scholarly journals Factors influencing functional results after surgery for ankle fractures

2018 ◽  
Vol 1 (2) ◽  
pp. 90-100
Author(s):  
Olivera Lupescu ◽  
Mihail Nagea ◽  
Nicolae-Marian Ciurea ◽  
Alina Grosu ◽  
Alexandru Lisias Dimitriu ◽  
...  
Keyword(s):  
Lower Limb ◽  
Functional Results ◽  
Trauma Centre ◽  
Functional Restoration ◽  
Classification Systems ◽  
Ankle Fractures ◽  
Articular Fractures ◽  
Factors Influencing ◽  
Level 1 ◽  
The Stability

Abstract Ankle fractures are frequent and have a significant impact upon the function of the lower limb, as this joint has a crucial role in standing and especially in walking. Several classification systems have been developed concerning these fractures, connecting the traumatic mechanism to their treatment. Due to their character of articular fractures, functional restoration of local anatomy is necessary; therefore, surgery is mandatory in displaced fractures, affecting the congruency, the stability or the mobility of the ankle joint. The purpose of this paper is to describe the factors influencing the results of surgical treatment in these fractures, as it results from the experience of a level 1 Trauma Centre.

scholarly journals Ankle Fracture Stability-based Classification

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0034
Author(s):  
James Michelson ◽  
John Delaney
Keyword(s):  
Classification System ◽  
Ankle Fracture ◽  
Area Under The Curve ◽  
Positive Outcome ◽  
Classification Systems ◽  
Ankle Fractures ◽  
Kappa Statistics ◽  
Pathologic Fractures ◽  
The Stability ◽  
Excellent Reproducibility

Category: Trauma Introduction/Purpose: Rotational ankle fractures are common in orthopaedic surgery, however existing classification systems are mostly descriptive in nature and do not explicitly guide surgical decision-making. A Stability-Based classification was developed recently to provide a more prognostic classification. The purpose of this study was to compare the reproducibility of existing ankle fracture classifications, and determine the ability of the Stability-Based classification to predict clinical treatment. Methods: One hundred ninety-three consecutive ankle fractures treated at our institution were retrospectively analyzed. Rotational type injury patterns in patients >18 years old were included. None of the subjects were clinically treated or evaluated by the study authors. The fractures were treated by attending physicians who were unaware of the Stability-Based classification system. Pathologic fractures were excluded. Three observers classified injury radiographs using the Lauge-Hansen, Weber/AO, and Stability-Based classifications systems. Reproducibility (inter-observer variation) of each classification system was calculated using kappa statistics. Prognostic values were evaluated by calculating the area under the curve (AUC) for the ROC curves (using surgery as the positive outcome) for each classification. Results: The Stability-Based classification was showed the excellent reproducibility (kappa .938, 95% CI .921-.952), along with the Weber/AO classification (kappa .97, 95% CI .961-.976), while the Lauge-Hansen had the lowest reproducibility (kappa .74, 95%CI .664-.795). The AUC for the three classifications were .883 (95%CI .852-.914), .626 (95%CI .576-.675), and .698 (95%CI .641-.755), respectively (Figure 1). The AUC was significantly better for the Stability-Based classification compared to the other 2 classifications (p<.001). Conclusion: The AO/Weber classification had excellent reproducibility, but did not predict the need for surgical stabilization accurately. In contrast, the Stability-Based classification system was both highly reproducible (kappa .938) with excellent prognostic ability to identify patients who got surgery (AUC .883). Furthermore, there were no patients who were classified as stable who failed non-operative treatment. The Stability-Based classification was found to have superior prognostic capacity compared to both the Lauge-Hansen and AO/Weber classification systems. This extends earlier studies by showing the reproducibility of the Stability-Based classification system and directly demonstrating its prognostic superiority to other classification systems.

scholarly journals Availability of “in hours” trauma theatres and its effect on the management of open lower limb fractures: experience from a level 1 trauma centre

Injury Extra ◽  
2010 ◽  
Vol 41 (12) ◽  
pp. 141
Author(s):  
S. Radha ◽  
S. Senevirathna ◽  
P. Baker ◽  
A. Hui ◽  
A. Rajeev ◽  
...  
Keyword(s):  
Lower Limb ◽  
Trauma Centre ◽  
Lower Limb Fractures ◽  
Level 1 ◽  
Limb Fractures

Current literature review on methods for measuring the stability of osseointegrable implants.

2020 ◽  
Vol 2 (4) ◽  
pp. 64-78
Author(s):  
Noha El-Wassefy ◽  
Lars Sennerby ◽  
Dhoom SIngh Mehta ◽  
Thiago De Santana Santos
Keyword(s):  
Literature Review ◽  
Current Literature ◽  
Implant Survival ◽  
Implant Stability ◽  
Implant Placement ◽  
Factors Influencing ◽  
Case Documentation ◽  
Bone To Implant Contact ◽  
The Stability

“Osseointegration” as formulated by Alberktson is crucial for implant survival and success. Osseointegration is a measure of implant stability. Measuring implant stability helps to arrive at decisions as to loading of an implant, allows choice of protocol on a patient to patient basis and provides better case documentation. A successful implant reflects good bone to implant contact and is determined by implant stability both primary and secondary. Implant stability is achieved at two different stages – primary (immediately after implant placement) and secondary (3-4 months after implant placement). Implant stability has been confirmed to affect the process of osseointegration and therefore is essential to understand the methods to measure implant stability and factors influencing. Various methods are developed to assess implant stability which suggests the prognosis of an implant.

