Early Appropriate Care: Definitive Stabilization of Femoral Fractures Within 24 Hours of Injury Is Safe in Most Patients With Multiple Injuries

2011 ◽  
Vol 71 (1) ◽  
pp. 175-185 ◽  
Author(s):  
Nickolas J. Nahm ◽  
John J. Como ◽  
John H. Wilber ◽  
Heather A. Vallier
Keyword(s):  
Femoral Fractures ◽  
Multiple Injuries ◽  
Appropriate Care ◽  
Early Appropriate Care

scholarly journals A prospective study on management of polytrauma with early appropriate care

2019 ◽  
Vol 5 (2) ◽  
pp. 118-122
Author(s):  
Vaibhav Bhadbhade ◽  
◽  
Sandeep DN ◽  
Keyword(s):  
Prospective Study ◽  
Appropriate Care ◽  
A Prospective Study ◽  
Early Appropriate Care

Issues of comprehensive diagnostics and treatment of polytrauma

2021 ◽  
Vol 19 (3) ◽  
pp. 95-98
Author(s):  
G. V. LOBANOV ◽  
Keyword(s):  
Mortality Rate ◽  
Minimally Invasive ◽  
High Mortality ◽  
Functional Outcomes ◽  
Minimally Invasive Treatment ◽  
Invasive Treatment ◽  
Appropriate Care ◽  
Safe Management ◽  
Definitive Surgery ◽  
Early Appropriate Care

High mortality rate and organizational problems in rendering assistance make researchers in many countries pay special attention to implement protocols and conception allowing to improve the early appropriate treating of polytrauma (Early Appropriate Care, EAC)), the strategy of safe operations (Safe Definitive Surgery, SDS), and prompt individual safe treatment (Prompt Individualised Safe Management, PR.I.S.M.). We propose the conception of «metabolic rehabilitation», which enables to significantly reduce the mortality and disability rates and improve the functional outcomes. Despite the recent advances, the problem of accurate diagnostics and minimally invasive treatment remains topical in polytrauma clinic.

scholarly journals Demystifying damage control in musculoskeletal trauma

2016 ◽  
Vol 98 (5) ◽  
pp. 291-294 ◽  
Author(s):  
P Bates ◽  
P Parker ◽  
I McFadyen ◽  
I Pallister
Keyword(s):  
Large Scale ◽  
Major Trauma ◽  
Damage Control ◽  
Trauma Surgery ◽  
Major Surgery ◽  
Surgical Trauma ◽  
Trauma Patients ◽  
Appropriate Care ◽  
Fracture Management ◽  
Early Appropriate Care

Trauma care has evolved rapidly over the past decade. The benefits of operative fracture management in major trauma patients are well recognised. Concerns over early total care arose when applied broadly. The burden of additional surgical trauma could constitute a second hit, fuelling the inflammatory response and precipitating a decline into acute respiratory distress syndrome, sepsis and multiple organ dysfunction syndrome. Temporary external fixation aimed to deliver the benefits of fracture stabilisation without the risk of major surgery. This damage control orthopaedics approach was advocated for those in extremis and a poorly defined borderline group. An increasing understanding of the physiological response to major trauma means there is now a need to refine our treatment options. A number of large scale retrospective reviews indicate that early definitive fracture fixation is beneficial in the majority of major trauma patients. It is recommended that patients are selected appropriately on the basis of their response to resuscitation. The hope is that this approach (dubbed ‘safe definitive fracture surgery’ or ‘early appropriate care’) will herald an era when care is individualised for each patient and their circumstances. The novel Damage Control in Orthopaedic Trauma Surgery course at The Royal College of Surgeons of England aims to equip senior surgeons with the insights and mindset necessary to contribute to this key decision making process as well as also the technical skills to provide damage control interventions when needed, relying on the improved techniques of damage control resuscitation and advances in the understanding of early appropriate care.

scholarly journals O40: PRE-OPERATIVE MANAGEMENT AND SENSITISATION IN VASCULARIZED COMPOSITE ALLOTRANSPLANTATION: A SYSTEMATIC REVIEW

2021 ◽  
Vol 108 (Supplement_1) ◽  
Author(s):  
L Geoghegan ◽  
M Al-Khalil ◽  
A Scarborough ◽  
A Murray ◽  
F Issa
Keyword(s):  
Systematic Review ◽  
Soft Tissue ◽  
Tissue Injury ◽  
Management Strategies ◽  
Soft Tissue Injury ◽  
Operative Management ◽  
Hla Antibodies ◽  
Appropriate Care ◽  
Reconstructive Transplantation ◽  
Early Appropriate Care

Abstract Introduction Vascularised composite allotransplantation (VCA) permits like-for-like reconstruction following extensive soft tissue injuries. The initial management of extensive soft tissue injury can lead to the development of anti-HLA antibodies through injury, transfusion and cadaveric grafting. The role of antibody-mediated rejection, donor-specific antibodies and graft rejection in the context of VCA remains unclear. This systematic review aimed to determine whether pre-operative management strategies influence immunological outcome following VCA. Method A systematic review of MEDLINE, EMBASE and CINAHL using a PRISMA-compliant methodology up to February 2019 was conducted. Pre-operative, procedural and long-term outcome data were collected and recorded for all VCA recipients on an individual patient basis. Result The search revealed 3,847 records of which 114 met inclusion criteria and reported clinical data related to 100 patients who underwent 129 VCA transplants. Trauma (50%) and burns (15%) were the most frequent indications for VCA. Of all 114 studies, only one reported acute resuscitative management. Fifteen patients (14.7%) were sensitized prior to reconstructive transplantation with an 80% incidence of acute rejection in the first post-operative year. Seven patients demonstrated graft vasculopathy, only one of whom had demonstrated panel reactive antibodies. Conclusion Currently employed acute management strategies predispose to the development of anti-HLA antibodies, adding to the already complex immunological challenge of VCA. Early appropriate care is warranted in patients with extensive soft tissue loss where the resuscitative needs should be balanced against strategies to mitigate the immunological burden, particularly as reconstructive transplantation becomes a feasible option for future soft tissue coverage. Take-home message Acute resuscitative management may sensitise potential transplant recipients following major soft tissue injury. Early appropriate care is warranted.

Early Appropriate Care

2016 ◽  
Vol 30 (6) ◽  
pp. 306-311 ◽  
Author(s):  
Heather A. Vallier ◽  
Andrea J. Dolenc ◽  
Timothy A. Moore
Keyword(s):  
Appropriate Care ◽  
Early Appropriate Care

Options and hazards of the early appropriate care protocol for trauma patients with major fractures: Towards safe definitive surgery

Injury ◽  
2016 ◽  
Vol 47 (4) ◽  
pp. 787-791 ◽  
Author(s):  
H.C. Pape ◽  
H. Andruszkow ◽  
R. Pfeifer ◽  
F. Hildebrand ◽  
B.M. Barkatali
Keyword(s):  
Trauma Patients ◽  
Appropriate Care ◽  
Care Protocol ◽  
Definitive Surgery ◽  
Early Appropriate Care
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