Aims. This study estimated trends in incidence of
Aims. The aim of this study was to investigate the relationship between the Orthopaedic Trauma Society (OTS) classification of
Aims. To evaluate the impact of negative pressure wound therapy (NPWT) on the odds of having deep infections and health-related quality of life (HRQoL) following
Aims. The management of open lower limb fractures in the United Kingdom
has evolved over the last ten years with the introduction of major
trauma networks (MTNs), the publication of standards of care and
the wide acceptance of a combined orthopaedic and plastic surgical approach
to management. The aims of this study were to report recent changes
in outcome of
Aims. Ankle fractures are common injuries and the third most common fragility fracture. In all, 40% of ankle fractures in the frail are open and represent a complex clinical scenario, with morbidity and mortality rates similar to hip fracture patients. They have a higher risk of complications, such as wound infections, malunion, hospital-acquired infections, pressure sores, veno-thromboembolic events, and significant sarcopaenia from prolonged bed rest. Methods. A modified Delphi method was used and a group of experts with a vested interest in best practice were invited from the British Foot and Ankle Society (BOFAS), British Orthopaedic Association (BOA), Orthopaedic Trauma Society (OTS), British Association of Plastic & Reconstructive Surgeons (BAPRAS), British Geriatric Society (BGS), and the British Limb Reconstruction Society (BLRS). Results. In the first stage, there were 36 respondents to the survey, with over 70% stating their unit treats more than 20 such cases per year. There was a 50:50 split regarding if the timing of surgery should be within 36 hours, as per the hip fracture guidelines, or 72 hours, as per the
Aims. To describe a new objective classification for
Aims. Despite long-standing dogma, a clear relationship between the timing of surgical irrigation and debridement (I&D) and the development of subsequent deep infection has not been established in the literature. Traditionally, I&D of an
Objectives.
Aims.
Aims. The purpose of this study was to determine whether intracellular Staphylococcus aureus is associated with recurrent infection in a rat model of
Aims. It has been generally accepted that
Abstract. Objective.
There are 33 million people worldwide currently infected with human immunodeficiency virus (HIV). This complex disease affects many of the processes involved in wound and fracture healing, and there is little evidence available to guide the management of
We describe the results of treatment of
Aims. To evaluate interobserver reliability of the Orthopaedic Trauma
Association’s
Aims. Understanding of
Many studies report the incidence and prevalence of surgical site infections (SSIs) following
Aims. The aim of this study was to estimate the cost-effectiveness of negative-pressure wound therapy (NPWT) in comparison with standard wound management after initial surgical wound debridement in adults with severe
Introduction. We investigated the usefulness of flap surgery for Gustilo type IIIB and C severe
Patients infected with HIV presenting with an
Aims. The Fluid Lavage in
This study explores the relationship between
delay to surgical debridement and deep infection in a series of
364 consecutive patients with 459
Aims. The Open-Fracture Patient Evaluation Nationwide (OPEN) study was performed to provide clarity in
The aim of this abstract is to show that when dealing with an infected non-union, all possibilities of treatment must be considered in order to choose the best treatment plan for each patient. This case shows the evolution of an infected non-union following type III
We undertook a retrospective case-control study
to assess the clinical variables associated with infections in
Modern principles for the treatment of
The results of immediate plate fixation of 97
Aim.
