Trauma

You are looking at 1 - 10 of 66 items

Marc Saab CHU Lille, Orthopaedic and Traumatology Department, Hôpital Roger Salengro, Lille, France
University of Lille, INSERM, CHU Lille, U1008 – Advanced Drug Delivery Systems and Biomaterials, Lille, France

Search for other papers by Marc Saab in
Google Scholar
PubMed
Close
,
Cédric Zobrist University of Lille, CNRS, INRAE, Centrale Lille, UMR 8207 – UMET – Unité Matériaux et Transformations, Lille, France

Search for other papers by Cédric Zobrist in
Google Scholar
PubMed
Close
,
Nicolas Blanchemain University of Lille, INSERM, CHU Lille, U1008 – Advanced Drug Delivery Systems and Biomaterials, Lille, France

Search for other papers by Nicolas Blanchemain in
Google Scholar
PubMed
Close
,
Bernard Martel University of Lille, CNRS, INRAE, Centrale Lille, UMR 8207 – UMET – Unité Matériaux et Transformations, Lille, France

Search for other papers by Bernard Martel in
Google Scholar
PubMed
Close
, and
Feng Chai University of Lille, INSERM, CHU Lille, U1008 – Advanced Drug Delivery Systems and Biomaterials, Lille, France

Search for other papers by Feng Chai in
Google Scholar
PubMed
Close

Purpose

  • The aim of this study was to conduct a systematic literature review analyzing the results of in vivo rat femoral defect models using biomaterials for improving the induced membrane technique (IMT).

Methods

  • Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the PubMed, Embase, and Web of Science databases were searched. Inclusion criteria were studies reporting results of the IMT in in vivo rat femoral critical-sized defect models using a biomaterial possibly combined with molecules. Methodologic quality was assessed with the Animal Research: Reporting In Vivo Experiments guidelines.

Results

  • Twenty studies met the inclusion criteria. Femoral stabilization with plate and screws was the most frequent. Histologic, biomechanical, and/or radiologic analyses were performed. In two-stage strategies, the PMMA spacer could be associated with bioactive molecules to enhance IM growth factor expression and improve bone formation. Modulating the roughness of spacers could increase IM thickness and accelerate its formation. In one-stage strategies, human tissue-derived membranes combined with bone grafting achieved bone formation comparable to a standard IMT. All calcium phosphate grafts seemed to require a functionalization with growth factors or bone marrow mononuclear cells to improve outcomes compared with non-functionalized grafts.

Conclusion

  • This systematic review described the main parameters of the in vivo rat femoral defect models using biomaterials to improve the induced membrane technique. Although the studies included had several methodological limitations that may limit the scope of these conclusions, one- and two-stage strategies reported promising results with biomaterials to improve the IMT.

Open access
Vanessa Morello Division of Orthopaedic and Trauma Surgery, University Hospitals of Geneva, Geneva, Switzerland

Search for other papers by Vanessa Morello in
Google Scholar
PubMed
Close
and
Axel Gamulin Division of Orthopaedic and Trauma Surgery, University Hospitals of Geneva, Geneva, Switzerland

Search for other papers by Axel Gamulin in
Google Scholar
PubMed
Close

Introduction

  • Acute compartment syndrome (ACS) is an orthopedic emergency that may lead to devastating sequelae. Diagnosis may be difficult. The aim of this systematic review is to identify clinical and radiological risk factors for ACS occurrence in tibial fractures.

Methods

  • PubMed® database was searched in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. Additional articles were found by a manual research of selected references and authors’ known articles.

Results

  • The identification process individualized 2758 via database and 30 via other methods. After screening and eligibility assessment, 29 articles were included. Age, gender, occupation, comorbidities, medications, habits, polytrauma, multiple injuries, mechanism, sports, site, open vs closed, contiguous lesion, classification, and pattern were found to be related to ACS occurrence.

Conclusions

  • Younger age and male gender are strong independent risk factors in tibial plateau and shaft fractures. High-energy fractures, polytrauma, more proximal fractures and fractures with contiguous skeletal lesions are aggravating risk factors; higher AO/OTA and Schatzker classification types, increased displacement of the tibia relative to the femur, and increased tibial joint surface width are associated risk factors in tibial plateau fractures; higher AO Foundation/Orthopaedic Trauma Association classification types and subgroups and more proximal fractures within the diaphysis are associated risk factors in tibial shaft fracture. Open fractures do not prevent ACS occurrence. Increased fracture length is the only factor suggesting a higher risk of ACS in tibial pilon fractures. The presence of each independent predictor may have a cumulative effect increasing the risk of ACS occurrence.

