Outpatient lower extremity fracture surgery: should we be concerned?

Author(s):  
Charlotte N. Shields ◽  
Sara Solasz ◽  
Leah J. Gonzalez ◽  
Yixuan Tong ◽  
Sanjit R. Konda ◽  
...  
2018 ◽  
Vol 42 (4) ◽  
pp. 747-753 ◽  
Author(s):  
Siem A. Dingemans ◽  
Merel F. N. Birnie ◽  
Manouk Backes ◽  
Vincent M. de Jong ◽  
Jan S. Luitse ◽  
...  

2021 ◽  
Vol 3 (4) ◽  
pp. 01-06
Author(s):  
Anupama Wadhwa

Background: Pain management for lower extremity fracture surgeries can be challenging. The purpose of this study is to determine whether the use of ketamine and methadone are more effective than ketamine and morphine to reduce postoperative pain and morphine requirements in patients undergoing lower extremity fracture surgery. Materials and Methods: Seventy-five patients 18-65 years of age, ASA class I-III, were enrolled in this study, which scheduled for elective lower extremity orthopedic surgery involving fracture of femur or tibia were recruited for the study. Thirty-eight randomized to the Methadone group and 37 randomized into the Morphine group. Participants were randomized to either one of the two groups: methadone (2ug/kg fentanyl, 0.2 mg/kg ketamine and 0.2 mg/kg methadone IV) versus control (2 ug/kg fentanyl, 0.2mg/kg ketamine and 0.2 mg/kg morphine IV). The primary outcome was total morphine equivalent (MEQ) during the first 24 and 48 hours after surgery. Secondary outcomes included postoperative pain scores in PACU, at 24 and 48 hours, as well as postoperative nausea and vomiting (PONV). Results: There was no difference in intraoperative consumption of fentanyl between the Methadone group 360mcg and Morphine group 344mcg. In the first 24 hours postoperatively, the Methadone group consumed less MEQ compared with the Morphine group (36.1 mg vs 54.8 mg, p=0.0072), showed lower pain scores than the Morphine group (p=0.0146), and experienced more nausea and vomiting than the Morphine group. There were no differences in sedation in both groups. Conclusion: The intraoperative use of intravenous methadone significantly reduced post-operative opioid requirement in patients undergoing lower extremity fracture surgery. The results also demonstrated the methadone group had a higher rate of PONV.


2018 ◽  
Vol 42 (9) ◽  
pp. 2287-2287
Author(s):  
Siem A. Dingemans ◽  
Merel F. N. Birnie ◽  
Manouk Backes ◽  
Vincent M. de Jong ◽  
Jan S. Luitse ◽  
...  

2021 ◽  
Vol 27 ◽  
pp. 107602962110029
Author(s):  
Wenjie Chang ◽  
Bin Wang ◽  
Qiwei Li ◽  
Yongkui Zhang ◽  
Wenpeng Xie

Objective: The objective of this work is to discuss and analyze the related factors of lower extremity fracture complicated by preoperative deep vein thrombosis (DVT). Methods: A total of 11,891 patients with closed fractures of lower extremities were selected. By analyzing each patient’s gender, age, presence or absence of diabetes and hypertension, preoperative plasma D-dimer level, and color Doppler ultrasound of the lower extremity vein, the pertinent factors of the patients with lower extremity fractures complicated by preoperative DVT were analyzed. Results: A total of 578 with preoperative DVT were detected, displaying a total incidence of 4.86%. All patients were categorized into either the DVT group or non-DVT group. The results demonstrate that there were statistically significant differences between the 2 groups in age, the presence of diabetes and hypertension, the fracture site, and the preoperative plasma D-dimer level ( P < 0.05). Logistic multivariate analysis revealed that age, the presence of diabetes, and the preoperative plasma D-dimer level of patients were independent risk factors for lower extremity fracture complicated by DVT. Conclusion: Age, the presence of diabetes, the fracture site, and increased D-dimer levels were found to be potential risk factors and indicators for preoperative DVT in patients with lower extremity fractures. In addition, the preoperative plasma D-dimer level has certain guiding significance for the prediction of venous thrombosis after lower extremity fracture, which is conducive to the early prediction and diagnosis of DVT, but it often must be followed with good clinic acumen and examinations.


2015 ◽  
Vol 29 (1) ◽  
pp. e12-e17 ◽  
Author(s):  
Shawn R. Gilbert ◽  
Paul A. MacLennan ◽  
Ian Backstrom ◽  
Aaron Creek ◽  
Jeffrey Sawyer

PEDIATRICS ◽  
1986 ◽  
Vol 78 (5) ◽  
pp. 803-807
Author(s):  
Frederick P. Rivara ◽  
Ruth Ann Parish ◽  
Beth A. Mueller

This study sought to identify clinical predictors of extremity fracture in children with trauma. There were 189 children 1 to 15 years of age with 209 extremity injuries seen during a 9-month period. Gross deformity and point tenderness were the best predictors of upper extremity fracture; these two findings correctly identified 81% of children with fractures and 82% of these without fractures. Gross deformity and pain on motion best predicted lower extremity fracture, with 97% of children with fractures correctly identified. The study showed that physical examination is predictive of fractures in extremity injuries of children, regardless of age. In the absence of the specific physical findings identified by the study, the probability of diagnosing a fracture by roentgenographic findings is low.


Sign in / Sign up

Export Citation Format

Share Document