Trauma

You are looking at 61 - 70 of 76 items

Abdel Rahim Elniel Leeds Teaching Hospitals Trust, UK

Search for other papers by Abdel Rahim Elniel in
Google Scholar
PubMed
Close
and
Peter V. Giannoudis Academic Department of Trauma and Orthopaedics, Leeds Teaching Hospitals, University of Leeds, UK; NIHR Leeds Biomedical Research Unit, Chapel Allerton Hospital, UK

Search for other papers by Peter V. Giannoudis in
Google Scholar
PubMed
Close

  • Open fractures of the lower extremity are the most common open long bone injuries, yet their management remains a topic of debate.

  • This article discusses the basic tenets of management and the subsequent impact on clinical outcome. These include the rationale for initial debridement, antimicrobial cover, addressing the soft-tissue injury and definitive skeletal management.

  • The classification of injury severity continues to be a useful tool in guiding treatment and predicting outcome and prognosis. The Gustilo-Anderson classification continues to be the mainstay, but the adoption of severity scores such as the Ganga Hospital score may provide additional predictive utility.

  • Recent literature has challenged the perceived need for rapid debridement within 6 hours and the rationale for prolonged antibiotic therapy in the open fracture. The choice of definitive treatment must be decided against known efficacy and injury severity/type.

  • Recent data demonstrate better outcomes with internal fixation methods in most open tibial fractures, but external fixation continues to be an appropriate choice in more severe injuries. The incidence of infection and non-union has decreased with new treatment approaches but continues to be a source of significant morbidity and mortality.

  • Assessment of functional outcome using various measures has been prevalent in the literature, but there is limited consensus regarding the best measures to be used.

Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.170072

Open access
Pedro Cano-Luís Orthopaedic Surgery and Traumatology Department, Hospital Universitario Virgen del Rocío, Spain

Search for other papers by Pedro Cano-Luís in
Google Scholar
PubMed
Close
,
Miguel Ángel Giráldez-Sánchez Orthopaedic Surgery and Traumatology Department, Hospital Universitario Virgen del Rocío, Spain

Search for other papers by Miguel Ángel Giráldez-Sánchez in
Google Scholar
PubMed
Close
, and
Pablo Andrés-Cano Orthopaedic Surgery and Traumatology Department, Hospital Universitario Virgen del Rocío, Spain

Search for other papers by Pablo Andrés-Cano in
Google Scholar
PubMed
Close

  • The most common cause of post-traumatic pelvic asymmetry is, by far, initial nonoperative treatment.

  • Open reduction and internal fixation of unstable pelvic fractures are recommended to avoid pelvic nonunion or subsequent structural deformities.

  • The most common symptom is pelvic pain. Pelvic instability is another symptom, as well as persistent urogenital problems and neurological sequelae.

  • Preoperative evaluation of these patients requires careful clinical and functional assessment, in addition to a complete radiological study.

  • Surgical treatment of pelvic fracture nonunions is technically demanding and has potentially serious complications.

  • We have developed a new classification that modifies and completes Mears and Velyvis’s classification in which we highlight two types of post-traumatic sequelae with different clinical conditions and whose basic differentiating element is whether pelvic deformity is present or not. Based on this classification, we have established our strategy of surgical treatment.

Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.170069.

Open access
Horacio Caviglia Department of Orthopaedic Surgery and Traumatology, Dr. Juan A. Fernández General Hospital, Argentina.

Search for other papers by Horacio Caviglia in
Google Scholar
PubMed
Close
,
Adrian Mejail Department of Orthopaedic Surgery and Traumatology, Dr. Juan A. Fernández General Hospital, Argentina.

Search for other papers by Adrian Mejail in
Google Scholar
PubMed
Close
,
Maria Eulalia Landro Department of Orthopaedic Surgery and Traumatology, Dr. Juan A. Fernández General Hospital, Argentina.

Search for other papers by Maria Eulalia Landro in
Google Scholar
PubMed
Close
, and
Nosratolah Vatani Department of Orthopaedic Surgery and Traumatology, Dr. Juan A. Fernández General Hospital, Argentina.

Search for other papers by Nosratolah Vatani in
Google Scholar
PubMed
Close

  • The objective of surgery for acetabular fractures is to achieve precise reduction to restore joint congruence, fix internal bone fragments, avoid displacement of the fracture and allow rapid rehabilitation.

  • Open reduction and internal fixation is the benchmark method for displaced acetabular fractures, but open reductions can increase morbidity, causing neurovascular injury, blood loss, heterotopic bone formation, infection and poor wound healing.