Open access
Mehnoor Khaliq Leeds Orthopaedic & Trauma Sciences, School of Medicine, University of Leeds, Leeds, England

Search for other papers by Mehnoor Khaliq in
Google Scholar
PubMed
Close
,
Vasileios P Giannoudis Leeds Orthopaedic & Trauma Sciences, School of Medicine, University of Leeds, Leeds, England

Search for other papers by Vasileios P Giannoudis in
Google Scholar
PubMed
Close
,
Jeya Palan Leeds Teaching Hospitals NHS Trust, Leeds, England

Search for other papers by Jeya Palan in
Google Scholar
PubMed
Close
,
Hemant G Pandit Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, England

Search for other papers by Hemant G Pandit in
Google Scholar
PubMed
Close
, and
Bernard H van Duren Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, England

Search for other papers by Bernard H van Duren in
Google Scholar
PubMed
Close

  • Patients undergoing planned or unplanned orthopaedic procedures involving their upper or lower extremity can prevent them from safe and timely return to driving, where they commonly ask, ‘Doctor, when can I drive?’ Driving recommendations after such procedures are varied. The current evidence available is based on a heterogenous data set with varying degrees of sample size and markedly differing study designs.

  • This instructional review article provides a scoping overview of studies looking at return to driving after upper or lower extremity surgery in both trauma and elective settings and, where possible, to provide clinical recommendations for return to driving.

  • Medline, EMBASE, SCOPUS, and Web of Science databases were searched according to a defined search protocol to elicit eligible studies. Articles were included if they reviewed adult drivers who underwent upper or lower extremity orthopaedic procedures, were written in English, and offered recommendations about driving.

  • A total of 68 articles were included in the analysis, with 36 assessing the lower extremity and 37 reviewing the upper extremity. The evidence available from the studies reviewed was of poor methodological quality. There was a lack of adequately powered, high quality, randomised controlled trials (RCTs) with large sample sizes to assess safe return to driving for differing subset of injuries.

  • Many articles provide generic guidelines on return to driving when patients feel safe to perform an emergency stop procedure with adequate steering wheel control.

  • In future, RCTs should be performed to develop definitive return to driving protocols in patients undergoing upper and lower extremity procedures.

Open access
Markus Jaschke Department of Orthopaedics, Traumatology and Oncology of the Musculoskeletal System, Pomeranian Medical University Szczecin, Poland

Search for other papers by Markus Jaschke in
Google Scholar
PubMed
Close
,
Krzysztof Rekawek Department of Orthopaedics, Traumatology and Oncology of the Musculoskeletal System, Pomeranian Medical University Szczecin, Poland

Search for other papers by Krzysztof Rekawek in
Google Scholar
PubMed
Close
,
Sebastian Sokolowski Department of Orthopaedics, Traumatology and Oncology of the Musculoskeletal System, Pomeranian Medical University Szczecin, Poland

Search for other papers by Sebastian Sokolowski in
Google Scholar
PubMed
Close
, and
Lukasz Kolodziej Department of Orthopaedics, Traumatology and Oncology of the Musculoskeletal System, Pomeranian Medical University Szczecin, Poland

Search for other papers by Lukasz Kolodziej in
Google Scholar
PubMed
Close

  • Distal biceps tendon (DBT) is a relatively rare injury mainly occurring in middle-aged men while in eccentric biceps muscle contraction.

  • Clinical appearance with proximal avulsion of the muscle and specific clinical tests are most of the time sufficient for diagnosing DBT, but if needed ultrasonography and MRI, most often in FABS view, can be used to ensure diagnosis of DBT and partial DBT.

  • Surgical anatomical reinsertion has shown to be a successful method of treatment, although conservative treatment can be initiated in older patients.

  • Two different approaches are described in literature: single- and double-incision techniques with different fixation methods proving to have similarly good results.

  • Major complications of surgical intervention are posterior interosseous nerve palsy and symptomatic heterotropic ossification.

