic trainees: what are the differences?

LENUS (Irish Health Repository)

Banks, L N

2012-02-01

British Trainees have gradually had their working week curtained over the last 8 years. The Republic of Ireland Trainees have not been subjected to the European Working Time Directive prior to 2009 and have therefore worked on average, more hours than their British counterparts. We wanted to see if the differing schemes had an impact on recruiting and training orthopaedic surgeons. We surveyed Republic of Ireland orthopaedic specialist registrars (SpRs) and North West (NW) British SpRs\\/specialist trainees (ST3 and above) to see if there were any discernable differences in working patterns and subsequent training exposure. A standard proforma was given to Irish Trainees and to NW SpRs\\/STs at their National or regional teaching (January\\/February 2009). 62% of Irish and 47% of British NW Trainees responded. Irish trainees were more likely to have obtained a post-graduate degree (p = 0.03). The Irish worked more hours per week (p < 0.001) doing more trauma operative lists (p = 0.003) and more total cases per 6 months than the NW British (p = 0.003). This study suggests that more hours worked, equals more operative exposure, without detriment to the academic side of training. Obviously it is not possible to say whether fewer operations make for a poorer surgeon, but the evidence suggests that it may be true.

Delayed presentation of carotid artery dissection following major orthopaedic trauma resulting in dense hemiparesis.

LENUS (Irish Health Repository)

Edmundson, S P

2012-01-31

We report a 30-year-old patient who was involved in a high-velocity road traffic accident and developed a left-sided hemiparesis, which was noted in the post-operative period following bilateral femoral intramedullary nailing. CT scanning of the brain revealed infarcts in the right frontal and parietal lobes in the distribution of the right middle cerebral artery. CT angiography showed occlusion of the right internal carotid artery consistent with internal carotid artery dissection. He was anticoagulated and nine months later was able to walk independently. An awareness of this injury is needed to diagnose blunt trauma to the internal carotid artery. Even in the absence of obvious neck trauma, carotid artery dissection should be suspected in patients with a neurological deficit in the peri-operative period.

Isolated syndesmotic injury in acute ankle trauma: Comparison of plain film radiography with 3 T MRI

International Nuclear Information System (INIS)

Schoennagel, B.P.; Karul, M.; Avanesov, M.; Bannas, P.; Gold, G.; Großterlinden, L.G.; Rupprecht, M.; Adam, G.; Yamamura, J.

2014-01-01

Highlights: • Isolated syndesmotic injury is a frequent finding after acute ankle trauma. • Cut-off values and accuracy of plain film radiograph measurements were determined. • The TFCS and the MCS have the potential to detect isolated syndesmotic injury. • Appropriate cut-off values allow detection of isolated syndesmotic injury. • Only MRI reveals severity of isolated syndesmotic injury and concomitant injuries. - Abstract: Objectives: To determine cut-off values and the accuracy of plain film measurements for the detection of isolated syndesmotic injury after acute ankle trauma and to investigate MRI findings of concomitant ankle injury. Methods: Eighty-four consecutive patients with absent fracture in plain film radiographs were prospectively evaluated for isolated syndesmotic injury after acute ankle trauma. The tibiofibular clear space (TFCS), the tibiofibular overlap (TFO), and the medial clear space (MCS) were independently assessed in plain radiographs by two readers. MRI performed at 3 T within 24 h served as the reference standard. MRI was evaluated for syndesmotic injury, using a four-scale grading system (0 = normal syndesmosis, 1a = periligamentous edema, 1b = intraligamentous edema, 2 = partial rupture, 3 = complete rupture), and for concomitant ankle injury. Inter-observer variability for x-ray measurements was assessed using Bland–Altman diagrams. ROC analyses were performed to determine cut-off values and sensitivity and specificity for TFCS, TFO, and MCS. Results: Eleven of 84 patients (13.1%) revealed syndesmotic injury (Grade 2 or 3) according to MRI. Between patients with and without syndesmotic injury significantly different measurements were obtained for TFCS (p = 0.003) and MCS (p = 0.04). ROC derived cut-off values were 5.3 mm for TFCS, 2.8 mm for TFO, and 2.8 mm for MCS. Sensitivity and specificity was 82% and 75% for TFCS, 36% and 78% for TFO, and 73% and 59% for MCS. The bias and limits of agreement were −0.04 mm and [−1

Isolated syndesmotic injury in acute ankle trauma: Comparison of plain film radiography with 3 T MRI

Energy Technology Data Exchange (ETDEWEB)

Schoennagel, B.P., E-mail: b.schoennagel@uke.uni-hamburg.de [Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg (Germany); Karul, M.; Avanesov, M.; Bannas, P.; Gold, G. [Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg (Germany); Großterlinden, L.G. [Department of Trauma-, Hand- and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg (Germany); Rupprecht, M. [Department of Pediatric Orthopedics, Children' s Hospital Hamburg-Altona, Bleickenallee 38, 22763 Hamburg (Germany); Adam, G.; Yamamura, J. [Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg (Germany)

2014-10-15

Highlights: • Isolated syndesmotic injury is a frequent finding after acute ankle trauma. • Cut-off values and accuracy of plain film radiograph measurements were determined. • The TFCS and the MCS have the potential to detect isolated syndesmotic injury. • Appropriate cut-off values allow detection of isolated syndesmotic injury. • Only MRI reveals severity of isolated syndesmotic injury and concomitant injuries. - Abstract: Objectives: To determine cut-off values and the accuracy of plain film measurements for the detection of isolated syndesmotic injury after acute ankle trauma and to investigate MRI findings of concomitant ankle injury. Methods: Eighty-four consecutive patients with absent fracture in plain film radiographs were prospectively evaluated for isolated syndesmotic injury after acute ankle trauma. The tibiofibular clear space (TFCS), the tibiofibular overlap (TFO), and the medial clear space (MCS) were independently assessed in plain radiographs by two readers. MRI performed at 3 T within 24 h served as the reference standard. MRI was evaluated for syndesmotic injury, using a four-scale grading system (0 = normal syndesmosis, 1a = periligamentous edema, 1b = intraligamentous edema, 2 = partial rupture, 3 = complete rupture), and for concomitant ankle injury. Inter-observer variability for x-ray measurements was assessed using Bland–Altman diagrams. ROC analyses were performed to determine cut-off values and sensitivity and specificity for TFCS, TFO, and MCS. Results: Eleven of 84 patients (13.1%) revealed syndesmotic injury (Grade 2 or 3) according to MRI. Between patients with and without syndesmotic injury significantly different measurements were obtained for TFCS (p = 0.003) and MCS (p = 0.04). ROC derived cut-off values were 5.3 mm for TFCS, 2.8 mm for TFO, and 2.8 mm for MCS. Sensitivity and specificity was 82% and 75% for TFCS, 36% and 78% for TFO, and 73% and 59% for MCS. The bias and limits of agreement were −0.04 mm and [−1

Alcohol acute intoxication before sepsis impairs the wound healing of intestinal anastomosis: rat model of the abdominal trauma patient

Directory of Open Access Journals (Sweden)

Morais Pedro

2012-08-01

Full Text Available Abstract Introduction Most trauma patients are drunk at the time of injury. Up to 2% of traumatized patients develop sepsis, which considerably increases their mortality. Inadequate wound healing of the colonic repair can lead to postoperative complications such as leakage and sepsis. Objective To assess the effects of acute alcohol intoxication on colonic anastomosis wound healing in septic rats. Methods Thirty six Wistar rats were allocated into two groups: S (induction of sepsis and AS (alcohol intake before sepsis induction. A colonic anastomosis was performed in all groups. After 1, 3 or 7 days the animals were killed. Weight variations, mortality rate, histopathology and tensile breaking strength of the colonic anastomosis were evaluated. Results There was an overall mortality of 4 animals (11.1%, three in the group AS (16.6% and one in the S group (5.5%. Weight loss occurred in all groups. The colon anastomosis of the AS group didn’t gain strength from the first to the seventh postoperative day. On the histopathological analysis there were no differences in the deposition of collagen or fibroblasts between the groups AS and S. Conclusion Alcohol intake increased the mortality rate three times in septic animals. Acute alcohol intoxication delays the acquisition of tensile strength of colonic anastomosis in septic rats. Therefore, acute alcohol intoxication before sepsis leads to worse prognosis in animal models of the abdominal trauma patients.

Racial and ethnic diversity in orthopaedic surgery residency programs.

Science.gov (United States)

Okike, Kanu; Utuk, Mekeme E; White, Augustus A

2011-09-21

Although the U.S. population is increasingly diverse, the field of orthopaedic surgery has historically been less diverse. The purpose of this study was to quantify the representation of racial and ethnic minorities among orthopaedic surgery residents compared with those in other fields of medicine and to determine how these levels of diversity have changed over time. We determined the representation of minorities among residents in orthopaedic surgery and in other fields by analyzing the Graduate Medical Education reports published annually by the Journal of the American Medical Association (JAMA), which provided data for African-Americans from 1968 to 2008, Hispanics from 1990 to 2008, Asians from 1995 to 2008, and American Indians/Alaskan Natives and Native Hawaiians/Pacific Islanders from 2001 to 2008. During the 1990s and 2000s, representation among orthopaedic residents increased rapidly for Asians (+4.53% per decade, p < 0.0001) and gradually for Hispanics (+1.37% per decade, p < 0.0001) and African-Americans (+0.68% per decade, p = 0.0003). Total minority representation in orthopaedics averaged 20.2% during the most recent years studied (2001 to 2008), including 11.7% for Asians, 4.0% for African-Americans, 3.8% for Hispanics, 0.4% for American Indians/Alaskan Natives, and 0.3% for Native Hawaiians/Pacific Islanders. However, orthopaedic surgery was significantly less diverse than all of the other residencies examined during this time period (p < 0.001). This was due primarily to the lower representation of Hispanics and Asians in orthopaedic surgery than in any of the other fields of medicine. Minority representation in orthopaedic residency programs has increased over time for Asians, Hispanics, and African-Americans. In spite of these gains, orthopaedic surgery has remained the least diverse of the specialty training programs considered in this study. While further efforts are needed to determine the factors underlying this lack of representation, we

Contemporary management of acute kidney trauma

Directory of Open Access Journals (Sweden)

Inês Anselmo da Costa

2016-01-01

Full Text Available Renal injury occurs in 1%–5% of all traumas, causing disability or even death. The American Association for the Surgery of Trauma (AAST renal injury scale should be used when injuries are reported. Although there is a consensus regarding handling of lower-grade injuries conservatively, the same cannot be said for the higher-grades, for which different specialists handle either conservatively or surgically. A search of the MEDLINE database was undertaken by using the following filters: English language articles, full-text availability, last five years, humans. Pediatric studies were excluded. For most renal injuries in hemodynamically stable, patients can be safely handled conservatively. An organized assessment and treatment system can reduce the need for nephrectomy in most other cases, as has occurred in the last two decades. The AAST injury scale should be updated in light of the advancements in imaging techniques, in order to fine tune grading and treatment.

Early versus delayed decompression in acute subaxial cervical spinal cord injury: A prospective outcome study at a Level I trauma center from India

OpenAIRE

Gupta, Deepak Kumar; Vaghani, Gaurang; Siddiqui, Saquib; Sawhney, Chhavi; Singh, Pankaj Kumar; Kumar, Atin; Kale, S. S.; Sharma, B. S.

2015-01-01

Aims: This study was done with the aim to compare the clinical outcome and patients’ quality of life between early versus delayed surgically treated patients of acute subaxial cervical spinal cord injury. The current study was based on the hypothesis that early surgical decompression and fixations in acute subaxial cervical spinal cord trauma is safe and is associated with improved outcome as compared to delayed surgical decompression. Materials and Methods: A total of 69 patients were recrui...

Circulating histones are mediators of trauma-associated lung injury.

Science.gov (United States)

Abrams, Simon T; Zhang, Nan; Manson, Joanna; Liu, Tingting; Dart, Caroline; Baluwa, Florence; Wang, Susan Siyu; Brohi, Karim; Kipar, Anja; Yu, Weiping; Wang, Guozheng; Toh, Cheng-Hock

2013-01-15

Acute lung injury is a common complication after severe trauma, which predisposes patients to multiple organ failure. This syndrome largely accounts for the late mortality that arises and despite many theories, the pathological mechanism is not fully understood. Discovery of histone-induced toxicity in mice presents a new dimension for elucidating the underlying pathophysiology. To investigate the pathological roles of circulating histones in trauma-induced lung injury. Circulating histone levels in patients with severe trauma were determined and correlated with respiratory failure and Sequential Organ Failure Assessment (SOFA) scores. Their cause-effect relationship was studied using cells and mouse models. In a cohort of 52 patients with severe nonthoracic blunt trauma, circulating histones surged immediately after trauma to levels that were toxic to cultured endothelial cells. The high levels were significantly associated with the incidence of acute lung injury and SOFA scores, as well as markers of endothelial damage and coagulation activation. In in vitro systems, histones damaged endothelial cells, stimulated cytokine release, and induced neutrophil extracellular trap formation and myeloperoxidase release. Cellular toxicity resulted from their direct membrane interaction and resultant calcium influx. In mouse models, cytokines and markers for endothelial damage and coagulation activation significantly increased immediately after trauma or histone infusion. Pathological examinations showed that lungs were the predominantly affected organ with edema, hemorrhage, microvascular thrombosis, and neutrophil congestion. An anti-histone antibody could reduce these changes and protect mice from histone-induced lethality. This study elucidates a new mechanism for acute lung injury after severe trauma and proposes that circulating histones are viable therapeutic targets for improving survival outcomes in patients.

Circulating Histones Are Mediators of Trauma-associated Lung Injury

Science.gov (United States)

Abrams, Simon T.; Zhang, Nan; Manson, Joanna; Liu, Tingting; Dart, Caroline; Baluwa, Florence; Wang, Susan Siyu; Brohi, Karim; Kipar, Anja; Yu, Weiping

2013-01-01

Rationale: Acute lung injury is a common complication after severe trauma, which predisposes patients to multiple organ failure. This syndrome largely accounts for the late mortality that arises and despite many theories, the pathological mechanism is not fully understood. Discovery of histone-induced toxicity in mice presents a new dimension for elucidating the underlying pathophysiology. Objectives: To investigate the pathological roles of circulating histones in trauma-induced lung injury. Methods: Circulating histone levels in patients with severe trauma were determined and correlated with respiratory failure and Sequential Organ Failure Assessment (SOFA) scores. Their cause–effect relationship was studied using cells and mouse models. Measurements and Main Results: In a cohort of 52 patients with severe nonthoracic blunt trauma, circulating histones surged immediately after trauma to levels that were toxic to cultured endothelial cells. The high levels were significantly associated with the incidence of acute lung injury and SOFA scores, as well as markers of endothelial damage and coagulation activation. In in vitro systems, histones damaged endothelial cells, stimulated cytokine release, and induced neutrophil extracellular trap formation and myeloperoxidase release. Cellular toxicity resulted from their direct membrane interaction and resultant calcium influx. In mouse models, cytokines and markers for endothelial damage and coagulation activation significantly increased immediately after trauma or histone infusion. Pathological examinations showed that lungs were the predominantly affected organ with edema, hemorrhage, microvascular thrombosis, and neutrophil congestion. An anti-histone antibody could reduce these changes and protect mice from histone-induced lethality. Conclusions: This study elucidates a new mechanism for acute lung injury after severe trauma and proposes that circulating histones are viable therapeutic targets for improving survival

Readability of Orthopedic Trauma Patient Education Materials on the Internet.

Science.gov (United States)

Mohan, Rohith; Yi, Paul H; Morshed, Saam

In this study, we used the Flesch-Kincaid Readability Scale to determine the readability levels of orthopedic trauma patient education materials on the American Academy of Orthopaedic Surgeons (AAOS) website and to examine how subspecialty coauthorship affects readability level. Included articles from the AAOS online patient education library and the AAOS OrthoPortal website were categorized as trauma or broken bones and injuries on the AAOS online library or were screened by study authors for relevance to orthopedic trauma. Subsequently, the Flesch-Kincaid scale was used to determine each article's readability level, which was reported as a grade level. Subspecialty coauthorship was noted for each article. A total of 115 articles from the AAOS website were included in the study and reviewed. Mean reading level was grade 9.1 for all articles reviewed. Nineteen articles (16.5%) were found to be at or below the eighth-grade level, and only 1 article was at or below the sixth-grade level. In addition, there was no statistically significant difference between articles coauthored by the various orthopedic subspecialties and those authored exclusively by AAOS. Orthopedic trauma readability materials on the AAOS website appear to be written at a reading comprehension level too high for the average patient to understand.

Surgical site infection among patients undergone orthopaedic ...

African Journals Online (AJOL)

Surgical site infection among patients undergone orthopaedic surgery at Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania. ... of surgical site infection at Muhimbili Orthopedic Institute was high. This was associated with more than 2 hours length of surgery, lack of prophylaxis use, and pre-operative hospital stay.

Misdiagnosing absent pedicle of cervical spine in the acute trauma setting

Directory of Open Access Journals (Sweden)

Fahad H. Abduljabbar

2015-09-01

Full Text Available Congenital absence of cervical spine pedicle can be easily misdiagnosed as facet dislocation on plain radiographs especially in the acute trauma setting. Additional imaging, including computed tomography (CT-scan with careful interpretation is required in order to not misdiagnose cervical posterior arch malformation with subsequent inappropriate management. A 39-year-old patient presented to the emergency unit of our university hospital after being trampled by a cow over her back and head followed by loss of consciousness, retrograde amnesia and neck pain. Her initial cervical CT-scan showed possible C5-C6 dislocation, then, it became clear that her problem was a misdiagnosed congenital cervical abnormality. Patient was treated symptomatically without consequences. The congenital absence of a cervical pedicle is a very unusual condition that is easily misdiagnosed. Diagnosis can be accurately confirmed with a CT-scan of the cervical spine. Symptomatic conservative treatment will result in resolution of the symptoms.

Cranium-brain trauma in computed tomographs - diagnosis and clinical correlation

International Nuclear Information System (INIS)

Wrasse, K.

1982-01-01

For the successful treatment of intracranial complications in the case of cranium-brain trauma a quick and exact diagnosis is necessary. The goal of this work was to test and evaluate the effectivity of computed tomography for neurotraumatology. Using 565 patients, who were acutely or at one time suffering from a cranium-brain trauma, the high validity of computed tomography for these injuries was proven. The following areas in question were studied with respect to the value of computed tomography in comparison to them: angiography, X-ray diagnostic, echoencephalography, brain scintigraphy, electroencephalography and neurological-psychopathological findings from cranium-brain trauma. Statement possibilities and difficulties of computed tomography are discussed in the cases of the following neurotraumatological diseases: extracranial hematomas; acute cranium-brain traumas; traumatic arachnoidal bleeding; diffuse brain edema; transtentorial herniation and brain contusions. At the end the diagnostic and therapeutic procedures in the case of cranium-brain trauma are presented. (orig.) [de

[Surgical tactics in duodenal trauma].

Science.gov (United States)

Ivanov, P A; Grishin, A V

2004-01-01

Results of surgical treatment of 61 patients with injuries of the duodenum are analyzed. The causes of injuries were stab-incised wounds in 24 patients, missile wound -- in 7, closed abdominal trauma -- in 26, trauma of the duodenum during endoscopic papillosphincterotomy -- in 4. All the patients underwent surgery. Complications were seen in 32 (52.5%) patients, 21 patients died, lethality was 34.4%. Within the first 24 hours since the trauma 7 patients died due to severe combined trauma, blood loss, 54 patients survived acute period of trauma, including 28 patients after open trauma, 26 -- after closed and 4 -- after trauma of the duodenum during endoscopic papillosphincterotomy. Diagnostic and surgical policies are discussed. Results of treatment depending on kind and time of surgery are regarded. It is demonstrated that purulent complications due to retroperitoneal phlegmona, traumatic pancreatitis, pneumonia are the causes of significant number of unfavorable outcomes. Therefore, it is important to adequately incise and drainage infected parts of retroperitoneal fat tissue with two-lumen drainages. Decompression through duodenal tube is the effective procedure for prophylaxis of suture insufficiency and traumatic pancreatitis. Suppression of pancreatic and duodenal secretion with octreotid improves significantly surgical treatment results.

The consistency between scientific papers presented at the Orthopaedic Trauma Association and their subsequent full-text publication.

Science.gov (United States)

Preston, Charles F; Bhandari, Mohit; Fulkerson, Eric; Ginat, Danial; Egol, Kenneth A; Koval, Kenneth J

2006-02-01

To determine the consistency of conclusions/statements made in podium presentations at the annual meeting of the Orthopaedic Trauma Association (OTA) with those in subsequent full-text publications. Also, to evaluate the nature and consistency of study design, methods, sample sizes, results and assign a corresponding level of evidence. Abstracts of the scientific programs of the OTA from 1994 to 1997 (N = 254) were queried by using the PubMed database to identify those studies resulting in a peer-reviewed, full-text publication. Of the 169 articles retrieved, 137 studies were the basis of our study after the exclusion criteria were applied: non-English language, basic science studies, anatomic dissection studies, and articles published in non-peer-reviewed journals. Information was abstracted onto a data form: first from the abstract published in the final meeting program, and then from the published journal article. Information was recorded regarding study issues, including the study design, primary objective, sample size, and statistical methods. We provided descriptive statistics about the frequency of consistent results between abstracts and full-text publications. The results were recorded as percentages and a 95% confidence interval was applied to each value. Study results were recorded for the abstract and full-text publication comparing results and the overall conclusion. A level of scientific-based evidence was assigned to each full-text publication. The final conclusion of the study remained the same 93.4% of the time. The method of study was an observational case series 52% of the time and a statement regarding the rate of patient follow-up was reported 42% of the time. Of the studies published, 18.2% consisted of a sample size smaller than the previously presented abstract. When the published papers had their level of evidence graded, 11% were level I, 16% level II, 17% level III, and 56% level IV. Authors conclusions were consistent with those in full

Smartphone apps for orthopaedic sports medicine - a smart move?

Science.gov (United States)

Wong, Seng Juong; Robertson, Greg A; Connor, Katie L; Brady, Richard R; Wood, Alexander M

2015-01-01

With the advent of smartphones together with their downloadable applications (apps), there is increasing opportunities for doctors, including orthopaedic sports surgeons, to integrate such technology into clinical practice. However, the clinical reliability of these medical apps remains questionable. We reviewed available apps themed specifically towards Orthopaedic Sports Medicine and related conditions and assessed the level of medical professional involvement in their design and content, along with a review of these apps. The most popular smartphone app stores (Android, Apple, Blackberry, Windows, Samsung, Nokia) were searched for Orthopaedic Sports medicine themed apps, using the search terms; Orthopaedic Sports Medicine, Orthopaedics, Sports medicine, Knee Injury, Shoulder Injury, Anterior Cruciate Ligament Tear, Medial Collateral Ligament Tear, Rotator Cuff Tear, Meniscal Tear, Tennis Elbow. All English language apps related to orthopaedic sports medicine were included. A total of 76 individual Orthopaedic Sports Medicine themed apps were identified. According to app store classifications, there were 45 (59 %) medical themed apps, 28 (37 %) health and fitness themed apps, 1 (1 %) business app, 1 (1 %) reference app and 1 (1 %) sports app. Forty-nine (64 %) apps were available for download free of charge. For those that charged access, the prices ranged from £0.69 to £69.99. Only 51 % of sports medicine apps had customer satisfaction ratings and 39 % had named medical professional involvement in their development or content. We found the majority of Orthopaedic Sports Medicine apps had no named medical professional involvement, raising concerns over their content and evidence-base. We recommend increased regulation of such apps to improve the accountability of app content.

Coronary artery dissection following chest trauma

Directory of Open Access Journals (Sweden)

Manoj K Agarwala

2016-01-01

Full Text Available Chest trauma has a high rate of mortality. Coronary dissection causing myocardial infarction (MI following blunt chest trauma is rare. We describe the case of an anterior MI following blunt chest trauma. A 39-year-old male was received in our hospital following a motorcycle accident. The patient was asymptomatic before the accident. The patient underwent craniotomy for evacuation of hematoma. He developed severe chest pain and an electrocardiogram (ECG revealed anterior ST segment elevation following surgery. Acute coronary event was medically managed; subsequently, coronary angiogram was performed that showed dissection in the left anterior coronary artery, which was stented.

Myth or reality : Hematocrit and hemoglobin differ in trauma

NARCIS (Netherlands)

Nijboer, Johanna M. M.; van der Horst, Iwan C. C.; Hendriks, Herman G. D.; ten Duis, Hendrik-Jan; Nijsten, Maarten W. N.

Background: Estimating blood loss in trauma patients usually involves the determination of hematocrit (Ht) or hemoglobin (Hb). However, in trauma patients, a poorly substantiated habit exists to determine both Ht and Hb in assessing acute blood loss. This suggests that Ht and Hb provide different

A Clinico- Epidemiological Study Of Filarial Related Orthopaedic Manifestations

Directory of Open Access Journals (Sweden)

Patond K.R

1992-01-01

Full Text Available An epidemiological study was undertaken to study the incidence and distribution of orthopaedic manifestations of filariasis in an endemic area. A total of 207 cases were clinically examined and investigated. Patients were divided into three groups , viz., Group A: Orthopaedic manifestations with no history of filariasis . Group B: Orthopaedic manifestations with history of filariasis such as microfilaraemia or filarial fevers etc., Group C: Orthopaedic manifestations with chronic manifestations such as elephantiasis, hydrocele etc. To confirm filarial etiology, all the cases were examined for the presence of filarial antibody by indirect ELISA using wuchereda bancrofti microfilarial excretory- secretary antigen (wd Mf ESAg . A total of 61 of 102 patients of Group A, 14 of 21 patients of group B, and 73 of 84 patients of Group C were positive for filarial antibody. This study showed the prevalence of filarial antibody in about 71.4% of various orthopaedic manifestations.

Whole spine MRI in the assessment of acute vertebral body trauma

International Nuclear Information System (INIS)

Green, R.A.R.; Saifuddin, A.

2004-01-01

To determine the incidence and types of multilevel vertebral body injury in association with acute spinal trauma as assessed by whole spine MRI. All acute admissions to a regional spinal injury unit had whole spine MRI carried out, to detect occult vertebral body injury. Two radiologists assessed 127 cases prospectively, over a period of 3 years. All cases had T2-weighted sagittal imaging of the whole spine (where possible using a T2-weighted fat-suppressed sequence), with T1-weighted imaging in both sagittal and axial planes covering the primary injury. The incidence of secondary injury (defined as either bone bruising, wedge compression fracture or burst fracture) was determined and defined by type, site and relationship to the primary injury. Seventy-seven per cent of cases had a secondary injury level. Of these, bone bruising was the commonest but often occurred in combination with secondary wedge compression fracture or burst fracture. MRI detected 27 non-contiguous wedge compression fractures and 16 non-contiguous burst fractures, giving an incidence of secondary level, non-contiguous fracture of approximately 34%. A higher frequency of secondary vertebral body injury may be defined by MRI than has been described in previous studies based on radiographic evaluation of the whole spine. Whole spine MRI in assessment for occult vertebral body fracture enables increased confidence in the conservative or surgical management of patients with severe spinal injury. (orig.)

[Orthopaedic day surgery in Emilia-Romagna].

Science.gov (United States)

Rolli, M; Rodler, M; Petropulacos, K; Baldi, R

2001-09-01

It is well known that the organizational model of day surgery, concerning surgical problems defined by the literature as minor, has the aim of optimising the use of hospital resources and facilitating patients and their families, from a psychological and social point of view, by reducing hospitalisation time and the associated complications, and ensuring the same efficacy and more appropriateness of treatment. This study is firstly aimed at analysing the impact that the healthcare policy of the Emilia Romagna Region has had on the development of day surgery practice. Secondly, it compares the patients treated in orthopaedic day surgery in the hospitals of Bologna, Modena, Ferrara, Parma, Reggio Emilia, Maggiore hospital of Bologna and Rizzoli Orthopaedic Institute of Bologna (II.OO.R). In the period 1997-2000 there was a marked increase in the number of operations carried out in day surgery in all of the above-mentioned hospitals. Also in the unispecialistic orthopaedic hospital there was a surprising increase in the percentage of operations carried out in day surgery with respect to the total number of operations performed. The aim of the Rizzoli Orthopaedic Institute and the Emilia Romagna Region is to further implement this form of healthcare, contextually potentiating the appropriateness of hospital admission and avoiding, when not necessary, other forms of healthcare.

Coping and emotional distress during acute hospitalization in older persons with earlier trauma: the case of Holocaust survivors.

Science.gov (United States)

Kimron, Lee; Cohen, Miri

2012-06-01

Older persons with earlier trauma are often more vulnerable to stresses of old age. To examine the levels of emotional distress in relation to cognitive appraisal of acute hospitalization and coping strategies in Holocaust survivors compared with an age- and education-matched group of elderly persons without Holocaust experience. This is a cross-sectional study of 63 Holocaust survivors, 65 years and older, hospitalized for an acute illness, and 57 age-, education- and hospital unit-matched people without Holocaust experience. Participants completed appraisal and coping strategies (COPE) questionnaires, and the brief symptoms inventory (BSI-18). Holocaust survivors reported higher levels of emotional distress, appraised the hospitalization higher as a threat and lower as a challenge, and used more emotion-focused and less problem-focused or support-seeking coping strategies than the comparison group. Study variables explained 65% of the variance of emotional distress; significant predictors of emotional distress in the final regression model were not having a partner and more use of emotion-focused coping. The latter mediated the relation of group variable and challenge appraisal to emotional distress. Health professionals must be aware of the potential impact of the hospital environment on the survivors of Holocaust as well as survivors of other trauma. Being sensitive to their specific needs may reduce the negative impact of hospitalization.

Efficacies of various diagnostic modalities in acute trauma of the cervical spine

Energy Technology Data Exchange (ETDEWEB)

Tani, Ichiro (St. Marianna Univ., Kawasaki (Japan). School of Medicine)

1993-12-01

The author reviewed 71 consecutive cases of acute trauma of the cervical spine to define efficacies of various modalities such as plain film, CT and MRI. Pathologies on CT and/or MRI additionally found to plain films were analyzed and correlated to three groups divided according to neurological deficit. The following conclusions were obtained. The usefulness of plain films as the first modality of choice was confirmed. Both CT and MRI are necessary in addition to abnormal plain films in this group if patients have neurological deficit. MRI may be a modality of choice following plain films if they are negative. In the group of brachial plexus palsy MRI should be performed before CT to demonstrate traumatic meningocele. CT myelography is also useful although it is invasive. It is warranted to say that in the asymptomatic group CT and MRI are not indicated, because additionally found abnormalities are clinically insignificant. (author).

A Descriptive Study Of The Burden Of Animal-Related Trauma At Cork University Hospital.

LENUS (Irish Health Repository)

Sheehan, M

2018-01-01

Farming is the most dangerous occupation in Ireland1 and the incidence of farm accidents is rising. This study examines major farm animal-related trauma treated at Cork University Hospital over a 5 year period. There were 54 patients admitted to Cork University Hospital (C.U.H.) with major farm animal-related trauma. The median age was 56 years, 85% were male and the median hospital length of stay was four days. Older patients had longer lengths of stay; 5.5 vs 4 days (p=0.026). Tibia\\/fibula fractures were the most common injuries (N=13, 24%); head injury occurred in six patients (11%). There were 32 (59%) patients who required surgery, the majority for orthopaedic injuries. There were nine patients (16.7%) admitted to the intensive care unit; their median ICU stay was four days. Injury prevention and treatment strategies require that the age profile, mechanism of injury and injury patterns of farmers sustaining animal-related trauma is recognised.

Inpatient consultations to an orthopaedic service: the hidden workload.

LENUS (Irish Health Repository)

O'Malley, N T

2011-12-01

While the quality and efficiency of out-patient orthopaedic referrals are well documented in the literature, there is little on the standard and appropriateness of inpatient orthopaedic consultations.

Variation in National ACGME Case Log Data for Pediatric Orthopaedic Fellowships: Are Fellow Coding Practices Responsible?

Science.gov (United States)

McClure, Philip K; Woiczik, Marcella; Karol, Lori; Sankar, Wudbhav N

The introduction of the 80-hour work week for Accreditation Council for Graduate Medical Education (ACGME) accredited fellowship programs initiated many efforts to optimize surgical training. One particular area of interest is on recording and tracking surgical experiences. The current standard is logging cases based on Current Procedural Terminology codes, which are primarily designed for billing. Proposed guidelines from the ACGME regarding logging exist, but their implementation is unknown, as is the variation in case volume across fellowship programs. The purpose of this study was to investigate variability in the national case log data, and explore potential sources of variation using fellow surveys. National ACGME case log data for pediatric orthopaedic fellowships from 2012 to 2015 were reviewed, with particular attention to the domains of spine, pelvis/hip, arthroscopy, trauma, and other (which includes clubfoot casting). To explore potential sources of case log variability, a survey on case logging behavior was distributed to all pediatric orthopaedic fellows for the academic year 2015 to 2016. Reported experiences based on ACGME case logs varied widely between fellows with percentage difference of up to 100% in all areas. Similarly, wide variability is present in coding practices of pediatric orthopaedic fellows, who often lack formal education on the topic of appropriate coding/logging. In the survey, hypothetical case scenarios had an absolute difference in recorded codes of up to 13 and a percentage difference of up to 100%. ACGME case log data for pediatric orthopaedic fellowships demonstrates wide variability in reported surgical experiences. This variability may be due, in part, to differences in logging practices by individual fellows. This observation makes meaningful interpretation of national data on surgical volume challenging. Proposed surgical experience minimums should be interpreted in light of these data, and may not be advisable unless

Impact of a TeamSTEPPS Trauma Nurse Academy at a Level 1 Trauma Center.

