scholarly journals Management Algorithm of External Fixation in Lower Leg Arterial Injury for Limb Salvages

2021 ◽  
Author(s):  
Lei Jin ◽  
Song Zhang ◽  
Motao Liu ◽  
Yuxuan Zhang ◽  
Xin Lin ◽  
...  
Keyword(s):  
External Fixation ◽  
Limb Ischemia ◽  
Arterial Injury ◽  
Lower Leg ◽  
Deep Infection ◽  
Healing Time ◽  
Clinical Effects ◽  
Level Of Evidence ◽  
Superficial Infection ◽  
Arterial Injuries

Abstract Purpose: The purpose of this study was to review the roles of using external fixation to rescue the patients who sustained arterial injuries in the lower legs.Methods: Demographics, surgical treatment and outcomes in 88 patients with lower leg arterial injuries treated by external fixation at two trauma centers from 2009 to 2018 were reviewed. The primary outcome was the rate of successful lower leg salvage, while secondary outcomes were complications and functional recovery.Results:80 patients (90 legs) maintained a successful lower leg salvage. The patients were followed up for an average of 15.5±5.5 months. 6 patients (8 pins) experienced pin-tract infection, pins loosening happened in 2 patients (4 pins), 7 patients (7 legs) developed wound superficial infection, 3 patients (3 legs) with a deep infection developed osteomyelitis, 16 patients (17 legs) suffered the bone nonunion or bone defect. The average healing time of fracture was 5.6±4.3months. The maintain of external fixation average time was 5.8±3.6 months. Conclusion: With correctly judging the condition of limb ischemia, mastering reasonably the operation indications, and preventing complications, good clinical effects can be achieved when external fixation is used.Level of evidence: Retrospective cohort, level IV.

scholarly journals Management Algorithm of External Fixation in Lower Leg Arterial Injury for Limb Salvages

2021 ◽  
Author(s):  
Lei Jin ◽  
Song Zhang ◽  
Motao Liu ◽  
Yuxuan Zhang ◽  
Xin Lin ◽  
...  
Keyword(s):  
External Fixation ◽  
Limb Ischemia ◽  
Arterial Injury ◽  
Lower Leg ◽  
Deep Infection ◽  
Healing Time ◽  
Clinical Effects ◽  
Level Of Evidence ◽  
Superficial Infection ◽  
Arterial Injuries

AbstractPurposeThe purpose of this study was to review the roles of using external fixation to rescue the patients who sustained arterial injuries in the lower legs.MethodsDemographics, surgical treatment and outcomes in 88 patients with lower leg arterial injuries treated by external fixation at two trauma centers from 2009 to 2018 were reviewed. The primary outcome was the rate of successful lower leg salvage, while secondary outcomes were complications and functional recovery.Results80 patients (90 legs) maintained a successful lower leg salvage. The patients were followed up for an average of 15.5±5.5 months. 6 patients (8 pins) experienced pin-tract infection, pins loosening happened in 2 patients (4 pins), 7 patients (7 legs) developed wound superficial infection, 3 patients (3 legs) with a deep infection developed osteomyelitis, 16 patients (17 legs) suffered the bone nonunion or bone defect. The average healing time of fracture was 5.6±4.3months. The maintain of external fixation average time was 5.8±3.6 months.ConclusionWith correctly judging the condition of limb ischemia, mastering reasonably the operation indications, and preventing complications, good clinical effects can be achieved when external fixation is used.Level of evidenceRetrospective cohort, level IV.

scholarly journals Management of subtrochanteric femur fractures: is open reduction associated with poor outcomes?

2021 ◽  
Author(s):  
Michalis Panteli ◽  
James Shen Hwa Vun ◽  
Robert Michael West ◽  
Anthony John Howard ◽  
Ippokratis Pountos ◽  
...  
Keyword(s):  
Open Reduction ◽  
Femoral Fractures ◽  
Deep Infection ◽  
Surgical Time ◽  
Level Of Evidence ◽  
Superficial Infection ◽  
Non Union ◽  
Cerclage Wire ◽  
Femur Fractures ◽  
Increased Risk