  • Overall outcome of surgical intervention has shown high subjective satisfaction with slight weakness in flexion and supination but mostly without loss in range of motion.

Open access
J Tomás Rojas Shoulder, Elbow and Orthopaedic Sports Medicine, Orthopädie Sonnenhof, Bern, Switzerland
Department of Orthopaedics and Trauma Surgery, Hospital San José – Clínica Santa María, Santiago, Chile

Search for other papers by J Tomás Rojas in
Google Scholar
PubMed
Close
,
Mustafa S Rashid Department of Trauma & Orthopaedic Surgery, Wrightington Hospital, Wigan, United Kingdom

Search for other papers by Mustafa S Rashid in
Google Scholar
PubMed
Close
, and
Matthias A Zumstein Shoulder, Elbow and Orthopaedic Sports Medicine, Orthopädie Sonnenhof, Bern, Switzerland
Shoulder, Elbow Unit, Sportsclinicnumber1, Bern, Switzerland
Shoulder, Elbow and Orthopaedic Sports Medicine, Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, Bern, Switzerland
Campus Stiftung Lindenhof Bern, Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland

Search for other papers by Matthias A Zumstein in
Google Scholar
PubMed
Close

  • Shoulder stiffness is a frequent complication after proximal humeral fractures treated with or without surgery. Shoulder stiffness is associated with high rates of absence from work and a significant financial burden for the healthcare system.

  • Secondary stiffness is characterized by additional extracapsular adhesions, including subacromial, subcoracoid, and subdeltoid spaces, usually derived from post-fracture or post-surgical extraarticular hematomas.

  • Several secondary causes may coexist with capsular and extracapsular adhesions decreasing the shoulder motion, such as malunion, nonunion, metalwork failure, infection, and osteoarthritis, among others.

  • Conservative treatment, usually prescribed for primary shoulder stiffness, has shown unfavorable results in secondary stiffness, and surgical intervention may be required.

  • Surgical interventions need to be patient-specific. Usually, open or arthroscopic fibro-arthrolysis and subacromial release are performed, together with plate removal and biceps tenotomy/tenodesis. In severe osteoarthritis, shoulder replacement may be indicated. Ruling out infection is recommended in every case.

Open access
Lorenzo Massimo Oldrini Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland

Search for other papers by Lorenzo Massimo Oldrini in
Google Scholar
PubMed
Close
,
Alessandro Sangiorgio Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland

Search for other papers by Alessandro Sangiorgio in
Google Scholar
PubMed
Close
,
Pietro Feltri Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland

Search for other papers by Pietro Feltri in
Google Scholar
PubMed
Close
,
Francesco Marbach Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland

Search for other papers by Francesco Marbach in
Google Scholar
PubMed
Close
,
Giuseppe Filardo Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland

Search for other papers by Giuseppe Filardo in
Google Scholar
PubMed
Close
, and
Christian Candrian Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland

Search for other papers by Christian Candrian in
Google Scholar
PubMed
Close

Purpose

  • To compare the two main surgical approaches to address proximal humerus fractures (PHFs) stratified for Neer fracture types, to demonstrate which approach gives the best result for each fracture type.

Methods

  • A literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in PubMed, Web of Science, and Cochrane databases up to 4 January 2022. Inclusion criteria were studies comparing open reduction and internal fixation (ORIF) with deltopectoral (DP) approach and minimally invasive plate osteosynthesis (MIPO) with deltosplit (DS) approach of PHFs. Patient’s demographic data, fracture type, Constant–Murley Score (CMS), operation time, blood loss, length of hospital stay, complications, fluoroscopy time, and radiological outcomes were extracted. Results were stratified for each type of Neer fracture.

Results

  • Eleven studies (798 patients) were included in the meta-analysis. No functional difference was found in the CMS between the two groups for each type of Neer (P = n.s.): for PHFs Neer II, the mean CMS was 72.5 (s.e. 5.9) points in the ORIF group and 79.6 (s.e. 2.5) points in the MIPO group; for Neer III, 77.8 (s.e. 2.0) in the ORIF and 76.4 (se 3.0) in the MIPO; and for Neer IV, 70.6 (s.e. 2.7) in the ORIF and 60.9 (s.e. 6.3) in the MIPO. The operation time in the MIPO group was significantly lower than in the ORIF group for both Neer II (P = 0.0461) and Neer III (P = 0.0037) fractures.