Science.gov (United States)

Peters, V Kristen; Harvey, Ellen M; Wright, Andi; Bath, Jennifer; Freeman, Dan; Collier, Bryan

2018-01-01

Nurses are crucial members of the team caring for the acutely injured trauma patient. Until recently, nurses and physicians gained an understanding of leadership and supportive roles separately. With the advent of a multidisciplinary team approach to trauma care, formal team training and simulation has transpired. Since 2007, our Level I trauma system has integrated TeamSTEPPS (Team Strategies & Tools to Enhance Performance & Patient Safety; Agency for Healthcare Research and Quality, Rockville, MD) into our clinical care, joint training of nurses and physicians, using simulations with participation of all health care providers. With the increased expectations of a well-orchestrated team and larger number of emergency nurses, our program created the Trauma Nurse Academy. This academy provides a core of experienced nurses with an advanced level of training while decreasing the variability of personnel in the trauma bay. Components of the academy include multidisciplinary didactic education, the Essentials of TeamSTEPPS, and interactive trauma bay learning, to include both equipment and drug use. Once completed, academy graduates participate in the orientation and training of General Surgery and Emergency Medicine residents' trauma bay experience and injury prevention activities. Internal and published data have demonstrated growing evidence linking trauma teamwork training to knowledge and self-confidence in clinical judgment to team performance, patient outcomes, and quality of care. Although trauma resuscitations are stressful, high risk, dynamic, and a prime environment for error, new methods of teamwork training and collaboration among trauma team members have become essential. Copyright © 2017 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

Post-trauma ratings of pre-collision pain and psychological distress predict poor outcome following acute whiplash trauma: A 12-month follow-up study

DEFF Research Database (Denmark)

Carstensen, Tina

2008-01-01

emergency departments or primary care after car accidents in four counties in Denmark. After the collision patients received a questionnaire on psychological distress, unspecified pain and socio-demographics and 12months later a follow-up on work capability and neck pain was performed. Risk factors were...... were not associated with poor outcome. In conclusion unspecified as opposed to specified pain (neck pain) before the collision is associated with poor recovery and high accumulation of pre-collision psychological distress is associated with considerable neck pain at follow-up. However, no conclusions...... on causality can be drawn. Personal characteristics before the collision are important for recovery and attention to pre-collision characteristics may contribute to the prevention of poor recovery after acute whiplash trauma....

Post-trauma ratings of pre-collision pain and psychological distress predict poor outcome following acute whiplash trauma: A 12-month follow-up study

DEFF Research Database (Denmark)

Carstensen, Tina; Frostholm, Lisbeth; Ørnbøl, Eva

2008-01-01

emergency departments or primary care after car accidents in four counties in Denmark. After the collision patients received a questionnaire on psychological distress, unspecified pain and socio-demographics and 12 months later a follow-up on work capability and neck pain was performed. Risk factors were...... of accident were not associated with poor outcome. In conclusion unspecified as opposed to specified pain (neck pain) before the collision is associated with poor recovery and high accumulation of pre-collision psychological distress is associated with considerable neck pain at follow-up. However......, no conclusions on causality can be drawn. Personal characteristics before the collision are important for recovery and attention to pre-collision characteristics may contribute to the prevention of poor recovery after acute whiplash trauma....

The Evolving Science of Trauma Resuscitation.

Science.gov (United States)

Harris, Tim; Davenport, Ross; Mak, Matthew; Brohi, Karim

2018-02-01

This review summarizes the evolution of trauma resuscitation from a one-size-fits-all approach to one tailored to patient physiology. The most dramatic change is in the management of actively bleeding patients, with a balanced blood product-based resuscitation approach (avoiding crystalloids) and surgery focused on hemorrhage control, not definitive care. When hemostasis has been achieved, definitive resuscitation to restore organ perfusion is initiated. This approach is associated with decreased mortality, reduced duration of stay, improved coagulation profile, and reduced crystalloid/vasopressor use. This article focuses on the tools and methods used for trauma resuscitation in the acute phase of trauma care. Copyright © 2017 Elsevier Inc. All rights reserved.

Smartphones in orthopaedics.

Science.gov (United States)

Al-Hadithy, Nawfal; Gikas, Panagiotis D; Al-Nammari, Shafic Said

2012-08-01

With the introduction of the European Working Time Directive, surgical trainees are facing limited training opportunities and doctors are required to maximise their training opportunities. Smartphone sales have been rapidly increasing over the last five years and can be used as a training tool for the orthopaedic trainee and surgeon. Common uses include applications (AO, eLogbook and PubMed), Ebooks, online Logbooks, Guidelines and surgical techniques. In addition, smartphones can be used to immediately complete work-based assessments, in the absence of computers, hopefully increasing completion rates and reliability. Some journals now provide podcasts and video tutorials which may be accessed on smartphones, which is useful for higher examinations. Smartphones can also be used in the clinical setting to take photographs of wounds. Smartphones are enjoying increased uptake and application in the workplace and we review their use for orthopaedic surgeons and trainees to allow them to make the most out of their training opportunities.

Neuroimaging of nonaccidental head trauma: pitfalls and controversies

Energy Technology Data Exchange (ETDEWEB)

Fernando, Sujan [University of Missouri-Kansas School of Medicine, Department of Medicine, Kansas City, MO (United States); Obaldo, Ruby E. [The University of Kansas Medical Center, Department of Radiology, Kansas City, MO (United States); Walsh, Irene R. [The University of Missouri-Kansas City, Children' s Mercy Hospitals and Clinics, Department of Emergency Medicine, Kansas City, MO (United States); Lowe, Lisa H. [The University of Missouri-Kansas City, Children' s Mercy Hospitals and Clinics, Department of Radiology, Kansas City, MO (United States)

2008-08-15

Although certain neuroimaging appearances are highly suggestive of abuse, radiological findings are often nonspecific. The objective of this review is to discuss pitfalls, controversies, and mimics occurring in neuroimaging of nonaccidental head trauma in order to allow the reader to establish an increased level of comfort in distinguishing between nonaccidental and accidental head trauma. Specific topics discussed include risk factors, general biomechanics and imaging strategies in nonaccidental head trauma, followed by the characteristics of skull fractures, normal prominent tentorium and falx versus subdural hematoma, birth trauma versus nonaccidental head trauma, hyperacute versus acute on chronic subdural hematomas, expanded subarachnoid space versus subdural hemorrhage, controversy regarding subdural hematomas associated with benign enlarged subarachnoid spaces, controversy regarding hypoxia as a cause of subdural hematoma and/or retinal hemorrhages without trauma, controversy regarding the significance of retinal hemorrhages related to nonaccidental head trauma, controversy regarding the significance of subdural hematomas in general, and pitfalls of glutaric aciduria type 1 and hemophagocytic lymphohistiocytosis mimicking nonaccidental head trauma. (orig.)

Neuroimaging of nonaccidental head trauma: pitfalls and controversies

International Nuclear Information System (INIS)

Fernando, Sujan; Obaldo, Ruby E.; Walsh, Irene R.; Lowe, Lisa H.

2008-01-01

Although certain neuroimaging appearances are highly suggestive of abuse, radiological findings are often nonspecific. The objective of this review is to discuss pitfalls, controversies, and mimics occurring in neuroimaging of nonaccidental head trauma in order to allow the reader to establish an increased level of comfort in distinguishing between nonaccidental and accidental head trauma. Specific topics discussed include risk factors, general biomechanics and imaging strategies in nonaccidental head trauma, followed by the characteristics of skull fractures, normal prominent tentorium and falx versus subdural hematoma, birth trauma versus nonaccidental head trauma, hyperacute versus acute on chronic subdural hematomas, expanded subarachnoid space versus subdural hemorrhage, controversy regarding subdural hematomas associated with benign enlarged subarachnoid spaces, controversy regarding hypoxia as a cause of subdural hematoma and/or retinal hemorrhages without trauma, controversy regarding the significance of retinal hemorrhages related to nonaccidental head trauma, controversy regarding the significance of subdural hematomas in general, and pitfalls of glutaric aciduria type 1 and hemophagocytic lymphohistiocytosis mimicking nonaccidental head trauma. (orig.)

MRI in the assessment of the supportive soft tissues of the cervical spine in acute trauma in children

Energy Technology Data Exchange (ETDEWEB)

Keiper, M.D.; Zimmerman, R.A.; Bilaniuk, L.T. [Department of Radiology, Children`s Hospital of Philadelphia, PA (United States)

1998-06-01

We carried out a retrospective analysis of imaging and clinical findings in 52 children with a history of cervical spinal trauma. No patient had evidence of a fracture on plain films or CT. All had MRI at 1.5 T because of persistent or delayed symptoms, unexplained findings of injury or instability, or as further assessment of the extent of soft-tissue injury. Clinical follow-up ranged from 6 months to 3.5 years. MRI was evaluated for its influence on therapy and outcome. MRI was positive in 16 (31 %) of 52 patients. Posterior soft-tissue or ligamentous injury was the most common finding in the 10 patients with mild to moderate trauma, while acute disc bulges and longitudinal ligament disruption, each seen in one case, were uncommon. MRI was superior to CT for assessment of the extent of soft-tissue injury and for identification of spinal cord injuries and intracanalicular hemorrhage in the six patients with more severe trauma. MRI specifically influenced the management of all four patients requiring surgery by extending the level of posterior stabilization. No patients with normal MRI or any of the 10 with radiographically stable soft-tissue injury on MRI, developed delayed clinical or radiographic evidence of instability or deformity. (orig.) With 2 figs., 2 tabs., 24 refs.

The Use of Novel Adopters for Acute Rib Fixation in Critical Chest Trauma, Undertaken by Orthopaedic Surgeons: an Observational Cohort Study

Directory of Open Access Journals (Sweden)

Jermin Paul J.

2015-05-01

Full Text Available Background: Surgical stabilisation of acute rib fractures has recently undergone rapid change in the UK with respect to what type of injury is surgically stabilised and who undertakes the operation. This paper presents a review of the literature on surgical fixation and presents our early clinical experience using a recently introduced stabilising system.

Imaging of diaphragmatic rupture after trauma

International Nuclear Information System (INIS)

Eren, S.; Kantarci, M.; Okur, A.

2006-01-01

Traumatic rupture of the diaphragm usually results from blunt or penetrating injuries, or iatrogenic causes. Most cases are initially overlooked in the acute phase because they present with variable clinical and radiological signs. An overlooked diaphragmatic injury presents as a hernia many years later with potentially serious complications, therefore selection of the most appropriate radiological technique and accurate diagnosis of traumatic diaphragmatic hernias (DH) on the first admission is important. Although the diagnosis of diaphragmatic injuries is problematic, various investigations may be used for diagnosis. We describe the imaging findings of 19 traumatic DH cases with various imaging techniques. The patients were acute trauma cases or cases with prior trauma or thoraco-abdominal surgery with clinical suspicion of DH. An evaluation of the imaging techniques used in the diagnosis of DH is presented

Cost comparison of orthopaedic fracture pathways using discrete event simulation in a Glasgow hospital

Science.gov (United States)

Jenkins, Paul J; McDonald, David A; Van Der Meer, Robert; Morton, Alec; Nugent, Margaret; Rymaszewski, Lech A

2017-01-01

Objective Healthcare faces the continual challenge of improving outcome while aiming to reduce cost. The aim of this study was to determine the micro cost differences of the Glasgow non-operative trauma virtual pathway in comparison to a traditional pathway. Design Discrete event simulation was used to model and analyse cost and resource utilisation with an activity-based costing approach. Data for a full comparison before the process change was unavailable so we used a modelling approach, comparing a virtual fracture clinic (VFC) with a simulated traditional fracture clinic (TFC). Setting The orthopaedic unit VFC pathway pioneered at Glasgow Royal Infirmary has attracted significant attention and interest and is the focus of this cost study. Outcome measures Our study focused exclusively on patients with non-operative trauma attending emergency department or the minor injuries unit and the subsequent step in the patient pathway. Retrospective studies of patient outcomes as a result of the protocol introductions for specific injuries are presented in association with activity costs from the models. Results Patients are satisfied with the new pathway, the information provided and the outcome of their injuries (Evidence Level IV). There was a 65% reduction in the number of first outpatient face-to-face (f2f) attendances in orthopaedics. In the VFC pathway, the resources required per day were significantly lower for all staff groups (p≤0.001). The overall cost per patient of the VFC pathway was £22.84 (95% CI 21.74 to 23.92) per patient compared with £36.81 (95% CI 35.65 to 37.97) for the TFC pathway. Conclusions Our results give a clearer picture of the cost comparison of the virtual pathway over a wholly traditional f2f clinic system. The use of simulation-based stochastic costings in healthcare economic analysis has been limited to date, but this study provides evidence for adoption of this method as a basis for its application in other healthcare settings

Social Media in Pediatric Orthopaedics.

Science.gov (United States)

Lander, Sarah T; Sanders, James O; Cook, Peter C; O'Malley, Natasha T

Internet searches and social media utilization in health care has exploded over the past 5 years, and patients utilize it to gain information on their health conditions and physicians. Social media has the potential to serve as a means for education, communication, and marketing in all health care specialties. Physicians are sometimes reluctant to engage because of concerns of privacy, litigation, and lack of experience with this modality. Many surgical subspecialties have capitalized on social media but no study to date has examined the specific footprint of pediatric orthopaedic surgeons in this realm. We aim to quantify the utilization of individual social media platforms by pediatric orthopaedic surgeons, and identify any differences between private and hospital-based physicians, but also regional differences. Using the Pediatric Orthopaedic Society of North America Member Directory, each active member's social media presence was reviewed through an Internet search. Members were stratified on the basis of practice model and geographic location. Individual Internet searches, social media sites, and number of publications were reviewed for social media presence. Of 987 Pediatric Orthopaedic Society of North America members, 95% had a professional webpage, 14.8% a professional Facebook page, 2.2% a professional Twitter page, 36.8% a LinkedIn profile, 25.8% a ResearchGate profile, 33% at least 1 YouTube. Hospital-based physicians had a lower mean level of utilization of social media compared with their private practice peers, and a higher incidence of Pubmed publications. Private practice physicians had double the social media utilization. Regional differences reveal that practicing Pediatric Orthopaedists in the Northeast had increased utilization of ResearchGate and LinkedIn and the West had the lowest mean social media utilization levels. The rapid expansion of social media usage by patients and their family members is an undeniable force affecting the health

Advanced Technologies in Trauma Critical Care Management

Science.gov (United States)

2012-01-01

largely replaced diagnostic peritoneal lavage for identifying intra-abdominal fluid in trauma patients. Furthermore, with the addition of chest windows...authors use chest ultrasound in the following manner: To identify a pneumothorax or hemothorax that needs to be drained acutely To differentiate...these situations, Technologies in the Trauma ICU 913 the authors first insert 2 or 3 chest tubes and position them as usual. A sterile nonad- herent

Sick Leave within 5 Years of Whiplash Trauma Predicts Recovery: A Prospective Cohort and Register-Based Study.

Science.gov (United States)

Carstensen, Tina Birgitte Wisbech; Fink, Per; Oernboel, Eva; Kasch, Helge; Jensen, Troels Staehelin; Frostholm, Lisbeth

2015-01-01

10-22% of individuals sustaining whiplash trauma develop persistent symptoms resulting in reduced working ability and decreased quality of life, but it is poorly understood why some people do not recover. Various collision and post-collision risk factors have been studied, but little is known about pre-collision risk factors. In particular, the impact of sickness and socioeconomic factors before the collision on recovery is sparsely explored. The aim of this study was to examine if welfare payments received within five years pre-collision predict neck pain and negative change in provisional situation one year post-collision. 719 individuals with acute whiplash trauma consecutively recruited from emergency departments or primary care after car accidents in Denmark completed questionnaires on socio-demographic and health factors immediately after the collision. After 12 months, a visual analogue scale on neck pain intensity was completed. 3595 matched controls in the general population were sampled, and national public register data on social benefits and any other welfare payments were obtained for participants with acute whiplash trauma and controls from five years pre-collision to 15 months after. Participants with acute whiplash trauma who had received sickness benefit for more than 12 weeks pre-collision had increased odds for negative change in future provisional situation (Odds Ratio (OR) (95% Confidence Interval (CI) = 3.8 (2.1;7.1)) and future neck pain (OR (95%CI) = 3.3 (1.8;6.3)), controlling for other known risk factors. Participants with acute whiplash trauma had weaker attachment to labour market (more weeks of sick leave (χ2(2) = 36.7, p whiplash trauma raised the odds for future negative change in provisional situation (OR (95%CI) = 3.1 (2.3;4.4)) compared with controls. Sick leave before the collision strongly predicted prolonged recovery following whiplash trauma. Participants with acute whiplash trauma had weaker attachment to labour market pre

PCR IN TRAUMATOLOGY AND ORTHOPAEDICS: METHOD DESCRIPTION AND APPLICABILITY

Directory of Open Access Journals (Sweden)

E. M. Polyakova

2014-01-01

Full Text Available Review brief presents description of polymerase chain reaction method (PCR and its most common variants. Three PCR-based lines of research, carried out in the traumatology and orthopaedics, include identifying a causative agents of the implant-associated infection after orthopaedic surgery; detection of antibiotic resistance genes and biofilm forming genes. It was shown that PCR can be used as additional method for detection of genetic disorders, significant for traumatology and orthopaedics, and for investigation of cartilage and bone regeneration.

How formative courses about damage control surgery and non-operative management improved outcome and survival in unstable politrauma patients in a Mountain Trauma Center.

Science.gov (United States)

Bellanova, Giovanni; Buccelletti, Francesco; Berletti, Riccardo; Cavana, Marco; Folgheraiter, Giorgio; Groppo, Francesca; Marchetti, Chiara; Marzano, Amelia; Massè, Alessandro; Musetti, Antonio; Pelanda, Tina; Ricci, Nicola; Tugnoli, Gregorio; Papadia, Damiano; Ramponi, Claudio

2016-01-01

Aim of this study is to analyze how the starting of Course of Trauma in our hospital improved survival and organization in management of polytraumatized patients. We analysed all major trauma patients (Injury Severity Score (Injury Severity Score (ISS)> 15) treated at Emergency Department of the Santa Chiara Hospital between January 2011 and December 2014. The training courses (TC) were named "management of polytrauma" (MP) and "clinical cases discussion" (CCD), and started in November 2013. We divided the patients between two groups: before November 2013 (pre-TC group) and after November 2013 (post-TC group). MTG's courses (EMC accredited), CCD and MP courses started in November 2013. The target of these courses was the multidisciplinary management of polytrauma patient; the courses were addressed to general surgeons, anaesthesiologists, radiologists, orthopaedics and emergency physicians. Respectively 110 and 78 doctors were formed in CCD's and MP's courses. Patients directly transported to our trauma centre rose from 67.5% to 83% (pOperative Management, Trauma Course, Trauma Team, Trauma Center.

Using financial incentives to improve value in orthopaedics.

Science.gov (United States)

Lansky, David; Nwachukwu, Benedict U; Bozic, Kevin J

2012-04-01

A variety of reforms to traditional approaches to provider payment and benefit design are being implemented in the United States. There is increasing interest in applying these financial incentives to orthopaedics, although it is unclear whether and to what extent they have been implemented and whether they increase quality or reduce costs. We reviewed and discussed physician- and patient-oriented financial incentives being implemented in orthopaedics, key challenges, and prerequisites to payment reform and value-driven payment policy in orthopaedics. We searched the MEDLINE database using as search terms various provider payment and consumer incentive models. We retrieved a total of 169 articles; none of these studies met the inclusion criteria. For incentive models known to the authors to be in use in orthopaedics but for which no peer-reviewed literature was found, we searched Google for further information. Provider financial incentives reviewed include payments for reporting, performance, and patient safety and episode payment. Patient incentives include tiered networks, value-based benefit design, reference pricing, and value-based purchasing. Reform of financial incentives for orthopaedic surgery is challenged by (1) lack of a payment/incentive model that has demonstrated reductions in cost trends and (2) the complex interrelation of current pay schemes in today's fragmented environment. Prerequisites to reform include (1) a reliable and complete data infrastructure; (2) new business structures to support cost sharing; and (3) a retooling of patient expectations. There is insufficient literature reporting the effects of various financial incentive models under implementation in orthopaedics to know whether they increase quality or reduce costs. National concerns about cost will continue to drive experimentation, and all anticipated innovations will require improved collaboration and data collection and reporting.

[Chances and Risks of Telemedicine in Orthopaedics and Trauma Surgery].

Science.gov (United States)

Holderried, Martin; Schlipf, Madeleine; Höper, Ansgar; Meier, Reinhard; Stöckle, Ulrich; Kraus, Tobias Maximilian

2018-02-01

The use of information technology (IT) in health care has continuously increased. This includes software solutions for digitalisation, data storage and innovative approaches in diagnostics. The facilitation of the access to specific information, even by the patient, has changed daily clinical work. Patients inform themselves about symptoms, diagnostic methods and treatment options. This urge for information and the wish for the best treatment is summarised in the expression "patient empowerment". In some countries, the gap between do-it-yourself diagnosis and telemedicine via the telephone has already been closed. A sophisticated telemedical hotline may help to improve consultation and treatment of patients living in remote regions or rural communities. Traumatology telemedicine may also be used in trauma environments, such as disasters or mass casualties. Therefore, the purpose of this study was to assess the demand for e-health solutions among patients seeking the help of the emergency department in a trauma hospital. A total of 255 patients (age range 18 - 75 years) were included in the study and were surveyed with the use of a questionnaire. As regards personal data, the questionnaire asked the patient about their Internet habits and about interesting topics they had researched in the world wide web. However, the questionnaire was specifically designed to ask for potential benefits and the patient's expectations for e-health solutions. Expected weaknesses and procedures for telemedical services were also included in a subsection. 43.5% of the patient cohort were woman and 56.5% men. The average distance to the hospital was 39.86 km. 223 patients were insured by the governmental health service providers and 32 had private insurance coverage. Aside from online shopping and online banking, the search for health topics was most frequent. The greatest fear was the lack of personal contact to the doctor (71.2%). Patients were also concerned about the safety of

Magnetic resonance tomography for trauma of the cervical spine

International Nuclear Information System (INIS)

Meydam, K.; Sehlen, S.; Schlenkhoff, D.; Kiricuta, J.C.; Beyer, H.K.

1986-01-01

Twenty patients who had suffered spinal trauma were examined by magnetic resonance tomography. Fifteen patients with first degree trauma in Erdmann's classification showed no abnormality. Magnetic resonance tomography of the cervical spine appears to be a suitable method for investigating patients with whiplash injuries. It is indicated following severe flexion injuries with subluxations and neurological symptoms, since it is the only method that can demonstrate the spinal cord directly and completely and show the extent of cord compression. For patients with thoracic trauma and rapidly developing neurological symptoms, magnetic resonance tomography is ideal for showing post-traumatic syringomyelia. Magnetic resonance tomography following whiplash injuries is recommended if plain films of the cervical spine show any abnormalities, as well as for the investigation of acute or sub-acute neurological abnormalities. The various findings are discussed. (orig.) [de

Magnetic resonance tomography for trauma of the cervical spine

Energy Technology Data Exchange (ETDEWEB)

Meydam, K.; Sehlen, S.; Schlenkhoff, D.; Kiricuta, J.C.; Beyer, H.K.

1986-12-01

Twenty patients who had suffered spinal trauma were examined by magnetic resonance tomography. Fifteen patients with first degree trauma in Erdmann's classification showed no abnormality. Magnetic resonance tomography of the cervical spine appears to be a suitable method for investigating patients with whiplash injuries. It is indicated following severe flexion injuries with subluxations and neurological symptoms, since it is the only method that can demonstrate the spinal cord directly and completely and show the extent of cord compression. For patients with thoracic trauma and rapidly developing neurological symptoms, magnetic resonance tomography is ideal for showing post-traumatic syringomyelia. Magnetic resonance tomography following whiplash injuries is recommended if plain films of the cervical spine show any abnormalities, as well as for the investigation of acute or sub-acute neurological abnormalities. The various findings are discussed.

Safety syringes and anti-needlestick devices in orthopaedic surgery.

Science.gov (United States)

Sibbitt, Wilmer L; Band, Philip A; Kettwich, Lawrence G; Sibbitt, Cristina R; Sibbitt, Lori J; Bankhurst, Arthur D

2011-09-07

The American Academy of Orthopaedic Surgery (AAOS), The Joint Commission, the Occupational Safety and Health Administration (OSHA), and the Needlestick Safety and Prevention Act encourage the integration of safety-engineered devices to prevent needlestick injuries to health-care workers and patients. We hypothesized that safety syringes and needles could be used in outpatient orthopaedic injection and aspiration procedures. The study investigated the orthopaedic uses and procedural idiosyncrasies of safety-engineered devices, including (1) four safety needles (Eclipse, SafetyGlide, SurGuard, and Magellan), (2) a mechanical safety syringe (RPD), (3) two automatic retractable syringes (Integra, VanishPoint), (4) three manual retractable syringes (Procedur-SF, Baksnap, Invirosnap), and (5) three shielded syringes (Safety-Lok, Monoject, and Digitally Activated Shielded [DAS] Syringe). The devices were first tested ex vivo, and then 1300 devices were used for 425 subjects undergoing outpatient arthrocentesis, intra-articular injections, local anesthesia, aspiration biopsy, and ultrasound-guided procedures. During the clinical observation, there were no accidental needlesticks (0 needlesticks per 1300 devices). Safety needles could be successfully used on a Luer syringe but were limited to ≤1.5 in (≤3.81 cm) in length and the shield could interfere with sonography. The mechanical safety syringes functioned well in all orthopaedic procedures. Automatic retractable syringes were too small for arthrocentesis of the knee, and the plunger blew out and prematurely collapsed with high-pressure injections. The manual retractable syringes and shielded syringes could be used with conventional needles for most orthopaedic procedures. The most effective and reliable safety devices for orthopaedic syringe procedures are shielded safety needles, mechanical syringes, manual retractable syringes, and shielded syringes, but not automatic retractable syringes. Even when adopting

Orthopaedic training in Kenya

African Journals Online (AJOL)

Background: Orthopaedic training in Kenya, like in other East, central and .... quite a number of good facilities that would train an ... provide a forum for exchange of ideas and training. (2,3) ... administrators purely interested in service provision,.

Occult Pneumothoraces in Acute Trauma Patients

Directory of Open Access Journals (Sweden)

Chad Berryman

2012-12-01

Full Text Available Introduction: Many traumatic pneumothoraces (PTX are not seen on initial chest radiograph (CR(occult PTX but are detected only on computed tomography (CT. Although CR remains the first toolfor detecting PTX, most trauma patients with significant thoracoabdominal injuries will receive both CTand CR. The primary objective of this study was to retrospectively determine the effectiveness of CR fordetecting PTX in trauma patients. Our hypotheses were that CR is a sensitive indicator of PTX on CT,that chest pain and shortness of breath are good predictors of PTX on CR, and that we could determineother predictors of PTX on CR.Methods: All trauma patients presenting to our Level I trauma center with a CT-diagnosed PTX over a2-year period who had both a CR and a chest CT were included. The CT reading was considered thegold standard for PTX diagnosis. Electronic medical records were searched using key words fordiagnoses, symptoms, demographics, and radiologic results. We recorded the official radiologistreadings for both CR and CT (positive or negative and the size of the PTX on CT (large, moderate,small, or tiny. The outcome variable was dichotomized based on presence or absence of PTXdetected on CR. Descriptive statistics and v2 tests were used for univariate analysis. A regressionanalysis was performed to determine characteristics predictive of a PTX on CR, and 1 variable wasadded to the model for every 10 positive CRs. With equal-size groups, this study has the power of 80%to detect a 10% absolute difference in single predictors of PTX on CR with 45 subjects in each group.Results: There were 134 CT-documented PTXs included in the study. Mean age was 42, and 74%were men. For 66 (49% patients, PTX was detected on CR (sensitivity¼50%. The CR detected 30%of small PTX, 35% of moderate PTX, and 33% of large PTX. Comparing patients with and without PTXon CR, there were no significant differences in shortness of breath or chest pain. There no

Occult pneumothoraces in acute trauma patients.

Science.gov (United States)

Ernst, Amy A; McIntyre, William A; Weiss, Steven J; Berryman, Chad

2012-11-01

Many traumatic pneumothoraces (PTX) are not seen on initial chest radiograph (CR) (occult PTX) but are detected only on computed tomography (CT). Although CR remains the first tool for detecting PTX, most trauma patients with significant thoracoabdominal injuries will receive both CT and CR. The primary objective of this study was to retrospectively determine the effectiveness of CR for detecting PTX in trauma patients. Our hypotheses were that CR is a sensitive indicator of PTX on CT, that chest pain and shortness of breath are good predictors of PTX on CR, and that we could determine other predictors of PTX on CR. All trauma patients presenting to our Level I trauma center with a CT-diagnosed PTX over a 2-year period who had both a CR and a chest CT were included. The CT reading was considered the gold standard for PTX diagnosis. Electronic medical records were searched using key words for diagnoses, symptoms, demographics, and radiologic results. We recorded the official radiologist readings for both CR and CT (positive or negative) and the size of the PTX on CT (large, moderate, small, or tiny). The outcome variable was dichotomized based on presence or absence of PTX detected on CR. Descriptive statistics and χ(2) tests were used for univariate analysis. A regression analysis was performed to determine characteristics predictive of a PTX on CR, and 1 variable was added to the model for every 10 positive CRs. With equal-size groups, this study has the power of 80% to detect a 10% absolute difference in single predictors of PTX on CR with 45 subjects in each group. There were 134 CT-documented PTXs included in the study. Mean age was 42, and 74% were men. For 66 (49%) patients, PTX was detected on CR (sensitivity = 50%). The CR detected 30% of small PTX, 35% of moderate PTX, and 33% of large PTX. Comparing patients with and without PTX on CR, there were no significant differences in shortness of breath or chest pain. There no relationships between PTX detected

Length of stay and medical stability for spinal cord-injured patients on admission to an inpatient rehabilitation hospital: a comparison between a model SCI trauma center and non-SCI trauma center.

Science.gov (United States)

Ploumis, A; Kolli, S; Patrick, M; Owens, M; Beris, A; Marino, R J

2011-03-01

Retrospective database review. To compare lengths of stay (LOS), pressure ulcers and readmissions to the acute care hospital of patients admitted to the inpatient rehabilitation facility (IRF) from a model spinal cord injury (SCI) trauma center or from a non-SCI acute hospital. Only sparse data exist comparing the status of patients admitted to IRF from a model SCI trauma center or from a non-SCI acute hospital. Acute care, IRF and total LOS were compared between patients transferred to IRF from the SCI center (n=78) and from non-SCI centers (n=131). The percentages of pressure ulcers on admission to IRF and transfer back to acute care were also compared. Patients admitted to IRF from the SCI trauma center (SCI TC) had significantly shorter (P=0.01) acute care LOS and total LOS compared with patients admitted from non-SCI TCs. By neurological category, acute-care LOS was less for all groups admitted from the SCI center, but statistically significant only for tetraplegia. There was no significant difference in the incidence of readmissions to acute care from IRF. More patients from non-SCI centers (34%) than SCI centers (12%) had pressure ulcers (PSCI TCs before transfer to IRF can significantly lower acute-care LOS or total LOS and incidence of pressure ulcers compared with non-SCI TCs. Patients admitted to IRF from SCI TCs are no more likely to be sent back to an acute hospital than those from non-SCI TCs.

Establishing a children's orthopaedic hospital for Malawi: A review ...

African Journals Online (AJOL)

ordinate the MNCP since 2007. At present the program has a total of 29 clinics, which have treated 5748 patients. Furthermore, BCIH has overseen the full or partial training of 5 orthopaedic surgeons and 82 orthopaedic clinical officers in Malawi.

A scoping review on health economics in neurosurgery for acute spine trauma.

Science.gov (United States)

Chan, Brian C F; Craven, B Catharine; Furlan, Julio C

2018-05-01

OBJECTIVE Acute spine trauma (AST) has a relatively low incidence, but it often results in substantial individual impairments and societal economic burden resulting from the associated disability. Given the key role of neurosurgeons in the decision-making regarding operative management of individuals with AST, the authors performed a systematic search with scoping synthesis of relevant literature to review current knowledge regarding the economic burden of AST. METHODS This systematic review with scoping synthesis included original articles reporting cost-effectiveness, cost-utility, cost-benefit, cost-minimization, cost-comparison, and economic analyses related to surgical management of AST, whereby AST is defined as trauma to the spine that may result in spinal cord injury with motor, sensory, and/or autonomic impairment. The initial literature search was carried out using MEDLINE, EMBASE, CINAHL, CCTR, and PubMed. All original articles captured in the literature search and published from 1946 to September 27, 2017, were included. Search terms used were the following: (cost analysis, cost effectiveness, cost benefit, economic evaluation or economic impact) AND (spine or spinal cord) AND (surgery or surgical). RESULTS The literature search captured 5770 titles, of which 11 original studies met the inclusion/exclusion criteria. These 11 studies included 4 cost-utility analyses, 5 cost analyses that compared the cost of intervention with a comparator, and 2 studies examining direct costs without a comparator. There are a few potentially cost-saving strategies in the neurosurgical management of individuals with AST, including 1) early surgical spinal cord decompression for acute traumatic cervical spinal cord injury (or traumatic thoracolumbar fractures, traumatic cervical fractures); 2) surgical treatment of the elderly with type-II odontoid fractures, which is more costly but more effective than the nonoperative approach among individuals with age at AST between 65

Early detection of myocardial infarction following blunt chest trauma by computed tomography: a case report.