Pathologic Fibrinolysis is More Common in a Rural Trauma Setting

2020 ◽  
pp. 000313482097372
Author(s):  
James M. Bardes ◽  
Daniel J. Grabo ◽  
Sijin Wen ◽  
Alison Wilson
Keyword(s):  
Trauma Team ◽  
Rural Environment ◽  
Trauma Patients ◽  
Future Studies ◽  
Factors Influencing ◽  
American College Of Surgeons ◽  
Level 1 ◽  
Transferred Patients ◽  
Prehospital Time ◽  
Level 1 Trauma Center

Introduction Fibrinolysis (lysis) has been extensively studied in trauma patients. Many studies on the distribution of lysis phenotype have been conducted in setting with short prehospital time. This study aimed to evaluate the distribution of lysis phenotypes in a population with prolonged prehospital times in a rural environment. Methods A retrospective study was performed at an American College of Surgeons-verified level 1 trauma center, serving a large rural population. Full trauma team activations from January 1, 2017 to August 31, 2018 were evaluated, and all patients with an ISS>15 analyzed. Thromboelastography was routinely performed on all participants on arrival. Lysis phenotypes were classified based on LY30 results: shutdown (≤.8%), physiologic (.9-2.9%), and hyper (>2.9%). Results 259 patients were evaluated, 134 (52%) presented direct from the scene. For scene patients, lysis distribution was 24% physiologic, 49% shutdown, and 27% hyper. Transferred patients demonstrated a reduction in physiologic lysis to 14% ( P = .03), shutdown present in 66%, and hyper in 20%. Empiric prehospital tranexamic acid was given to 18 patients, physiologic lysis was present in 6%, shutdown 72%, and hyper 22%; this increase was not statistically significant ( P = .5). Conclusion Fibrinolysis phenotypes are not consistent across all trauma populations. This study showed rural trauma patients had a significantly increased rate of pathologic lysis. This was consistent for scene and transfer patients who received care at another facility prior to arrival for definitive care. Future studies to evaluate the factors influencing these differences are warranted.

scholarly journals The management and outcome of paediatric splenic injuries in the Netherlands

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Maike Grootenhaar ◽  
Dominique Lamers ◽  
Karin Kamphuis-van Ulzen ◽  
Ivo de Blaauw ◽  
Edward C. Tan
Keyword(s):  
The Netherlands ◽  
Hospital Stay ◽  
Operative Management ◽  
Trauma Centre ◽  
Management Approach ◽  
Haemodynamic Instability ◽  
Low Grade ◽  
High Grade ◽  
Level 1 ◽  
Non Operative Management

Abstract Background Non-operative management (NOM) is generally accepted as a treatment method of traumatic paediatric splenic rupture. However, considerable variations in management exist. This study analyses local trends in aetiology and management of paediatric splenic injuries and evaluates the implementation of the guidelines proposed by the American Paediatric Surgical Association (APSA) in a level 1 trauma centre. Methods The charts of paediatric patients with blunt splenic injury (BSI) who were admitted or transferred to a level 1 trauma centre between 2003 and 2020 were retrospectively assessed. Information pertaining to demographics, mechanism of injury, injury description, associated injuries, intervention and outcomes were analysed and compared to international literature. Results There were 130 patients with BSI identified (63.1% male), with a mean age of 11.3 ± 4.0 and a mean Injury Severity Score (ISS) of 21.6 ± 13.7. Bicycle accidents were the most common trauma mechanism (23.1%). Sixty-four percent were multi-trauma patients, 25% received blood transfusions, and 31% were haemodynamically unstable. Mean injury grade was 3.0, with 30% of patients having a high-grade injury. In total, 75% of patients underwent NOM with a 100% efficacy rate. Total splenectomy rate was 6.2%. Four patients died due to brain damage. Patients with a high-grade BSI (grades IV–V) had a significantly higher ISS and longer bedrest and more often presented with an active blush on computed tomography (CT) scans than patients with a low-grade BSI (grades I–III). Non-operative management was mainly the choice of treatment in both groups (76.6% and 79.5%, respectively). Haemodynamic instability was a predictor for operative management (OM) (p = 0.001). Predictors for a longer length of stay (LOS) included concomitant injuries, haemodynamic instability and OM (all p < 0.02). Interobserver agreement in the grading of BSI is moderate, with a Cohens Kappa coefficient of 0.493. Conclusion Non-operative management has proven to be a realistic management approach in both low- and high-grade splenic injuries. Consideration for operative management should be based on haemodynamic instability. Compared to the anticipated length of bedrest and hospital stay outlined in the APSA guidelines, the Netherlands can reduce the length of bedrest and hospital stay through their non-operative management. Level of evidence Therapeutic study, level III

scholarly journals Development and temporal external validation of a simple risk score tool for prediction of outcomes after severe head injury based on admission characteristics from level-1 trauma centre of India using retrospectively collected data