Conclusion

  • The MIPO with DS approach demonstrated no significant differences in the results to the ORIF with DP approach for the different Neer fractures in terms of functional results, with a similar outcome, especially for the Neer II and III fracture types. The MIPO technique proved to be as safe and effective as the ORIF approach.

Open access
Cora Rebecca Schindler Department of Trauma-, Hand and Reconstructive Surgery, University Hospital Frankfurt, Frankfurt am Main, Germany

Search for other papers by Cora Rebecca Schindler in
Google Scholar
PubMed
Close
,
Ramona Sturm Department of Trauma-, Hand and Reconstructive Surgery, University Hospital Frankfurt, Frankfurt am Main, Germany

Search for other papers by Ramona Sturm in
Google Scholar
PubMed
Close
,
Jason Alexander Hörauf Department of Trauma-, Hand and Reconstructive Surgery, University Hospital Frankfurt, Frankfurt am Main, Germany

Search for other papers by Jason Alexander Hörauf in
Google Scholar
PubMed
Close
,
Ingo Marzi Department of Trauma-, Hand and Reconstructive Surgery, University Hospital Frankfurt, Frankfurt am Main, Germany

Search for other papers by Ingo Marzi in
Google Scholar
PubMed
Close
, and
Philipp Störmann Department of Trauma-, Hand and Reconstructive Surgery, University Hospital Frankfurt, Frankfurt am Main, Germany

Search for other papers by Philipp Störmann in
Google Scholar
PubMed
Close

  • ‘Damage control’ is the therapeutic strategy in the treatment of polytraumatized patients and aims at securing vital functions and controlling bleeding with a favorable effect on the post-traumatic immune response.

  • The post-traumatic immune dysfunction is based on a disturbed balance between immunostimulatory and anti-inflammatory mechanisms. The extent of the immunological ‘second hit’ can be limited by delaying deferable surgical therapies until organ stabilization has been achieved by the treating surgeon.

  • Pelvic sling is easy to apply and noninvasive with effective pelvic reduction. Pelvic angiography vs pelvic packing are not antagonistic, but rather should be considered as complementary methods.

  • Operating as early as possible on unstable spinal injuries with confirmed or suspected neurological deficits by decompression and stabilization with a dorsal internal fixator.

  • Dislocations, unstable or open fracture, vascular involvement, and compartment syndrome are considered emergency indications. In extremity fracture treatment, primary definitive osteosynthesis is often dispensed with and instead, temporary stabilization with an external fixator is performed.

Open access
Vasileios P Giannoudis Major Trauma Centre, Leeds Teaching Hospitals NHS Trust
Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, United Kingdom

Search for other papers by Vasileios P Giannoudis in
Google Scholar
PubMed
Close
,
Paul Rodham Major Trauma Centre, Leeds Teaching Hospitals NHS Trust
Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, United Kingdom

Search for other papers by Paul Rodham in
Google Scholar
PubMed
Close
,
Peter V Giannoudis Major Trauma Centre, Leeds Teaching Hospitals NHS Trust
Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, United Kingdom

Search for other papers by Peter V Giannoudis in
Google Scholar
PubMed
Close
, and
Nikolaos K Kanakaris Major Trauma Centre, Leeds Teaching Hospitals NHS Trust
Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, United Kingdom

Search for other papers by Nikolaos K Kanakaris in
Google Scholar
PubMed
Close

  • Management of severely injured patients remains a challenge, characterised by a number of advances in clinical practice over the last decades. This evolution refers to all different phases of patient treatment from prehospital to the long-term rehabilitation of the survivors.

  • The spectrum of injuries and their severity is quite extensive, which dictates a clear understanding of the existing nomenclature.

  • What is defined nowadays as polytrauma or major trauma, together with other essential terms used in the orthopaedic trauma literature, is described in this instructional review.

  • Furthermore, an analysis of contemporary management strategies (early total care (ETG), damage control orthopaedics (DCO), early appropriate care (EAC), safe definitive surgery (SDS), prompt individualised safe management (PRISM) and musculoskeletal temporary surgery (MuST)) advocated over the last two decades is presented.

  • A focused description of new methods and techniques that have been introduced in clinical practice recently in all different phases of trauma management will also be presented.