Science.gov (United States)

Lee, Thung-Lip; Hsuan, Chin-Feng; Shih, Chen-Hsiang; Liang, Huai-Wen; Tsai, Hsing-Shan; Tseng, Wei-Kung; Hsu, Kwan-Lih

2017-02-10

Blunt cardiac trauma encompasses a wide range of clinical entities, including myocardial contusion, cardiac rupture, valve avulsion, pericardial injuries, arrhythmia, and even myocardial infarction. Acute myocardial infarction due to coronary artery dissection after blunt chest trauma is rare and may be life threatening. Differential diagnosis of acute myocardial infarction from cardiac contusion at this setting is not easy. Here we demonstrated a case of blunt chest trauma, with computed tomography detected myocardium enhancement defect early at emergency department. Under the impression of acute myocardial infarction, emergent coronary angiography revealed left anterior descending artery occlusion. Revascularization was performed and coronary artery dissection was found after thrombus aspiration. Finally, the patient survived after coronary stenting. Perfusion defects of myocardium enhancement on CT after blunt chest trauma can be very helpful to suggest myocardial infarction and facilitate the decision making of emergent procedure. This valuable sign should not be missed during the initial interpretation.

Challenges in treating post-traumatic stress disorder and attachment trauma.

Science.gov (United States)

Allen, Jon G

2003-06-01

Treating women suffering from trauma poses significant challenges. The diagnostic prototype of post-traumatic stress disorder (PTSD) is based on single-event trauma, such as sexual assault in adulthood. Several effective cognitive- behavioral treatments for such traumas have been developed, although many treated patients continue to experience residual symptoms. Even more problematic is the complex developmental psychopathology stemming from a lifetime history of multiple traumas, often beginning with maltreatment in early attachment relationships. A history of attachment trauma undermines the development of capacities to regulate emotional distress and thereby complicates the treatment of acute trauma in adulthood. Such complex trauma requires a multifaceted treatment approach that must balance processing of traumatic memories with strategies to contain the intense emotions this processing evokes. Moreover, conducting such treatment places therapists at risk for secondary trauma such that trauma therapists also must process this stressful experience and implement strategies to regulate their own distress.

Red herring: Acute back pain after combined spinal epidural for labor analgesia

Directory of Open Access Journals (Sweden)

Yoong Chuan Tay

2018-04-01

Full Text Available Symphysis pubis diastases complicate 1:300 to 1:30,000 pregnancies. Peripartum pain in chronological sequence with labor epidural analgesia often attracts instinctive causation and distress. Predisposing risk factors include macrosomia, short second stage of labor, forceps use, multiparity, small pelvis, intense uterine contractions, previous pelvic ring pathology and trauma. A gestational diabetic primigravid parturient presents with acute post-partum back pain after an uneventful analgesic labor epidural. Her pain distributed over the right paravertebral L5-S1 region without radiculopathy, worsened with positional change and accompanied by urinary incontinence, precluding child care. Spine imaging incidentally revealed a 38 mm symphysis pubis diastasis. A pelvic binder by orthopaedics aided physiotherapy and ambulation. Pubic diastases are usually conservatively managed, unless separation exceeds 5 cm when early surgery may improve functional outcomes. Although symptoms may recur in subsequent pregnancies, it does not preclude vaginal delivery. Early recognition and prompt management aim to reduce parturient morbidity and promote resumption of activity. Keywords: Symphysis pubis diasthesis, Pubic symphysis diasthesis, Post-epidural pain, Labor epidural pain, Post-partum pain

Infrastructure and clinical practice for the detection and management of trauma-associated haemorrhage and coagulopathy.

Science.gov (United States)

Driessen, A; Schäfer, N; Albrecht, V; Schenk, M; Fröhlich, M; Stürmer, E K; Maegele, M

2015-08-01

Early detection and management of post-traumatic haemorrhage and coagulopathy have been associated with improved outcomes, but local infrastructures, logistics and clinical strategies may differ. To assess local differences in infrastructure, logistics and clinical management of trauma-associated haemorrhage and coagulopathy, we have conducted a web-based survey amongst the delegates to the 15th European Congress of Trauma and Emergency Surgery (ECTES) and the 2nd World Trauma (WT) Congress held in Frankfurt, Germany, 25-27 May 2014. 446/1,540 delegates completed the questionnaire yielding a response rate of 29%. The majority specified to work as consultants/senior physicians (47.3%) in general (36.1%) or trauma/orthopaedic surgery (44.5%) of level I (70%) or level II (19%) trauma centres. Clinical assessment (>80%) and standard coagulation assays (74.6%) are the most frequently used strategies for early detection and monitoring of bleeding trauma patients with coagulopathy. Only 30% of the respondents declared to use extended coagulation assays to better characterise the bleeding and coagulopathy prompted by more individualised treatment concepts. Most trauma centres (69%) have implemented local protocols based on international and national guidelines using conventional blood products, e.g. packed red blood cell concentrates (93.3%), fresh frozen plasma concentrates (93.3%) and platelet concentrates (83%), and antifibrinolytics (100%). 89% considered the continuous intake of anticoagulants including "new oral anticoagulants" and platelet inhibitors as an increasing threat to bleeding trauma patients. This study confirms differences in infrastructure, logistics and clinical practice for the detection and management of trauma-haemorrhage and trauma-associated coagulopathy amongst international centres. Ongoing work will focus on geographical differences.

Planning for life after orthopaedics.

Science.gov (United States)

Barr, Joseph S; McCaslin, Michael J; Hinds, Cynthia K

2014-01-01

The word retirement is going out of fashion. Many orthopaedic surgeons want to work in some capacity when they stop performing surgery. Making a smooth transition from a busy orthopaedic practice to alternative work demands advanced planning. The surgeon must consider personal issues that involve how to use human capital (his or her accumulated knowledge and experience). New ventures, hobbies, travel, and spending time with family and friends are some possibilities. Plans for slowing down or leaving the practice should be discussed and agreed on well ahead of time. Agreements for buyouts may be difficult to work out and will require creative thinking. The solo practitioner can close the practice or hire a successor. Financial planning is perhaps the most important consideration and should be started by approximately age 40. It is recommended that the surgeon develop a portfolio of secure investments and annuities to provide adequate income for as long as is needed and then to turn the residual income to one's family, favorite charities, or other desired cause. A team of competent advisors is needed to help develop and achieve one's goals, create financial security, and provide the discipline to carry out the needed planning for life after orthopaedics.

Compressed-air power tools in orthopaedic surgery: exhaust air is a potential source of contamination.

Science.gov (United States)

Sagi, H C; DiPasquale, Thomas; Sanders, Roy; Herscovici, Dolfi

2002-01-01

To determine if the exhaust from surgical compressed-air power tools contains bacteria and if the exhaust leads to contamination of sterile surfaces. Bacteriologic study of orthopaedic power tools. Level I trauma center operative theater. None. Part I. Exhaust from two sterile compact air drills was sampled directly at the exhaust port. Part II. Exhaust from the drills was directed at sterile agar plates from varying distances. The agar plates represented sterile surfaces within the operative field. Part III. Control cultures. A battery-powered drill was operated over open agar plates in similar fashion as the compressed-air drills. Agar plates left open in the operative theater served as controls to rule out atmospheric contamination. Random cultures were taken from agar plates, gloves, drills, and hoses. Incidence of positive cultures. In Part I, all filters from both compressed-air drill exhausts were culture negative ( = 0.008). In Part II, the incidence of positive cultures for air drills number one and number two was 73% and 82%, respectively. The most commonly encountered organisms were, coagulase-negative Staphylococcus, and Micrococcus species. All control cultures from agar plates, battery-powered drill, gloves, and hoses were negative ( compressed-air power tools in orthopaedic surgery may contribute to the dissemination of bacteria onto the surgical field. We do not recommend the use of compressed-air power tools that do not have a contained exhaust.

The efficacy of an extended scope physiotherapy clinic in paediatric orthopaedics.

LENUS (Irish Health Repository)

O Mir, Marie

2016-04-01

The demand for paediatric orthopaedic care is growing, and providing the service required is an increasingly challenging task. Physiotherapist-led triage clinics are utilised in adult orthopaedics to enable the provision of care to patients who may not require a surgical consult. The Physiotherapy Orthopaedic Triage Clinic (POTC) was established in Our Lady\\'s Children\\'s Hospital Crumlin in response to increasing demands on the paediatric orthopaedic service. The clinic is run by physiotherapists working in an advanced practice role (APP), and is the first paediatric clinic of its type and scale in the Republic of Ireland.

Preceding trauma in childhood hematogenous bone and joint infections.

Science.gov (United States)

Pääkkönen, Markus; Kallio, Markku J T; Lankinen, Petteri; Peltola, Heikki; Kallio, Pentti E

2014-03-01

Preceding trauma may play a role in the etiology and pathogenesis of hematogenous bone and joint infections. Among 345 children with an acute hematogenous bone and/or joint infection, 20% reported trauma during a 2-week period leading to infection. Blunt impact, bruises, or excoriations were commonly reported. The rate was similar to that in the general pediatric population obtained from the literature. In the study group, patients with and without trauma were similar in age, serum C-reactive protein and erythrocyte sedimentation rate, length of hospitalization, and late sequelae. Preceding minor trauma did not prove to be significant as an etiological or as a prognostic factor.

Lung Microbiota Is Related to Smoking Status and to Development of Acute Respiratory Distress Syndrome in Critically Ill Trauma Patients.

Science.gov (United States)

Panzer, Ariane R; Lynch, Susan V; Langelier, Chaz; Christie, Jason D; McCauley, Kathryn; Nelson, Mary; Cheung, Christopher K; Benowitz, Neal L; Cohen, Mitchell J; Calfee, Carolyn S

2018-03-01

Cigarette smoking is associated with increased risk of acute respiratory distress syndrome (ARDS) in patients after severe trauma; however, the mechanisms underlying this association are unknown. To determine whether cigarette smoking contributes to ARDS development after trauma by altering community composition of the lung microbiota. We studied the lung microbiota of mechanically ventilated patients admitted to the ICU after severe blunt trauma. To do so, we used 16S ribosomal RNA gene amplicon sequencing of endotracheal aspirate samples obtained on ICU admission (n = 74) and at 48 hours after admission (n = 30). Cigarette smoke exposure (quantified using plasma cotinine), ARDS development, and other clinical parameters were correlated with lung microbiota composition. Smoking status was significantly associated with lung bacterial community composition at ICU admission (P = 0.007 by permutational multivariate ANOVA [PERMANOVA]) and at 48 hours (P = 0.03 by PERMANOVA), as well as with significant enrichment of potential pathogens, including Streptococcus, Fusobacterium, Prevotella, Haemophilus, and Treponema. ARDS development was associated with lung community composition at 48 hours (P = 0.04 by PERMANOVA) and was characterized by relative enrichment of Enterobacteriaceae and of specific taxa enriched at baseline in smokers, including Prevotella and Fusobacterium. After severe blunt trauma, a history of smoking is related to lung microbiota composition, both at the time of ICU admission and at 48 hours. ARDS development is also correlated with respiratory microbial community structure at 48 hours and with taxa that are relatively enriched in smokers at ICU admission. The data derived from this pilot study suggest that smoking-related changes in the lung microbiota could be related to ARDS development after severe trauma.

Head trauma and CT

International Nuclear Information System (INIS)

Samejima, Kanji; Yoshii, Nobuo; Tobari, Chitoshi

1979-01-01

In our cases of acute and subacute subdural hematoma, the use of CT was evaluated. In our department of surgery, acute subdural hematoma was found in 46 of 388 patients of head trauma who underwent CT. Acute subdural hematoma, like epidural hematoma was usually visualized as a high-density area along the cranial inner table, and this was easily differenciated from epidural hematoma because of difference in shape from the other. The picture of acute subdural hematoma was occasionally confused with that of intracerebral hematoma or cerebral contusion. Single use of CT does not differenciate subacute subdural hematoma from chronic subdural hematoma. However, CT usually visualized acute hematoma as a high-density area, showing the extent of hematoma. Comparison of the thickness of hematoma with the axis deviation of the median part such as the 3rd cerebral ventricle suggested severity of cerebral edema. CT also revealed bilateral or multiple lesions of cerebral contusion or intracerebral hematoma. (Ueda, J.)

The Placenta: Applications in Orthopaedic Sports Medicine.

Science.gov (United States)

McIntyre, James Alexander; Jones, Ian A; Danilkovich, Alla; Vangsness, C Thomas

2018-01-01

Placenta has a long history of use for treating burns and wounds. It is a rich source of collagen and other extracellular matrix proteins, tissue reparative growth factors, and stem cells, including mesenchymal stem cells (MSCs). Recent data show its therapeutic potential for orthopaedic sports medicine indications. To provide orthopaedic surgeons with an anatomic description of the placenta, to characterize its cellular composition, and to review the literature reporting the use of placenta-derived cells and placental tissue allografts for orthopaedic sports medicine indications in animal models and in humans. Systematic review. Using a total of 63 keyword combinations, the PubMed and MEDLINE databases were searched for published articles describing the use of placental cells and/or tissue for orthopaedic sports medicine indications. Information was collected on placental tissue type, indications, animal model, study design, treatment regimen, safety, and efficacy outcomes. Results were categorized by indication and subcategorized by animal model. Outcomes for 29 animal studies and 6 human studies reporting the use of placenta-derived therapeutics were generally positive; however, the placental tissue source, clinical indication, and administration route were highly variable across these studies. Fourteen animal studies described the use of placental tissue for tendon injuries, 13 studies for osteoarthritis or articular cartilage injuries, 3 for ligament injuries, and 1 for synovitis. Both placenta-derived culture-expanded cells (epithelial cells or MSCs) and placental tissue allografts were used in animal studies. In all human studies, commercial placental allografts were used. Five of 6 human studies examined the treatment of foot and ankle pathological conditions, and 1 studied the treatment of knee osteoarthritis. A review of the small number of reported studies revealed a high degree of variability in placental cell types, placental tissue preparation, routes

Sick Leave within 5 Years of Whiplash Trauma Predicts Recovery: A Prospective Cohort and Register-Based Study

Science.gov (United States)

Carstensen, Tina Birgitte Wisbech; Fink, Per; Oernboel, Eva; Kasch, Helge; Jensen, Troels Staehelin; Frostholm, Lisbeth

2015-01-01

Background 10–22% of individuals sustaining whiplash trauma develop persistent symptoms resulting in reduced working ability and decreased quality of life, but it is poorly understood why some people do not recover. Various collision and post-collision risk factors have been studied, but little is known about pre-collision risk factors. In particular, the impact of sickness and socioeconomic factors before the collision on recovery is sparsely explored. The aim of this study was to examine if welfare payments received within five years pre-collision predict neck pain and negative change in provisional situation one year post-collision. Methods and Findings 719 individuals with acute whiplash trauma consecutively recruited from emergency departments or primary care after car accidents in Denmark completed questionnaires on socio-demographic and health factors immediately after the collision. After 12 months, a visual analogue scale on neck pain intensity was completed. 3595 matched controls in the general population were sampled, and national public register data on social benefits and any other welfare payments were obtained for participants with acute whiplash trauma and controls from five years pre-collision to 15 months after. Participants with acute whiplash trauma who had received sickness benefit for more than 12 weeks pre-collision had increased odds for negative change in future provisional situation (Odds Ratio (OR) (95% Confidence Interval (CI) = 3.8 (2.1;7.1)) and future neck pain (OR (95%CI) = 3.3 (1.8;6.3)), controlling for other known risk factors. Participants with acute whiplash trauma had weaker attachment to labour market (more weeks of sick leave (χ2(2) = 36.7, p whiplash trauma raised the odds for future negative change in provisional situation (OR (95%CI) = 3.1 (2.3;4.4)) compared with controls. Conclusions Sick leave before the collision strongly predicted prolonged recovery following whiplash trauma. Participants with acute whiplash trauma

Sick Leave within 5 Years of Whiplash Trauma Predicts Recovery: A Prospective Cohort and Register-Based Study.

Directory of Open Access Journals (Sweden)

Tina Birgitte Wisbech Carstensen

Full Text Available 10-22% of individuals sustaining whiplash trauma develop persistent symptoms resulting in reduced working ability and decreased quality of life, but it is poorly understood why some people do not recover. Various collision and post-collision risk factors have been studied, but little is known about pre-collision risk factors. In particular, the impact of sickness and socioeconomic factors before the collision on recovery is sparsely explored. The aim of this study was to examine if welfare payments received within five years pre-collision predict neck pain and negative change in provisional situation one year post-collision.719 individuals with acute whiplash trauma consecutively recruited from emergency departments or primary care after car accidents in Denmark completed questionnaires on socio-demographic and health factors immediately after the collision. After 12 months, a visual analogue scale on neck pain intensity was completed. 3595 matched controls in the general population were sampled, and national public register data on social benefits and any other welfare payments were obtained for participants with acute whiplash trauma and controls from five years pre-collision to 15 months after. Participants with acute whiplash trauma who had received sickness benefit for more than 12 weeks pre-collision had increased odds for negative change in future provisional situation (Odds Ratio (OR (95% Confidence Interval (CI = 3.8 (2.1;7.1 and future neck pain (OR (95%CI = 3.3 (1.8;6.3, controlling for other known risk factors. Participants with acute whiplash trauma had weaker attachment to labour market (more weeks of sick leave (χ2(2 = 36.7, p < 0.001 and unemployment (χ2(2 = 12.5, p = 0.002 pre-collision compared with controls. Experiencing a whiplash trauma raised the odds for future negative change in provisional situation (OR (95%CI = 3.1 (2.3;4.4 compared with controls.Sick leave before the collision strongly predicted prolonged recovery

Bone Adaptation Around Orthopaedic Implants of Varying Materials

DEFF Research Database (Denmark)

Bagge, Mette

1998-01-01

The bone adaptation around orthopaedic implants is simulated using a three-dimensional finite element model. The remodeling scheme has its origin in optimization methods, and includes anisotropy and time-dependent loading......The bone adaptation around orthopaedic implants is simulated using a three-dimensional finite element model. The remodeling scheme has its origin in optimization methods, and includes anisotropy and time-dependent loading...

Prevalence and pattern of small animal orthopaedic conditions at ...

African Journals Online (AJOL)

Small animal orthopaedic case records of a 20-year period were surveyed to obtain the prevalence and pattern of orthopaedic conditions presented to the Veterinary Teaching Hospital (VTH), University of Ibadan, Nigeria, with the objective of providing data for planning on small animal healthcare facilities, policy ...

Thought control strategies and rumination in youth with acute stress disorder and posttraumatic stress disorder following single-event trauma.

Science.gov (United States)

Meiser-Stedman, Richard; Shepperd, Alicia; Glucksman, Ed; Dalgleish, Tim; Yule, William; Smith, Patrick

2014-02-01

Certain thought control strategies for managing the intrusive symptoms of posttraumatic stress disorder (PTSD) are thought to play a key role in its onset and maintenance. Whereas measures exist for the empirical assessment of such thought control strategies in adults, relatively few studies have explored how children and adolescents manage posttraumatic intrusive phenomena. In a prospective longitudinal study of 10-16-year-olds with PTSD, who were survivors of road traffic collisions and assaults, a variety of thought control strategies were assessed in the acute phase. These included strategies thought to be protective (reappraisal, social support) as well as maladaptive (distraction, punishment, worry). Ruminative responses to the trauma were assessed at the follow-up assessment. Posttraumatic stress symptoms (PTSS) at each assessment were associated with the use of punishment and reappraisal, whereas social support and rumination were associated with PTSS symptoms at follow-up. Distraction was unrelated to PTSS at any time point. Rumination accounted for variance in PTSS symptoms at follow-up, even when accounting for baseline PTSS, and was found to mediate the relationships between reappraisal and punishment at baseline and PTSS at the follow-up assessment. The present study found no evidence to support advocating any particular thought control strategy for managing the intrusive symptoms of PTSD in youth in the acute posttrauma phase, and raised concerns over the use of reappraisal coping strategies. The study underscores the importance of ruminative responses in the onset and maintenance of PTSD in trauma-exposed youth.

Spinal trauma. An imaging approach

Energy Technology Data Exchange (ETDEWEB)

Cassar-Pullicino, V.N. [The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire (United Kingdom). Dept. of Radiology; Imhof, H. [University and General Hospital Vienna (Austria). Dept. of Radiodiagnostics

2006-07-01

The diagnosis of trauma to the spine - where the slightest oversight may have catastrophic results - requires a thorough grasp of the spectrum of resultant pathology as well as the imaging modalities used in making an accurate diagnosis. In Spinal Trauma, the internationally renowned team of experts provides a comprehensive, cutting-edge exposition of the current vital role of imaging in the diagnosis and treatment of injuries to the axial skeleton. Beginning with a valuable clinical perspective of spinal trauma, the book offers the reader a unique overview of the biomechanics underlying the pathology of cervical trauma. Acute trauma topics include: - Optimization of imaging modalities - Malalignment - signs and significance - Vertebral fractures - detection and implications - Classification of thoraco-lumbar fractures - rationale and relevance - Neurovascular injury. Distilling decades of clinical and teaching expertise, the contributors further discuss the current role of imaging in special focus topics, which include: - The pediatric spine - Sports injuries - The rigid spine - Trauma in the elderly - Vertebral collapse, benign and malignant - Spinal trauma therapy - Vertebral fractures and osteoporosis - Neuropathic spine. All throughout the book, the focus is on understanding the injury, and its implications and complications, through 'an imaging approach'. Lavishly illustrated with hundreds of superb MR images and CT scans, and clear full-color drawings, the authors conclude with a look into the future, defining clinical trends and research directions. Spinal Trauma - with its broad scope, practical imaging approach, and current focus - is designed to enhance confidence and accuracy, making it essential reading for clinicians and radiologists at all levels. (orig.)

Spinal trauma. An imaging approach

International Nuclear Information System (INIS)

Cassar-Pullicino, V.N.; Imhof, H.

2006-01-01

The diagnosis of trauma to the spine - where the slightest oversight may have catastrophic results - requires a thorough grasp of the spectrum of resultant pathology as well as the imaging modalities used in making an accurate diagnosis. In Spinal Trauma, the internationally renowned team of experts provides a comprehensive, cutting-edge exposition of the current vital role of imaging in the diagnosis and treatment of injuries to the axial skeleton. Beginning with a valuable clinical perspective of spinal trauma, the book offers the reader a unique overview of the biomechanics underlying the pathology of cervical trauma. Acute trauma topics include: - Optimization of imaging modalities - Malalignment - signs and significance - Vertebral fractures - detection and implications - Classification of thoraco-lumbar fractures - rationale and relevance - Neurovascular injury. Distilling decades of clinical and teaching expertise, the contributors further discuss the current role of imaging in special focus topics, which include: - The pediatric spine - Sports injuries - The rigid spine - Trauma in the elderly - Vertebral collapse, benign and malignant - Spinal trauma therapy - Vertebral fractures and osteoporosis - Neuropathic spine. All throughout the book, the focus is on understanding the injury, and its implications and complications, through 'an imaging approach'. Lavishly illustrated with hundreds of superb MR images and CT scans, and clear full-color drawings, the authors conclude with a look into the future, defining clinical trends and research directions. Spinal Trauma - with its broad scope, practical imaging approach, and current focus - is designed to enhance confidence and accuracy, making it essential reading for clinicians and radiologists at all levels. (orig.)

Orthopaedic surgeries - assessment of ionising radiations exposure in health care workers

International Nuclear Information System (INIS)

Leite, E.S.; Uva, A.S.

2006-01-01

Full text of publication follows: 1. Objectives: The health care workers are exposed to ionizing radiations during their activities. In the operating rooms, the ionizing radiations are used in orthopaedic surgery and the dose depends on some factors, like the characteristics of the equipment. This study aims to: Estimate the occupational dose of ionizing radiations exposure of the orthopaedic doctors and nurses during the orthopaedic surgeries, in a Portuguese operating room; Sensitize the health care workers to use the individual dosimeter and to adopt radiation preventive measures. 2. Population and methods The study was conducted on nine Orthopaedic doctors and two nurses of an operating room of a hospital in Lisbon neighborhoods. We made a risk evaluating concerning: the radiations dose in different points, corresponding to gonads, hands and crystalline lens levels of all the professionals, during the surgeries; the average period of radiation in the orthopaedic surgeries; the number of annual orthopaedic surgeries, looking for that in the surgeries registers, to estimate the annual ionizing radiations dose of each orthopaedic doctor and nurse. 3. Results The annual doses estimated at different levels for orthopaedic doctors were the following: gonads: between 20,63 and 68,75 mGy; hands: 4,95 16,50 mGy; crystalline lens: 8,25 27,50 mGy). For the orthopaedic nurses: gonads: 130,63 151,25 mGy; hands: 31,35 36,30 mGy; crystalline lens 52,25 60,25 mGy. 4. Conclusions Although the location and positions of health care workers are not the same during the different surgeries and the equipment has an automatic control of the X ray emission, the annual ionizing radiations dose exposure for health care workers is an important one. The risk rating justifies the use of individual dosimeters for better individual dose assessment as part of an ionizing radiations prevention program. As a matter of fact preventive measures begin with a good quantitative risk assessment of

Intranasal Ketamine Administration for Narcotic Dose Decrement in Patients Suffering from Acute Limb Trauma in Emergency Department: a Double-Blind Randomized Placebo-Controlled Trial

Directory of Open Access Journals (Sweden)

Ali Mohammadshahi

2018-04-01

Full Text Available Introduction: pain management is an important and challenging issue in emergency medicine. Despite the conduct of several studies on this topic, pain is still handled improperly in many cases. Objective: This study investigated the effectiveness of low-dose IN ketamine administration in reducing the need for opiates in patients in acute pain resulting from limb injury. Method: This randomized, double-blind, placebo-controlled trial was conducted to assess the possible effect of low-dose intranasal (IN ketamine administration in decreasing patients' narcotic need. Patients in emergency department suffering from acute isolated limb trauma were included. One group of patients received 0.5 mg/kg intravenous morphine sulfate and 0.02 ml/kg IN ketamine. The other group received the same dose of morphine sulfate and 0.02 ml/kg IN distilled water. Pain severity was measured using the 11 points numerical rating scale at 0, 10, 30, 60, 120, and 180 minutes. Results: Ninety-one patients with mean age of 31.62 ± 9.13 years were enrolled (54.9% male. The number of requests for supplemental medication was significantly lower in patients who received ketamine (12 patients (30% than those who received placebo (27 patients (67.5% (p = 0.001. Conclusion: It is likely that low-dose IN ketamine is effective in reducing the narcotic need of patients suffering from acute limb trauma.

Magnetic resonance imaging of acute trauma of the cervical spine: spectrum of findings

Energy Technology Data Exchange (ETDEWEB)

Forster, B.B.; Koopmans, R.A. [British Columbia Univ., Vancouver, BC (Canada). Faculty of Medicine

1995-06-01

The magnetic resonance imaging (MRI) spectrum of acute injury to the cervical spine was illustrated in this pictorial essay. The appearance of the traumatized cord was discussed, including intramedullary hemorrhage, and the causes of spinal cord compression, such as disk herniation, epidural hematoma, fracture, dislocation and underlying spinal stenosis. The ability of MRI to directly reveal the severity of cord injury and simultaneously indicate the cause of cord compression proved particularly useful in the management of incomplete injury, for which surgical intervention may prevent further deterioration. The protocol for MRI of cervical spinal trauma included sagittal T1-weighted and T2-weighted conventional spin-echo sequences. In addition, transverse T2-weighted gradient-echo images were obtained. MRI`s ability to directly reveal the extent of cord injury was said to be a powerful tool in the management of incomplete injuries where further deterioration could be prevented by timely surgical intervention. 7 refs., 12 figs.

Ireland's contribution to orthopaedic literature: a bibliometric analysis.

Science.gov (United States)

Kennedy, C; O Sullivan, P; Bilal, M; Walsh, A

2013-10-01

Bibliometric analysis of scientific performance within a country or speciality, facilitate the recognition of factors that may further enhance research activity and performance. Our aim was to illicit the current state of Irelands orthopaedic research output in terms of quantity and quality. We performed a retrospective bibliometric analysis of all Irish orthopaedic publications over the past 5 years, in the top 20 peer-reviewed orthopaedic journals. Utilising the MEDLINE database, each journal was evaluated for articles that were published over the study period. Reviews, editorials, reports and letters were excluded. Each article abstract was analysed for research content, and country of origin. A nation's mean IF was defined by multiplying each journal's IF by the number of articles. Publications per million (PmP) was calculated by dividing the total number of publications by the population of each country. We analysed a total of 25,595 article abstracts. Ireland contributed 109 articles in total (0.42% of all articles), however ranking according to population per million was 10th worldwide. Ireland ranked 18th worldwide in relation to mean impact factor, which was 2.91 over the study period. Ireland published in 16 of the top 20 journals, 9 of these were of European origin, and 1 of the top 5 was of American origin. In total, 61 Irish articles were assignable to clinical orthopaedic units. Clinical based studies (randomised controlled trials, observational, and epidemiology/bibliometric articles) and research based studies (In vivo, In vitro, and biomechanical) numbered 76 (69.7%) and 33 (30.2%) articles, respectively. This study provides a novel overview of current Irish orthopaedic related research, and how our standards translate to the worldwide orthopaedic community. In order to maintain our publication productivity, academic research should continue to be encouraged at post graduate level. Copyright © 2013 Royal College of Surgeons of Edinburgh

Are the claims made in orthopaedic print advertisements valid?

Science.gov (United States)

Davidson, Donald J; Rankin, Kenneth S; Jensen, Cyrus D; Moverley, Robert; Reed, Mike R; Sprowson, Andrew P

2014-05-01

Advertisements are commonplace in orthopaedic journals and may influence the readership with claims of clinical and scientific fact. Since the last assessment of the claims made in orthopaedic print advertisements ten years ago, there have been legislative changes and media scrutiny which have shaped this practice. The purpose of this study is to re-evaluate these claims. Fifty claims from 50 advertisements were chosen randomly from six highly respected peer-reviewed orthopaedic journals (published July-December 2011). The evidence supporting each claim was assessed and validated by three orthopaedic surgeons. The assessors, blinded to product and company, rated the evidence and answered the following questions: Does the evidence as presented support the claim made in the advertisement and what is the quality of that evidence? Is the claim supported by enough evidence to influence your own clinical practice? Twenty-eight claims cited evidence from published literature, four from public presentations, 11 from manufacturer "data held on file" and seven had no supporting evidence. Only 12 claims were considered to have high-quality evidence and only 11 were considered well supported. A strong correlation was seen between the quality of evidence and strength of support (Spearman r = 0.945, p advertisements. High-quality evidence is required by orthopaedic surgeons to influence clinical practice and this evidence should be sought by manufacturers wishing to market a successful product.

Transfusion practices in trauma

Directory of Open Access Journals (Sweden)

V Trichur Ramakrishnan

2014-01-01

Full Text Available Resuscitation of a severely traumatised patient with the administration of crystalloids, or colloids along with blood products is a common transfusion practice in trauma patients. The determination of this review article is to update on current transfusion practices in trauma. A search of PubMed, Google Scholar, and bibliographies of published studies were conducted using a combination of key-words. Recent articles addressing the transfusion practises in trauma from 2000 to 2014 were identified and reviewed. Trauma induced consumption and dilution of clotting factors, acidosis and hypothermia in a severely injured patient commonly causes trauma-induced coagulopathy. Early infusion of blood products and early control of bleeding decreases trauma-induced coagulopathy. Hypothermia and dilutional coagulopathy are associated with infusion of large volumes of crystalloids. Hence, the predominant focus is on damage control resuscitation, which is a combination of permissive hypotension, haemorrhage control and haemostatic resuscitation. Massive transfusion protocols improve survival in severely injured patients. Early recognition that the patient will need massive blood transfusion will limit the use of crystalloids. Initially during resuscitation, fresh frozen plasma, packed red blood cells (PRBCs and platelets should be transfused in the ratio of 1:1:1 in severely injured patients. Fresh whole blood can be an alternative in patients who need a transfusion of 1:1:1 thawed plasma, PRBCs and platelets. Close monitoring of bleeding and point of care coagulation tests are employed, to allow goal-directed plasma, PRBCs and platelets transfusions, in order to decrease the risk of transfusion-related acute lung injury.

Acute Kidney Injury in Trauma Patients Admitted to Critical Care: Development and Validation of a Diagnostic Prediction Model.

Science.gov (United States)

Haines, Ryan W; Lin, Shih-Pin; Hewson, Russell; Kirwan, Christopher J; Torrance, Hew D; O'Dwyer, Michael J; West, Anita; Brohi, Karim; Pearse, Rupert M; Zolfaghari, Parjam; Prowle, John R

2018-02-26

Acute Kidney Injury (AKI) complicating major trauma is associated with increased mortality and morbidity. Traumatic AKI has specific risk factors and predictable time-course facilitating diagnostic modelling. In a single centre, retrospective observational study we developed risk prediction models for AKI after trauma based on data around intensive care admission. Models predicting AKI were developed using data from 830 patients, using data reduction followed by logistic regression, and were independently validated in a further 564 patients. AKI occurred in 163/830 (19.6%) with 42 (5.1%) receiving renal replacement therapy (RRT). First serum creatinine and phosphate, units of blood transfused in first 24 h, age and Charlson score discriminated need for RRT and AKI early after trauma. For RRT c-statistics were good to excellent: development: 0.92 (0.88-0.96), validation: 0.91 (0.86-0.97). Modelling AKI stage 2-3, c-statistics were also good, development: 0.81 (0.75-0.88) and validation: 0.83 (0.74-0.92). The model predicting AKI stage 1-3 performed moderately, development: c-statistic 0.77 (0.72-0.81), validation: 0.70 (0.64-0.77). Despite good discrimination of need for RRT, positive predictive values (PPV) at the optimal cut-off were only 23.0% (13.7-42.7) in development. However, PPV for the alternative endpoint of RRT and/or death improved to 41.2% (34.8-48.1) highlighting death as a clinically relevant endpoint to RRT.