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e040778
Author(s):  
Vineet Kumar Kamal ◽  
Ravindra Mohan Pandey ◽  
Deepak Agrawal
Keyword(s):  
Hospital Mortality ◽  
External Validation ◽  
Trauma Centre ◽  
Unfavourable Outcome ◽  
Motor Score ◽  
Validation Data ◽  
Data Set ◽  
Development Data ◽  
Level 1 ◽  
Pupillary Reactivity

ObjectiveTo develop and validate a simple risk scores chart to estimate the probability of poor outcomes in patients with severe head injury (HI).DesignRetrospective.SettingLevel-1, government-funded trauma centre, India.ParticipantsPatients with severe HI admitted to the neurosurgery intensive care unit during 19 May 2010–31 December 2011 (n=946) for the model development and further, data from same centre with same inclusion criteria from 1 January 2012 to 31 July 2012 (n=284) for the external validation of the model.Outcome(s)In-hospital mortality and unfavourable outcome at 6 months.ResultsA total of 39.5% and 70.7% had in-hospital mortality and unfavourable outcome, respectively, in the development data set. The multivariable logistic regression analysis of routinely collected admission characteristics revealed that for in-hospital mortality, age (51–60, >60 years), motor score (1, 2, 4), pupillary reactivity (none), presence of hypotension, basal cistern effaced, traumatic subarachnoid haemorrhage/intraventricular haematoma and for unfavourable outcome, age (41–50, 51–60, >60 years), motor score (1–4), pupillary reactivity (none, one), unequal limb movement, presence of hypotension were the independent predictors as its 95% confidence interval (CI) of odds ratio (OR)_did not contain one. The discriminative ability (area under the receiver operating characteristic curve (95% CI)) of the score chart for in-hospital mortality and 6 months outcome was excellent in the development data set (0.890 (0.867 to 912) and 0.894 (0.869 to 0.918), respectively), internal validation data set using bootstrap resampling method (0.889 (0.867 to 909) and 0.893 (0.867 to 0.915), respectively) and external validation data set (0.871 (0.825 to 916) and 0.887 (0.842 to 0.932), respectively). Calibration showed good agreement between observed outcome rates and predicted risks in development and external validation data set (p>0.05).ConclusionFor clinical decision making, we can use of these score charts in predicting outcomes in new patients with severe HI in India and similar settings.

Clinical and economic effects of selective radiological evaluation of high-energy trauma patients: a prospective experience of a level 1 busy trauma centre

2014 ◽  
Vol 32 (7) ◽  
pp. 535-538 ◽  
Author(s):  
Shahram Paydar ◽  
Armin Ahmadi ◽  
Behnam Dalfardi ◽  
Alireza Shakibafard ◽  
Hamidreza Abbasi ◽  
...  
Keyword(s):  
High Energy ◽  
Trauma Centre ◽  
Economic Effects ◽  
Trauma Patients ◽  
Radiological Evaluation ◽  
High Energy Trauma ◽  
Level 1

Stability of spinosad resistance inFrankliniella occidentalis(Pergande) under laboratory conditions

2008 ◽  
Vol 98 (4) ◽  
pp. 355-359 ◽  
Author(s):  
P. Bielza ◽  
V. Quinto ◽  
C. Grávalos ◽  
E. Fernández ◽  
J. Abellán ◽  
...  
Keyword(s):  
Resistant Strain ◽  
Selection Pressure ◽  
Frankliniella Occidentalis ◽  
Western Flower Thrips ◽  
Laboratory Conditions ◽  
Flower Thrips ◽  
Factors Influencing ◽  
Stability Of Resistance ◽  
The Stability ◽  
Successive Generations

AbstractThe stability of spinosad resistance in western flower thrips (WFT),Frankliniella occidentalis(Pergande), populations with differing initial frequencies of resistance was studied in laboratory conditions. The stability of resistance was assessed in bimonthly residual bioassays in five populations with initial frequencies of 100, 75, 50, 25 and 0% of resistant individuals. There were no consistent changes in susceptibility of the susceptible strain after eight months without insecticide pressure. In the resistant strain, very highly resistant to spinosad (RF50>23,000-fold), resistance was maintained up to eight months without further exposure to spinosad. In the absence of any immigration of susceptible genes into the population, resistance was stable. In the case of the population with different initial frequency of resistant thrips, spinosad resistance declined significantly two months later in the absence of selection pressure. With successive generations, these strains did not change significantly in sensitivity. Spinosad resistance inF. occidentalisdeclined significantly in the absence of selection pressure and the presence of susceptible WFT. These results suggest that spinosad resistance probably is unstable under field conditions, primarily due to the immigration of susceptible WFT. Factors influencing stability or reversion of spinosad resistance are discussed.

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