  • An anatomical reduction with a gap of 2 mm or less is a predictor of good joint function and reduced risk of post-traumatic osteoarthritis.

  • The percutaneous approach is associated with fewer complications than open techniques, but acetabular geometry makes percutaneous screw insertion a challenging procedure.

  • The percutaneous technique is recommended for non-displaced or slightly displaced fractures, and in obese, osteoporotic and elderly patients who cannot receive total joint arthroplasty.

  • We recommend the use of intramedullary cannulated screws.

  • Fracture reductions are achieved by manual traction of the affected bones. If some fracture displacement remains, accessory windows can be used to introduce a ball spike pusher, a hook or a Steinmann pin which can be used as a joystick to rotate the fracture.

  • In this paper, we describe the accessory windows for the anterior column, the quadrilateral plate and the posterior column. We detail the position, direction and kind of screws used to stabilize the anterior and posterior columns.

Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.170054

Open access
Philipp Schleicher Zentrum für Wirbelsäulenchirurgie und Neurotraumatologie, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Germany

Search for other papers by Philipp Schleicher in
Google Scholar
PubMed
Close
,
Andreas Pingel Zentrum für Wirbelsäulenchirurgie und Neurotraumatologie, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Germany

Search for other papers by Andreas Pingel in
Google Scholar
PubMed
Close
, and
Frank Kandziora Zentrum für Wirbelsäulenchirurgie und Neurotraumatologie, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Germany

Search for other papers by Frank Kandziora in
Google Scholar
PubMed
Close

  • Cervical spine injuries are frequent and often caused by a blunt trauma mechanism. They can have severe consequences, with a high mortality rate and a high rate of neurological lesions.

  • Diagnosis is a three-step process: 1) risk assessment according to the history and clinical features, guided by a clinical decision rule such as the Canadian C-Spine rule; 2) imaging if needed; 3) classification of the injury according to different classification systems in the different regions of the cervical spine.

  • The urgency of treatment is dependent on the presence of a neurological lesion and/or instability. The treatment strategy depends on the morphological criteria as defined by the classification.

Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.170076

Open access
Vasileios Lampridis Frimley Park Hospital, UK

Search for other papers by Vasileios Lampridis in
Google Scholar
PubMed
Close
,
Nikolaos Gougoulias Frimley Park Hospital, UK

Search for other papers by Nikolaos Gougoulias in
Google Scholar
PubMed
Close
, and
Anthony Sakellariou Frimley Park Hospital, UK

Search for other papers by Anthony Sakellariou in
Google Scholar
PubMed
Close

  • Medial column (deltoid ligament) integrity is of key importance when considering the stability of isolated lateral malleolus ankle fractures.

  • Weight-bearing radiographs are the best method of evaluating stability of isolated distal fibula fractures.

  • Computed tomography (CT) scanning is mandatory for the assessment of complex ankle fractures, especially those involving the posterior malleolus.

  • Most isolated trans-syndesmotic fibular fractures (Weber-B, SER, AO 44-B) are stable and can safely be treated non-operatively.

  • Posterior malleolus fractures, regardless of size, should be considered for surgical fixation to restore stability, reduce the need for syndesmosis fixation, and improve contact pressure distribution.

Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.170057

Open access
Rafik Yassa North West Deanery, Manchester, UK

Search for other papers by Rafik Yassa in
Google Scholar
PubMed
Close
,
Mahdi Yacine Khalfaoui North West Deanery, Manchester, UK

Search for other papers by Mahdi Yacine Khalfaoui in
Google Scholar
PubMed
Close
,
Ihab Hujazi North West Deanery, Manchester, UK

Search for other papers by Ihab Hujazi in
Google Scholar
PubMed
Close
,
Hannah Sevenoaks North West Deanery, Manchester, UK

Search for other papers by Hannah Sevenoaks in
Google Scholar
PubMed
Close
, and
Paul Dunkow Blackpool Victoria Teaching Hospitals, Blackpool, UK

Search for other papers by Paul Dunkow in
Google Scholar
PubMed
Close

  • Hip fractures are common and increasing with an ageing population. In the United Kingdom, the national guidelines recommend operative intervention within 36 hours of diagnosis. However, long-term anticoagulant treatment is frequently encountered in these patients which can delay surgical intervention. Despite this, there are no set national standards for management of drug-induced coagulopathy pre-operatively in the context of hip fractures.