An evaluation of the quality of statistical design and analysis of published medical research: results from a systematic survey of general orthopaedic journals.

Science.gov (United States)

Parsons, Nick R; Price, Charlotte L; Hiskens, Richard; Achten, Juul; Costa, Matthew L

2012-04-25

The application of statistics in reported research in trauma and orthopaedic surgery has become ever more important and complex. Despite the extensive use of statistical analysis, it is still a subject which is often not conceptually well understood, resulting in clear methodological flaws and inadequate reporting in many papers. A detailed statistical survey sampled 100 representative orthopaedic papers using a validated questionnaire that assessed the quality of the trial design and statistical analysis methods. The survey found evidence of failings in study design, statistical methodology and presentation of the results. Overall, in 17% (95% confidence interval; 10-26%) of the studies investigated the conclusions were not clearly justified by the results, in 39% (30-49%) of studies a different analysis should have been undertaken and in 17% (10-26%) a different analysis could have made a difference to the overall conclusions. It is only by an improved dialogue between statistician, clinician, reviewer and journal editor that the failings in design methodology and analysis highlighted by this survey can be addressed.

An evaluation of the quality of statistical design and analysis of published medical research: results from a systematic survey of general orthopaedic journals

Directory of Open Access Journals (Sweden)

Parsons Nick R

2012-04-01

Full Text Available Abstract Background The application of statistics in reported research in trauma and orthopaedic surgery has become ever more important and complex. Despite the extensive use of statistical analysis, it is still a subject which is often not conceptually well understood, resulting in clear methodological flaws and inadequate reporting in many papers. Methods A detailed statistical survey sampled 100 representative orthopaedic papers using a validated questionnaire that assessed the quality of the trial design and statistical analysis methods. Results The survey found evidence of failings in study design, statistical methodology and presentation of the results. Overall, in 17% (95% confidence interval; 10–26% of the studies investigated the conclusions were not clearly justified by the results, in 39% (30–49% of studies a different analysis should have been undertaken and in 17% (10–26% a different analysis could have made a difference to the overall conclusions. Conclusion It is only by an improved dialogue between statistician, clinician, reviewer and journal editor that the failings in design methodology and analysis highlighted by this survey can be addressed.

Acute injury of the ankle joint; Akutes Trauma des Sprunggelenks

Energy Technology Data Exchange (ETDEWEB)

Breitenseher, M.J. [Univ. Klinik fuer Radiodiagnostik, Abt. fuer Osteologie und Besondere Klinische Einrichtung Magnet Resonanz, AKH, Wien (Austria)]|[Ludwig-Boltzmann-Institut fuer Radiologisch-Physikalische Tumordiagnostik, Vienna (Austria)

1999-01-01

The diagnosis of lateral collateral ankle ligament trauma is based on patient history, clinical examination, and clinical stress tests. If the clinical stress test is positive, stress radiography could be performed. There is no consensus about the usefulness of stress radiography in acute ankle sprain, particularly about the cut-off talar tilt angle beyond which a two-ligament rupture would be certain, ranging from 5 to 30 . Today MRI is not used for this indication, although it allows, with controlled positioning of the foot and with defined sections, visualization of injured lateral collateral ankle ligaments. In ankle injuries, plain radiographs form the established basis of diagnostic imaging and can provide definitive answers in most cases. CT is used in complex fractures for complete visualization. MRI is the method of choice for several diagnostic problem cases, including occult fractures and post-traumatic avascular necrosis. In tendon injuries, MRI is important if ultrasound is not diagnostic. Generally, for the evaluation of acute ankle injuries, MRI is the most important second-step procedure when radiographs are nondiagnostic. (orig.) [Deutsch] Die Diagnose einer lateralen Bandverletzung beim frischen Sprunggelenkstrauma fusst auf der Anamnese, der klinischen Untersuchung und klinischen Stresstests. Bei positiven klinischen Stresstests kann eine Stressradiographie durchgefuehrt werden. Es gibt keine Uebereinstimmung fuer den Wert der Stressradiographie beim frischen Supinationstrauma des Sprunggelenks, insbesonders fuer den Winkel der Aufklappbarkeit bei einer Zweibandverletzung, der von 5 -30 reicht. Die MRT wird zur Zeit bei dieser Indikation nur in Einzelfaellen benutzt, obwohl sie mit definierter Fusspositionierung und Ausrichtung der Untersuchungsebene eine ausgezeichnete Beurteilung der Sprunggelenksbaende erlaubt. Bei knoecherner Sprunggelenksverletzungen ist die Verwendung des konventionellen Roentgen die etablierte Methode und meist

Head trauma in female professional wrestlers

International Nuclear Information System (INIS)

Nomoto, Jun; Seiki, Yoshikatsu; Nemoto, Masaaki

2007-01-01

The clinical characteristics of head trauma were evaluated in 18 wrestlers belonging to a female professional wrestling organization, 13 regular members and five trainees aged 15-34 years. Medical examinations for head trauma were performed in all wrestlers, and wrestlers treated at our emergency outpatient department were clinically evaluated. In addition, the relationships of head trauma with duration of the wrestling career of 1-16 years (mean 8 years) in the regular members, and less than 1 year in the five trainees, and body mass index (BMI) of 21.0-32.0 in the 16 subjects, excluding two trainees, was evaluated. Chronic symptoms were noted in four of the 18 wrestlers with long wrestling careers (16 years in 1, 13 years in 1, and 5 years in 2). Three wrestlers with symptoms immediately after head trauma showed recurrent retrograde amnesia and had low BMI (21.6, 21.6, and 23.1). Five wrestlers were treated at our emergency outpatient clinic, three required hospitalization and two showed intracranial traumatic changes on computed tomography (acute subdural hematoma in 1 and diffuse brain swelling in 1). Head trauma in female professional wrestlers is associated with longer wrestling career and low BMI. Periodic medical examinations are recommended to monitor for signs of head trauma. (author)

Multicystic encephalopathy in abusive head trauma

NARCIS (Netherlands)

Kubat, Bela; Bilo, Rob A. C.; van Rijn, Rick R.

2014-01-01

The proof of abusive head trauma (AHT) in infants is difficult, especially in cases with a long posttraumatic survival period. In the acute phase, injury to the cranio-cervical junction causes disturbances in respiratory and cardiac control, leading to apnea and bradycardia. Infants who survive the

Limited Blood Transfusions Are Safe in Orthopaedic Trauma Patients.

Science.gov (United States)

Dolenc, Andrea J; Morris, William Z; Como, John J; Wagner, Karl G; Vallier, Heather A

2016-12-01

Controversy exists over association of blood transfusions with complications. The purpose was to assess effects of limited transfusions on complication rates and hospital course. Level 1 trauma center. Three hundred seventy-one consecutive patients with Injury Severity Score ≥16 underwent fixation of fractures of spine (n = 111), pelvis (n = 72), acetabulum (n = 57), and/or femur (n = 179). Those receiving >3 units of packed red blood cell were excluded. Fracture type, associated injuries, treatment details, ventilation time, complications, and hospital stay were prospectively recorded. Ninety-eight patients with 107 fractures received limited transfusion, and 119 patients with 123 fractures were not transfused. The groups did not differ in age, fracture types, time to fixation, or associated injuries. Lowest hematocrit was lower in the transfused group (22.8 vs. 30.0, P < 0.0001). Surgical duration (3:23 vs. 2:28) and estimated blood loss (462 vs. 211 mL) were higher in transfused patients (all P < 0.003). Pulmonary complications occurred in 12% of transfused and 4% of nontransfused, (P = 0.10). Mean days of mechanical ventilation (2.51 vs. 0.45), intensive care unit days (4.5 vs. 1.5) and total hospital stay (8.8 vs. 5.7) were higher in transfused patients (all P ≤ 0.006). After multivariate analysis, limited transfusion was associated with increased hospital and intensive care unit stays and mechanical ventilation time, but not with complications. Patients receiving ≤3 units of packed red blood cell had lower hematocrit and greater surgical burden, but no difference in complications versus the nontransfused group. Limited blood transfusions are likely safe, excepting a possible association with longer mechanical ventilation times and hospital stays. Therapeutic level III. See Instructions for Authors for a complete description of levels of evidence.

Cost comparison of orthopaedic fracture pathways using discrete event simulation in a Glasgow hospital.

Science.gov (United States)

Anderson, Gillian H; Jenkins, Paul J; McDonald, David A; Van Der Meer, Robert; Morton, Alec; Nugent, Margaret; Rymaszewski, Lech A

2017-09-07

Healthcare faces the continual challenge of improving outcome while aiming to reduce cost. The aim of this study was to determine the micro cost differences of the Glasgow non-operative trauma virtual pathway in comparison to a traditional pathway. Discrete event simulation was used to model and analyse cost and resource utilisation with an activity-based costing approach. Data for a full comparison before the process change was unavailable so we used a modelling approach, comparing a virtual fracture clinic (VFC) with a simulated traditional fracture clinic (TFC). The orthopaedic unit VFC pathway pioneered at Glasgow Royal Infirmary has attracted significant attention and interest and is the focus of this cost study. Our study focused exclusively on patients with non-operative trauma attending emergency department or the minor injuries unit and the subsequent step in the patient pathway. Retrospective studies of patient outcomes as a result of the protocol introductions for specific injuries are presented in association with activity costs from the models. Patients are satisfied with the new pathway, the information provided and the outcome of their injuries (Evidence Level IV). There was a 65% reduction in the number of first outpatient face-to-face (f2f) attendances in orthopaedics. In the VFC pathway, the resources required per day were significantly lower for all staff groups (p≤0.001). The overall cost per patient of the VFC pathway was £22.84 (95% CI 21.74 to 23.92) per patient compared with £36.81 (95% CI 35.65 to 37.97) for the TFC pathway. Our results give a clearer picture of the cost comparison of the virtual pathway over a wholly traditional f2f clinic system. The use of simulation-based stochastic costings in healthcare economic analysis has been limited to date, but this study provides evidence for adoption of this method as a basis for its application in other healthcare settings. © Article author(s) (or their employer(s) unless otherwise

Ischemic Stroke Following Multiple Traumas in a Child: A Case Report

Directory of Open Access Journals (Sweden)

Pei-Jung Lin

2006-04-01

Full Text Available Stroke is an uncommon disorder in children but an increasingly recognized cause of disability. Acute stroke may be attributable to trauma, but this topic is seldom discussed. In limited reports, most ischemic strokes following trauma were detected after a considerable delay. Early recognition of stroke following trauma might reduce secondary neurologic complications. We report a case of posterior cerebral artery area infarct following multiple traumas in a child. A comprehensive etiologic survey was undertaken and discussed. Although the definite pathogenesis is still unclear, adequate, individualized, and uncomplicated management can significantly affect the outcome.

Patient Perspectives of Midlevel Providers in Orthopaedic Sports Medicine.

Science.gov (United States)

Manning, Blaine T; Bohl, Daniel D; Hannon, Charles P; Redondo, Michael L; Christian, David R; Forsythe, Brian; Nho, Shane J; Bach, Bernard R

2018-04-01

Midlevel providers (eg, nurse practitioners and physician assistants) have been integrated into orthopaedic systems of care in response to the increasing demand for musculoskeletal care. Few studies have examined patient perspectives toward midlevel providers in orthopaedic sports medicine. To identify perspectives of orthopaedic sports medicine patients regarding midlevel providers, including optimal scope of practice, reimbursement equity with physicians, and importance of the physician's midlevel provider to patients when initially selecting a physician. Cross-sectional study; Level of evidence, 3. A total of 690 consecutive new patients of 3 orthopaedic sports medicine physicians were prospectively administered an anonymous questionnaire prior to their first visit. Content included patient perspectives regarding midlevel provider importance in physician selection, optimal scope of practice, and reimbursement equity with physicians. Of the 690 consecutive patients who were administered the survey, 605 (87.7%) responded. Of these, 51.9% were men and 48.1% were women, with a mean age of 40.5 ± 15.7 years. More than half (51.2%) perceived no differences in training levels between physician assistants and nurse practitioners. A majority of patients (62.9%) reported that the physician's midlevel provider is an important consideration when choosing a new orthopaedic sports medicine physician. Patients had specific preferences regarding which services should be physician provided. Patients also reported specific preferences regarding those services that could be midlevel provided. There lacked a consensus on reimbursement equity for midlevel practitioners and physicians, despite 71.7% of patients responding that the physician provides a higher-quality consultation. As health care becomes value driven and consumer-centric, understanding patient perspectives on midlevel providers will allow orthopaedic sports medicine physicians to optimize efficiency and patient

The 25 most cited articles in arthroscopic orthopaedic surgery.

Science.gov (United States)

Cassar Gheiti, Adrian J; Downey, Richard E; Byrne, Damien P; Molony, Diarmuid C; Mulhall, Kevin J

2012-04-01

The purpose of this study was to use Web of Knowledge to determine which published arthroscopic surgery-related articles have been cited most frequently by other authors by ranking the 25 most cited articles. We furthermore wished to determine whether there is any difference between a categorical "journal-by-journal" analysis and an "all-database" analysis in arthroscopic surgery and whether such a search methodology would alter the results of previously published lists of "citation classics" in the field. We analyzed the characteristics of these articles to determine what qualities make an article important to this subspecialty of orthopaedic surgery. Web of Knowledge was searched on March 7, 2011, using the term "arthroscopy" for citations to articles related to arthroscopy in 61 orthopaedic journals and using the all-database function. Each of the 61 orthopaedic journals was searched separately for arthroscopy-related articles to determine the 25 most cited articles. An all-database search for arthroscopy-related articles was carried out and compared with a journal-by-journal search. Each article was reviewed for basic information including the type of article, authorship, institution, country, publishing journal, and year published. The number of citations ranged from 189 to 567 in a journal-by-journal search and from 214 to 1,869 in an all-database search. The 25 most cited articles on arthroscopic surgery were published in 11 journals: 8 orthopaedic journals and 3 journals from other specialties. The most cited article in arthroscopic orthopaedic surgery was published in The New England Journal of Medicine, which was not previously identified by a journal-by-journal search. An all-database search in Web of Knowledge gives a more in-depth methodology of determining the true citation ranking of articles. Among the top 25 most cited articles, autologous chondrocyte implantation/transplantation is currently the most cited and most popular topic in arthroscopic

Role of contrast-enhanced helical CT in the evaluation of acute thoracic aortic injuries after blunt chest trauma

International Nuclear Information System (INIS)

Scaglione, M.; Pinto, A.; Pinto, F.; Romano, L.; Ragozzino, A.; Grassi, R.

2001-01-01

The purpose of this retrospective study was to determine the value of contrast-enhanced helical CT for detecting and managing acute thoracic aortic injury (ATAI). Between June 1995 and February 2000, 1419 consecutive chest CT examinations were performed in the setting of major blunt trauma. The following CT findings were considered indicative of ATAI: intimal flap; pseudoaneurysm; contour irregularity; lumen abnormality; and extravasation of contrast material. On the basis of these direct findings no further diagnostic investigations were performed. Isolated mediastinal hematoma on CT scans was considered an indirect sign of ATAI: In these cases, thoracic aortography was performed even if CT indicated normal aorta. Seventy-seven patients had abnormal CT scans: Among the 23 patients with direct CT signs, acute thoracic aortic injuries was confirmed at thoracotomy in 21. Two false-positive cases were observed. The 54 remaining patients had isolated mediastinal hematoma without aortic injuries at CT and corresponding negative angiograms. The 1342 patients with negative CT scans were included in the 8-month follow-up program and did not show any adverse sequela based on clinical and radiographic criteria. Contrast-enhanced helical CT has a critical role in the exclusion of thoracic aortic injuries in patient with major blunt chest trauma and prevents unnecessary thoracic aortography. Direct CT signs of ATAI do not require further diagnostic investigations to confirm the diagnosis: Isolated aortic bands or contour vessel abnormalities should be first considered as possible artifacts or related to non-traumatic etiologies especially when mediastinal hematoma is absent. In cases of isolated mediastinal hematoma other possible sources of bleeding should be considered before directing patients to thoracic aortography. (orig.)

The use of three-dimensional printing technology in orthopaedic surgery.

Science.gov (United States)

Wong, Tak Man; Jin, Jimmy; Lau, Tak Wing; Fang, Christian; Yan, Chun Hoi; Yeung, Kelvin; To, Michael; Leung, Frankie

2017-01-01

Three-dimensional (3-D) printing or additive manufacturing, an advanced technology that 3-D physical models are created, has been wildly applied in medical industries, including cardiothoracic surgery, cranio-maxillo-facial surgery and orthopaedic surgery. The physical models made by 3-D printing technology give surgeons a realistic impression of complex structures, allowing surgical planning and simulation before operations. In orthopaedic surgery, this technique is mainly applied in surgical planning especially revision and reconstructive surgeries, making patient-specific instruments or implants, and bone tissue engineering. This article reviews this technology and its application in orthopaedic surgery.

Craniocerebral trauma in the child abuse syndrome: Radiological observations

International Nuclear Information System (INIS)

Merten, D.F.; Osborne, D.R.S.; Leonidas, J.C.

1984-01-01

Experience with craniocerebral trauma in 712 physically abused children is reviewed. Ninety-three (13%) had evidence of head trauma (cranial and/or intracranial). Seventy-seven of these patients had computed tomography (CT) of the head, and 47 had CT evidence of intracranial injury. Extracerebral fluid collections, predominantly convexity subdural hemorrhage, were the most common acute intracranial lesions. Concurrent intracranial and skeletal trauma (cranial and/or ectracranial) was present in 33 of the 47 patients (70%) with intracranial injury. A high incidence of skull fractures (45%) in those children with intracranial lesions suggest a significant role for impact head injuries (''battering'') in the pathogenesis of craniocerebral trauma in the child abuse syndrome. Greater emphasis on CT examination in evaluation of the abuse infant and child is recommended. (orig.)

The Role of 3D Modelling and Printing in Orthopaedic Tissue Engineering: A Review of the Current Literature.

Science.gov (United States)

Shaunak, Shalin; Dhinsa, Baljinder S; Khan, Wasim S

2017-01-01

Orthopaedic surgery lends itself well to advances in technology. An area of interest and ongoing research is that of the production of scaffolds for use in trauma and elective surgery. 3D printing provides unprecedented accuracy in terms of micro- and macro-structure and geometry for scaffold production. It can also be utilised to construct scaffolds of a variety of different materials and more recently has allowed for the construction of bio-implants which recapitulate bone and cartilage tissue. This review seeks to look at the various methods of 3DP, the materials used, elements of functionality and design, as well as modifications to increase the biomechanics and bioactivity of 3DP scaffolds. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Orthopaedic Rehabilitation Device Actuated with Pneumatic Muscles

Directory of Open Access Journals (Sweden)

Ioana Petre

2014-07-01

Full Text Available Year after year recovery clinics worldwide report significant numbers of lower limb bearing joint disabilities. An effective method for the speedy rehabilitation of patients with such afflictions is Continuous Passive Motion (CPM, drawing upon a range of specific equipment. This paper presents an innovative constructive solution for such orthopaedic rehabilitation equipment, designed to ensure a swift reintegration of patients at as low a cost as possible. The absolute novelty consists in the utilization of the linear pneumatic muscle as actuator of the orthopaedic rehabilitation equipment, thus achieving a light and highly compliant construction that satisfies safety requirements related to man-machine interaction. Pneumatic muscles are bio-inspired actuation systems characterized by a passive variable compliant behaviour. This property, deployed in rehabilitation systems, enables the development of human friendly devices, which are comfortable for the patients, and capable of safe interaction. This paper presents the constructive schematic of the orthopaedic rehabilitation equipment, the structure of the actuation and positioning system, and several of its functional characteristics.

Are severely injured trauma victims in Norway offered advanced pre-hospital care? National, retrospective, observational cohort.

Science.gov (United States)

Wisborg, T; Ellensen, E N; Svege, I; Dehli, T

2017-08-01

Studies of severely injured patients suggest that advanced pre-hospital care and/or rapid transportation provides a survival benefit. This benefit depends on the disposition of resources to patients with the greatest need. Norway has 19 Emergency Helicopters (HEMS) staffed by anaesthesiologists on duty 24/7/365. National regulations describe indications for their use, and the use of the national emergency medical dispatch guideline is recommended. We assessed whether severely injured patients had been treated or transported by advanced resources on a national scale. A national survey was conducted collecting data for 2013 from local trauma registries at all hospitals caring for severely injured patients. Patients were analysed according to hospital level; trauma centres or acute care hospitals with trauma functions. Patients with an Injury Severity Score (ISS) > 15 were considered severely injured. Three trauma centres (75%) and 17 acute care hospitals (53%) had data for trauma patients from 2013, a total of 3535 trauma registry entries (primary admissions only), including 604 victims with an ISS > 15. Of these 604 victims, advanced resources were treating and/or transporting 51%. Sixty percent of the severely injured admitted directly to trauma centres received advanced services, while only 37% of the severely injured admitted primarily to acute care hospitals received these services. A highly developed and widely distributed HEMS system reached only half of severely injured trauma victims in Norway in 2013. © 2017 The Authors. Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.

Open access publishing: a study of current practices in orthopaedic research.

Science.gov (United States)

Sabharwal, Sanjeeve; Patel, Nirav; Johal, Karanjeev

2014-06-01

Open access (OA) publications have changed the paradigm of dissemination of scientific research. Their benefits to low-income countries underline their value; however, critics question exorbitant publication fees as well as their effect on the peer review process and research quality. This study reports on the prevalence of OA publishing in orthopaedic research and compares benchmark citation indices as well as evidence quality derived from OA journals with conventional subscription based orthopaedic journals. All 63 orthopaedic journals listed in ISI's Web of Knowledge Journal Citation Report (JCR) were examined. Bibliometric data attributed to each journal for the year 2012 was acquired from the JCR. Studies that fulfilled the criteria of level I evidence were identified for each journal within PubMed. Individual journal websites were reviewed to identify their open access policy. A total of 38 (60.3 %) journals did not offer any form of OA publishing; however, 20 (31.7 %) hybrid journals were identified which offered authors the choice to publish their work as OA if a publication fee was paid. Only five (8 %) journals published all their articles as OA. There was variability amongst the different publication fees for OA articles. Journals that published OA articles did not differ from subscription based journals on the basis of 2012 impact factor, citation number, self citation proportion or the volume of level I evidence published (p > 0.05). OA journals are present in orthopaedic research, though in small numbers. Over a third of orthopaedic journals catalogued in the ISI Web of Knowledge JCR® are hybrid journals that provide authors with the opportunity to publish their articles as OA after a publication fee is paid. This study suggests equivalent importance and quality of articles between OA and subscription based orthopaedic journals based on bibliometric data and the volume of level I evidence produced. Orthopaedic researchers must recognize the

Profile of chest trauma in Zaria Nigeria: A prelminary report

Directory of Open Access Journals (Sweden)

S A Edaigbini

2011-01-01

Materials and Methods A prospective study of trauma patients admitted to Ahmadu Bello University Teaching Hospital through the Accident and Emergency units was commenced in January 2008.This preliminary report is for the period of 27months.The clinical history, physical examination and outcome of management recorded in a predesigned proforma, were analysed with SPSS 15 and the patients were followed up in the surgical outpatient department. Results A total of 4784 patients (3143 men and 1641 women were admitted during this period for trauma. There were a total of 628(13.13% deaths. Of the 42 consecutive patients identified with chest trauma35 (83.3% were males and 7(16.7% were females. The age range was from 5-75years and the mean age was 35.4years, while the most affected ages were in the range of 20 to 49years. Blunt injury constituted 71.4% and penetrating injury constituted 28.6%. Road traffic accident was responsible for 61.9%, stab injury 21.4%, falls 7.1%, gunshot injury 4.8%, impalement 2.4% and animal attack also 2.4%. The average time taken between accident and admission was 31hours,40minutes and 12seconds while the average duration of hospital stay was 16.10 days. The injury pattern included rib fracture(s (23.8%, hemopneumothorax (14.3%, hemothorax (7.1%, pneumothorax (4.8%, combinations of chest injuries (7.1%, chest laceration 7.1%, bruises 11.9%, lung contusion 4.8%, subcutaneous empyema 2.4%, flail chest 4.8% and no specific injury (11.9%. Associated injuries included head injury (63.6%, orthopaedic injury (27.3% and combinations (abdominal, head, orthopaedic (9.1%. The fatality of road traffic accident was 36.8%. No patient was attended to by paramedics at the scene of accident while 21.9% of the patients had pre-hospital resuscitation in peripheral clinics before admission. The transfusion requirement was 14.3%. One patient (2.4% required a median sternotomy and cardiopulmonary bypass, 54.8% required tube thoracostomy while 42.9% had general

Teamwork in Trauma: System Adjustment to a Protocol for the Management of Multiply Injured Patients.

Science.gov (United States)

Vallier, Heather A; Moore, Timothy A; Como, John J; Dolenc, Andrea J; Steinmetz, Michael P; Wagner, Karl G; Smith, Charles E; Wilczewski, Patricia A

2015-11-01

We developed a protocol to determine the timing of definitive fracture care based on the adequacy of resuscitation. Inception of this project required a multidisciplinary group, including physicians from anesthesiology, general trauma and critical care, neurosurgery, orthopaedic spine, and orthopaedic trauma. The purposes of this study were to review our initial experience with adherence to protocol recommendations and to assess barriers to implementation. Prospective. Level 1 trauma center. Definitive fixation of pelvis, acetabulum, spine, and femur fractures within 36 hours of injury, based on laboratory parameters for acidosis. Three hundred five consecutive skeletally mature patients with Injury Severity Score ≥ 16 (mean, 26.4) and 346 fractures of the proximal or diaphyseal femur (n = 152), pelvic ring (n = 56), acetabulum (n = 44), and/or spine (n = 94) were treated surgically. Adherence to the protocol was defined as definitive fixation within 36 hours of injury in resuscitated patients. All patients were adequately resuscitated within that time. Patient demographic and injury characteristics, date and time of presentation, and reasons for delay were recorded. Two hundred fifty-one patients (82%) with 287 fractures were treated according to the protocol, whereas 54 patients (18%) with 59 fractures were definitively stabilized on a delayed basis (mean, 90 hours). Delay was not related to patient age, Injury Severity Score, day of week, or time of presentation. Before implementation of this protocol, 76% were treated on a delayed basis, demonstrating improvement for each fracture type: spine (79% of previous patients with delay), pelvis (57%), acetabulum (72%), and femur (22%); all P < 0.0001 for more frequently delayed surgery before the protocol. Surgeon choice to delay the procedure accounted for 67% of reasons for delay. Other reasons included intensivist choice (13%), operating room availability (7.4%), patient choice (3.7%), severe head injury (5

GLP-1 improves neuropathology after murine cold lesion brain trauma

DEFF Research Database (Denmark)

DellaValle, Brian; Hempel, Casper; Johansen, Flemming Fryd

2014-01-01

brain trauma. METHODS: Severe trauma was induced with a stereotactic cryo-lesion in mice and thereafter treated with vehicle, liraglutide, or liraglutide + GLP-1 receptor antagonist. A therapeutic window was established and lesion size post-trauma was determined. Reactive oxygen species were visualized......-neurodegenerative proteins increased with Lira-driven CREB activation. INTERPRETATION: These results show that Lira has potent effects after experimental trauma in mice and thus should be considered a candidate for critical care intervention post-injury. Moreover, activation of CREB in the brain by Lira - described......OBJECTIVES: In this study, we address a gap in knowledge regarding the therapeutic potential of acute treatment with a glucagon-like peptide-1 (GLP-1) receptor agonist after severe brain trauma. Moreover, it remains still unknown whether GLP-1 treatment activates the protective, anti...

Cause of trauma-induced coagulopathy.

Science.gov (United States)

Davenport, Ross A; Brohi, Karim

2016-04-01

Trauma-induced coagulopathy (TIC) is a multifactorial, global failure of the coagulation system to sustain adequate haemostasis after trauma haemorrhage. Damage control resuscitation is associated with improved outcomes although the mechanisms of how it corrects TIC have yet to be fully characterized. Identification of predominant pathophysiological pathways in TIC is required to develop effective treatment algorithms for trauma haemorrhage. TIC is described by varying degrees of dysfibrinogenaemia, hyperfibrinolysis, endothelial dysfunction and impaired platelet activity, dependent on the magnitude of trauma, and severity of haemorrhagic shock. Acute traumatic coagulopathy is the early endogenous process mediated by the protein C pathway in response to tissue injury and hypoperfusion. Thrombin generation appears maintained with altered fibrinogen utilization and activation of fibrinolytic pathways representing key components of TIC. Shedding of the endothelial glycocalyx appears capable of triggering systemic thrombin generation, protein C activation and hyperfibrinolysis and may itself represent a therapeutic target. Further advances in TIC treatment require an enhanced understanding of the dynamic changes in the equilibrium between pro and anticoagulant factors, downstream effectors, and the host response. Delineating the interaction between fibrinolysis, fibrinogen utilization, platelet activity, and thrombin generation may provide opportunity for targeted intervention.

Psychological debriefing (PD of trauma: a proposed model for Africa

Directory of Open Access Journals (Sweden)

E L Van Dyk

2010-03-01

Full Text Available Africa is a continent with severe trauma. Traumatic events include experiences of child soldiers, people living in war and conflict zones, and people struggling with the HIV/AIDS pandemic. These events cause high levels of trauma. The trauma causes psychological disorders like post traumatic stress disorder, acute stress disorder and combat stress reaction, specific in the military environment. This article focuses on a better understanding of the implications of trauma for military people and civilians. It discusses the different theories and models of psychological debriefing. Lastly the article discusses psychological debriefing models for military forces and the civil ian population to prevent severe psychopathology after traumatic incidents in Africa.

Smartphones in orthopaedics

OpenAIRE

Al-Hadithy, Nawfal; Gikas, Panagiotis D; Al-Nammari, Shafic Said

2012-01-01

With the introduction of the European Working Time Directive, surgical trainees are facing limited training opportunities and doctors are required to maximise their training opportunities. Smartphone sales have been rapidly increasing over the last five years and can be used as a training tool for the orthopaedic trainee and surgeon. Common uses include applications (AO, eLogbook and PubMed), Ebooks, online Logbooks, Guidelines and surgical techniques. In addition, smartphones can be used to ...

Complications to evaluate adult trauma care: An expert consensus study.

Science.gov (United States)

Moore, Lynne; Lauzier, François; Stelfox, Henry Thomas; Le Sage, Natalie; Bourgeois, Gilles; Clément, Julien; Shemilt, Michèle; Turgeon, Alexis F

2014-08-01

Complications affect up to 37% of patients hospitalized for injury and increase mortality, morbidity, and costs. One of the keys to controlling complications for injury admissions is to monitor in-hospital complication rates. However, there is no consensus on which complications should be used to evaluate the quality of trauma care. The objective of this study was to develop a consensus-based list of complications that can be used to assess the acute phase of adult trauma care. We used a three-round Web-based Delphi survey among experts in the field of trauma care quality with a broad range of clinical expertise and geographic diversity. The main outcome measure was median importance rating on a 5-point Likert scale (very low to very high); complications with a median of 4 or greater and no disagreement were retained. A secondary measure was the perceived quality of information on each complication available in patient files. Of 19 experts invited to participate, 17 completed the first (brainstorming) round and 16 (84%) completed all rounds. Of 73 complications generated in Round 1, a total of 25 were retained including adult respiratory distress syndrome, hospital-acquired pneumonia, sepsis, acute renal failure, deep vein thrombosis, pulmonary embolism, wound infection, decubitus ulcers, and delirium. Of these, 19 (76%) were perceived to have high-quality or very high-quality information in patient files by more than 50% of the panel members. This study proposes a consensus-based list of 25 complications that can be used to evaluate the quality of acute adult trauma care. These complications can be used to develop an informative and actionable quality indicator to evaluate trauma care with the goal of decreasing rates of hospital complications and thus improving patient outcomes and resource use. DRG International Classification of Diseases codes are provided.

Organizational network in trauma management in Italy

Directory of Open Access Journals (Sweden)

Osvaldo Chiara

2005-10-01

Full Text Available In Italy, as in other western countries, trauma is a leading cause of death during the first four decades of life, with almost 18.000 of deaths per year. Since 80s organized systems for trauma care, including a pre-hospital emergency medical system and a network of hospitals designated as Trauma Centres, have been developed in north American countries. Effectiveness of trauma systems has been investigated comparing the post-system to the pre-system trauma care with the method of panel evaluation of preventable death rates and comparison of observed survival with expected probability of survival. In Italy, a pre-hospital emergency medical system has been implemented on a national scale, while a trauma network has not been developed. Nowadays, trauma patients are often admitted to the closest hospital, independently from local resources. The Superior Council of Ministry of Health has presented in 2004 a new trauma system model (SIAT based on the recognition in the field of patients with more serious injuries and the transportation to general hospitals with resources and multidisciplinary teams specialized in trauma care (trauma team. The designation of few trauma team hospitals, one highly specialized Centre (CTS and two area Centres (CTZ every two millions of inhabitants allows each Centre to treat at least 250 severe trauma patients per year to increase experience. Less severe injured patients may be treated in non-trauma team acute care facilities, according to the inclusive system model. The development of trauma team services in some Italian hospitals has demonstrated an increase in survival and a decrease in preventable death rate from 42% to 7,6%. Economic studies of Ministry of Health have established that the implementation of a trauma system model on a national scale with a 25% decrease of preventable trauma deaths and disabilities would save 7500 million of euros of public money. Therefore, in our country the concentration of severely

Management of Patients with Orthopaedic Implants Undergoing Dental Procedures.