Abstract Purpose The aim of this study was to identify factors associated with the need for open reduction in subtrochanteric femoral fractures and investigate the effect of cerclage wiring compared to open reduction alone, on the development of complications, especially infection and non-union. Methods All consecutive patients with a fracture involving the subtrochanteric region were retrospectively identified, over an 8-year period. Data documented and analysed included patient demographics, fracture characteristics, patient comorbidities, time to fracture union and development of complications. Results A total of 512 patients met the inclusion criteria (523 fractures). Open reduction was performed in 48% (247) of the fractures. Following matching and regression analysis, we identified diaphyseal extension of the fracture to be associated with an open reduction (OR: 2.30; 95% CI 1.45–3.65; p < 0.001). Open reduction was also associated with an increased risk of superficial infection (OR: 7.88; 95% CI 1.63–38.16; p = 0.010), transfusion within 48 h following surgery (OR: 2.44; 95% CI 1.96–4.87; p < 0.001) and a prolonged surgical time (OR: 3.09; 95% CI 1.96–4.87; p < 0.001). The risk of non-union, deep infection and overall mortality was not increased with open reduction. The use of cerclage wires [50 out of 201 fractures (24.9%) treated with an open reduction] to achieve anatomical reduction as compared to open reduction alone significantly reduced the risk of non-union (OR: 0.20; 95% CI 0.06–0.74; p = 0.015). Conclusion Open reduction of subtrochanteric fractures is not associated with an increased risk of deep infection and non-union, even though it is associated with an increased risk of superficial infection, prolonged surgical time and transfusion. The use of cerclage wire is associated with reduced risk of non-union with little evidence of an increase in complications. Level of evidence III.

scholarly journals SECONDARY INTERNAL OSTEOSYNTHESIS WITH LOCKING PLATES FOR RECENT OR OLD OPEN FRACTURE OF THE TIBIA, OVERLAPPING PROVISIONAL EXTERNAL FIXATOR PIN SITES: IS THE INFECTION RISK INCREASED?

2020 ◽  
pp. 1-3
Author(s):  
Garg Uttam Kumar ◽  
Shukla S. K ◽  
Pathak S. K ◽  
Usmani I. A
Keyword(s):  
External Fixation ◽  
External Fixator ◽  
Open Fracture ◽  
Locking Plate ◽  
Deep Infection ◽  
Site Infection ◽  
Superficial Infection ◽  
Pin Site ◽  
The Mean ◽  
Type Of Fracture

Twenty-two patients had a severe open fracture of the tibia that was initially treated by external fixation and subsequently by locking plate. The external fixation had been maintained for an average of fifty-nine days (range, 15 to 240 days). The mean interval between removal of the external fixator and plating was twenty-six days (range, 10 to 44 days). five out of twelve patients who had an infection at one or more of the pin sites, developed one superficial and four deep infection. In comparison, only one of the ten patients who had not had a pin-site infection had a superficial infection. An analysis of other variables, including the duration of external fixation, wound coverage, other injuries, and the type of fracture, showed that none was a predictor of infection either at the pin sites or around the plate. We concluded that a pin-site infection that develops during external fixation is a contraindication to the subsequent plating in patients who have a fracture of the tibia.

scholarly journals Profile vs Tubular Plate in Unimalleolar or Bimalleolar Fractures: is There a Real Difference in Wound complications?

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0015
Author(s):  
Paolo Ceccarini ◽  
Rosario Petruccelli ◽  
Michele Bisaccia ◽  
Giuseppe Rinonapoli ◽  
Auro Caraffa
Keyword(s):  
Wound Dehiscence ◽  
Deep Infection ◽  
Ankle Fractures ◽  
Bone Union ◽  
Wound Complications ◽  
Fisher Exact Test ◽  
Superficial Infection ◽  
Operative Care ◽  
Group B