Aims. The aim of this study was to estimate economic outcomes associated with deep surgical site infection (SSI) in patients with an
Infection is a common complication of severe
This clinical case refers to a male patient, 45 years old, with a past medical history of Hepatitis C, admitted at the Emergency Department on July 2014, after a fall from 7 meters high at his workplace – dump – which resulted in an
Background. Traditional recommendations suggest that
Aims. The aim of this study was to explore the patients’ experience
of recovery from
This work refers to a male patient, 25 years of age, admitted in the Emergency Department following a bicycle accident, of which resulted an
Aims. The aim of this study was to report the outcomes of patients with severe
Purpose: The choice of irrigating fluid and delivery pressure remains controversial. Identifying surgeons’ preferences in techniques and the rationale for their choices may aid in focusing educational activities to the orthopaedic community as well as planning future clinical trials. Our objective was to clarify current opinion with regard to the irrigation of
The optimal choice of irrigating solution or irrigating pressure in the initial management of
Introduction and objectives: The purpose of the research is to show the agreement and reproducibility among 5 observers when they are questioned about 51
Between June 1999 and May 2003 we undertook direct primary closure of the skin wounds of 173 patients with Gustilo and Anderson grade-IIIA and grade-IIIB
Most animal studies indicate that early irrigation
and debridement reduce infection after an
Background. In 2011 Aird et al published their results of the effects of HIV on early wound healing in
Objective. To assess the beneficial use of polypropylene mesh impregnated with vancomycin in an experimental model
We describe the results of treatment of
Purpose: The optimal choice of irrigating solution or irrigating pressure in the initial management of
This paper outlines the history of advances made in the treatment of
We have systematically reviewed the effect of alternative methods of stabilisation of
We reviewed 43 patients treated from 1984 to 1988 for
Split-thickness skin excision can be used as a one-stage procedure for the accurate diagnosis of flap viability and the immediate treatment of friction-avulsion injuries in severe
Aims.
Aim. Antibiotic prophylaxis is critical for the prevention of fracture related infection (FRI) in trauma patients, particularly those with open wounds. Administration of prophylactic antibiotics prior to arrival at the hospital (e.g. by paramedics) may reduce intraoperative bacterial load and has been recommended; however scientific evidence for pre-hospital administration is scarce. Methods. The contaminated rabbit humeral osteotomy model of Arens was modified to resemble the sequence of events in
The June 2023 Trauma Roundup. 360. looks at: Aspirin or low-molecular-weight heparin for thromboprophylaxis?; Lateral plating or retrograde nailing for distal femur fractures?; Sciatic nerve palsy after acetabular fixation: what about patient position?; How reliable is the new OTA/AO classification for trochanteric hip fractures?; Young hip fractures: is a medial buttress the answer?; When is the best time to ‘flap’ an
The December 2022 Trauma Roundup. 360. looks at: Anterior approach for acetabular fractures using anatomical plates; Masquelet–Ilizarov for the management of bone loss post debridement of infected tibial nonunion; Total hip arthroplasty – better results after low-energy displaced femoral neck fracture in young patients; Unreamed intramedullary nailing versus external fixation for the treatment of open tibial shaft fractures in Uganda: a randomized clinical trial; The Open-Fracture Patient Evaluation Nationwide (OPEN) study: the management of
As there is little information on the factors that influence fracture union following intramedullary nailing of the tibia we retrospectively investigated patient-, injury- and treatment-related factors in 161 patients with closed or grade I
Aims. The aim of this study was to perform the first population-based description of the epidemiological and health economic burden of fracture-related infection (FRI). Methods. This is a retrospective cohort study of operatively managed orthopaedic trauma patients from 1 January 2007 to 31 December 2016, performed in Queensland, Australia. Record linkage was used to develop a person-centric, population-based dataset incorporating routinely collected administrative, clinical, and health economic information. The FRI group consisted of patients with International Classification of Disease 10th Revision diagnosis codes for deep infection associated with an implanted device within two years following surgery, while all others were deemed not infected. Demographic and clinical variables, as well as healthcare utilization costs, were compared. Results. There were 111,402 patients operatively managed for orthopaedic trauma, with 2,775 of these (2.5%) complicated by FRI. The development of FRI had a statistically significant association with older age, male sex, residing in rural/remote areas, Aboriginal or Torres Strait Islander background, lower socioeconomic status, road traffic accident, work-related injuries,
Aims. Fractures of the distal radius are common, and form a considerable proportion of the trauma workload. We conducted a study to examine the patterns of injury and treatment for adult patients presenting with distal radius fractures to a major trauma centre serving an urban population. Methods. We undertook a retrospective cohort study to identify all patients treated at our major trauma centre for a distal radius fracture between 1 June 2018 and 1 May 2021. We reviewed the medical records and imaging for each patient to examine patterns of injury and treatment. We undertook a binomial logistic regression to produce a predictive model for operative fixation or inpatient admission. Results. Overall, 571 fractures of the distal radius were treated at our centre during the study period. A total of 146 (26%) patients required an inpatient admission, and 385 surgical procedures for fractures of the distal radius were recorded between June 2018 and May 2021. The most common mechanism of injury was a fall from a height of one metre or less. Of the total fractures, 59% (n = 337) were treated nonoperatively, and of those patients treated with surgery, locked anterior-plate fixation was the preferred technique (79%; n = 180). Conclusion. The epidemiology of distal radius fractures treated at our major trauma centre replicated the classical bimodal distribution described in the literature. Patient age,
Aims. Clinical management of
Introduction.