Science.gov (United States)

Quinn, Robert H; Murray, Jayson N; Pezold, Ryan; Sevarino, Kaitlyn S

2017-07-01

The American Academy of Orthopaedic Surgeons, in collaboration with the American Dental Association, has developed Appropriate Use Criteria (AUC) for the Management of Patients with Orthopaedic Implants Undergoing Dental Procedures. Evidence-based information, in conjunction with the clinical expertise of physicians, was used to develop the criteria to improve patient care and obtain best outcomes while considering the subtleties and distinctions necessary in making clinical decisions. The Management of Patients with Orthopaedic Implants Undergoing Dental Procedures AUC clinical patient scenarios were derived from indications of patients with orthopaedic implants presenting for dental procedures, as well as from current evidence-based clinical practice guidelines and supporting literature to identify the appropriateness of the use of prophylactic antibiotics. The 64 patient scenarios and 1 treatment were developed by the writing panel, a group of clinicians who are specialists in this AUC topic. Next, a separate, multidisciplinary, voting panel (made up of specialists and nonspecialists) rated the appropriateness of treatment of each patient scenario using a 9-point scale to designate a treatment as Appropriate (median rating, 7 to 9), May Be Appropriate (median rating, 4 to 6), or Rarely Appropriate (median rating, 1 to 3).

[Famous figures of the Poznań orthopaedics of the period of the occupation and post-war years. Coryphees of Polish orthopaedics].

Science.gov (United States)

Barcikowski, Władysław

2008-01-01

In this article author presents, from a perspective of own memories is portraying persons which he met in his professional activity. They participated in forming the orthopaedics in Poznań and different nooks of Poland. He resembles their, often very dramatic, fates and the influence they had on Polish medicine reviving after the II world war. With the special attention he is reminding one of most well-known and valued celebrities of the Polish orthopaedics professor Wiktor Dega.

The research agenda for trauma critical care

NARCIS (Netherlands)

Asehnoune, Karim; Balogh, Zsolt; Citerio, Giuseppe; Cap, Andre; Billiar, Timothy; Stocchetti, Nino; Cohen, Mitchell J.; Pelosi, Paolo; Curry, Nicola; Gaarder, Christine; Gruen, Russell; Holcomb, John; Hunt, Beverley J.; Juffermans, Nicole P.; Maegele, Mark; Midwinter, Mark; Moore, Frederick A.; O'Dwyer, Michael; Pittet, Jean-François; Schöchl, Herbert; Schreiber, Martin; Spinella, Philip C.; Stanworth, Simon; Winfield, Robert; Brohi, Karim

2017-01-01

In this research agenda on the acute and critical care management of trauma patients, we concentrate on the major factors leading to death, namely haemorrhage and traumatic brain injury (TBI). In haemostasis biology, the results of randomised controlled trials have led to the therapeutic focus

Social Competence and Temperament in Children with Chronic Orthopaedic Disability

Science.gov (United States)

Yagmurlu, Bilge; Yavuz, H. Melis

2015-01-01

The aim of the study was to investigate social competence in children with orthopaedic disability and its concurrent relations to child's temperament, health condition, and maternal warmth. Participants were 68 Turkish children (mean = 5.94 years) with chronic orthopaedic disability and their mothers coming from disadvantaged backgrounds. Mother…

Battlefield-Acquired Immunogenicity to Metals Affects Orthopaedic Implant Outcome

Science.gov (United States)

2015-10-01

Award Number: W81XWH-10-2-0138 TITLE: Battlefield-Acquired Immunogenicity to Metals Affects Orthopaedic Implant Outcome PRINCIPAL INVESTIGATOR...Immunogenicity to Metals Affects Orthopaedic pla t Outcome 5b. GRANT NUMBER W91ZSQ0135N646 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) Nadim James...DISTRIBUTION / AVAILABILITY STATEMENT Approved for public release; distribution unlimited 13. SUPPLEM ENTARY NOTES 14. ABSTRACT The effects of battlefield

Orthopaedic Patient Information on the World Wide Web: An Essential Review.

Science.gov (United States)

Cassidy, John Tristan; Baker, Joseph F

2016-02-17

Patients increasingly use the Internet to research health-related issues. Internet content, unlike other forms of media, is not regulated. Although information accessed online can impact patients' opinions and expectations, there is limited information about the quality or readability of online orthopaedic information. PubMed, MEDLINE, and Google Scholar were searched using anatomic descriptors and three title keywords ("Internet," "web," and "online"). Articles examining online orthopaedic information from January 1, 2000, until April 1, 2015, were recorded. Articles were assessed for the number of reviewers evaluating the online material, whether the article examined for a link between authorship and quality, and the use of recognized quality and readability assessment tools. To facilitate a contemporary discussion, only publications since January 1, 2010, were considered for analysis. A total of thirty-eight peer-reviewed articles published since 2010 examining the quality and/or readability of online orthopaedic information were reviewed. For information quality, there was marked variation in the quality assessment methods utilized, the number of reviewers, and the manner of reporting. To date, the majority of examined information is of poor quality. Studies examining readability have focused on pages produced by professional orthopaedic societies. The quality and readability of online orthopaedic information are generally poor. For modern practices to adapt to the Internet and to prevent misinformation, the orthopaedic community should develop high-quality, readable online patient information. Copyright © 2016 by The Journal of Bone and Joint Surgery, Incorporated.

Parent and Child Agreement for Acute Stress Disorder, Post-Traumatic Stress Disorder and Other Psychopathology in a Prospective Study of Children and Adolescents Exposed to Single-Event Trauma

Science.gov (United States)

Meiser-Stedman, Richard; Smith, Patrick; Glucksman, Edward; Yule, William; Dalgleish, Tim

2007-01-01

Examining parent-child agreement for Acute Stress Disorder (ASD) and Post-Traumatic Stress Disorder (PTSD) in children and adolescents is essential for informing the assessment of trauma-exposed children, yet no studies have examined this relationship using appropriate statistical techniques. Parent-child agreement for these disorders was examined…

Trauma patient discharge and care transition experiences: Identifying opportunities for quality improvement in trauma centres.

Science.gov (United States)

Gotlib Conn, Lesley; Zwaiman, Ashley; DasGupta, Tracey; Hales, Brigette; Watamaniuk, Aaron; Nathens, Avery B

2018-01-01

Challenges delivering quality care are especially salient during hospital discharge and care transitions. Severely injured patients discharged from a trauma centre will go either home, to rehabilitation or another acute care hospital with complex management needs. This purpose of this study was to explore the experiences of trauma patients and families treated in a regional academic trauma centre to better understand and improve their discharge and care transition experiences. A qualitative study using inductive thematic analysis was conducted between March and October 2016. Telephone interviews were conducted with trauma patients and/or a family member after discharge from the trauma centre. Data collection and analysis were completed inductively and iteratively consistent with a qualitative approach. Twenty-four interviews included 19 patients and 7 family members. Participants' experiences drew attention to discharge and transfer processes that either (1) Fostered quality discharge or (2) Impeded quality discharge. Fostering quality discharge was ward staff preparation efforts; establishing effective care continuity; and, adequate emotional support. Impeding discharge quality was perceived pressure to leave the hospital; imposed transfer decisions; and, sub-optimal communication and coordination around discharge. Patient-provider communication was viewed to be driven by system, rather than patient need. Inter-facility information gaps raised concern about receiving facilities' ability to care for injured patients. The quality of trauma patient discharge and transition experiences is undermined by system- and ward-level processes that compete, rather than align, in producing high quality patient-centred discharge. Local improvement solutions focused on modifiable factors within the trauma centre include patient-oriented discharge education and patient navigation; however, these approaches alone may be insufficient to enhance patient experiences. Trauma patients

The changing nature of death on the trauma service.

Science.gov (United States)

Kahl, Jessica E; Calvo, Richard Y; Sise, Michael J; Sise, C Beth; Thorndike, Jonathan F; Shackford, Steven R

2013-08-01

Recent innovations in care have improved survival following injury. Coincidentally, the population of elderly injured patients with preexisting comorbidities has increased. We hypothesized that this increase in elderly injured patients may have combined with recent care innovations to alter the causes of death after trauma. We reviewed demographics, injury characteristics, and cause of death of in-hospital deaths of patients admitted to our Level I trauma service from 2000 through 2011. Cause of death was classified as acute hemorrhagic shock; severe traumatic brain injury or high spinal cord injury; complications of preexisting medical condition only (PM); survivable trauma combined with complications of preexisting medical condition (TCoM); multiple-organ failure, sepsis, or adult respiratory distress syndrome (MOF/S/ARDS), or trauma not otherwise categorized (e.g., asphyxiation). Major trauma care advances implemented on our service during the period were identified, and trends in the causes of death were analyzed. Of the 27,276 admissions, 819 (3%) eligible nonsurvivors were identified for the cause-of-death analyses. Causes of death were severe traumatic brain injury or high spinal cord injury at 44%, acute hemorrhagic shock at 28%, PM at 11%, TCoM at 10%, MOF/S/ARDS at 2%, and trauma not otherwise categorized at 5%. Mean age at death increased across the study interval (range, 47-57 years), while mean Injury Severity Score (ISS) decreased (range, 28-35). There was a significant increase in deaths because of TCoM (3.3-20.9%) and PM (6.7-16.4%), while deaths caused by MOF/S/ARDS decreased from 5% to 0% by 2007. Compared with year 2000, the annual adjusted mortality rate decreased consistently starting in 2009, after the 2002 to 2007 adoption of four major trauma practice guidelines. Mortality caused by preexisting medical conditions has increased, while markedly fewer deaths resulted from the complications of injury. Future improvements in outcomes will require

The effect of the quality of vital sign recording on clinical decision making in a regional acute care trauma ward.

Science.gov (United States)

Keene, Claire M; Kong, Victor Y; Clarke, Damian L; Brysiewicz, Petra

2017-10-01

Recording vital signs is important in the hospital setting and the quality of this documentation influences clinical decision making. The Modified Early Warning Score (MEWS) uses vital signs to categorise the severity of a patient's physiological derangement and illustrates the clinical impact of vital signs in detecting patient deterioration and making management decisions. This descriptive study measured the quality of vital sign recordings in an acute care trauma setting, and used the MEWS to determine the impact the documentation quality had on the detection of physiological derangements and thus, clinical decision making. Vital signs recorded by the nursing staff of all trauma patients in the acute care trauma wards at a regional hospital in South Africa were collected from January 2013 to February 2013. Investigator-measured values taken within 2 hours of the routine observations and baseline patient information were also recorded. A MEWS for each patient was calculated from the routine and investigator-measured observations. Basic descriptive statistics were performed using EXCEL. The details of 181 newly admitted patients were collected. Completion of recordings was 81% for heart rate, 88% for respiratory rate, 98% for blood pressure, 92% for temperature and 41% for GCS. The recorded heart rate was positively correlated with the investigator's measurement (Pearson's correlation coefficient of 0.76); while the respiratory rate did not correlate (Pearson's correlation coefficient of 0.02). In 59% of patients the recorded respiratory rate (RR) was exactly 20 breaths per minute and 27% had a recorded RR of exactly 15. Seven percent of patients had aberrant Glasgow Coma Scale readings above the maximum value of 15. The average MEWS was 2 for both the recorded (MEWS(R)) and investigator (MEWS(I)) vitals, with the range of MEWS(R) 0-7 and MEWS(I) 0-9. Analysis showed 59% of the MEWS(R) underestimated the physiological derangement (scores were lower than the MEWS

Advanced practice physiotherapy in paediatric orthopaedics: innovation and collaboration to improve service delivery.

Science.gov (United States)

Ó Mír, M; O'Sullivan, C

2018-02-01

One in eight paediatric primary care presentations is for a musculoskeletal (MSK) disorder. These patients are frequently referred to paediatric orthopaedic surgeons; however, up to 50% of referrals are for normal variants. This results in excessive wait-times and impedes access for urgent surgical cases. Adult MSK medicine has successfully utilised advanced practice physiotherapists (APP) managing non-surgical candidates, with documented benefits both to patients and services. There is a gap in the literature with regard to APP in paediatric orthopaedics. In this review, we investigate demands on paediatric orthopaedic services, examine the literature regarding APP in paediatric orthopaedics and explore the value the role has to offer current outpatient services. Paediatric orthopaedic services are under-resourced with concurrent long wait times. Approximately 50% of referrals are for normal variants, which do not require specialist intervention. Poor musculoskeletal examination skills and low diagnostic confidence amongst primary care physicians have been identified as a cause of inappropriate referrals. APP clinics for normal variants have reported independent management rate and discharge rates of 95% and marked reduction in patient wait times. There is limited evidence to support the APP in paediatric orthopaedics. Further studies are needed investigating diagnostic agreement, patient/stakeholder satisfaction, patient outcomes and economic evaluation. Paediatric orthopaedics is in crisis as to how to effectively manage the overwhelming volume of referrals. Innovative multidisciplinary solutions are required so that the onus is not solely on physicians to provide all services. The APP in paediatric orthopaedics may be part of the solution.

Activated Protein C Drives the Hyperfibrinolysis of Acute Traumatic Coagulopathy.

Science.gov (United States)

Davenport, Ross A; Guerreiro, Maria; Frith, Daniel; Rourke, Claire; Platton, Sean; Cohen, Mitchell; Pearse, Rupert; Thiemermann, Chris; Brohi, Karim

2017-01-01

Major trauma is a leading cause of morbidity and mortality worldwide with hemorrhage accounting for 40% of deaths. Acute traumatic coagulopathy exacerbates bleeding, but controversy remains over the degree to which inhibition of procoagulant pathways (anticoagulation), fibrinogen loss, and fibrinolysis drive the pathologic process. Through a combination of experimental study in a murine model of trauma hemorrhage and human observation, the authors' objective was to determine the predominant pathophysiology of acute traumatic coagulopathy. First, a prospective cohort study of 300 trauma patients admitted to a single level 1 trauma center with blood samples collected on arrival was performed. Second, a murine model of acute traumatic coagulopathy with suppressed protein C activation via genetic mutation of thrombomodulin was used. In both studies, analysis for coagulation screen, activated protein C levels, and rotational thromboelastometry (ROTEM) was performed. In patients with acute traumatic coagulopathy, the authors have demonstrated elevated activated protein C levels with profound fibrinolytic activity and early depletion of fibrinogen. Procoagulant pathways were only minimally inhibited with preservation of capacity to generate thrombin. Compared to factors V and VIII, proteases that do not undergo activated protein C-mediated cleavage were reduced but maintained within normal levels. In transgenic mice with reduced capacity to activate protein C, both fibrinolysis and fibrinogen depletion were significantly attenuated. Other recognized drivers of coagulopathy were associated with less significant perturbations of coagulation. Activated protein C-associated fibrinolysis and fibrinogenolysis, rather than inhibition of procoagulant pathways, predominate in acute traumatic coagulopathy. In combination, these findings suggest a central role for the protein C pathway in acute traumatic coagulopathy and provide new translational opportunities for management of

Craniocerebral trauma in the child abuse syndrome: Radiological observations

Energy Technology Data Exchange (ETDEWEB)

Merten, D.F.; Osborne, D.R.S.; Radkowski, M.A.; Leonidas, J.C.

1984-07-01

Experience with craniocerebral trauma in 712 physically abused children is reviewed. Ninety-three (13%) had evidence of head trauma (cranial and/or intracranial). Seventy-seven of these patients had computed tomography (CT) of the head, and 47 had CT evidence of intracranial injury. Extracerebral fluid collections, predominantly convexity subdural hemorrhage, were the most common acute intracranial lesions. Concurrent intracranial and skeletal trauma (cranial and/or ectracranial) was present in 33 of the 47 patients (70%) with intracranial injury. A high incidence of skull fractures (45%) in those children with intracranial lesions suggest a significant role for impact head injuries (''battering'') in the pathogenesis of craniocerebral trauma in the child abuse syndrome. Greater emphasis on CT examination in evaluation of the abuse infant and child is recommended.

Annals of African Medicine - Vol 3, No 3 (2004)

African Journals Online (AJOL)

Psychoactive substance misuse among Nigerian adolescents. OO Omigbodun, O Babalola. Anti-tuberculous chemotherapy: 120 years on. CN Ekweani. Community level nutrition information system for action in rural communities ... Opinion: Role of rural orthopaedic and trauma assistants in orthopaedic and trauma care.

Teleconsultation in paediatric orthopaedics in Djibouti: evaluation of response performance.

Science.gov (United States)

Bertani, A; Launay, F; Candoni, P; Mathieu, L; Rongieras, F; Chauvin, F

2012-11-01

Djibouti has no paediatric orthopaedics department and three options are available for difficult cases: transfer of the patient to another country; overseas mission transfer to Djibouti by a specialised surgical team; and management by a local orthopaedic surgeon receiving guidance from an expert. The extreme poverty of part of the population of Djibouti often precludes the first two options. Telemedecine can allow the local orthopaedic surgeon to receive expert advice. HYPOTHESES AND STUDY DESIGN: We prospectively recorded all the paediatric orthopaedics teleconsultations that occurred between November 2009 and November 2011. Our objective was to assess the performance of the teleconsultations. We hypothetized that this option was influential in decision making. We assessed the influence of the teleconsultation on patient management (i.e., change in the surgical indication and/or procedure). We then used the electronic patient records to compare the actual management to that recommended retrospectively by two independent orthopaedic surgeon consultants who had experience working overseas. Finally, we assessed the clinical outcomes in the patients. Of 48 teleconsultations for 39 patients, 13 dealt with diagnostic problems and 35 with therapeutic problems. The teleconsultation resolved the diagnostic uncertainties in 90% of cases. Advice from the expert modified the management in 37 (77%) teleconsultations; the change was related to the surgical indication in 18 cases, the surgical technique in 13 cases, and both in six cases. Agreement between the advice from the independent consultants and the treatment delivered by the local surgeon was 2.2/3. Clinical outcomes were good or very good in 31 (81%) of the 38 treated patients. This study establishes the feasibility and usefulness of paediatric orthopaedics teleconsultations in Djibouti. The introduction of telemedicine has changed our approach to challenges raised by patients in remote locations or precarious

Orthopaedic Considerations for the Adult With Osteogenesis Imperfecta.

Science.gov (United States)

Roberts, Timothy T; Cepela, Daniel J; Uhl, Richard L; Lozman, Jeffery

2016-05-01

Osteogenesis imperfecta is a heritable group of collagen-related disorders that affects up to 50,000 people in the United States. Although the disease is most symptomatic in childhood, adults with osteogenesis imperfecta also are affected by the sequelae of the disease. Orthopaedic manifestations include posttraumatic and accelerated degenerative joint disease, kyphoscoliosis, and spondylolisthesis. Other manifestations of abnormal collagen include brittle dentition, hearing loss, cardiac valve abnormalities, and basilar invagination. In general, nonsurgical treatment is preferred for management of acute fractures. High rates of malunion, nonunion, and subsequent deformity have been reported with both closed and open treatment. When surgery is necessary, surgeons should opt for load-sharing intramedullary devices that span the entire length of the bone; locking plates and excessively rigid fixation generally should be avoided. Arthroplasty may be considered for active patients, but the procedure frequently is associated with complications in this patient population. Underlying deformities, such as malunion, bowing, rotational malalignment, coxa vara, and acetabular protrusio, pose specific surgical challenges and underscore the importance of preoperative planning.

The newest progress of research on acute trauma-induced coagulopathy

Directory of Open Access Journals (Sweden)

Wei Wang

2016-05-01

Full Text Available Traumatic injury remains the leading cause of death with bleeding in the world, representing the main cause of preventable death. But if immediate management could be applied, the outcomes will be dramatically improved. Trauma-induced coagulopathy (TIC as an early endogenous process in many traumatic patients is driven by the multi-tissue injury and shock, and is associated with increased mortality and bad outcomes in the multi-trauma patients. The understanding of the mechanisms of TIC and its effect on the outcomes of severely injured patients has been developed over the past few years. Here, we aim to review the current understanding and recent findings in the pathobiology of coagulopathy. The principal causes of TIC are hypoperfusion, inflammation response and the activation of the neurohumoral system. Hypoperfusion causes the activation of many biomarkers, like protein C, syndecan-1, plasminogen, and so on. The elevation of these markers indicates the damage of the endothelium, which will lead to autoheparinization in body. When accompanied with acidosis, hypothermia, and hemodilution, the mortality of trauma patients will rise significantly. This article aims to focus on our updated acknowledges on the principal mechanisms and causes of the TIC.

Hemostatic resuscitation is neither hemostatic nor resuscitative in trauma hemorrhage.

Science.gov (United States)

Khan, Sirat; Brohi, Karim; Chana, Manik; Raza, Imran; Stanworth, Simon; Gaarder, Christine; Davenport, Ross

2014-03-01

Trauma hemorrhage continues to carry a high mortality rate despite changes in modern practice. Traditional approaches to the massively bleeding patient have been shown to result in persistent coagulopathy, bleeding, and poor outcomes. Hemostatic (or damage control) resuscitation developed from the discovery of acute traumatic coagulopathy and increased recognition of the negative consequences of dilutional coagulopathy. These strategies concentrate on early delivery of coagulation therapy combined with permissive hypotension. The efficacy of hemostatic resuscitation in correcting coagulopathy and restoring tissue perfusion during acute hemorrhage has not been studied. This is a prospective cohort study of ROTEM and lactate measurements taken from trauma patients recruited to the multicenter Activation of Coagulation and Inflammation in Trauma (ACIT) study. A blood sample is taken on arrival and during the acute bleeding phase after administration of every 4 U of packed red blood cells (PRBCs), up to 12 U. The quantity of blood products administered within each interval is recorded. Of the 106 study patients receiving at least 4 U of PRBC, 27 received 8 U to 11 U of PRBC and 31 received more than 12 U of PRBC. Average admission lactate was 6.2 mEq/L. Patients with high lactate (≥5 mEq/L) on admission did not clear lactate until hemorrhage control was achieved, and no further PRBC units were required. On admission, 43% of the patients were coagulopathic (clot amplitude at 5 minutes ≤ 35 mm). This increased to 49% by PRBC 4; 62% by PRBC 8 and 68% at PRBC 12. The average fresh frozen plasma/PRBC ratio between intervals was 0.5 for 0 U to 4 U of PRBC, 0.9 for 5 U to 8 U of PRBC, 0.7 for 9 U to 12 U of PRBC. There was no improvement in any ROTEM parameter during ongoing bleeding. While hemostatic resuscitation offers several advantages over historical strategies, it still does not achieve correction of hypoperfusion or coagulopathy during the acute phase of trauma

The pathophysiology of trauma-induced coagulopathy.

Science.gov (United States)

Frith, Daniel; Brohi, Karim

2012-12-01

Transfusion paradigms and protocols have evolved at a rapid pace in the last few years to ameliorate the adverse effects of trauma-induced coagulopathy (TIC). This has occurred despite fragmented and inadequate knowledge of the underlying pathophysiology that they are supposed to treat. This review will collate and assimilate the most recent data about TIC in order to present our state-of-the-art understanding of this condition. TIC was conventionally construed simply as depletion, dysfunction or dilution of procoagulant factors. However, contemporary understanding recognizes it as an imbalance of the dynamic equilibrium between procoagulant factors, anticoagulant factors, platelets, endothelium and fibrinolysis. The endogenous component of TIC (acute traumatic coagulopathy) is not merely a consumptive coagulopathy, but is characterized by isolated factor V inhibition, dysfibrinogenaemia, systemic anticoagulation, impaired platelet function and hyperfibrinolysis. Acute traumatic coagulopathy then becomes exacerbated by hypothermia, acidosis and resuscitation with hypocoagulable fluids. Further improvement in the outcome from trauma-haemorrhage is possible with more refined and tailored haemostatic resuscitation. Achieving this will depend upon a better understanding of the haemostatic defects that develop after injury.

42 Editorial ADVOCACY IN ORTHOPAEDICS

African Journals Online (AJOL)

2017-09-11

Sep 11, 2017 ... East African Orthopaedic Journal. Advocacy may be ... taxation of medical equipment and implants in Kenya. In 2013 a change ... Asia countries especially India were doing the opposite. They reduced ... Most developing countries have been dealing with communicable ... The role of advocacy is huge here.

Do Orthopaedic Surgeons Acknowledge Uncertainty?

NARCIS (Netherlands)

Teunis, Teun; Janssen, Stein; Guitton, Thierry G.; Ring, David; Parisien, Robert

2016-01-01

Much of the decision-making in orthopaedics rests on uncertain evidence. Uncertainty is therefore part of our normal daily practice, and yet physician uncertainty regarding treatment could diminish patients' health. It is not known if physician uncertainty is a function of the evidence alone or if

Reading the small print - labelling recommendations for orthopaedic implants.

Science.gov (United States)

Haene, Roger A; Sandhu, Ranbir S; Baxandall, Richard

2009-11-01

There exist, currently, no clear guidelines regarding standards for surgical implant labelling. Dimensions of the laminar flow canopies in orthopaedic use fixes the distance at which implant labels can be read. Mistakes when reading the label on an implant box can pose health risks for patients, and financial consequences for medical institutions. Using scientifically validated tools such as the Snellen Chart Formula, a theoretical minimum standard for text on implant labels was reached. This theoretical standard was then tested under real operating conditions. After discovering a minimum practical standard for implant labels, the authors then audited current labels in use on a wide range of orthopaedic implant packages. Furthermore, other non-text-related labelling problems were also noted. There is a definite minimum standard which should be observed when implant labels are manufactured. Implants in current use bear labels on the packaging that are of an insufficient standard to ensure patient safety in theatre. The authors have established text parameters that will increase the legibility of implant labels. In the interests of improving risk management in theatre, therefore, the authors propose a standard for orthopaedic implant labelling, and believe this will provide a useful foundation for further discussion between the orthopaedic community and implant manufacturers.

American Orthopaedic Society for Sports Medicine

Science.gov (United States)

... Upcoming Meetings Online Education Archived Meetings Faculty Resources Sports Medicine Fellowships Traveling Fellowship Submit an Abstract Submit ... Support AOSSM Research Publications Toggle American Journal of Sports Medicine Sports Health: A Multidisciplinary Approach Orthopaedic Journal ...

Strategically Leapfrogging Education in Prehospital Trauma Management: Four-Tiered Training Protocols.

Science.gov (United States)

Abraham, Rohit; Vyas, Dinesh; Narayan, Mayur; Vyas, Arpita

2015-12-01

Trauma-related injury in fast developing countries are linked to 90% of international mortality rates, which can be greatly reduced by improvements in often non-existent or non-centralized emergency medical systems (EMS)-particularly in the pre-hospital care phase. Traditional trauma training protocols-such as Advanced Trauma Life Support (ATLS), International Trauma Life Support (ITLS), and Basic Life Support (BLS)-have failed to produce an effective pre-hospital ground force of medical first responders. To overcome these barriers, we propose a new four-tiered set of trauma training protocols: Massive Open Online Course (MOOC) Trauma Training, Acute Trauma Training (ATT), Broad Trauma Training (BTT), and Cardiac and Trauma Training (CTT). These standards are specifically differentiated to accommodate the educational and socioeconomic diversity found in fast developing settings, where each free course is taught in native, lay language while ensuring the education standards are maintained by fully incorporating high-fidelity simulation, video-recorded debriefing, and retraining. The innovative pedagogy of this trauma education program utilizes MOOC for global scalability and a "train-the-trainer" approach for exponential growth-both components help fast developing countries reach a critical mass of first responders needed for the base of an evolving EMS.

Investigation on Alteration of Compression of Knitted Orthopaedic Supports during Exploitation

Directory of Open Access Journals (Sweden)

Diana ALIŠAUSKIENĖ

2012-12-01

Full Text Available One of the areas of medical textile is the spacer knitted orthopaedic products. The concept of compression therapy of orthopaedic supports lies on a simple and efficient mechanical principle – it consists of applying elastic garment around the limb. Spacer orthopaedic supports are knitted on flat knitting machines equipped with especial elastomeric thread feeder. Compression made by the support depends on the support area, shape and characteristics of knitting. Because of orthopaedic supports are intended for durable wearing and need to vouchsafe compression of fixed value, it is very important to known how processes acting during exploitation influence alteration of compression values. The aim of this study was to establish the alteration of compression of knitted support during exploitation, i. e. after multifold extension, washing and drying. The samples were knitted on a flat double needle bed knitting machine in combined jacquard-laid-in pattern with elastomeric weft threads. It was established that compressive properties of knits after cyclic tensile load changed slightly, i. e. range between margins of error. It was measured that knitted orthopaedic supports dimensions and density after washing and drying cycles changes significant, i. e. knitted supports shrinks and thickens and their compression decreases.DOI: http://dx.doi.org/10.5755/j01.ms.18.4.3097

Genital piercings in the context of acute sexual assault.

Science.gov (United States)

Goldberg, Amy P

2017-11-01

After an acute sexual assault, children and adolescents often present for medical evaluation and treatment. Physicians have an important role in both the medical and legal components of these cases. Careful physical examination and questioning are important in determining the origin of the trauma. In the presented case report, genital trauma after an acute sexual assault was noted and attributed to the alleged offender's penis piercing. The genital trauma caused by the piercing provided physical evidence linking offender to victim and may have implications for the victim's risk of HIV infection and other blood borne pathogens. Copyright © 2017 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

A basic introduction to statistics for the orthopaedic surgeon.

Science.gov (United States)

Bertrand, Catherine; Van Riet, Roger; Verstreken, Frederik; Michielsen, Jef

2012-02-01

Orthopaedic surgeons should review the orthopaedic literature in order to keep pace with the latest insights and practices. A good understanding of basic statistical principles is of crucial importance to the ability to read articles critically, to interpret results and to arrive at correct conclusions. This paper explains some of the key concepts in statistics, including hypothesis testing, Type I and Type II errors, testing of normality, sample size and p values.

The surgeon and his tools-the case for a focused orthopaedic theatre induction programme

Directory of Open Access Journals (Sweden)

Wong Shaun KS

2008-10-01

Full Text Available Abstract Background Induction programme for trainee doctors in the UK generally do not focus on the surgical aspects of their jobs. In this context we decided to conduct a telephonic survey among the hospitals belonging to three orthopaedic training regions in the UK from the point of view of the diversity of instrumentations and implants used for index procedures. Results We chose four index trauma & orthopaedic procedures (Total hip replacement, total knee replacement, intramedullary nailing and external fixator systems for long bone fractures. A telephonic survey was done in six NHS trust hospitals which were part of an orthopaedic training rotation (2 from England, 2 from Wales and 2 from Scotland. In total there were 39 different instrumentation systems for these 4 index procedures in the 6 trusts (see table 1. These comprise 12 Total hip replacement (THR systems, 14 total knee replacement (TKR systems, 9 intra-medullary nailing systems, and 4 external fixator systems. The number of different systems for each trust ranged from 7 to 19. There is a vast array of implants and instrumentation systems in each trust, as highlighted by our survey. The surgical tools are not the same in each hospitals. This situation is more complicated when trainees move to new hospitals as part of training rotations. Table 1 Number of implants/instrumentations used in each of the 6 UK trusts (3 training regions. IMPLANT E1 E2 W1 W2 S1 S2 Total Knee Replacement 4 5 2 4 3 2 Total Hip Replacement 3 4 3 6 3 3 Intramnedullary nailing 2 1 1 6 2 3 External fixators 2 3 2 2 1 1 TOTAL 11 13 8 18 9 9 E = England, W = Wales, S = Scotland Conclusion In view of this we feel that more focused theatre based induction programmes for higher surgical trainees is advocated in each hospital trust so trainees can familiarise themselves with the tools available to them. This could include discussion with the consultants and senior theatre staff along with representatives from the

Patients with severe head trauma who talk and then deteriorate

Energy Technology Data Exchange (ETDEWEB)

Isayama, Kazuo; Nakazawa, Shozo; Kobayashi, Shiro; Yokota, Hiroyuki; Ikeda, Yukio; Yajima, Kouzo; Yano, Masami; Otsuka, Toshibumi

1987-08-01

Patients with severe head trauma who talk and then deteriorate (or die) are analyzed by means of clinical signs, computerized tomography (CT), and outcome. The twelve severely head-injured patients had an initial verbal score on the Glasgow coma scale (GCS) of 3 or more and a GCS score of 9 or more. There were 8 male and 4 female patients. The ages of these patients ranged from 23 to 85 years (average age 60.9 years); nine of the patients were older than 60 years of age. An initial CT revealed subdural hematoma in 7 cases and traumatic subarachnoid hemorrhage in 8 cases. Serial CT could be used for 9 cases; delayed intracerebral hematoma was found in 5 patients, and acute cerebral swelling, in 3 patients. The elderly tended to have the hematoma, while the young tended to have acute cerebral swelling. Concerning the Glasgow outcome scale of cases of head trauma who talk and then deteriorate three months after trauma, there was moderate disability in 2 cases and a persistent vegetative state in one, while 9 had died.

Cow-related trauma: a 10-year review of injuries admitted to a single institution.