  • As the understanding of trauma pathophysiology and subsequently the clinical practice continuously evolves, as the means of scientific interaction and exchange of knowledge improves dramatically, observing different standards between different healthcare systems and geographic regions remains problematic.

  • Positive impact on the survivorship rates and decrease in disability can only be achieved with teamwork training on technical and non-technical skills, as well as with efficient use of the available resources.

Open access
Luke Turley Department of Orthopaedics, Midland Regional Hospital Tullamore, Tullamore, Ireland

Search for other papers by Luke Turley in
Google Scholar
PubMed
Close
,
Ian Barry Department of Plastic Surgery, Royal Perth Hospital, Perth, Western Australia, Australia

Search for other papers by Ian Barry in
Google Scholar
PubMed
Close
, and
Eoin Sheehan Department of Orthopaedics, Midland Regional Hospital Tullamore, Tullamore, Ireland

Search for other papers by Eoin Sheehan in
Google Scholar
PubMed
Close

Background

  • Open tibial shaft fractures comprise almost 45% of all open fractures and are frequently the result of high-energy trauma. Due to contamination, limited soft tissue coverage of the tibial shaft and poor tibial blood supply, open tibial shaft fractures are associated with high rates of complication including malunion, non-union and infection. Intramedullary nailing (IMN) is a mainstay of treatment. This study aims to determine the frequency of the various complications in this cohort.

Methods

  • A systematic review of papers published on Embase, PubMed and Cochrane databases pertaining to the use of IMN to fix open tibial shaft fractures were included. The available evidence was collated in regard to the incidence of union, malunion, non-union and infection seen in this cohort.

Results

  • A total of 2767 citations were reviewed, and 17 studies comprising 1850 patients were included in the analysis. There was a delayed union rate of 22.4%, malunion rate of 8.3%, non-union rate of 9.7% and infection rate of 8.1% (95% CI: 5.7%–10.8%) in this patient cohort. Subgroup analysis showed a 3-fold increase in non-union and a 2-fold increase in deep infection among Gustilo III injuries compared to Gustilo I and II.

Conclusions

  • IMN for open tibial shaft fractures results in high rates of union and low rates of infection, comparable to figures seen in closed injuries and superior to those seen with alternative methods of fixation. There is a substantially increased risk of complication associated with Gustilo III injuries, reinforcing the significance of the soft tissue injury in these patients.

Open access
Andrew J Harrison Bioventus International, Taurusavenue, Hoofddorp, Netherlands

Search for other papers by Andrew J Harrison in
Google Scholar
PubMed
Close
,
Michael R Redler Connecticut Orthopaedics, Department of Orthopaedics, University of Virginia, Frank H. Netter School of Medicine, Quinnipiac University, USA

Search for other papers by Michael R Redler in
Google Scholar
PubMed
Close
,
David M Taylor Leeds General Infirmary, Leeds, UK

Search for other papers by David M Taylor in
Google Scholar
PubMed
Close
,
Ansar Mahmood Department Trauma & Orthopaedic Surgery, Queen Elizabeth Hospital, Birmingham, UK

Search for other papers by Ansar Mahmood in
Google Scholar
PubMed
Close
,
John T Jones Statistician - Raleigh, NC

Search for other papers by John T Jones in
Google Scholar
PubMed
Close
,
Yukihiro Arai Department of Orthopaedic Surgery, Teikyo University School of Medicine

Search for other papers by Yukihiro Arai in
Google Scholar
PubMed
Close
, and
Yoshinobu Watanabe Department of Orthopaedic Surgery, Teikyo University School of Medicine

Search for other papers by Yoshinobu Watanabe in
Google Scholar
PubMed
Close

  • Low-intensity pulsed ultrasound (LIPUS) treatment of fractures has been available to the orthopaedic community for nearly three decades; however, it is still considered an experimental treatment by some clinicians, even though there is a wealth of clinical data.

  • Based on the evaluation of clinical trial data, we have established key criteria which can lead to LIPUS success and avoid failure. These are fracture gap size and stability, accurate transducer placement and minimum treatment number.

  • However, from a clinician’s view, the correct attitude to treatment must be observed, and this has also been discussed.

  • It is hoped, armed with this new evaluation of the clinical data, that clinicians can treat patients with LIPUS more effectively, resulting in fewer failures of treatment.

Open access