Search Results
Search for other papers by Paul L Rodham in
Google Scholar
PubMed
Search for other papers by Vasileios P Giannoudis in
Google Scholar
PubMed
Department of Trauma & Orthopaedics, University of Leeds, Leeds, United Kingdom of Great Britain and Northern Ireland
Search for other papers by Nikolaos K Kanakaris in
Google Scholar
PubMed
Search for other papers by Peter V Giannoudis in
Google Scholar
PubMed
-
The ability to enhance fracture healing is paramount in modern orthopaedic trauma, particularly in the management of challenging cases including peri-prosthetic fractures, non-union and acute bone loss.
-
Materials utilised in enhancing fracture healing should ideally be osteogenic, osteoinductive, osteoconductive, and facilitate vascular in-growth.
-
Autologous bone graft remains the gold standard, providing all of these qualities. Limitations to this technique include low graft volume and donor site morbidity, with alternative techniques including the use of allograft or xenograft.
-
Artificial scaffolds can provide an osteoconductive construct, however fail to provide an osteoinductive stimulus, and frequently have poor mechanical properties.
-
Recombinant bone morphogenetic proteins can provide an osteoinductive stimulus; however, their licencing is limited and larger studies are required to clarify their role.
-
For recalcitricant non-unions or high-risk cases, the use of composite graft combining the above techniques provides the highest chances of successfully achieving bony union.
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
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
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
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
-
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.