LENUS (Irish Health Repository)

Murphy, Colin G

2012-02-01

INTRODUCTION: Bovine-related injuries to farmers are common in rural communities. Many injuries are significant requiring hospital admission and surgery. We reviewed all cattle-related injuries admitted to a regional trauma centre over 10 years and detail the nature of the injuries. METHOD: A retrospective review was undertaken, using hospital inpatient coding system (HIPE) to identify patients admitted following cow-related trauma for the last 10 years. From retrieved charts mechanism of injury was identified, demographics recorded and Injury Severity Score (ISS) and Trauma Injury Severity Score (TRISS) calculated based on the injuries sustained. RESULTS: 47 patients were identified, with a median age of 53 years. 4 injuries occurred in children, and 12 in patients over 65 years old. Three-quarters of those injured were male. Kicking was the most common mechanism of injury (n=21), but charge\\/head-butt injuries and trampling injuries were associated with more serious injury scores. 72% of patients were admitted under Orthopaedics as their primary care team, 25% under General Surgeons, with one patient admitted medically. Mean ISS score was 6.9 (range 1-50). 41 operative interventions were performed on 30 patients during their admission. 6.3% of patients required admission to Intensive Care with a mean length of stay of 12.3 days (range 2-21 days). There was no mortality. CONCLUSION: Cow-related trauma is a common among farming communities and is a potentially serious mechanism of injury that appears to be under-reported in a hospital context. Bovine-related head-butt and trampling injuries should be considered akin to high-velocity trauma.

77 FR 66848 - Minimum Clinically Important Difference: An Outcome Metric in Orthopaedic Device Science and...

Science.gov (United States)

2012-11-07

...] Minimum Clinically Important Difference: An Outcome Metric in Orthopaedic Device Science and Regulation... Clinically Important Difference: An Outcome Metric in Orthopaedic Device Science and Regulation.'' FDA is co... (MCID) for patient-reported outcome (PRO) instruments used in orthopaedic extremity device-related...

Media's role in broadcasting acute stress following the Boston Marathon bombings.

Science.gov (United States)

Holman, E Alison; Garfin, Dana Rose; Silver, Roxane Cohen

2014-01-07

We compared the impact of media vs. direct exposure on acute stress response to collective trauma. We conducted an Internet-based survey following the Boston Marathon bombings between April 29 and May 13, 2013, with representative samples of residents from Boston (n = 846), New York City (n = 941), and the remainder of the United States (n = 2,888). Acute stress symptom scores were comparable in Boston and New York [regression coefficient (b) = 0.43; SE = 1.42; 95% confidence interval (CI), -2.36, 3.23], but lower nationwide when compared with Boston (b = -2.21; SE = 1.07; 95% CI, -4.31, -0.12). Adjusting for prebombing mental health (collected prospectively), demographics, and prior collective stress exposure, six or more daily hours of bombing-related media exposure in the week after the bombings was associated with higher acute stress than direct exposure to the bombings (continuous acute stress symptom total: media exposure b = 15.61 vs. direct exposure b = 5.69). Controlling for prospectively collected prebombing television-watching habits did not change the findings. In adjusted models, direct exposure to the 9/11 terrorist attacks and the Sandy Hook School shootings were both significantly associated with bombing-related acute stress; Superstorm Sandy exposure wasn't. Prior exposure to similar and/or violent events may render some individuals vulnerable to the negative effects of collective traumas. Repeatedly engaging with trauma-related media content for several hours daily shortly after collective trauma may prolong acute stress experiences and promote substantial stress-related symptomatology. Mass media may become a conduit that spreads negative consequences of community trauma beyond directly affected communities.

Access to Orthopaedic Surgical Care in Northern Tanzania: A Modelling Study.

Science.gov (United States)

Premkumar, Ajay; Ying, Xiaohan; Mack Hardaker, W; Massawe, Honest H; Mshahaba, David J; Mandari, Faiton; Pallangyo, Anthony; Temu, Rogers; Masenga, Gileard; Spiegel, David A; Sheth, Neil P

2018-04-25

The global burden of musculoskeletal disease and resulting disability is enormous and is expected to increase over the next few decades. In the world's poorest regions, the paucity of information defining and quantifying the current state of access to orthopaedic surgical care is a major problem in developing effective solutions. This study estimates the number of individuals in Northern Tanzania without adequate access to orthopaedic surgical services. A chance tree was created to model the probability of access to orthopaedic surgical services in the Northern Tanzanian regions of Arusha, Kilimanjaro, Tanga, Singida, and Manyara, with respect to four dimensions: timeliness, surgical capacity, safety, and affordability. Timeliness was estimated by the proportion of people living within a 4-h driving distance from a hospital with an orthopaedic surgeon, capacity by comparing number of surgeries performed to the number of surgeries indicated, safety by applying WHO Emergency and Essential Surgical Care infrastructure and equipment checklists, and affordability by approximating the proportion of the population protected from catastrophic out-of-pocket healthcare expenditure. We accounted for uncertainty in our model with one-way and probabilistic sensitivity analyses. Data sources included the Tanzanian National Bureau of Statistics and Ministry of Finance, World Bank, World Health Organization, New Zealand Ministry of Health, Google Corporation, NASA population estimator, and 2015 hospital records from Kilimanjaro Christian Medical Center, Machame Hospital, Nkoroanga Hospital, Mt. Meru Hospital, and Arusha Lutheran Medical Center. Under the most conservative assumptions, more than 90% of the Northern Tanzanian population does not have access to orthopaedic surgical services. There is a near absence of access to orthopaedic surgical care in Northern Tanzania. These findings utilize more precise country and region-specific data and are consistent with prior published

Corruption in the health care sector: A barrier to access of orthopaedic care and medical devices in Uganda.

Science.gov (United States)

Bouchard, Maryse; Kohler, Jillian C; Orbinski, James; Howard, Andrew

2012-05-03

Globally, injuries cause approximately as many deaths per year as HIV/AIDS, tuberculosis and malaria combined, and 90% of injury deaths occur in low- and middle- income countries. Given not all injuries kill, the disability burden, particularly from orthopaedic injuries, is much higher but is poorly measured at present. The orthopaedic services and orthopaedic medical devices needed to manage the injury burden are frequently unavailable in these countries. Corruption is known to be a major barrier to access of health care, but its effects on access to orthopaedic services is still unknown. A qualitative case study of 45 open-ended interviews was conducted to investigate the access to orthopaedic health services and orthopaedic medical devices in Uganda. Participants included orthopaedic surgeons, related healthcare professionals, industry and government representatives, and patients. Participants' experiences in accessing orthopaedic medical devices were explored. Thematic analysis was used to analyze and code the transcripts. Analysis of the interview data identified poor leadership in government and corruption as major barriers to access of orthopaedic care and orthopaedic medical devices. Corruption was perceived to occur at the worker, hospital and government levels in the forms of misappropriation of funds, theft of equipment, resale of drugs and medical devices, fraud and absenteeism. Other barriers elicited included insufficient health infrastructure and human resources, and high costs of orthopaedic equipment and poverty. This study identified perceived corruption as a significant barrier to access of orthopaedic care and orthopaedic medical devices in Uganda. As the burden of injury continues to grow, the need to combat corruption and ensure access to orthopaedic services is imperative. Anti-corruption strategies such as transparency and accountability measures, codes of conduct, whistleblower protection, and higher wages and benefits for workers could be

Corruption in the health care sector: A barrier to access of orthopaedic care and medical devices in Uganda

Directory of Open Access Journals (Sweden)

Bouchard Maryse

2012-05-01

Full Text Available Abstract Background Globally, injuries cause approximately as many deaths per year as HIV/AIDS, tuberculosis and malaria combined, and 90% of injury deaths occur in low- and middle- income countries. Given not all injuries kill, the disability burden, particularly from orthopaedic injuries, is much higher but is poorly measured at present. The orthopaedic services and orthopaedic medical devices needed to manage the injury burden are frequently unavailable in these countries. Corruption is known to be a major barrier to access of health care, but its effects on access to orthopaedic services is still unknown. Methods A qualitative case study of 45 open-ended interviews was conducted to investigate the access to orthopaedic health services and orthopaedic medical devices in Uganda. Participants included orthopaedic surgeons, related healthcare professionals, industry and government representatives, and patients. Participants’ experiences in accessing orthopaedic medical devices were explored. Thematic analysis was used to analyze and code the transcripts. Results Analysis of the interview data identified poor leadership in government and corruption as major barriers to access of orthopaedic care and orthopaedic medical devices. Corruption was perceived to occur at the worker, hospital and government levels in the forms of misappropriation of funds, theft of equipment, resale of drugs and medical devices, fraud and absenteeism. Other barriers elicited included insufficient health infrastructure and human resources, and high costs of orthopaedic equipment and poverty. Conclusions This study identified perceived corruption as a significant barrier to access of orthopaedic care and orthopaedic medical devices in Uganda. As the burden of injury continues to grow, the need to combat corruption and ensure access to orthopaedic services is imperative. Anti-corruption strategies such as transparency and accountability measures, codes of conduct

Corruption in the health care sector: A barrier to access of orthopaedic care and medical devices in Uganda

Science.gov (United States)

2012-01-01

Background Globally, injuries cause approximately as many deaths per year as HIV/AIDS, tuberculosis and malaria combined, and 90% of injury deaths occur in low- and middle- income countries. Given not all injuries kill, the disability burden, particularly from orthopaedic injuries, is much higher but is poorly measured at present. The orthopaedic services and orthopaedic medical devices needed to manage the injury burden are frequently unavailable in these countries. Corruption is known to be a major barrier to access of health care, but its effects on access to orthopaedic services is still unknown. Methods A qualitative case study of 45 open-ended interviews was conducted to investigate the access to orthopaedic health services and orthopaedic medical devices in Uganda. Participants included orthopaedic surgeons, related healthcare professionals, industry and government representatives, and patients. Participants’ experiences in accessing orthopaedic medical devices were explored. Thematic analysis was used to analyze and code the transcripts. Results Analysis of the interview data identified poor leadership in government and corruption as major barriers to access of orthopaedic care and orthopaedic medical devices. Corruption was perceived to occur at the worker, hospital and government levels in the forms of misappropriation of funds, theft of equipment, resale of drugs and medical devices, fraud and absenteeism. Other barriers elicited included insufficient health infrastructure and human resources, and high costs of orthopaedic equipment and poverty. Conclusions This study identified perceived corruption as a significant barrier to access of orthopaedic care and orthopaedic medical devices in Uganda. As the burden of injury continues to grow, the need to combat corruption and ensure access to orthopaedic services is imperative. Anti-corruption strategies such as transparency and accountability measures, codes of conduct, whistleblower protection, and higher

Diagnostic imaging of the acutely injured patient

International Nuclear Information System (INIS)

Berquist, T.H.

1985-01-01

This book provides an analysis of pathophysiologic concepts of trauma and reviews the effectiveness of the available imaging modalities in acute trauma of various organ system. Topics covered are chest injuries; abdominal trauma; fractures of long bones; the foot and ankle; the knee; hand and wrist; the elbow; the shoulder; the pelvis hips; the spine; the skull and facial trauma and the clinical assessment of multiple injuries patients. Comparative evaluation of diagnostic techniques of radiography is discussed. Normal anatomy and bone fractures along with soft-tissue injuries are described

"Is There An App For That?" Orthopaedic Patient Preferences For A Smartphone Application.

Science.gov (United States)

Datillo, Jonathan R; Gittings, Daniel J; Sloan, Matthew; Hardaker, William M; Deasey, Matthew J; Sheth, Neil P

2017-08-16

Patients are seeking out medical information on the Internet and utilizing smartphone health applications ("apps"). Smartphone use has exponentially increased among orthopaedic surgeons and patients. Despite this increase, patients are rarely directed to specific apps by physicians. No study exists querying patient preferences for a patient-centered, orthopaedic smartphone application. The purpose of this study is to 1) determine Internet use patterns amongst orthopaedic patients; 2) ascertain access to and use of smartphones; and 3) elucidate what features orthopaedic patients find most important in a smartphone application. We surveyed patients in an orthopaedic practice in an urban academic center to assess demographics, access to and patterns of Internet and Smartphone use, and preferences for features in a smartphone app. A total of 310 surveys were completed. Eighty percent of patients reported Internet access, and 62% used the Internet for health information. Seventy-seven percent owned smartphones, 45% used them for health information, and 28% owned health apps. Only 11% were referred to an app by a physician. The highest ranked features were appointment reminders, ability to view test results, communication with physicians, and discharge instructions. General orthopaedic information and pictures or videos explaining surgery were the 2 lowest ranked features. Seventy-one percent of patients felt an app with some of the described features would improve their healthcare experiences, and 40% would pay for the app. The smartphone is an under-utilized tool to enhance patient-physician communication, increase satisfaction, and improve quality of care. Patients were enthusiastic about app features that are often included in patient health portals, but ranked orthopaedic educational features lowest. Further study is required to elucidate how best to use orthopaedic apps as physician-directed educational opportunities to promote patient satisfaction and quality of

Long-term neuroglobin expression of human astrocytes following brain trauma.

Science.gov (United States)

Chen, Xiameng; Liu, Yuan; Zhang, Lin; Zhu, Peng; Zhu, Haibiao; Yang, Yu; Guan, Peng

2015-10-08

Neuroglobin (Ngb), a 17 kDa monomeric protein, was initially described as a vertebrate oxygen-binding heme protein in 2000 and detected in metabolically active organs or cells, like the brain, peripheral nervous system as well as certain endocrine cells. A large array of initial experimental work reported that Ngb displayed a neuron restricted expression pattern in mammalian brains. However, growing evidence indicated astrocytes may also express Ngb under pathological conditions. To address the question whether human astrocytes express Ngb under traumatic insults, we investigated Ngb immuno-reactivity in post-mortem human brain tissues that died of acute, sub-acute and chronic brain trauma, respectively. We observed astrocytic Ngb expression in sub-acute and chronic traumatic brains rather than acute traumatic brains. Strikingly, the Ngb immuno-reactive astrocytes were still strongly detectable in groups that died 12 months after brain trauma. Our findings may imply an unexplored role of Ngb in astrocytes and the involved mechanisms were suggested to be further characterized. Also, therapeutic application of Ngb or Ngb-inducible chemical compounds in neuro-genesis or astrocytic scar forming can be expected. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Prevalence and factors of burnout among Australian orthopaedic trainees: a cross-sectional study.

Science.gov (United States)

Arora, Manit; Diwan, Ashish D; Harris, Ian A

2014-12-01

To assess the prevalence and factors of burnout among Australian orthopaedic trainees. 236 orthopaedic registrars of the Australian Orthopaedic Association were invited to participate in a 32-item survey by email. The questionnaire assessed potential factors associated with burnout, satisfaction with the choice of orthopaedics as a career and work-life balance, and subjective overall health, as well as 3 subscales of the Maslach Burnout Inventory - Human Services Survey for assessing burnout: emotional exhaustion, depersonalisation, and personal accomplishment. Participants with high levels of either emotional exhaustion or depersonalisation were defined as having burnout. Those with and without burnout were compared. 51 (22%) of the 236 trainees completed the questionnaire. Of whom, 88% were satisfied with their choice of orthopaedics as a career, whereas 27% were satisfied with their work-life balance. 27 (53%) respondents were considered burned out. Compared with those who did not burn out, those who burned out were less satisfied with their careers (p=0.004) and work-life balance (p=0.021). 53% of Australian orthopaedic trainees were burned out. Burnout trainees were more likely to be dissatisfied with their career choice and worklife balance. Active interventions to combat burnout and improve work-life balance are needed.

Pediatric Orthopaedic Workforce in 2014: Current Workforce and Projections for the Future.

Science.gov (United States)

Sawyer, Jeffrey R; Jones, Kerwyn C; Copley, Lawson A; Chambers, Stephanie

2017-01-01

The changing nature of the United States (US) health care system has prompted debate concerning the physician supply. The basic questions are: do we have an adequate number of surgeons to meet current demands and are we training the correct number of surgeons to meet future demands? The purpose of this analysis was to characterize the current pediatric orthopaedic workforce in terms of supply and demand, both present and future. Databases were searched (POSNA, SF Match, KID, MGMA) to determine the current pediatric orthopaedic workforce and workforce distribution, as well as pediatric orthopaedic demand. The number of active Pediatric Orthopaedic Society of North America (POSNA) members increased over the past 20 years, from 410 in 1993 to 653 in 2014 (155% increase); however, the density of POSNA members is not equally distributed, but correlates to population density. The number of estimated pediatric discharges, orthopaedic and nonorthopaedic, has remained relatively stable from 6,348,537 in 1997 to 5,850,184 in 2012. Between 2003 and 2013, the number of pediatric orthopaedic fellows graduating from Accreditation Council for Graduate Medical Education and non-Accreditation Council for Graduate Medical Education programs increased from 39 to 50 (29%), with a peak of 67 fellows (71%) in 2009. Although predicting the exact need for pediatric orthopaedic surgeons (POS) is impossible because of the complex interplay among macroeconomic, governmental, insurance, and local factors, some trends were identified: the supply of POS has increased, which may offset the expected numbers of experienced surgeons who will be leaving the workforce in the next 10 to 15 years; macroeconomic factors influencing demand for physician services, driven by gross domestic product and population growth, are expected to be stable in the near future; expansion of the scope of practice for POS is expected to continue; and further similar assessments are warranted. Level II-economic and

Etiology of Readmissions Following Orthopaedic Procedures and Medical Admissions. A Comparative Analysis.

Science.gov (United States)

Maslow, Jed; Hutzler, Lorraine; Slover, James; Bosco, Joseph

2015-12-01

The Federal Government, the largest payer of health care, considers readmission within 30 days of discharge an indicator of quality of care. Many studies have focused on causes for and strategies to reduce readmissions following medical admissions. However, few studies have focused on the differences between them. We believe that the causes for readmission following orthopaedic surgery are markedly different than those following medical admissions, and therefore, the strategies developed to reduce medical readmissions will not be as effective in reducing readmissions after elective orthopaedic surgery. All unplanned 30-day readmissions following an index hospitalization for an elective orthopaedic procedure (primary and revision total joint arthroplasty and spine procedure) or for one of the three publicly reported medical conditions (AMI, HF, and pneumonia, which accounted for 11% of readmissions) were identified at our institution from 2010 through 2012. A total of 268 patients and 390 medical patients were identified as having an unplanned 30-day readmission. We reviewed a prospectively collected data base to determine the reason for readmission in each encounter. A total of 233 (86.9%) orthopaedic patients were readmitted for surgical complications, most commonly for a wound infection (56.0%) or wound complication (11.6%). Following an index admission of HF or AMI, the primary reason for readmission was a disease of the circulatory system (55.9% and 57.4%, respectively). Following an index admission for pneumonia, the primary reason for readmission was a disease of the respiratory system (34.5%). The causes of readmissions following orthopaedic surgery and medical admissions are different. Patients undergoing orthopaedic procedures are readmitted for surgical complications, frequently unrelated to aftercare, and medicine patients are readmitted for reasons related to the index diagnosis. Interventions designed to reduce orthopaedic readmissions must focus on

Readability of Orthopaedic Oncology-related Patient Education Materials Available on the Internet.

Science.gov (United States)

Shah, Akash K; Yi, Paul H; Stein, Andrew

2015-12-01

A person's health literacy is one of the most important indicators of a patient's health status. According to national recommendations, patient education materials should be written at no higher than the sixth- to eighth-grade reading level. The purpose of our study was to assess the readability of online patient education materials related to orthopaedic oncology on the websites of the American Academy of Orthopaedic Surgeons (AAOS), American Cancer Society (ACS), Bone and Cancer Foundation (BCF), and National Cancer Institute (NCI). We searched the online patient education libraries of the AAOS, ACS, BCF, and NCI for all articles related to orthopaedic oncology. The Flesch-Kincaid (FK) readability score was calculated for each article and compared between sources. A total of 227 articles were identified with an overall mean FK grade level of 9.8. Stratified by source, the mean FK grade levels were 10.1, 9.6, 11.1, and 9.5 for the AAOS, ACS, BCF, and NCI, respectively (P education materials related to orthopaedic oncology appear to be written at a level above the comprehension ability of the average patient. Copyright 2015 by the American Academy of Orthopaedic Surgeons.

Distribution of Trauma Care Facilities in Oman in Relation to High-Incidence Road Traffic Injury Sites: Pilot study.

Science.gov (United States)

Al-Kindi, Sara M; Naiem, Ahmed A; Taqi, Kadhim M; Al-Gheiti, Najla M; Al-Toobi, Ikhtiyar S; Al-Busaidi, Nasra Q; Al-Harthy, Ahmed Z; Taqi, Alaa M; Ba-Alawi, Sharif A; Al-Qadhi, Hani A

2017-11-01

Road traffic injuries (RTIs) are considered a major public health problem worldwide. In Oman, high numbers of RTIs and RTI-related deaths are frequently registered. This study aimed to evaluate the distribution of trauma care facilities in Oman with regards to their proximity to RTI-prevalent areas. This descriptive pilot study analysed RTI data recorded in the national Royal Oman Police registry from January to December 2014. The distribution of trauma care facilities was analysed by calculating distances between areas of peak RTI incidence and the closest trauma centre using Google Earth and Google Maps software (Google Inc., Googleplex, Mountain View, California, USA). A total of 32 trauma care facilities were identified. Four facilities (12.5%) were categorised as class V trauma centres. Of the facilities in Muscat, 42.9% were ranked as class IV or V. There were no class IV or V facilities in Musandam, Al-Wusta or Al-Buraimi. General surgery, orthopaedic surgery and neurosurgery services were available in 68.8%, 59.3% and 12.5% of the centres, respectively. Emergency services were available in 75.0% of the facilities. Intensive care units were available in 11 facilities, with four located in Muscat. The mean distance between a RTI hotspot and the nearest trauma care facility was 34.7 km; however, the mean distance to the nearest class IV or V facility was 83.3 km. The distribution and quality of trauma care facilities in Oman needs modification. It is recommended that certain centres upgrade their levels of trauma care in order to reduce RTI-associated morbidity and mortality in Oman.

Long Sick Leave after Orthopaedic Inpatient Rehabilitation: Treatment Failure or Relapse?

Science.gov (United States)

Mangels, Marija; Schwarz, Susanne; Worringen, Ulrike; Holme, Martin; Rief, Winfried

2011-01-01

We investigated whether short-term versus long-term sick leave after orthopaedic inpatient rehabilitation can be predicted by initial assessment information, the clinical status at discharge, or whether the follow-up interval is crucial for later sick leave. We examined 214 patients from an orthopaedic rehabilitation hospital at admission,…

[Malnutrition in Elderly Trauma Patients - Comparison of Two Assessment Tools].

Science.gov (United States)

Ihle, C; Bahrs, C; Freude, T; Bickel, M; Spielhaupter, I; Wintermeyer, E; Stollhof, L; Grünwald, L; Ziegler, P; Pscherer, S; Stöckle, U; Nussler, A

2017-04-01

Background: The prevalence of malnutrition in hospitalised patients is reported to be between 16 and 55 % across disciplines. Within hospital care, screening for malnutrition is required. However, in orthopaedics and trauma surgery, there is still no generally accepted recommendation for the methods for such a data survey. In the present study, the following aspects are to be investigated with the help of two established scores: (1) the prevalence of malnutrition in the patient population of geriatric trauma care, and (2) the correlation between methods of data survey. Material and Methods: Between June 2014 and June 2015, a consecutive series of hospitalised trauma patients were studied prospectively with two validated screening instruments to record nutritional status. The study was carried out at a municipal trauma surgery hospital, which is a first level interregional trauma centre as well as a university hospital. The Nutritional Risk Screening (NRS) and the Mini Nutritional Assessment (MNA Short and Long Form) were used. All patients were divided into three age groups:  80 years. The prevalence of malnutrition in geriatric trauma patients and the correlation between the screening instruments were determined. For a better comparison, prescreening and main assessment were applied to all patients. For statistical evaluation, both quantitative and semi-quantitative parameters were used. Furthermore, the Kolmogorov-Smirnov test, Spearman's correlation analysis and the chi-square test were applied. These tests were two-sided and had a level of significance of 5 %. The present study was partially funded by the Oskar-Helene-Heim Foundation. Results: 521 patients (43.8 % women, 56.2 % men), with a mean age of 53.96 ± 18.13 years, were statistically evaluated within the present study. Depending on the method of the data survey, malnutrition (NRS≥3) in geriatric trauma patients varied from 31.3 % (65-80 years) to 60 % (> 80 years). With MNA, 28

Orthopaedic complications of osteogenesis imperfecta; Les complications orthopediques de l'osteogenese imparfaite

Energy Technology Data Exchange (ETDEWEB)

Azrak, S.; Ksyar, R.; Ben Rais, N. [hOpital Ibn Sina, CHU de Rabat-Sale, Service de Medecine Nucleaire, Rabat-Sale (Morocco)

2009-12-15

Osteogenesis imperfecta is a genetic disease characterized by bone frailty. It is generally caused by an abnormal production of collagen, which is the main fibrous protein of the bone. Collagen is also present in the skin, tendons, the sclera of the eye and dentin. The most frequent manifestation of osteogenesis imperfecta is the occurrence of multiple fractures without major trauma. Severity and timing of the attack varies widely: some patients sustain a significant number of fractures during early childhood which may have a serious impact on growth, while others will have some fractures separated by a few years. In all cases, the bone strength improves in adulthood. The bone fractures cause pain and bone deformities sometimes result in a smaller size. Scoliosis is frequent and associated with painful vertebral collapses. We present a case of osteogenesis imperfecta in a 40-year-old adult and we describe the various orthopaedic complications of the disease, stressing the role of bone scintigraphy in the diagnosis and monitoring of these complications. (authors)

A CASE OF SELF-INDUCED ACUTE HYDROPS IN A PATIENT WITH IMPULSE CONTROL DISORDER ASSOCIATED WITH COMPULSIVE EYE TRAUMA

Directory of Open Access Journals (Sweden)

Bindu Madhavi

2016-03-01

Full Text Available PURPOSE To describe acute hydrops in a patient with impulse control disorder (not otherwise specified secondary to self-induced repetitive eye trauma. METHODS A 22-year-old male patient was referred from a psychiatrist with a diagnosis of impulse control disorder not otherwise specified (compulsive impulse self-mutilating behaviour for opacity and watering of both eyes (left eye more than right eye. Left eye showed features of acute hydrops with Descemet’s tear and right eye showed corneal opacity with Descemet’s tear (status post hydrops. RESULT The patient was prescribed cycloplegics, hypertonic saline for left eye and was advised against scratching the eye and was given protective goggles and was told for close followup in conjunction with psychiatric management. CONCLUSION Impulse control disorders are relatively common psychiatric conditions, yet are poorly understood by clinicians, patients suffering from the disorder and public. And hence identification of this disorder and close observation of patient allows for avoiding complications such as progression of hydrops, perforation and infection.

International Patients on Operation Vacation – Perspectives of Patients Travelling to Hungary for Orthopaedic Treatments

Directory of Open Access Journals (Sweden)

Eszter Kovacs

2014-11-01

Full Text Available Background The importance of cross-border healthcare, medical and health tourism plays a significant role in the European health policy and health management. After dentistry, orthopaedic treatments are the leading motivation for seeking care in Hungary, as patients with rheumatic and motion diseases are drawn to the thermal spas and well-established orthopaedic centres. This paper aims to gain insight into foreign patients’ perspectives on their experience of having sought medical tourism in orthopaedic care in Hungary. Methods A patient survey was conducted in 2012 on motivations for seeking treatment abroad, orthopaedic care received and overall satisfaction. In addition, health professionals’ interviews, and 17 phone interviews were conducted in 2013 with Romanian patients who had orthopaedic treatment in Hungary. Finally, medical records of foreign patients were analysed. Results The survey was completed by 115 participants – 61.1% females, mean age= 41.9, 87% Romanian origin. Most of the patients came to Hungary for orthopaedic surgeries, e.g. arthroscopy, knee/hip prosthesis or spinal surgery. 72.6% chose Hungary because of related to perceived better quality and longstanding culture of Hungarian orthopaedic care. Over 57% of patients reported being ‘very satisfied’ with care received and 41.6% ‘satisfied’. The follow-up interviews further reflected this level of satisfaction, therefore many respondents stating they have already recommended the Hungarian healthcare to others. Conclusion Based on the findings, patients from neighbouring regions are increasingly seeking orthopaedic care in Hungary. Patients having orthopaedic care are highly satisfied with the quality of care, the whole treatment process from the availability of information to discharge summaries and would consider returning for further treatments.

Assessment of acute pain in trauma

DEFF Research Database (Denmark)

Hebsgaard, Stine; Mannering, Anne; Zwisler, Stine T

2016-01-01

were treated with opioid analgesics or S-ketamine, while no pharmacological intervention was documented in 30 cases. Eight of the 138 cases with severe pain needed endotracheal intubation, whereas nine cases in the patients with mild or no pain needed endotracheal intubation; odds ratio (OR) 4.3 (p = 0......OBJECTIVE: To elucidate pain treatment with analgesics in a prehospital trauma population. DESIGN: Retrospective database study. SETTING: Prehospital data from the anesthesiologist-manned Mobile Emergency Care Unit (MECU) in Odense, Denmark, were extracted and subjected to analysis. PATIENTS...... MEASURES: Evaluation of the application of the pain scale Numeric Rating Scale (NRS). Furthermore, the authors performed a characterization of the patients with mild pain and severe pain according to specific parameters such as pharmacological interventions, opioid consumption, intubation, and others...

What is the best treatment to decrease pro-inflammatory cytokine release in acute skeletal muscle injury induced by trauma in rats: low-level laser therapy, diclofenac, or cryotherapy?

Science.gov (United States)

de Almeida, Patrícia; Tomazoni, Shaiane Silva; Frigo, Lucio; de Carvalho, Paulo de Tarso Camillo; Vanin, Adriane Aver; Santos, Larissa Aline; Albuquerque-Pontes, Gianna Móes; De Marchi, Thiago; Tairova, Olga; Marcos, Rodrigo Labat; Lopes-Martins, Rodrigo Álvaro Brandão; Leal-Junior, Ernesto Cesar Pinto

2014-03-01

Currently, treatment of muscle injuries represents a challenge in clinical practice. In acute phase, the most employed therapies are cryotherapy and nonsteroidal anti-inflammatory drugs. In the last years, low-level laser therapy (LLLT) has becoming a promising therapeutic agent; however, its effects are not fully known. The aim of this study was to analyze the effects of sodium diclofenac (topical application), cryotherapy, and LLLT on pro-inflammatory cytokine levels after a controlled model of muscle injury. For such, we performed a single trauma in tibialis anterior muscle of rats. After 1 h, animals were treated with sodium diclofenac (11.6 mg/g of solution), cryotherapy (20 min), or LLLT (904 nm; superpulsed; 700 Hz; 60 mW mean output power; 1.67 W/cm(2); 1, 3, 6 or 9 J; 17, 50, 100 or 150 s). Assessment of interleukin-1β and interleukin-6 (IL-1β and IL-6) and tumor necrosis factor-alpha (TNF-α) levels was performed at 6 h after trauma employing enzyme-linked immunosorbent assay method. LLLT with 1 J dose significantly decreased (p cryotherapy groups. On the other hand, treatment with diclofenac and cryotherapy does not decrease pro-inflammatory cytokine levels compared to the non-treated injured group. Therefore, we can conclude that 904 nm LLLT with 1 J dose has better effects than topical application of diclofenac or cryotherapy in acute inflammatory phase after muscle trauma.

Incidence and root causes of delays in emergency orthopaedic procedures: a single-centre experience of 36,017 consecutive cases over seven years.

Science.gov (United States)

Caesar, Ulla; Karlsson, Jon; Hansson, Elisabeth

2018-01-01

Emergency surgery is unplanned by definition and patients are scheduled for surgery with minimal preparation. Some patients who have sustained emergency orthopaedic trauma or other conditions must be operated on immediately or within a few hours, while others can wait until the hospital's resources permit and/or the patients' health status has been optimised as needed. This may affect the prioritisation procedures for both emergency and elective surgery and might result in waiting lists, not only for planned procedures but also for emergencies. The main purpose of this retrospective, observational, single-centre study was to evaluate and describe for the number and reasons of delays, as well as waiting times in emergency orthopaedic surgery using data derived from the hospital's records and registers. All the emergency patients scheduled for emergency surgery whose procedures were rescheduled and delayed between 1 January 2007 and 31 December 2013 were studied. We found that 24% (8474) of the 36,017 patients scheduled for emergency surgeries were delayed and rescheduled at least once, some several times. Eighty per cent of these delays were due to organisational causes. Twenty-one per cent of all the delayed patients had surgery within 24 h, whilst 41% waited for more than 24 h, up to 3 days. A large number of the clinic's emergency orthopaedic procedures were rescheduled and delayed and the majority of the delays were related to organisational reasons. The results can be interpreted in two ways; first, organisational reasons are avoidable and the potential for improvement is great and, secondly and most importantly, the delays might negatively affect patient outcomes.