Aims. Several studies have reported that patients presenting during the evening or weekend have poorer quality healthcare. Our objective was to examine how timely surgery for patients with severe
Aims. The aims of this study were to report the outcomes of patients with a complex fracture of the lower limb in the five years after they took part in the Wound Healing in Surgery for Trauma (WHIST) trial. Methods. The WHIST trial compared negative pressure wound therapy (NPWT) dressings with standard dressings applied at the end of the first operation for patients undergoing internal fixation of a complex fracture of the lower limb. Complex fractures included periarticular
Introduction: Open lower leg fractures are frequently associated with severe soft tissue damage. Cortical bone tissue is thus denudated. Osteomyelitis and impaired circulation with loss of bone tissue with subsequent defects are among the main complications, arising from the condition. Surfacing bone is judged on its perfusional conditione solely by the surgeon. Minor bleedings with decortication of the respective cortical bone serve as parameter for the clinical assessment and subsequent therapeutic decisions. Methods: 80 inbred white New Zealand rabbits with two groups of 40 animals each were employed. Each animal had a tibial fracture induced in a standardized fashion, stabilized by screw osteosynthesis. The fracture area was freed from soft tissue and periost and the medullary space reamed. After 3 or 7 days (group one or two, respectively), the tissue defect was covered by a local fascia-free gastrocnemius muscle flap. In increasing intervalls from one to 16 weeks, the implants were removed and the animals euthanized. At all three interventions, cortical microcirculation was measured by two-channel laser doppler flowmetry (LDF), counting erythrocyte flux as product of erythrocyte velocity with number of erthrocytes observed. Observed were cortical bone of the fragment created and of the adjacent cortical bone with and without periostal linig. The bone was removed after euthanisation and analysed histo-morphologically. All animals were kept in accordance with the procedures outlined in the “Guide for the Care a. Results: A muscle flap after three days led to significantly better perfusion as compared to 7 days with 24 vs 10 flux (mean +/− SEM; p <
0,05, paired t-test; baseline 1,4 flux ), resembling almost healthy values. Simultaneously, flap covering after three days displayed a lower rate of necroses with 23 vs. 40 % (p <
0,05, paired t-test). Incidence of osteomyelitis was as well higher in the 7-days-group (24%). Improved microcirculation as well as lower rate of infection were associated with the induction of neoperiost from the muscle flap. Discussion: Delayed plastic covering of open lower leg fractures led to delayed healing as well as infection in our experimental setting. Two-channel doppler was a reliable and little invasive means for the objective evaluation of conditions, associated with experimental
We present the results of using the Grosse-Kempf interlocking nail in the management of 125 closed and type I
Aims. The aim of this study was to develop a psychometrically sound measure of recovery for use in patients who have suffered an
We performed a retrospective review of the case notes of 84 consecutive patients who had suffered a severe (Gustilo IIIb or IIIc)
Objectives. As well as debridement and irrigation, soft-tissue coverage, and osseous stabilization, systemic antibiotic prophylaxis is considered the benchmark in the management of