  • The aim of this study was to evaluate the management protocols available in the current literature for the commonly encountered coagulopathy-inducing agents.

  • We reviewed the current literature, identified the reversal agents used in coagulopathy management and assessed the evidence to determine the optimal timing, doses and routes of administration.

  • Warfarin and other vitamin K antagonists (VKA) can be reversed effectively using vitamin K with a dose in the range of 2 mg to 10 mg intravenously to correct coagulopathy.

  • The role of fresh frozen plasma is not clear from the current evidence while prothrombin complex remains a reliable and safe method for immediate reversal of VKA-induced coagulopathy in hip fracture surgery or failed vitamin K treatment reversal.

  • The literature suggests that surgery should not be delayed in patients on classical antiplatelet medications (aspirin or clopidogrel), but spinal or regional anaesthetic methods should be avoided for the latter. However, evidence regarding the use of more novel antiplatelet medications (e.g. ticagrelor) and direct oral anticoagulants remains a largely unexplored area in the context of hip fracture surgery. We suggest treatment protocols based on best available evidence and guidance from allied specialties.

  • Hip fracture surgery presents a common management dilemma where semi-urgent surgery is required. In this article, we advocate an evidence-based algorithm as a guide for managing these anticoagulated patients.

Cite this article: EFORT Open Rev 2017;2:394–402. DOI: 10.1302/2058-5241.2.160083

Open access
Alexandre Sitnik Belarus Republic Scientific and Practical Center for Traumatology and Orthopedics, Kizhevatova str 60-4, 220024 Minsk, Belarus

Search for other papers by Alexandre Sitnik in
Google Scholar
PubMed
Close
,
Aleksander Beletsky Belarus Republic Scientific and Practical Center for Traumatology and Orthopedics, Kizhevatova str 60-4, 220024 Minsk, Belarus

Search for other papers by Aleksander Beletsky in
Google Scholar
PubMed
Close
, and
Steven Schelkun Naval Hospital, San Diego, California, USA

Search for other papers by Steven Schelkun in
Google Scholar
PubMed
Close

  • Results of the treatment of intra-articular fractures of the distal tibia have improved significantly during the last two decades.

  • Recognition of the role of soft tissues has led to the development of a staged treatment strategy. At the first stage, joint-bridging external fixation and fibular fixation are performed. This leads to partial reduction of the distal tibial fracture and allows time for the healing of soft tissues and detailed surgical planning.

  • Definitive open reduction and internal fixation of the tibial fracture is performed at a second stage, when the condition of the soft tissues is safe. The preferred surgical approach(es) is chosen based on the fracture morphology as determined from standard radiographic views and computed tomography.

  • Meticulous atraumatic soft-tissue handling and the use of modern fixation techniques for the metaphyseal component such as minimally invasive plate osteosynthesis further facilitate healing.

Cite this article: EFORT Open Rev 2017;2:352-361. DOI: 10.1302/2058-5241.2.150047

Open access
Ippokratis Pountos Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, UK

Search for other papers by Ippokratis Pountos in
Google Scholar
PubMed
Close
and
Peter V. Giannoudis Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, and NIHR Leeds Biomedical Research Unit, Chapel Allerton Hospital, LS7 4SA Leeds, West Yorkshire, Leeds, UK

Search for other papers by Peter V. Giannoudis in
Google Scholar
PubMed
Close

  • The effective management of articular impacted fractures requires the successful elevation of the osteochondral fragment to eliminate joint incongruency and the stable fixation of the fragments providing structural support to the articular surface.

  • The anatomical restoration of the joint can be performed either with elevation through a cortical window, through balloon-guided osteoplasty or direct visualisation of the articular surface.

  • Structural support of the void created in the subchondral area can be achieved through the use of bone graft materials (autologous tricortical bone), or synthetic bone graft substitutes.

  • In the present study, we describe the available techniques and materials that can be used in treating impacted osteochondral fragments with special consideration of their epidemiology and treatment options.