Media’s role in broadcasting acute stress following the Boston Marathon bombings

Science.gov (United States)

Holman, E. Alison; Garfin, Dana Rose; Silver, Roxane Cohen

2014-01-01

We compared the impact of media vs. direct exposure on acute stress response to collective trauma. We conducted an Internet-based survey following the Boston Marathon bombings between April 29 and May 13, 2013, with representative samples of residents from Boston (n = 846), New York City (n = 941), and the remainder of the United States (n = 2,888). Acute stress symptom scores were comparable in Boston and New York [regression coefficient (b) = 0.43; SE = 1.42; 95% confidence interval (CI), −2.36, 3.23], but lower nationwide when compared with Boston (b = −2.21; SE = 1.07; 95% CI, −4.31, −0.12). Adjusting for prebombing mental health (collected prospectively), demographics, and prior collective stress exposure, six or more daily hours of bombing-related media exposure in the week after the bombings was associated with higher acute stress than direct exposure to the bombings (continuous acute stress symptom total: media exposure b = 15.61 vs. direct exposure b = 5.69). Controlling for prospectively collected prebombing television-watching habits did not change the findings. In adjusted models, direct exposure to the 9/11 terrorist attacks and the Sandy Hook School shootings were both significantly associated with bombing-related acute stress; Superstorm Sandy exposure wasn't. Prior exposure to similar and/or violent events may render some individuals vulnerable to the negative effects of collective traumas. Repeatedly engaging with trauma-related media content for several hours daily shortly after collective trauma may prolong acute stress experiences and promote substantial stress-related symptomatology. Mass media may become a conduit that spreads negative consequences of community trauma beyond directly affected communities. PMID:24324161

Bioactive Coatings for Orthopaedic Implants—Recent Trends in Development of Implant Coatings

Directory of Open Access Journals (Sweden)

Bill G. X. Zhang

2014-07-01

Full Text Available Joint replacement is a major orthopaedic procedure used to treat joint osteoarthritis. Aseptic loosening and infection are the two most significant causes of prosthetic implant failure. The ideal implant should be able to promote osteointegration, deter bacterial adhesion and minimize prosthetic infection. Recent developments in material science and cell biology have seen the development of new orthopaedic implant coatings to address these issues. Coatings consisting of bioceramics, extracellular matrix proteins, biological peptides or growth factors impart bioactivity and biocompatibility to the metallic surface of conventional orthopaedic prosthesis that promote bone ingrowth and differentiation of stem cells into osteoblasts leading to enhanced osteointegration of the implant. Furthermore, coatings such as silver, nitric oxide, antibiotics, antiseptics and antimicrobial peptides with anti-microbial properties have also been developed, which show promise in reducing bacterial adhesion and prosthetic infections. This review summarizes some of the recent developments in coatings for orthopaedic implants.

Exposure to 100% Oxygen Abolishes the Impairment of Fracture Healing after Thoracic Trauma.

Directory of Open Access Journals (Sweden)

Julia Kemmler

Full Text Available In polytrauma patients a thoracic trauma is one of the most critical injuries and an important trigger of post-traumatic inflammation. About 50% of patients with thoracic trauma are additionally affected by bone fractures. The risk for fracture malunion is considerably increased in such patients, the pathomechanisms being poorly understood. Thoracic trauma causes regional alveolar hypoxia and, subsequently, hypoxemia, which in turn triggers local and systemic inflammation. Therefore, we aimed to unravel the role of oxygen in impaired bone regeneration after thoracic trauma. We hypothesized that short-term breathing of 100% oxygen in the early post-traumatic phase ameliorates inflammation and improves bone regeneration. Mice underwent a femur osteotomy alone or combined with blunt chest trauma 100% oxygen was administered immediately after trauma for two separate 3 hour intervals. Arterial blood gas tensions, microcirculatory perfusion and oxygenation were assessed at 3, 9 and 24 hours after injury. Inflammatory cytokines and markers of oxidative/nitrosative stress were measured in plasma, lung and fracture hematoma. Bone healing was assessed on day 7, 14 and 21. Thoracic trauma induced pulmonary and systemic inflammation and impaired bone healing. Short-term exposure to 100% oxygen in the acute post-traumatic phase significantly attenuated systemic and local inflammatory responses and improved fracture healing without provoking toxic side effects, suggesting that hyperoxia could induce anti-inflammatory and pro-regenerative effects after severe injury. These results suggest that breathing of 100% oxygen in the acute post-traumatic phase might reduce the risk of poorly healing fractures in severely injured patients.

Massive Hematemesis from a Splenic Artery Pseudoaneurysm Presenting Two Years after Penetrating Trauma

Directory of Open Access Journals (Sweden)

Geraldine Abbey-Mensah

2018-01-01

Full Text Available Splenic artery pseudoaneurysms (PSA are rare entities and far less common than true aneurysms of the splenic artery. The most common etiology is pancreatitis, recurrent either in the setting of chronic pancreatitis or as an episode of acute pancreatitis. Less common causes include trauma, peptic ulcer disease, or iatrogenic causes. Almost all of the trauma-related case reports have been due to blunt trauma. We believe this to be the first reported case of a splenic artery PSA presenting with massive hematemesis at a significant time frame after penetrating trauma. Successful transcatheter treatment was performed and alternative techniques are also discussed.

Internet-based prevention of posttraumatic stress symptoms in injured trauma patients: design of a randomized controlled trial

Directory of Open Access Journals (Sweden)

Joanne Mouthaan

2011-11-01

Full Text Available Background: Injured trauma victims are at risk of developing Posttraumatic Stress Disorder (PTSD and other post-trauma psychopathology. So far, interventions using cognitive behavioral techniques (CBT have proven most efficacious in treating early PTSD in highly symptomatic individuals. No early intervention for the prevention of PTSD for all victims has yet proven effective. In the acute psychosocial care for trauma victims, there is a clear need for easily applicable, accessible, cost-efficient early interventions. Objective: To describe the design of a randomized controlled trial (RCT evaluating the effectiveness of a brief Internet-based early intervention that incorporates CBT techniques with the aim of reducing acute psychological distress and preventing long-term PTSD symptoms in injured trauma victims. Method: In a two armed RCT, 300 injured trauma victims from two Level-1 trauma centers in Amsterdam, the Netherlands, will be assigned to an intervention or a control group. Inclusion criteria are: being 18 years of age or older, having experienced a traumatic event according to the diagnostic criteria of the DSM-IV and understanding the Dutch language. The intervention group will be given access to the intervention's website (www.traumatips.nl, and are specifically requested to login within the first month postinjury. The primary clinical study outcome is PTSD symptom severity. Secondary outcomes include symptoms of depression and anxiety, quality of life, and social support. In addition, a cost-effectiveness analysis of the intervention will be performed. Data are collected at one week post-injury, prior to first login (baseline, and at 1, 3, 6 and 12 months. Analyses will be on an intention-to-treat basis. Discussion: The results will provide more insight into the effects of preventive interventions in general, and Internet-based early interventions specifically, on acute stress reactions and PTSD, in an injured population, during the

The relationship between processing style, trauma memory processes, and the development of posttraumatic stress symptoms in children and adolescents.

Science.gov (United States)

McKinnon, Anna; Brewer, Neil; Cameron, Kate; Nixon, Reginald D V

2017-12-01

Data-driven processing, peri-event fear, and trauma memory characteristics are hypothesised to play a core role in the development of Posttraumatic Stress Disorder. We assessed the relationships between these characteristics and Posttraumatic Stress (PTS) symptoms in a sample of youth. Study 1 (N = 36, 7-16 years), involved a sample of children who had undergone a stressful orthopaedic procedure. One week later they answered a series of probed recall questions about the trauma (assessed for accuracy by comparison to a video) and reported on their PTS symptoms. They also rated confidence in their probed recall answers to assess meta-cognitive monitoring of their memory for the trauma. In Study 2, a sample of injured children (N = 57, 7-16 years) were assessed within 1-month of a visit to an Emergency Department, and then at 3-month follow-up. They answered probed recall questions, made confidence ratings, and completed measures of data-driven processing, peri-event fear, PTS and associated psychopathology. Memories were verified using witness accounts. Studies 1 and 2 did not find an association between PTS symptoms and trauma memory accuracy or confidence. In Studies 1 and 2 data-driven processing predicted PTS symptoms. The studies had modest samples sizes and there were ceiling effects for some accuracy and confidence items. Data-driven processing at the time of a trauma was associated with PTS symptoms after accounting for fear at the time of the trauma. Accuracy of recall for trauma memories was not significantly related to PTS symptoms. No decisive conclusion could be drawn regarding the relation between confidence in trauma memories and PTS symptoms. Copyright © 2017 Elsevier Ltd. All rights reserved.

Orthopaedic Disorders in Myotonic Dystrophy Type 1: descriptive clinical study of 21 patients

Science.gov (United States)

2013-01-01

Background Myotonic Dystrophy Type 1 (DM1) is the most common form of hereditary myopathy presenting in adults. This autosomal-dominant systemic disorder is caused by a CTG repeat, demonstrating various symptoms. A mild, classic and congenital form can be distinguished. Often the quality of life is reduced by orthopaedic problems, such as muscle weakness, contractures, foot or spinal deformities, which limit patients’ mobility. The aim of our study was to gather information about the orthopaedic impairments in patients with DM1 in order to improve the medical care of patients, affected by this rare disease. Methods A retrospective clinical study was carried out including 21 patients (11 male and 10 female), all diagnosed with DM1 by genetic testing. All patients were seen during our special consultations for neuromuscular diseases, during which patients were interviewed and examined. We also reviewed surgery reports of our hospitalized patients. Results We observed several orthopaedic impairments: spinal deformities (scoliosis, hyperkyphosis, rigid spine), contractures (of the upper extremities and the lower extremities), foot deformities (equinus deformity, club foot, pes cavus, pes planovalgus, pes cavovarus, claw toes) and fractures. Five patients were affected by pulmonary diseases (obstructive airway diseases, restrictive lung dysfunctions). Twelve patients were affected by cardiac disorders (congenital heart defects, valvular heart defects, conduction disturbances, pulmonary hypertension, cardiomyopathy). Our patients received conservative therapy (physiotherapy, logopaedic therapy, ergotherapy) and we prescribed orthopaedic technical devices (orthopaedic custom-made shoes, insoles, lower and upper leg orthoses, wheelchair, Rehab Buggy). We performed surgery for spinal and foot deformities: the scoliosis of one patient was stabilized and seven patients underwent surgery for correction of foot deformities. Conclusions An orthopaedic involvement in DM1

Interdisciplinary Trauma Management in an Elderly Patient, A Case Report

Science.gov (United States)

Felt, George T; Soolari, Ahmad

2014-01-01

The current report reviews a case of mixed dental trauma consequent to a fall by an older patient. The patient’s teeth were forced out of alignment by the trauma and suffered pulpal necrosis. Treatment involved not only healing the acute injuries, but also attending to some subtle delayed problems that became apparent during treatment. Treatments involving endodontics, periodontics, orthodontics, and restorative dentistry were used to address all of the patient’s concerns. This insured that the traumatic occlusion was corrected, appropriate esthetics was restored and normal speech and function was regained. All signs of trauma were recognized, every treatment step was documented, and appropriate follow-up was provided throughout the recovery period. PMID:25419251

II Italian intersociety consensus statement on antithrombotic prophylaxis in orthopaedics and traumatology: arthroscopy, traumatology, leg immobilization, minor orthopaedic procedures and spine surgery.

Science.gov (United States)

Randelli, F; Romanini, E; Biggi, F; Danelli, G; Della Rocca, G; Laurora, N R; Imberti, D; Palareti, G; Prisco, D

2013-03-01

Pharmacological prophylaxis for preventing venous thromboembolism (VTE) is a worldwide established procedure in hip and knee replacement surgery, as well as in the treatment of femoral neck fractures, but few data exist in other fields of orthopaedics and traumatology. Thus, no guidelines or recommendations are available in the literature except for a limited number of weak statements about knee arthroscopy and lower limb fractures. In any case, none of them are a multidisciplinary effort as the one here presented. The Italian Society for Studies on Haemostasis and Thrombosis (SISET), the Italian Society of Orthopaedics and Traumatology (SIOT), the Association of Orthopaedic Traumatology of Italian Hospitals (OTODI), together with the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) and the Italian Society of General Medicine (SIMG) have set down easy and quick suggestions for VTE prophylaxis in a number of surgical conditions for which only scarce evidence is available. This inter-society consensus statement aims at simplifying the approach to VTE prophylaxis in the single patient with the goal to improve its clinical application.

Orthopaedic Aspects of Marfan Syndrome: The Experience of a Referral Center for Diagnosis of Rare Diseases

Science.gov (United States)

Fichera, Alessandro; De Luna, Vincenzo; Mancini, Federico; Caterini, Roberto

2016-01-01

Marfan syndrome is caused by mutations in the fibrillin-1 gene (FBN1). The most important features affect the cardiovascular system, eyes, and skeleton. The aim of this study was to report the most frequent musculoskeletal alterations observed in 146 patients affected by Marfan syndrome. Fifty-four patients (37%) underwent cardiac surgery and 11 of them received emergent surgery for acute aortic dissection. Ectopia lentis was found in 68 patients (47%) whereas myopia above 3D occurred in 46 patients (32%). Musculoskeletal anomalies were observed in all patients with Marfan syndrome. In 88 patients (60.2%), the associated “wrist and thumb sign” was present; in 58 patients (39.7%), pectus carinatum deformity; in 44 patients (30.1%), pectus excavatum; in 49 patients (33.5%), severe flatfoot; in 31 patients (21.2%), hindfoot deformity; in 54 patients (36.9%), reduced US/LS ratio or increased arm span-height ratio; in 37 patients (25.3%), scoliosis or thoracolumbar kyphosis; in 22 patients (15%), reduced elbow extension (170° or less). Acetabular protrusion was ascertained on radiographs in 27 patients (18.4%). Orthopaedic aspects of the disease are very important for an early diagnosis; however, we have not observed definite correlations between the extent of orthopaedic involvement and aortic complications. PMID:28050285

[Trauma and stressor-related disorders: diagnostic conceptualization in DSM-5].

Science.gov (United States)

Kapfhammer, H P

2014-05-01

The Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5) includes a distinct diagnostic group of trauma and stressor-related disorders that has been set apart from anxiety disorders. From a perspective of adult psychiatry this new disorder category includes posttraumatic stress disorder (PTSD), acute stress disorder (ASD), and adjustment disorders. The PTSD is based on narrower trauma criteria that focus on acute life-threatening situations, serious injury, or sexual violence by way of direct confrontation, witnessing or indirect confrontation. Indirect confrontation, however, is reserved only for violent or accidental events that occurred to close family members or friends. The former A2 criterion of an intense emotional reaction to trauma has been removed. A deliberately broad approach to clinical PTSD phenomenology has created an empirically driven new cluster of persistent negative alterations in cognition and mood due to experiencing traumatic events. The ASD has been reconceptualized as an intense stress syndrome with a clear need of acute treatment during the early course after traumatic exposure. Adjustment disorders continue to emphasize maladaptive emotional and behavioral responses to unspecific, non-traumatic stressors in an intensity that is beyond social or cultural norms. Neither complex PTSD nor prolonged grief disorders have received an independent diagnostic status within DSM-5. With respect to stress-related disorders major divergences between DSM-5 and the future International Classification of Diseases 11 (ICD-11) are to be expected.

Correlation of Level of Trauma Activation With Emergency Department Intervention.

Science.gov (United States)

Cooper, Michael C; Srivastava, Geetanjali

2018-06-01

In-hospital trauma team activation criteria are formulated to identify severely injured patients requiring specialized multidisciplinary care. Efficacy of trauma activation (TA) criteria is commonly measured by emergency department (ED) disposition, injury severity score, and mortality. Necessity of critical ED interventions is another measure that has been proposed to evaluate the appropriateness of TA criteria. Two-year retrospective cohort study of 1715 patients from our trauma registry at a Level 1 pediatric trauma center. We abstracted data on acute interventions, level and criterion of TA, ED disposition, and mortality. We report odds ratio (OR) with 95% confidence intervals (CIs), positive predictive value, and frequency of acute interventions. Trauma activation was initiated for 947 (55%) of the 1715 patients. There were 426 ED interventions performed on 235 patients (14%); 67.8% were in level 1 activations; 17.6% in level 2, and 14.6% in level 3. Highest-level activations were highly associated with need for ED interventions (OR, 16.1; 95% CI, 11.5-22.4). The ORs for requiring an ED intervention were low for lower level activations (OR, 0.4; 95% CI, 0.3-0.5), trauma service consults (OR, 0.3; 95% CI, 0.2-0.4), and certain mechanism-based criteria. The ORs for ED intervention for isolated motor vehicle collision (0.2; 95% CI, 0.1-0.7), isolated all-terrain vehicle rollover (0.4; 95% CI, 0.1-1.7), and suspected spinal cord injury (0.5; 95% CI, 0.1-3.7) were significantly lower than 1. Highest-level activation criteria correlate with high utilization of ED resources and interventions. Lower level activation criteria and trauma service consult criteria are not highly correlated with need for ED interventions. Downgrading isolated motor vehicle collision and all-terrain vehicle rollovers and suspected spinal cord injury to lower level activations could decrease the overtriage rate, and adding age-specific bradycardia as a physiologic criterion could improve our

Orthopaedic Sports Medicine Fellowship Interviews: Structure and Organization of the Interview Day.

Science.gov (United States)

Haislup, Brett D; Kraeutler, Matthew J; Baweja, Rishi; McCarty, Eric C; Mulcahey, Mary K

2017-12-01

Over the past few decades, there has been a trend toward an increasing subspecialization in orthopaedic surgery, with orthopaedic sports medicine being one of the most competitive subspecialties. Information regarding the application and interview process for sports medicine fellowships is currently lacking. To survey orthopaedic sports medicine fellowship program directors (PDs) to better define the structure of the sports medicine fellowship interview and to highlight important factors that PDs consider in selecting fellows. Cross-sectional study. A complete list of accredited programs was obtained from the American Orthopaedic Society for Sports Medicine (AOSSM) website. An anonymous survey was distributed to fellowship PDs of all Accreditation Council for Graduate Medical Education (ACGME)-accredited orthopaedic sports medicine fellowships in the United States. The survey included 12 questions about the fellowship interview and selection process. Of the 95 orthopaedic sports medicine fellowship PDs surveyed, 38 (40%) responded. Of these, 16 (42.1%) indicated that they interview between 21 and 30 applicants per year. Eleven of the 38 fellowship programs (28.9%) have only 1 fellow per year at their respective program. Most programs (27/37, 73%) reported that between 0 and 5 faculty members interview applicants, and 29 of the 38 programs (76.3%) arrange for applicants to have ≥4 interviews during their interview day. Large group interviews are conducted at 36 of 38 (94.7%) sports medicine fellowship programs, and most programs (24/38, 63.2%) hold individual interviews that last between 5 and 15 minutes. The most important applicant criterion taken into account by PDs was the quality of the interview, with an average score of 8.68 of 10. The most significant factor taken into account by PDs when deciding how to rank applicants was the quality of the interview. Many orthopaedic sports medicine fellowship programs interview between 21 and 30 applicants per year

High incidence of hemiarthroplasty for shoulder osteoarthritis among recently graduated orthopaedic surgeons.

Science.gov (United States)

Mann, Tobias; Baumhauer, Judith F; O'Keefe, Regis J; Harrast, John; Hurwitz, Shepard R; Voloshin, Ilya

2014-11-01

Primary glenohumeral osteoarthritis is a common indication for shoulder arthroplasty. Historically, both total shoulder arthroplasty (TSA) and hemi-shoulder arthroplasty (HSA) have been used to treat primary glenohumeral osteoarthritis. The choice between procedures is a topic of debate, with HSA proponents arguing that it is less invasive, faster, less expensive, and technically less demanding, with quality of life outcomes equivalent to those of TSA. More recent evidence suggests TSA is superior in terms of pain relief, function, ROM, strength, and patient satisfaction. We therefore investigated the practice of recently graduated orthopaedic surgeons pertaining to the surgical treatment of this disease. We hypothesized that (1) recently graduated, board eligible, orthopaedic surgeons with fellowship training in shoulder surgery are more likely to perform TSA than surgeons without this training; (2) younger patients are more likely to receive HSA than TSA; (3) patient sex affects the choice of surgery; (4) US geographic region affects practice patterns; and (5) complication rates for HSA and TSA are not different. We queried the American Board of Orthopaedic Surgery's database to identify practice patterns of orthopaedic surgeons taking their board examination. We identified 771 patients with primary glenohumeral osteoarthritis treated with TSA or HSA from 2006 to 2011. The rates of TSA and HSA were compared based on the treating surgeon's fellowship training, patient age and sex, US geographic region, and reported surgical complications. Surgeons with fellowship training in shoulder surgery were more likely (86% versus 72%; OR 2.32; 95% CI, 1.56-3.45, pguidelines for the treatment of glenohumeral osteoarthritis published by the American Academy of Orthopaedic Surgeons. These guidelines favor using TSA over HSA in the treatment of shoulder arthritis. Further investigation is needed to clarify if these practice patterns are isolated to recently graduated board

MRI of head trauma. Serial changes and comparison with CT

Energy Technology Data Exchange (ETDEWEB)

Fukuda, Osamu; Sato, Shuji; Suzuki, Takashi; Endo, Shunro; Takaku, Akira.

1988-08-01

Sequential changes in magnetic resonance imaging (MRI) were investigated in comparison with computed tomography (CT) in 31 cases of head trauma. Twenty-one of them were of acute head trauma; the first MRI study was performed within 48 hours after the accident. Forty-two intracranial lesions were observed in these cases on MRI. The other 10 cases were of chronic subdural hematoma, two cases of which had bilateral lesions. Fourteen lesions of acute head trauma and two lesions of chronic subdural hematoma were detected only by MRI. MRI was superior to CT for the detection of small contusions and thin extra-axial collections, especially those which were located near the bony structures. The abnormal lesions were visualized in MRI during a longer period than in CT. Because the signal intensity of a hematoma changed sequentially, the detection of brain edema was easier than that of a subarachnoid and parenchimal hemorrhage. Judging from this experience, it seems that careful attention should be taken in the diagnosis of hemorrhagic lesions. However, MRI was poor in tissue characterization because of the too-high tissue sensitivity. T/sub 2/-weight SE imaging was essentially sensitive and useful in the early stage.

Worldwide orthopaedic research activity 2010-2014: Publication rates in the top 15 orthopaedic journals related to population size and gross domestic product.

Science.gov (United States)

Hohmann, Erik; Glatt, Vaida; Tetsworth, Kevin

2017-06-18

To perform a bibliometric analysis of publications rates in orthopedics in the top 15 orthopaedic journals. Based on their 2015 impact factor, the fifteen highest ranked orthopaedic journals between January 2010 and December 2014 were used to establish the total number of publications; cumulative impact factor points (IF) per country were determined, and normalized to population size, GDP, and GDP/capita, comparison to the median country output and the global leader. Twenty-three thousand and twenty-one orthopaedic articles were published, with 66 countries publishing. The United States had 8149 publications, followed by the United Kingdom (1644) and Japan (1467). The highest IF was achieved by the United States (24744), United Kingdom (4776), and Japan (4053). Normalized by population size Switzerland lead. Normalized by GDP, Croatia was the top achiever. Adjusting GDP/capita, for publications and IF, China, India, and the United States were the leaders. Adjusting for population size and GDP, 28 countries achieved numbers of publications to be considered at least equivalent with the median academic output. Adjusting GDP/capita only China and India reached the number of publications to be considered equivalent to the current global leader, the United States. Five countries were responsible for 60% of the orthopaedic research output over this 5-year period. After correcting for GDP/capita, only 28 of 66 countries achieved a publication rate equivalent to the median country. The United States, United Kingdom, South Korea, Japan, and Germany were the top five countries for both publication totals and cumulative impact factor points.

Imaging of chest trauma: radiological patterns of injury and diagnostic algorithms

International Nuclear Information System (INIS)

Lomoschitz, Fritz M.; Eisenhuber, Edith; Linnau, Ken F.; Peloschek, Philipp; Schoder, Maria; Bankier, Alexander A.

2003-01-01

In patients after chest trauma, imaging plays a key role for both, the primary diagnostic work-up, and the secondary assessment of potential treatment. Despite its well-known limitations, the anteroposterior chest radiograph remains the starting point of the imaging work-up. Adjunctive imaging with computed tomography, that recently is increasingly often performed on multidetector computed tomography units, adds essential information not readily available on the conventional radiograph. This allows better definition of trauma-associated thoracic injuries not only in acute traumatic aortic injury, but also in pulmonary, tracheobronchial, cardiac, diaphragmal, and thoracic skeletal injuries. This article reviews common radiographic findings in patients after chest trauma, shows typical imaging features resulting from thoracic injury, presents imaging algorithms, and recalls to the reader less common but clinically relevant entities encountered in patients after thoracic trauma

ACR appropriateness criteria blunt chest trauma.

Science.gov (United States)

Chung, Jonathan H; Cox, Christian W; Mohammed, Tan-Lucien H; Kirsch, Jacobo; Brown, Kathleen; Dyer, Debra Sue; Ginsburg, Mark E; Heitkamp, Darel E; Kanne, Jeffrey P; Kazerooni, Ella A; Ketai, Loren H; Ravenel, James G; Saleh, Anthony G; Shah, Rakesh D; Steiner, Robert M; Suh, Robert D

2014-04-01

Imaging is paramount in the setting of blunt trauma and is now the standard of care at any trauma center. Although anteroposterior radiography has inherent limitations, the ability to acquire a radiograph in the trauma bay with little interruption in clinical survey, monitoring, and treatment, as well as radiography's accepted role in screening for traumatic aortic injury, supports the routine use of chest radiography. Chest CT or CT angiography is the gold-standard routine imaging modality for detecting thoracic injuries caused by blunt trauma. There is disagreement on whether routine chest CT is necessary in all patients with histories of blunt trauma. Ultimately, the frequency and timing of CT chest imaging should be site specific and should depend on the local resources of the trauma center as well as patient status. Ultrasound may be beneficial in the detection of pneumothorax, hemothorax, and pericardial hemorrhage; transesophageal echocardiography is a first-line imaging tool in the setting of suspected cardiac injury. In the blunt trauma setting, MRI and nuclear medicine likely play no role in the acute setting, although these modalities may be helpful as problem-solving tools after initial assessment. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. Copyright © 2014 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Sustainable Effectiveness of Applying Trauma Team Activation in Managing Trauma Patients in the Emergency Department.

Science.gov (United States)

Wuthisuthimethawee, Prasit; Molloy, Michael S; Ciottone, Gregory R

2015-09-01

To determine long term effectiveness of trauma team activation criteria by measuring emergency department length of stay (EDLOS) and 28-day mortality. A 3-year retrospective cohort study conducted in adult trauma patients who met one of the trauma team activation criteria (shock, penetrating torso injury, post traumatic arrest, respiratory rate of less than 12 or more than 30, and pulse rate of more than 120). Specific demographic data, physiologic parameters, EDLOS, injury severity score (ISS), and 28-day mortality were prospectively recorded into the Trauma Registry database. Multiple logistic regression analysis was used to determine factors affecting mortality. The Institutional Review Board approval was obtained prior to undertaking the project. Two hundred eighty two patients with a mean age of35.1 years old were eligible. The median ISS was 25 (range, 13-30). The median EDLOS was 85 minutes (range, 50-135) and the 28-day mortality rate was 46.5%. The mean age was 31.7 years in the survival group and 38.7 years in the fatal group (p = 0.001). The median ISS was 17 in the survival group and 26 in the fatal group (p = 0.000) and the median EDLOS was 110 minutes in the survival group and 82 minutes in the fatal group (p = 0.034). When compared to data prior to the TTA application, the median time of EDLOS improvedsustainably from 184 to 85 minutes (p = 0.000) and the mortality rate decreased from 66.7% to 46.5% (p = 0.057). The parameters affecting patient mortality were older age, high ISS, and shorter EDLOS. Trauma team activation criteria significantly improved acute trauma care in the emergency department and decreased mortality.

Barriers and facilitators experienced in collaborative prospective research in orthopaedic oncology

DEFF Research Database (Denmark)

Rendon, J S; Swinton, M; Bernthal, N

2017-01-01

by orthopaedic oncological surgeons involved or interested in prospective multicentre collaboration. METHODS: All surgeons who were involved, or had expressed an interest, in the ongoing Prophylactic Antibiotic Regimens in Tumour Surgery (PARITY) trial were invited to participate in a focus group to discuss......: The 13 surgeons who participated in the discussion represented orthopaedic oncology practices from seven countries (Argentina, Brazil, Italy, Spain, Denmark, United States and Canada). Four categories and associated themes emerged from the discussion: the need for collaboration in the field...... of orthopaedic oncology due to the rarity of the tumours and the need for high level evidence to guide treatment; motivational factors for participating in collaborative research including establishing proof of principle, learning opportunity, answering a relevant research question and being part...

Haemodialysis for post-traumatic acute renal failure - factors predicting outcome.

Science.gov (United States)

Machemehl, Thomas; Hsu, Peter; Pahad, Hussein; Williams, Paul; Yilmaz, Tugba H; Vassiliu, Pantelis; Boffard, Kenneth D; Degiannis, Elias; Doll, Dietrich

2013-07-29

Post-traumatic acute renal failure requiring renal replacement therapy in an intensive care unit (ICU) is associated with high mortality. To assess indicators of improved survival. This was a retrospective cohort study of 64 consecutive trauma patients (penetrating and blunt trauma and burns) who underwent haemodialysis (HD) over a period of 5 years. Information on pre-hospital and in-hospital resuscitation, trauma scores and physiological scores and daily ICU records were collected. The majority of the patients were dialysed with continuous venovenous haemofiltration in the early years of the study and later with sustained low-efficiency dialysis. Of the 64 patients 47 died, giving an overall mortality rate of 73%. Mortality was highest in the burns patients (84%). Survival in all patients, irrespective of injury, was unrelated to the Revised Trauma Score, Injury Severity Score, Acute Physiology and Chronic Health Evaluation Score or Trauma Injury Severity Score. The duration of HD did not differ significantly between the three trauma groups, and age was not a significant predictor of survival. Patients who were polyuric at the time of the initiation of HD had a lower mortality rate than those who were oliguric, anuric or normouric, although this did not reach statistical significance (p=0.09). Acute renal failure in trauma patients is associated with a low survival rate. Controversial conclusions have been presented in the literature. In this study, none of the parameters previously reported to affect survival proved to be valid, although the number of patients was comparable with those in other studies. Since understanding of the predictors and course of renal failure in trauma patients is still at an early stage, there is a need for multicentre prospective studies.

Evaluation of the orthopaedics and traumatology resident education in Turkey: A descriptive study.

Science.gov (United States)

Huri, Gazi; Cabuk, Yusuf Sertan; Gursoy, Safa; Akkaya, Mustafa; Ozkan, Secil; Oztuna, Volkan; Aydingoz, Onder; Senkoylu, Alparslan

2016-10-01

The objective of this study is to describe the current situation regarding the training, working conditions, future plans, fields of interest and satisfaction of orthopaedics and traumatology residents in Turkey. A descriptive survey questionnaire consisting of 24 questions was designed to identify the problems and solution suggestions concerning training of orthopaedic residents. All orthopaedics and traumatology residents who took the 2013 Progress Testing for Speciality in Medicine (UEGS) held by Turkish Orthopaedics and Traumatology Education Council (TOTEK) were surveyed in the class at the end thereof as well as the young orthopaedic surgeons who were reached through the email groups of Turkish Society of Orthopaedics and Traumatology - Residents and Young Attendings Council (TOTBID-AGUH). A total of 725 residents and 132 young attendings were surveyed. The most outstanding answers are as follows: 62,7% of the respondents replied to the question "Is there a training program/Is it being applied" as "yes/yes". It was found out that 94,3% of the respondents wanted to be involved in a rotation abroad. The "patient care" was the most common answer, with a ratio of 36,9%, to the question "What's the priority of the department you are studying in?". Regarding work conditions, "many emergency on-calls" was found to be the most important parameter affecting life conditions (p traumatology residents in Turkey face as regards their training, this survey stands as a pioneering study with a high participation rate. Analysis of survey data highlights the importance of several key factors such as the development of training programs and increasing the time spent with academicians as well as spreading and promotion of log book application. Copyright © 2016 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.

Does Residency Selection Criteria Predict Performance in Orthopaedic Surgery Residency?

Science.gov (United States)

Raman, Tina; Alrabaa, Rami George; Sood, Amit; Maloof, Paul; Benevenia, Joseph; Berberian, Wayne

2016-04-01

More than 1000 candidates applied for orthopaedic residency positions in 2014, and the competition is intense; approximately one-third of the candidates failed to secure a position in the match. However, the criteria used in the selection process often are subjective and studies have differed in terms of which criteria predict either objective measures or subjective ratings of resident performance by faculty. Do preresidency selection factors serve as predictors of success in residency? Specifically, we asked which preresidency selection factors are associated or correlated with (1) objective measures of resident knowledge and performance; and (2) subjective ratings by faculty. Charts of 60 orthopaedic residents from our institution were reviewed. Preresidency selection criteria examined included United States Medical Licensing Examination (USMLE) Step 1 and Step 2 scores, Medical College Admission Test (MCAT) scores, number of clinical clerkship honors, number of letters of recommendation, number of away rotations, Alpha Omega Alpha (AOA) honor medical society membership, fourth-year subinternship at our institution, and number of publications. Resident performance was assessed using objective measures including American Board of Orthopaedic Surgery (ABOS) Part I scores and Orthopaedics In-Training Exam (OITE) scores and subjective ratings by faculty including global evaluation scores and faculty rankings of residents. We tested associations between preresidency criteria and the subsequent objective and subjective metrics using linear correlation analysis and Mann-Whitney tests when appropriate. Objective measures of resident performance namely, ABOS Part I scores, had a moderate linear correlation with the USMLE Step 2 scores (r = 0.55, p communication skills" subsection of the global evaluations. We found that USMLE Step 2, number of honors in medical school clerkships, and AOA membership demonstrated the strongest correlations with resident performance. Our

Ventricular septal necrosis after blunt chest trauma

Directory of Open Access Journals (Sweden)

Alireza Ahmadi

2012-07-01

Full Text Available Ventricular Septal Defect (VSD after blunt chest trauma is a very rare traumatic affection.We report here a case of blunt chest injury-related VSD and pseudoaneurysm.A 30-year old male truck driver was referred from a trauma center to our hospital seven days after a blunt chest trauma and rib fracture. The patient had severe pulmonary edemaand echocardiography showed large VSD. Several mechanisms are involved in the pathogenesis of this affection including an acute compression of the heart muscle between the sternum and the spine, leading to excessive changes in the intrathoracic and most likely theintracardiac pressure after blunt chest injury. Traumatical patients with the same symptoms may be at risk of sudden death. Therefore, a high grade of suspicion is mandatory even without solid evidence of myocardial damage on the initial evaluation. In continue somehidden angles of this case was discussed. Given the prognostic implications of traumatic VSD with associated pseudoaneurysm, its detection has critical value for preventing its clinicalsequelae.