Category: Ankle; Trauma Introduction/Purpose: The aim of our study is to compare two types of plates, one third tubular plate and LCP distal fibula plate, evaluating the clinical outcome and the skin complications associated with their use. Methods: We collected the data of 122 consecutive unimalleolar or bimalleolar fractures treated by internal fixation for a closed, displaced distal closed fibular fracture. Exclusion criteria were: 1) open ankle fractures,2) trimalleolar fractures, 3) previous ankle fractures 4) severe venous insufficiency, 5) ankleosteoarthritis previous to surgery, 6) associated ankle dislocation. After this selection, 93 patients were included in our study and assigned in two groups, based on using of different implant: in group A48 patients were treated with one-third tubular and in group B 45 patients were treated with LCP distalfibula plate. There were no significant differences in the baseline characteristics. Patients received the same surgical procedure and the same post-operative care, then they were radiologically evaluated at1-3-12 months and clinical examination was made at 24 (range 15-36) months using AOFAS clinical rating system. All data were evaluated using chi-square test. Results: At the final 24-month follow-up a comparison between the two groups showed no statistical significant differences in reduction accuracy and bone union ratio at radiological examination. The wound complications rate of the overall study group was 7.6%. There were no statistical differences in the rate of wound complications between the two groups. There were no differences between both group in percentage of hardware removal at follow-up (overall 5.4%). In the group A occurred 1 deep infection, 2 superficial infection, no wound dehiscence; in group B occured 1 deep infection, 1 superficial infection and 2 wound dehiscence. There were no statistical differences in the rate of wound complications between the two groups (p=0.70; Fisher exact test). Conclusion: Our study has shown no difference in radiographic bone union rate, no significant differences in terms of clinical outcomes, in time of bone reduction and wound complication rate between the LCP distalfibula plate and conventional one-third tubular plate. RCT or metanalasys are in this case useful to improve scientific evidence and give more information for the correct surgical treatment of ankle fractures.

scholarly journals Functional Evaluation of Fracture Shaft of Femur Treated by Antegrade Closed Interlocking Nail at B.P. Koirala Institute of Health Sciences, Dharan

2018 ◽  
Vol 2 (3) ◽  
pp. 244-247
Author(s):  
Pradeep Kumar Gupta ◽  
Ramesh Basnet ◽  
Niraj Man Shrestha
Keyword(s):  
Traffic Accident ◽  
Road Traffic ◽  
Deep Infection ◽  
Health Sciences ◽  
Femoral Diaphysis ◽  
Functional Evaluation ◽  
Successful Management ◽  
Superficial Infection ◽  
Interlocking Nail ◽  
Grade Ii

Introduction: The management of fractures of the femoral diaphysis has changed considerably in the last 30 years. Since the advent and popularization of intramedullary nailing the treatment of fracture shaft of femur has become a good, safe and reproducible procedure for the successful management of fracture shaft of femur.Objective: The objective of the study was to assess the various postoperative outcomes of the interlocking nail of fracture shaft of femur.Methodology: This study was prospective cohort study conducted at B.P. Koirala Institute of Health Sciences, Dharan from March 2002 to Feb 2004. Seventy five consecutive patients, having fractures shaft of femur were treated by anterograde closed interlocking nail. Data analysis was done by using EpiInfo 2000 software.Results: The most common cause of fractures shaft of femur was road traffic accident (69.3%). The average union time was 14.9 ± 1.3 weeks. There was wound infection in four cases superficial infection in open grade II but no deep infection. There was two cases of pudendal nerve palsy which recovered within 4 months. There were 5 cases of broken interlocking distal screw and 4 cases had more than 1.5 cm shortening of femurConclusions: The antegrade reamed femoral nailing provides excellent results in management of fractures shaft of femur.Birat Journal of Health SciencesVol.2/No.3/Issue 4/Sep- Dec 2017, Page: 244-247

scholarly journals Topical glyceryl trinitrate for the treatment of tendinopathies: a systematic review

2018 ◽  
Vol 53 (4) ◽  
pp. 251-262 ◽  
Author(s):  
Dimitris Challoumas ◽  
Paul D Kirwan ◽  
Dmytro Borysov ◽  
Christopher Clifford ◽  
Michael McLean ◽  
...  
Keyword(s):  
Systematic Review ◽  
Glyceryl Trinitrate ◽  
Strong Evidence ◽  
Evidence Synthesis ◽  
Clinical Effects ◽  
Range Of Movement ◽  
Level Of Evidence ◽  
Moderate Evidence ◽  
Best Evidence Synthesis ◽  
Topical Glyceryl Trinitrate