Cite this article: EFORT Open Rev 2017;2. DOI: 10.1302/2058-5241.2.160072. Originally published online at www.efortopenreviews.org

Open access
Antomio Capone Orthopaedic and Trauma Unit, Department of Surgical Sciences, University of Cagliari, Italy

Search for other papers by Antomio Capone in
Google Scholar
PubMed
Close
,
Marcella Peri Department of Surgical Sciences, University of Cagliari, Italy

Search for other papers by Marcella Peri in
Google Scholar
PubMed
Close
, and
Michele Mastio Orthopaedic and Trauma Unit, Department of Surgical Sciences, University of Cagliari, Italy

Search for other papers by Michele Mastio in
Google Scholar
PubMed
Close

  • We performed a systematic review of the literature involving a number of databases to identify studies that included outcomes of surgical treatment of acetabular fractures in patients aged > 55 years. An initial search identified 1564 studies. After exclusion by two independent reviewers, 15 studies met the inclusion criteria. All studies were case series and the mean Coleman Methodology score for methodological quality assessment was 43.7 (standard deviation 12.3). There were 354 patients with acetabular fractures. Pooled analysis revealed a mean age of 71.6 years (55 to 96) and a mean follow-up of 43 months (20 to 188). Complex fractures were reported in 70.1% of patients.

  • Seven studies presented the results of open reduction and internal fixation (ORIF); in eight other studies a total hip arthroplasty (THA), alone or combined with different internal fixation techniques, was the chosen treatment. In the ORIF sub-group, conversion to THA was performed at a mean of 25.5 months with anatomical reduction in 11.6% and imperfect and poor reduction in 22.3%. In the THA sub-group, an acetabular ring or cage with a cemented acetabular component was used in four studies (52 patients) and a cementless acetabular component was implanted in five studies (78 patients). Six patients (4.9%) underwent revision at a mean of 39 months after the index procedure.

  • The analysis of intra-operative and post-operative parameters showed a statistical difference between the two sub-groups with regards to the mean operating time (236 mins ORIF vs 178 mins THA), the mean blood loss (707 mL ORIF vs 974 mL THA) and the mean mortality rate at one year (22.6% ORIF vs 8.8% THA).

  • Based on the current data available, acute THA (alone or in combination with internal fixation) may have a role in the treatment of older patients with complex acetabular fractures. Despite the wide heterogenecity of fracture types and patient co-morbidities, THA procedures were associated with lower rates of mortality and further surgery when compared with the ORIF procedures.

Cite this article: EFORT Open Rev 2017;2:97-103. DOI: 10.1302/2058-5241.2.160036

Open access
Josep Muñoz Vives Hospital Nostra Senyora de Meritxell, Andorra, Spain

Search for other papers by Josep Muñoz Vives in
Google Scholar
PubMed
Close
,
Jean-Christophe Bel Hospices Civils de Lyon, Lyon, France

Search for other papers by Jean-Christophe Bel in
Google Scholar
PubMed
Close
,
Arantxa Capel Agundez Hospital Universitario 12 de Octubre, Madrid, Spain

Search for other papers by Arantxa Capel Agundez in
Google Scholar
PubMed
Close
,
Francisco Chana Rodríguez Hospital General Universitario Gregorio Marañón, Madrid, Spain

Search for other papers by Francisco Chana Rodríguez in
Google Scholar
PubMed
Close
,
José Palomo Traver Hospital General de Castelló, Castelló de la Plana, Spain

Search for other papers by José Palomo Traver in
Google Scholar
PubMed
Close
,
Morten Schultz-Larsen Odense Universitetshospita, Odense, Denmark

Search for other papers by Morten Schultz-Larsen in
Google Scholar
PubMed
Close
, and
Theodoros Tosounidis Leeds General Infirmary, Leeds, UK

Search for other papers by Theodoros Tosounidis in
Google Scholar
PubMed
Close

  • In 1975, Blake and McBryde established the concept of ‘floating knee’ to describe ipsilateral fractures of the femur and tibia.1 This combination is much more than a bone lesion; the mechanism is usually a high-energy trauma in a patient with multiple injuries and a myriad of other lesions.

  • After initial evaluation patients should be categorised, and only stable patients should undergo immediate reduction and internal fixation with the rest receiving external fixation.

  • Definitive internal fixation of both bones yields the best results in almost all series.

  • Nailing of both bones is the optimal fixation when both fractures (femoral and tibial) are extra-articular.

  • Plates are the ‘standard of care’ in cases with articular fractures.

  • A combination of implants are required by 40% of floating knees.

  • Associated ligamentous and meniscal lesions are common, but may be irrelevant in the case of an intra-articular fracture which gives the worst prognosis for this type of lesion.

Cite this article: Muñoz Vives K, Bel J-C, Capel Agundez A, Chana Rodríguez F, Palomo Traver J, Schultz-Larsen M, Tosounidis, T. The floating knee. EFORT Open Rev 2016;1:375-382. DOI: 10.1302/2058-5241.1.000042.

Open access