Haemodialysis for post-traumatic acute renal failure – factors ...

African Journals Online (AJOL)

Background. Post-traumatic acute renal failure requiring renal replacement therapy in an intensive care unit (ICU) is associated with high mortality. Objective. To assess indicators of improved survival. Methods. This was a retrospective cohort study of 64 consecutive trauma patients (penetrating and blunt trauma and burns) ...

Orthopaedic podiatry triage: process outcomes of a skill mix initiative.

Science.gov (United States)

Homeming, Lyndon J; Kuipers, Pim; Nihal, Aneel

2012-11-01

The Orthopaedic Podiatry Triage Clinic (OPodTC) is a 'skill mix' model of care developed in Queensland Health to address the problem of lengthy waiting times for orthopaedic surgery on foot and ankle pathologies. It is based on the recognition that many orthopaedic surgery referrals can be identified early and treated conservatively with podiatry, averting the need for more costly and invasive surgical interventions. The model is collaborative and relies on screening and triage by the podiatrist, rather than delegation by the orthopaedic surgeon. Screening and triage through OPodTC was trialled at three Queensland Health hospital facilities during 2009 and 2010 to improve service timeliness. Patients identified by the OPodTC podiatrist as suitable for conservative management were provided with non-surgical podiatry interventions and discharged if appropriate. Those identified as still requiring surgical intervention after the benefit of interim conservative treatment provided by the podiatrist (or who chose to remain on the list) were returned to their previous place on the orthopaedic waiting list. This paper presents a summary and description of waiting list changes in association with this trial. The OPodTC intervention resulted in a reduction in the non-urgent category of the waiting list across the three hospitals of between 23.3% and 49.7%. Indications from wait-list service data demonstrated increased timeliness and improved patient flow, which are core goals of these skill mix initiatives. This study highlights the potential of screening and triage functions in the skill mix debate. In this example, conservative treatment options were considered first, suitable patients did not have to wait long periods to receive timely and appropriate interventions, and those for whom surgery was indicated, were provided with a more targeted service.

Understanding how orthopaedic surgery practices generate value for healthcare systems.

Science.gov (United States)

Olson, Steven A; Mather, Richard C

2013-06-01

Orthopaedic surgery practices can provide substantial value to healthcare systems. Increasingly, healthcare administrators are speaking of the need for alignment between physicians and healthcare systems. However, physicians often do not understand what healthcare administrators value and therefore have difficulty articulating the value they create in discussions with their hospital or healthcare organization. Many health systems and hospitals use service lines as an organizational structure to track the relevant data and manage the resources associated with a particular type of care, such as musculoskeletal care. Understanding service lines and their management can be useful for orthopaedic surgeons interested in interacting with their hospital systems. We provide an overview of two basic types of value orthopaedic surgeons create for healthcare systems: financial or volume-driven benefits and nonfinancial quality or value-driven patient care benefits. We performed a search of PubMed from 1965 to 2012 using the term "service line." Of the 351 citations identified, 18 citations specifically involved the use of service lines to improve patient care in both nursing and medical journals. A service line is a structure used in healthcare organizations to enable management of a subset of activities or resources in a focused area of patient care delivery. There is not a consistent definition of what resources are managed within a service line from hospital to hospital. Physicians can positively impact patient care through engaging in service line management. There is increasing pressure for healthcare systems and hospitals to partner with orthopaedic surgeons. The peer-reviewed literature demonstrates there are limited resources for physicians to understand the value they create when attempting to negotiate with their hospital or healthcare organization. To effectively negotiate for resources to provide the best care for patients, orthopaedic surgeons need to claim and

Novel variants in the PRDX6 Gene and the risk of Acute Lung Injury following major trauma

Directory of Open Access Journals (Sweden)

Localio A Russell

2011-05-01

Full Text Available Abstract Background Peroxiredoxin 6 (PRDX6 is involved in redox regulation of the cell and is thought to be protective against oxidant injury. Little is known about genetic variation within the PRDX6 gene and its association with acute lung injury (ALI. In this study we sequenced the PRDX6 gene to uncover common variants, and tested association with ALI following major trauma. Methods To examine the extent of variation in the PRDX6 gene, we performed direct sequencing of the 5' UTR, exons, introns and the 3' UTR in 25 African American cases and controls and 23 European American cases and controls (selected from a cohort study of major trauma, which uncovered 80 SNPs. In silico modeling was performed using Patrocles and Transcriptional Element Search System (TESS. Thirty seven novel and tagging SNPs were tested for association with ALI compared with ICU at-risk controls who did not develop ALI in a cohort study of 259 African American and 254 European American subjects that had been admitted to the ICU with major trauma. Results Resequencing of critically ill subjects demonstrated 43 novel SNPs not previously reported. Coding regions demonstrated no detectable variation, indicating conservation of the protein. Block haplotype analyses reveal that recombination rates within the gene seem low in both Caucasians and African Americans. Several novel SNPs appeared to have the potential for functional consequence using in silico modeling. Chi2 analysis of ALI incidence and genotype showed no significant association between the SNPs in this study and ALI. Haplotype analysis did not reveal any association beyond single SNP analyses. Conclusions This study revealed novel SNPs within the PRDX6 gene and its 5' and 3' flanking regions via direct sequencing. There was no association found between these SNPs and ALI, possibly due to a low sample size, which was limited to detection of relative risks of 1.93 and above. Future studies may focus on the role of

The Clinical and Economic Impact of Generic Locking Plate Utilization at a Level II Trauma Center.

Science.gov (United States)

Mcphillamy, Austin; Gurnea, Taylor P; Moody, Alastair E; Kurnik, Christopher G; Lu, Minggen

2016-12-01

In today's climate of cost containment and fiscal responsibility, generic implant alternatives represent an interesting area of untapped resources. As patents have expired on many commonly used trauma implants, generic alternatives have recently become available from a variety of sources. The purpose of this study was to examine the clinical and economic impact of a cost containment program using high quality, generic orthopaedic locking plates. The implants available for study were anatomically precontoured plates for the clavicle, proximal humerus, distal radius, proximal tibia, distal tibia, and distal fibula. Retrospective review. Level II Trauma center. 828 adult patients with operatively managed clavicle, proximal humerus, distal radius, proximal tibia, tibial pilon, and ankle fractures. Operative treatment with conventional or generic implants. The 414 patients treated with generic implants were compared with 414 patients treated with conventional implants. There were no significant differences in age, sex, presence of diabetes, smoking history or fracture type between the generic and conventional groups. No difference in operative time, estimated blood loss or intraoperative complication rate was observed. No increase in postoperative infection rate, hardware failure, hardware loosening, malunion, nonunion or need for hardware removal was noted. Overall, our hospital realized a 56% reduction in implant costs, an average savings of $1197 per case, and a total savings of $458,080 for the study period. Use of generic orthopaedic implants has been successful at our institution, providing equivalent clinical outcomes while significantly reducing implant expenditures. Based on our data, the use of generic implants has the potential to markedly reduce operative costs as long as quality products are used. Therapeutic Level III.

Evaluating the outcomes of a podiatry-led assessment service in a public hospital orthopaedic unit.

Science.gov (United States)

Bonanno, Daniel R; Medica, Virginia G; Tan, Daphne S; Spring, Anita A; Bird, Adam R; Gazarek, Jana

2014-01-01

In Australia, the demand for foot and ankle orthopaedic services in public health settings currently outweighs capacity. Introducing experienced allied health professionals into orthopaedic units to initiate the triage, assessment and management of patients has been proposed to help meet demand. The aim of this study was to evaluate the effect of introducing a podiatry-led assessment service in a public hospital orthopaedic unit. The outcomes of interest were determining: the proportion of patients discharged without requiring an orthopaedic appointment, agreement in diagnosis between the patient referral and the assessing podiatrist, the proportion of foot and ankle conditions presenting to the service, and the proportion of each condition to require an orthopaedic appointment. This study audited the first 100 patients to receive an appointment at a new podiatry-led assessment service. The podiatrist triaged 'Category 3' referrals consisting of musculoskeletal foot and ankle conditions and appointments were provided for those considered likely to benefit from non-surgical management. Following assessment, patients were referred to an appropriate healthcare professional or were discharged. At the initial appointment or following a period of care, patients were discharged if non-surgical management was successful, surgery was not indicated, patients did not want surgery, and if patient's failed to attend their appointments. All other patients were referred for an orthopaedic consultation as indicated. Ninety-five of the 100 patients (69 females and 31 males; mean age 51.9, SD 16.4 years) attended their appointment at the podiatry-led assessment service. The 95 referrals contained a total of 107 diagnoses, of which the podiatrist agreed with the diagnosis stated on the referral in 56 cases (Kappa =0.49, SE = 0.05). Overall, 34 of the 100 patients were referred to an orthopaedic surgeon and the remaining 66 patients were discharged from the orthopaedic waiting

National Institutes of Health Funding to Departments of Orthopaedic Surgery at U.S. Medical Schools.

Science.gov (United States)

Silvestre, Jason; Ahn, Jaimo; Levin, L Scott

2017-01-18

The National Institutes of Health (NIH) is the largest supporter of biomedical research in the U.S., yet its contribution to orthopaedic research is poorly understood. In this study, we analyzed the portfolio of NIH funding to departments of orthopaedic surgery at U.S. medical schools. The NIH RePORT (Research Portfolio Online Reporting Tools) database was queried for NIH grants awarded to departments of orthopaedic surgery in 2014. Funding totals were determined for award mechanisms and NIH institutes. Trends in NIH funding were determined for 2005 to 2014 and compared with total NIH extramural research funding. Funding awarded to orthopaedic surgery departments was compared with that awarded to departments of other surgical specialties in 2014. Characteristics of NIH-funded principal investigators were obtained from department web sites. In 2014, 183 grants were awarded to 132 investigators at 44 departments of orthopaedic surgery. From 2005 to 2014, NIH funding increased 24.3%, to $54,608,264 (p = 0.030), but the rates of increase seen did not differ significantly from those of NIH extramural research funding as a whole (p = 0.141). Most (72.6%) of the NIH funding was awarded through the R01 mechanism, with a median annual award of $343,980 (interquartile range [IQR], $38,372). The majority (51.1%) of the total funds supported basic science research, followed by translational (33.0%), clinical (10.0%), and educational (5.9%) research. NIH-funded orthopaedic principal investigators were predominately scientists whose degree was a PhD (71.1%) and who were male (79.5%). Eleven NIH institutes were represented, with the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) providing the preponderance (74.2%) of the funding. In 2014, orthopaedic surgery ranked below the surgical departments of general surgery, ophthalmology, obstetrics and gynecology, otolaryngology, and urology in terms of NIH funding received. The percentage increase of NIH

Differential Response of Neural Cells to Trauma-Induced Swelling In Vitro.

Science.gov (United States)

Jayakumar, A R; Taherian, M; Panickar, K S; Shamaladevi, N; Rodriguez, M E; Price, B G; Norenberg, M D

2018-02-01

Brain edema and the associated increase in intracranial pressure are major consequences of traumatic brain injury (TBI) that accounts for most early deaths after TBI. We recently showed that acute severe trauma to cultured astrocytes results in cell swelling. We further examined whether trauma induces cell swelling in neurons and microglia. We found that severe trauma also caused cell swelling in cultured neurons, whereas no swelling was observed in microglia. While severe trauma caused cell swelling in both astrocytes and neurons, mild trauma to astrocytes, neurons, and microglia failed to cell swelling. Since extracellular levels of glutamate are increased in brain post-TBI and microglia are known to release cytokine, and direct exposure of astrocytes to these molecules are known to stimulate cell swelling, we examined whether glutamate or cytokines have any additive effect on trauma-induced cell swelling. Exposure of cultured astrocytes to trauma caused cell swelling, and such swelling was potentiated by the exposure of traumatized astrocytes to glutamate and cytokines. Conditioned medium (CM) from traumatized astrocytes had no effect on neuronal swelling post-trauma, while CM from traumatized neurons and microglia potentiated the effect of trauma on astrocyte swelling. Further, trauma significantly increased the Na-K-Cl co-transporter (NKCC) activity in neurons, and that inhibition of NKCC activity diminished the trauma-induced neuronal swelling. Our results indicate that a differential sensitivity to trauma-induced cell swelling exists in neural cells and that neurons and microglia are likely to be involved in the potentiation of the astrocyte swelling post-trauma.

Evaluation of nutrition deficits in adult and elderly trauma patients.

Science.gov (United States)

Wade, Charles E; Kozar, Rosemary A; Dyer, Carmel B; Bulger, Eileen M; Mourtzakis, Marina; Heyland, Daren K

2015-05-01

As metabolism is often escalated following injury, severely injured trauma patients are at risk for underfeeding and adverse outcomes. From an international database of 12,573 critically ill, adult mechanically ventilated patients, who received a minimum of 3 days of nutrition therapy, trauma patients were identified and nutrition practices and outcomes compared with nontrauma patients. Within the trauma population, we compared nutrition practices and outcomes of younger vs older patients. There were 1279 (10.2%) trauma patients. They were younger, were predominantly male, had lower Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, and had an overall lower body mass index compared with nontrauma patients. Eighty percent of trauma patients received enteral feeding compared with 78% of nontrauma patients. Trauma patients were prescribed more calories and protein yet received similar amounts as nontrauma patients. Nutrition adequacy was reduced in both trauma and nontrauma patients. Survival was higher in trauma patients (86.6%) compared with nontrauma patients (71.8%). When patients who died were included as never discharged, trauma patients were more rapidly discharged from the intensive care unit (ICU) and hospital. Within the trauma population, 17.5% were elderly (≥65 years). The elderly had increased days of ventilation, ICU stay, and mortality compared with younger trauma patients. In a multivariable model, age and APACHE II score, but not nutrition adequacy, were associated with time to discharge alive from the hospital. Significant nutrition deficits were noted in all patients. Elderly trauma patients have worse outcomes compared with younger patients. Further studies are necessary to evaluate whether increased nutrition intake can improve the outcomes of trauma patients, especially geriatric trauma patients. © 2014 American Society for Parenteral and Enteral Nutrition.

Management of the Open Abdomen in Obese Trauma Patients.

Science.gov (United States)

Johnston, Matthew; Safcsak, Karen; Cheatham, Michael L; Smith, Chadwick P

2015-11-01

Obesity incidence in the trauma population is increasing. Abdominal compartment syndrome has poor outcomes when left untreated. Surgeons may treat obese patients differently because of concern for increased morbidity and mortality. We studied the effects of body mass index (BMI) on resource utilization and outcome. An Institutional Review Board-approved retrospective review of trauma patients requiring temporary abdominal closure (TAC) was performed. Patients were stratified as follows: Group 1-BMI = 18.5 to 24.9 kg/m(2), Group 2-BMI = 25 to 29.9 kg/m(2), Group 3-BMI = 30 to 39.9 kg/m(2), Group 4-BMI ≥ 40 kg/m(2). Demographic data, illness severity as defined by Injury Severity Score, Acute Physiology and Chronic Health Evaluation Score Version II and Simplified Acute Physiology Score Version II scores, resource utilization, fascial closure rate, and survival were collected. About 380 patients required TAC. Median age of Group 1 was significantly lower than Groups 2 and 3 (P = 0.001). Severity of illness did not differ. Group 4 had a longer intensive care unit stay compared with Groups 1 and 2 (P = 0.005). Group 4 required mechanical ventilation longer than Group 1 (P = 0.027). Hospital stay, fascial closure, and survival were equivalent. Obese trauma patients with TAC have a longer intensive care unit stay and more ventilator days, but there is no difference in survival or type of closure. TAC can be used safely in trauma patients with a BMI ≥ 30 kg/m(2).

The Malaysian Orthopaedic Association humanitarian mission to Indonesia and Sri Lanka.

Science.gov (United States)

Sharaf, I; Saw, A; Hyzan, Y; Sivananthan, K S

2005-07-01

The tsunami which occurred off the west coast of North Sumatra on December 26, 2004 devastated the coastal areas of North Sumatra, South-West Thailand, South-East India and Sri Lanka killing more than a quarter of a million people. The destruction was enormous with many coastal villages destroyed. The other countries affected were Malaysia, Myanmar, Maldives, Bangladesh, Somalia, Kenya, Tanzania and the Seychelles. In January 2005, volunteers went in weekly rotation to Banda Aceh in collaboration with Global Peace Mission. These were Dr Hyzan Yusof, Dr Suryasmi Duski, Dr Sharaf Ibrahim, Dr Saw Aik, Dr Kamariah Nor and Dr Nor Azlin. In Banda Aceh, the surgical procedures that we could do were limited to external fixation of open fractures and debriding infected wounds at the Indonesian Red Crescent field hospital. In February, a team comprising Dato Dr K S Sivananthan, Dr T Kumar and Dr S Vasan spent a week in Sri Lanka. In Sri Lanka, Dato Sivananthan and his team were able to perform elective orthopaedic operations in Dr Poonambalam Memorial Hospital. We appealed for national and international aid and received support from local hospitals and the orthopaedic industry. International aid bound for Banda Aceh arrived in Kuala Lumpur from the Philippine Orthopaedic Association, the Chiba Children's Hospital in Japan and the Chinese Orthopaedic Association. The COA donated 1.5 tons of orthopaedic equipments. A special handing over ceremony from the COA to the Indonesian Orthopaedic Association was held in Putrajaya in March. Malaysia Airlines flew in the donated equipment to Kuala Lumpur while the onward flight to Aceh was provided by the Royal Malaysian Air Force. In April, Dr Saw Aik and Dr Yong Su Mei joined the Tsu-Chi International Medical Association for volunteer services on Batam Island, Indonesia. The MOA acknowledges the many individuals and organizations, both governmental and non-governmental, for their contributions in the humanitarian efforts.

Regenerative orthopaedics: in vitro, in vivo...in silico.

Science.gov (United States)

Geris, Liesbet

2014-09-01

In silico, defined in analogy to in vitro and in vivo as those studies that are performed on a computer, is an essential step in problem-solving and product development in classical engineering fields. The use of in silico models is now slowly easing its way into medicine. In silico models are already used in orthopaedics for the planning of complicated surgeries, personalised implant design and the analysis of gait measurements. However, these in silico models often lack the simulation of the response of the biological system over time. In silico models focusing on the response of the biological systems are in full development. This review starts with an introduction into in silico models of orthopaedic processes. Special attention is paid to the classification of models according to their spatiotemporal scale (gene/protein to population) and the information they were built on (data vs hypotheses). Subsequently, the review focuses on the in silico models used in regenerative orthopaedics research. Contributions of in silico models to an enhanced understanding and optimisation of four key elements-cells, carriers, culture and clinics-are illustrated. Finally, a number of challenges are identified, related to the computational aspects but also to the integration of in silico tools into clinical practice.

State Variation in Medicaid Reimbursements for Orthopaedic Surgery.

Science.gov (United States)

Lalezari, Ramin M; Pozen, Alexis; Dy, Christopher J

2018-02-07

Medicaid reimbursements are determined by each state and are subject to variability. We sought to quantify this variation for commonly performed inpatient orthopaedic procedures. The 10 most commonly performed inpatient orthopaedic procedures, as ranked by the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample, were identified for study. Medicaid reimbursement amounts for those procedures were benchmarked to state Medicare reimbursement amounts in 3 ways: (1) ratio, (2) dollar difference, and (3) dollar difference divided by the relative value unit (RVU) amount. Variability was quantified by determining the range and coefficient of variation for those reimbursement amounts. The range of variability of Medicaid reimbursements among states exceeded $1,500 for all 10 procedures. The coefficients of variation ranged from 0.32 (hip hemiarthroplasty) to 0.57 (posterior or posterolateral lumbar interbody arthrodesis) (a higher coefficient indicates greater variability), compared with 0.07 for Medicare reimbursements for all 10 procedures. Adjusted as a dollar difference between Medicaid and Medicare per RVU, the median values ranged from -$8/RVU (total knee arthroplasty) to -$17/RVU (open reduction and internal fixation of the femur). Variability of Medicaid reimbursement for inpatient orthopaedic procedures among states is substantial. This variation becomes especially remarkable given recent policy shifts toward focusing reimbursements on value.

Toward the Development of Virtual Surgical Tools to Aid Orthopaedic FE Analyses

Directory of Open Access Journals (Sweden)

Srinivas C. Tadepalli

2010-01-01

Full Text Available Computational models of joint anatomy and function provide a means for biomechanists, physicians, and physical therapists to understand the effects of repetitive motion, acute injury, and degenerative diseases. Finite element models, for example, may be used to predict the outcome of a surgical intervention or to improve the design of prosthetic implants. Countless models have been developed over the years to address a myriad of orthopaedic procedures. Unfortunately, few studies have incorporated patient-specific models. Historically, baseline anatomic models have been used due to the demands associated with model development. Moreover, surgical simulations impose additional modeling challenges. Current meshing practices do not readily accommodate the inclusion of implants. Our goal is to develop a suite of tools (virtual instruments and guides which enable surgical procedures to be readily simulated and to facilitate the development of all-hexahedral finite element mesh definitions.

Development of an orthopedic surgery trauma patient handover checklist.

Science.gov (United States)

LeBlanc, Justin; Donnon, Tyrone; Hutchison, Carol; Duffy, Paul

2014-02-01

In surgery, preoperative handover of surgical trauma patients is a process that must be made as safe as possible. We sought to determine vital clinical information to be transferred between patient care teams and to develop a standardized handover checklist. We conducted standardized small-group interviews about trauma patient handover. Based on this information, we created a questionnaire to gather perspectives from all Canadian Orthopaedic Association (COA) members about which topics they felt would be most important on a handover checklist. We analyzed the responses to develop a standardized handover checklist. Of the 1106 COA members, 247 responded to the questionnaire. The top 7 topics felt to be most important for achieving patient safety in the handover were comorbidities, diagnosis, readiness for the operating room, stability, associated injuries, history/mechanism of injury and outstanding issues. The expert recommendations were to have handover completed the same way every day, all appropriate radiographs available, adequate time, all appropriate laboratory work and more time to spend with patients with more severe illness. Our main recommendations for safe handover are to use standardized checklists specific to the patient and site needs. We provide an example of a standardized checklist that should be used for preoperative handovers. To our knowledge, this is the first checklist for handover developed by a group of experts in orthopedic surgery, which is both manageable in length and simple to use.

Acute coagulopathy of trauma: hypoperfusion induces systemic anticoagulation and hyperfibrinolysis

NARCIS (Netherlands)

Brohi, Karim; Cohen, Mitchell J.; Ganter, Michael T.; Schultz, Marcus J.; Levi, Marcel; Mackersie, Robert C.; Pittet, Jean-François

2008-01-01

BACKGROUND: Coagulopathy is present at admission in 25% of trauma patients, is associated with shock and a 5-fold increase in mortality. The coagulopathy has recently been associated with systemic activation of the protein C pathway. This study was designed to characterize the thrombotic, coagulant

Acute osteomyelitis complicating a simple fracture. A case report.

Science.gov (United States)

Drummond-Webb, J J; Schnaid, E

1983-11-26

Osteomyelitis complicating a simple fracture is unusual, but the reason for its rarity is unknown. We report on a 9-year-old Black boy who developed acute osteomyelitis after sustaining an acute simple fracture of the femur. The causative role of trauma in acute osteomyelitis is discussed and 'the relative resistance of healthy bone' questioned.

Illinois trauma centers and community violence resources

Directory of Open Access Journals (Sweden)

Bennet Butler

2014-01-01

Full Text Available Background: Elder abuse and neglect (EAN, intimate partner violence (IPV, and street-based community violence (SBCV are significant public health problems, which frequently lead to traumatic injury. Trauma centers can provide an effective setting for intervention and referral, potentially interrupting the cycle of violence. Aims: To assess existing institutional resources for the identification and treatment of violence victims among patients presenting with acute injury to statewide trauma centers. Settings and Design: We used a prospective, web-based survey of trauma medical directors at 62 Illinois trauma centers. Nonresponders were contacted via telephone to complete the survey. Materials and Methods: This survey was based on a survey conducted in 2004 assessing trauma centers and IPV resources. We modified this survey to collect data on IPV, EAN, and SBCV. Statistical Analysis: Univariate and bivariate statistics were performed using STATA statistical software. Results: We found that 100% of trauma centers now screen for IPV, an improvement from 2004 (P = 0.007. Screening for EAN (70% and SBCV (61% was less common (P < 0.001, and hospitals thought that resources for SBCV in particular were inadequate (P < 0.001 and fewer resources were available for these patients (P = 0.02. However, there was lack of uniformity of screening, tracking, and referral practices for victims of violence throughout the state. Conclusion: The multiplicity of strategies for tracking and referring victims of violence in Illinois makes it difficult to assess screening and tracking or form generalized policy recommendations. This presents an opportunity to improve care delivered to victims of violence by standardizing care and referral protocols.

CT characteristics of Morel-Lavallee lesions: an under-recognized but significant finding in acute trauma imaging

International Nuclear Information System (INIS)

McKenzie, Gavin A.; Niederhauser, Blake D.; Collins, Mark S.; Howe, Benjamin M.

2016-01-01

To highlight the significance and imaging characteristics of Morel-Lavallee (ML) lesions, which have been well characterized on MRI, but are potentially under-recognized on CT. Twenty-eight Morel-Lavallee lesions were identified in 18 patients and were all clinically or surgically confirmed. Lesions were grouped into acute (<3 days), subacute (3-30 days), and chronic (>30 days) at the time of CT imaging. Charts were reviewed to gather patient characteristics, injury patterns, radiologist interpretation, treatment, and outcomes. Sixteen male and 2 female patients with a mean age of 50 years (range 19-80) at the date of their initial evaluation were identified. All patients had significant trauma that accounted for 28 ML lesions, all of which were in a characteristic subcutaneous location overlying the muscular fascial plane. Lesions on CT went through an evolution from hyperdense, poorly or moderately marginated without a pseudocapsule to being hypodense, with internal fat globules or septations and well marginated with a complete enhancing pseudocapsule. Only 1 (4 %) of the ML lesions was suggested and 7 (25 %) lesions were not commented on at all by the interpreting radiologist. Morel-Lavallee lesions are post-traumatic closed, internal, soft-tissue, degloving lesions that are potentially underrecognized on CT. Most acute ML lesions are nonspecific, resembling simple hematomas or contusions. ML lesions evolve as they age with subacute and chronic lesions demonstrating the known features described on MR imaging that should allow for an accurate imaging diagnosis. (orig.)

RADIOLOGY EDUCATION: A PILOT STUDY TO ASSESS KNOWLEDGE OF MEDICAL STUDENTS REGARDING IMAGING IN TRAUMA.

Science.gov (United States)

Siddiqui, Saad; Saeed, Muhammad Anwar; Shah, Noreen; Nadeem, Naila

2015-01-01

Trauma remains one of the most frequent presentations in emergency departments. Imaging has established role in setting of acute trauma with ability to identify potentially fatal conditions. Adequate knowledge of health professionals regarding trauma imaging is vital for improved healthcare. In this work we try to assess knowledge of medical students regarding imaging in trauma as well as identify most effective way of imparting radiology education. This cross-sectional pilot study was conducted at Aga Khan University Medical College & Khyber Girls Medical College, to assess knowledge of medical students regarding imaging protocols practiced in initial management of trauma patients. Only 40 & 20% respectively were able to identify radiographs included in trauma series. Very few had knowledge of correct indication for Focused abdominal sonography in trauma. Clinical radiology rotation was reported as best way of learning radiology. Change in curricula & restructuring of clinical radiology rotation structure is needed to improve knowledge regarding Trauma imaging.

AN ASSESSMENT OF THE NEED OF POLICE OFFICIALS FOR TRAUMA INTERVENTION PROGRAMMES – A QUALITATIVE APPROACH

Directory of Open Access Journals (Sweden)

Strydom, Herman

2015-09-01

Full Text Available lOfficials in the South African Police Service (SAPS are exposed to multiple traumatic incidents. The effect of such exposure is aggravated by various contributing factors that may cause intense trauma for the individual, family members and the police service. The risk factors include post-traumatic stress, acute stress, depression, alcohol abuse, suicide and impaired productivity. It is therefore important that officials have direct access to support. The efficacy of the present trauma intervention programmes in the SAPS is questioned, because despite their implementation police officials still present high levels of acute and behavioural problems

The spectrum of orthopaedics at Chris Hani Baragwanath Academic Hospital

OpenAIRE

Pillay, J; Ramokgopa, MT

2013-01-01

Chris Hani Baragwanath Academic Hospital (CHBAH) is the third largest hospital in the world and is the largest in the Southern hemisphere, serving a population of more than 3.5 million people.¹ The purpose of this review is to identify the orthopaedic-related health events that occur within the population being serviced by the hospital, and in doing so provide a tool to be used for improving orthopaedic-related patient care and outcomes in public health services.² We also took special interes...

Orthopaedic nurses' perception of research utilization - A cross sectional survey

DEFF Research Database (Denmark)

Berthelsen, Connie Bøttcher; Hølge-Hazelton, Bibi

2015-01-01

The call for evidence-based knowledge in clinical nursing practice has increased during recent decades and research in orthopaedic nursing is needed to improve patients' conditions, care and treatment. A descriptive cross-sectional survey was conducted to determine the self-perceived theoretical....... The results indicated that despite the majority of orthopaedic nurses having low self-perceived theoretical knowledge and practical research competencies, their interest and motivation to improve these were high, especially their inner motivation. However, the nurses' inner motivation was inhibited by a lack...

Burnout and quality of life among orthopaedic trainees in a modern educational programme

NARCIS (Netherlands)

van Vendeloo, S. N.; Brand, P. L. P.; Verheyen, C. C. P. M.

We aimed to determine quality of life and burnout among Dutch orthopaedic trainees following a modern orthopaedic curriculum, with strict compliance to a 48-hour working week. We also evaluated the effect of the clinical climate of learning on their emotional wellbeing. We assessed burnout, quality

Hematologic disorders in trauma patients during parenteral alimentation with lipids.

Science.gov (United States)

Faintuch, J; Machado, F K; Freire, A N; Reis, J R; Machado, M; Pinto, L P; Ramos, S M; Loebens, M; Jovchelevich, V; Pinotti, H W

1996-01-01

Total parenteral nutrition with lipids is a well-accepted modality of metabolic support in seriously ill trauma patients. Intolerance to lipid administration is unusual when dosage limits are not exceeded, and few hematologic disturbances have been recorded with modern fat emulsions. In the course of intravenous alimentation of six adults admitted for traumatic lesions, eosinophilia with or without leukocytopenia was noticed after periods of four days to five weeks. Principal clinical events and hematologic derangements were documented in this population. Sepsis was not always present in the patients by the time of the complication, and in those that did require antibiotics and other drugs, the prescription remained unchanged along the episode. Discontinuation of the nutritional regimen with lipids was followed by normalization of the hematologic profile, suggesting that an acute or sub-acute allergic reaction was responsible. The appearance of skin rash in two occasions reinforces this hypothesis, and the possibility of hemophagocytosis merits consideration in two of the cases who displayed reversible acute leukocytopenia. It is concluded that blood cell aberrations are possible during intravenous feeding with lipids in trauma subjects, but tend to respond to suppression of the lipid-containing nutritional prescription.

Decellularized Tissue and Cell-Derived Extracellular Matrices as Scaffolds for Orthopaedic Tissue Engineering

Science.gov (United States)

Cheng, Christina W.; Solorio, Loran D.; Alsberg, Eben

2014-01-01

The reconstruction of musculoskeletal defects is a constant challenge for orthopaedic surgeons. Musculoskeletal injuries such as fractures, chondral lesions, infections and tumor debulking can often lead to large tissue voids requiring reconstruction with tissue grafts. Autografts are currently the gold standard in orthopaedic tissue reconstruction; however, there is a limit to the amount of tissue that can be harvested before compromising the donor site. Tissue engineering strategies using allogeneic or xenogeneic decellularized bone, cartilage, skeletal muscle, tendon and ligament have emerged as promising potential alternative treatment. The extracellular matrix provides a natural scaffold for cell attachment, proliferation and differentiation. Decellularization of in vitro cell-derived matrices can also enable the generation of autologous constructs from tissue specific cells or progenitor cells. Although decellularized bone tissue is widely used clinically in orthopaedic applications, the exciting potential of decellularized cartilage, skeletal muscle, tendon and ligament cell-derived matrices has only recently begun to be explored for ultimate translation to the orthopaedic clinic. PMID:24417915

Blunt ocular trauma at the posterior pole in optical coherence tomography and fluorescein angiography

International Nuclear Information System (INIS)

Meyer, C.H.; Eter, N.; Mennel, S.; Kroll, P.

2007-01-01

Blunt ocular trauma at the posterior pole may involve a variety of retinal structures. We examined the most frequent retinal trauma (choroidal folds, commotion retinae, choroidal rupture, valsalva retinopathy, PPE-tears, Purtscher's Retinopathy etc.) by optical coherence tomography (OCT). The damaged pre-, intra- or subretinal structures were clearly visible. The OCT is during acute and chronic phases of different traumatic events an important diagnostic tool. (author) [de