ObjectiveTo produce a best evidence synthesis of the clinical effects of topical glyceryl trinitrate (GTN) in the treatment of tendinopathies.DesignA systematic review of published randomised controlled trials (RCTs) of the use of GTN in patients with tendinopathy.Data sourcesMEDLINE, Embase, Scopus and CINAHL from database inception to January 2018.MethodsWe examined RCTs comparing the effects of topical GTN with either placebo or other treatments on tendinopathy. Overall quality of each eligible study was determined based on a combined assessment of internal validity, external validity and precision. The level of evidence for each assessed parameter was rated based on the system by van Tulderet al.ResultsA total of 10 eligible RCTs were identified including patients with tendinopathy of the rotator cuff (n=4), wrist extensors (n=3), Achilles (n=2) and patellar (n=1) tendons. For all tendinopathies, improvements in pain were significant when comparing GTN versus placebo in the short term (<8 weeks; poor evidence). Significant improvements in midterm outcomes for treatment with GTN versus placebo included the following: patient satisfaction (strong evidence); chances of being asymptomatic with activities of daily living (strong evidence); range of movement (moderate evidence); strength (moderate evidence); pain (at night and with activity; poor evidence) and local tenderness (poor evidence). Patients treated with topical GTN reported a higher incidence of headaches than those who received placebo (moderate evidence).Conclusions and relevanceTreatment of tendinopathies with topical GTN for up to 6 months appears to be superior to placebo and may therefore be a useful adjunct to the treating healthcare professions.

scholarly journals Penetrating Proximity Wounds and Minimal Arterial Injuries may not be so Benign

2019 ◽  
pp. 1-4
Author(s):  
Jonathan Gates ◽  
Dina Tabello ◽  
Alfred Croteau ◽  
Adam Shen ◽  
Nishant Merchant
Keyword(s):  
Natural History ◽  
Watchful Waiting ◽  
Arterial Injury ◽  
Standard Approach ◽  
Vascular Injuries ◽  
Arterial Injuries ◽  
History Of

There is a well-established body of literature in the management of vascular injuries that underscores the benign natural history of minor so-called occult arterial injuries. The standard approach for the management of the proximity extremity wound has evolved into one of watchful waiting. We present a case of an occult arterial injury that declared itself with an acute arterial bleed after about 30 hours of observation indicating that caution and preparation remain critical in the management of these patients.

Upper-Extremity Arteries

2018 ◽  
pp. 219-236
Author(s):  
Adam Zybulewski ◽  
Ilya Livshitz ◽  
Bhumika Patel ◽  
Aaron Fischman
Keyword(s):  
Upper Extremity ◽  
Upper Limb ◽  
Treatment Options ◽  
Clinical Manifestations ◽  
Limb Ischemia ◽  
Arterial Injury ◽  
Arterial Access ◽  
Imaging Characteristics ◽  
Ischemic Syndrome

This chapter evaluates the spectrum of pathologic diseases that affect the upper-extremity arteries, their clinical manifestations, imaging characteristics, and treatment options. We review the role of surgical and endovascular intervention for the treatment of acute upper limb ischemia (AULI) and chronic upper limb ischemia (CULI), the clinical and imaging findings associated with Raynaud’s phenomenon, hypothenar hammer syndrome, distal hypoperfusion ischemic syndrome (DHIS), thromboangittis obliterans (TOA), thoracic outlet syndrome (TOS), giant cell arteritis, Bechet’s disease, radiation arteritis, and traumatic arterial injury, including compartment syndrome and pseudoanuerysm formation. Finally, the evolution of upper-extremity arterial access and use of transradial access (TRA), including benefits and risks, technique, and complications, are discussed.

Outcomes of the glove-gauze regimen for managing burn injuries of the hand

2020 ◽  
Vol 45 (7) ◽  
pp. 737-741
Author(s):  
Oleksandra Vyrva ◽  
Elliott Smock ◽  
Joel Pessa ◽  
Sunil M. Thirkannad
Keyword(s):  
Physical Therapy ◽  
Range Of Motion ◽  
Full Range ◽  
Effective Means ◽  
Healing Time ◽  
Full Thickness ◽  
Level Of Evidence ◽  
Partial Thickness ◽  
And Function ◽  
Hand Burns

We studied the efficacy of the glove-gauze regimen in treating superficial, partial-thickness and small full-thickness hand burns. Outcome measures included healing time, need for surgical intervention, need for formal physical therapy, restoration of range of motion, return to function and incidence of infection. All patients ( n = 123) successfully completed the regimen with an average healing time of 3.7 weeks. None required surgical debridement and seven (6%) required formal physical therapy. One hundred and eighteen patients (96%) regained full range of motion and 122 (99%) returned to their previous level of work. We believe that the glove-gauze regimen provides a simplified and effective means of managing hand burns. We conclude from our patients that the glove-gauze regimen is an effective treatment that can ensure uneventful healing of superficial, partial-thickness and small full-thickness burns. A majority of our patients healed with full range of motion and function without formal physical therapy. Level of evidence: IV

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