We aimed to quantify the health related quality of life in a series of patients suffering a variety of different tibial injuries. Patients with previous tibial injury, randomly selected from our trauma database, who successfully completed their entire course of treatment at our institution, were recalled for final assessment. Mean time to final follow-up was 37.4 months. Statistical analysis was performed using SPSS computer software. Overall, 130 patients were evaluated. There was no significant difference in the self-care dimension between the groups. Psychological problems were common in patients with IIIb and IIIc fractures, as well as amputees, with the highest incidence in those with IIIc fractures. Patients who had undergone amputation and those with IIIb
Objectives. Pilon fractures represent one of the most surgically challenging fractures in orthopaedics. Different techniques exist for their management, with open reduction and internal fixation (ORIF) and External fixation (Ex-Fix) the most widely used. Whilst there is a plethora of data regarding these strategies for Pilon fractures as a whole, very limited data exists solely on the management of
The aims of this study were to describe the epidemiology of metacarpal shaft fractures (MSFs), assess variation in treatment and complications following standard care, document hospital resource use, and explore factors associated with treatment modality. A multicentre, cross-sectional retrospective study of MSFs at six centres in the UK. We collected and analyzed healthcare records, operative notes, and radiographs of adults presenting within ten days of a MSF affecting the second to fifth metacarpal between 1 August 2016 and 31 July 2017. Total emergency department (ED) attendances were used to estimate prevalence.Aims
Methods
Since its approval by the FDA two decades ago, Negative Pressure Wound Therapy (NPWT) has become a valuable asset in the management of
We reviewed 1085 consecutive compound limb fractures treated in 914 patients at the University of Louisville over a nine-year period. Of these fractures, 240 (group 1) received only systemic antibiotic prophylaxis and 845 (group 2) were managed by the supplementary local use of aminoglycoside-polymethylmethacrylate (PMMA) beads. There were no significant differences in age, gender, fracture type, fracture location or follow-up between the two groups. All had copious wound irrigation, meticulous debridement and skeletal stabilisation, but wound management and the use of local antibiotic depended on the surgeon's individual preference and there was no randomisation. In group 1 there was an overall infection rate of 12% as against 3.7% in group 2 (p <
0.001). Both acute infection and local osteomyelitis showed a decreased incidence in group 2, but this was statistically significant only in Gustilo type-IIIB and type-IIIC fractures for acute infection, and only in type-II and type-IIIB fractures for chronic osteomyelitis. Our review suggests that the adjuvant use of local antibiotic-laden PMMA beads may reduce the incidence of infection in severe compound fractures.
Aims. The BOA/BAPRAS guidelines for the management of
Although it is widely accepted that grade IIIB
Purpose: Prevention of post-trauma infections is basically aimed at streptococcal, staphylococcal and anaerobic germs. An increasing number of
Aims. Type IIIB
Between 2005 and 2010 ten consecutive children
with high-energy open diaphyseal tibial fractures were treated by early
reduction and application of a programmable circular external fixator.
They were all male with a mean age of 11.5 years (5.2 to 15.4),
and they were followed for a mean of 34.5 months (6 to 77). Full
weight-bearing was allowed immediately post-operatively. The mean
time from application to removal of the frame was 16 weeks (12 to
21). The mean deformity following removal of the frame was 0.15°
(0° to 1.5°) of coronal angulation, 0.2° (0° to 2°) sagittal angulation,
1.1 mm (0 to 10) coronal translation, and 0.5 mm (0 to 2) sagittal
translation. All patients achieved consolidated bony union and satisfactory
wound healing. There were no cases of delayed or nonunion, compartment
syndrome or neurovascular injury. Four patients had a mild superficial
pin site infection; all settled with a single course of oral antibiotics.
No patient had a deep infection or re-fracture following removal
of the frame. The time to union was comparable with, or better than,
other published methods of stabilisation for these injuries. The
stable fixator configuration not only facilitates management of
the accompanying soft-tissue injury but enables anatomical post-injury
alignment, which is important in view of the limited remodelling
potential of the tibia in children aged >
ten years. Where appropriate
expertise exists, we recommend this technique for the management
of high-energy
The aim of this study was to report the pattern
of severe open diaphyseal tibial fractures sustained by military personnel,
and their orthopaedic–plastic surgical management.The
United Kingdom Military Trauma Registry was searched for all such
fractures sustained between 2006 and 2010. Data were gathered on
demographics, injury, management and preliminary outcome, with 49
patients with 57 severe
Of 110 consecutive
An analysis of 51 type III
We present a novel approach to the management of patients with longstanding heel ulcers complicated by
Severe
The aim of this study was to determine medium term functional outcomes in military casualties undergoing limb salvage for severe
Seventy-nine
The aim of this study was to establish medium term outcomes in military casualties following severe
We report the use of Grosse-Kempf reamed intramedullary nailing in the treatment of 41 Gustilo type II and III
We present the results of 13 patients who suffered severe injuries to the lower leg. Five sustained a traumatic amputation and eight a Gustilo-Anderson type IIIC
In this study we quantified and characterised
the return of functional mobility following open tibial fracture
using the Hamlyn Mobility Score. A total of 20 patients who had
undergone reconstruction following this fracture were reviewed at
three-month intervals for one year. An ear-worn movement sensor
was used to assess their mobility and gait. The Hamlyn Mobility
Score and its constituent kinematic features were calculated longitudinally,
allowing analysis of mobility during recovery and between patients
with varying grades of fracture. The mean score improved throughout
the study period. Patients with more severe fractures recovered
at a slower rate; those with a grade I Gustilo-Anderson fracture
completing most of their recovery within three months, those with
a grade II fracture within six months and those with a grade III
fracture within nine months. Analysis of gait showed that the quality of walking continued
to improve up to 12 months post-operatively, whereas the capacity
to walk, as measured by the six-minute walking test, plateaued after
six months. Late complications occurred in two patients, in whom the trajectory
of recovery deviated by >
0.5 standard deviations below that of
the remaining patients. This is the first objective, longitudinal
assessment of functional recovery in patients with an open tibial
fracture, providing some clarification of the differences in prognosis
and recovery associated with different grades of fracture. Cite this article:
Blast and ballistic weapons used on the battlefield cause devastating injuries rarely seen outside armed conflict. These extremely high-energy injuries predominantly affect the limbs and are usually heavily contaminated with soil, foliage, clothing and even tissue from other casualties. Once life-threatening haemorrhage has been addressed, the military surgeon’s priority is to control infection. Combining historical knowledge from previous conflicts with more recent experience has resulted in a systematic approach to these injuries. Urgent debridement of necrotic and severely contaminated tissue, irrigation and local and systemic antibiotics are the basis of management. These principles have resulted in successful healing of previously unsurvivable wounds. Healthy tissue must be retained for future reconstruction, vulnerable but viable tissue protected to allow survival and avascular tissue removed with all contamination. While recent technological and scientific advances have offered some advantages, they must be judged in the context of a hard-won historical knowledge of these wounds. This approach is applicable to comparable civilian injury patterns. One of the few potential benefits of war is the associated improvement in our understanding of treating the severely injured; for this positive effect to be realised these experiences must be shared.
We studied the outcome and functional status of 33 patients with 34 severe
We reviewed 26 patients who had had internal fixation of an open intra-articular supracondylar fracture of the humerus. All operations were performed using a posterior approach, 13 with a triceps split and 13 with an olecranon osteotomy. The outcome was assessed by means of the Mayo Elbow score, the Disability of the Arm, Shoulder and Hand (DASH) score and the SF-36 Physical Function score. Patients with an olecranon osteotomy had less good results.