scholarly journals Efficacy of Antibiotic Laden Collagen Sponge In Treating Open Fracture

2018 ◽  
Vol 17 (1) ◽  
Author(s):  
Kularaj Subramaniam ◽  
Aminuddin Che Ahmad
Keyword(s):  
Internal Fixation ◽  
Open Fracture ◽  
Female Gender ◽  
Blood Parameters ◽  
Collagen Sponge ◽  
Open Fractures ◽  
Predisposing Factor ◽  
Observational Cohort ◽  
Grade 3

Introduction: Open fractures are known as a major predisposing factor for a higher incidence of infection. The aim of this study was to assess the efficacy of antibiotic impregnated collagen sponge in reducing the risk of infection in open fractures Grade 3. Materials and Methods: This was an observational cohort study, evaluating the incidence of infection in open fractures of the femur Grade 3A/3B following insertion of gentamicin impregnated collagen sponge (Collatamp®) during definitive fracture fixation. Eryhtrocyte Sedimentation Rate (ESR) and total white count (TWC) were used as blood parameters to observe for the possibility of infection from pre-operatively up to follow up visits at the clinic. Results: A total number of 36 patients, whom had sustained open fracture of the femur Grade 3A/B, underwent internal fixation with antibiotic impregnated collagen sponge insertion. Overall, ESR and TWC in both male and female gender were downgoing trend, with p values of <0.001, and clinically there was no evidence of infection. No infection was identified in 97.2% of patients, following the internal fixation and antibiotic impregnated collagen sponge insertion. There was only one patient (2.8%) who developed infection following the definitive internal fixation and antibiotics impregnated collagen sponge insertion. Conclusion: The use of antibiotic impregnated collagen sponge in open fractures reduced the occurrence of infection. Furthermore, this allows for an uncomplicated union of the bone following definitive fixation.

scholarly journals Radical treatment of severe open fractures of extremities by orthoplastic surgery: a 10-year retrospective study

2020 ◽  
Author(s):  
Zhao Yang ◽  
Chao Xu ◽  
Yong-Gang Zhu ◽  
Jun Li ◽  
Zi-Xiang Wu ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Open Fracture ◽  
Aesthetic Surgery ◽  
Open Fractures ◽  
Soft Tissue Reconstruction ◽  
Central Unit ◽  
Chinese Characteristics ◽  
Tissue Reconstruction ◽  
The Mean

Abstract Orthoplastic treatment based on the collaboration of orthopedic and plastic surgeons in an “orthoplastic” central unit has been recommended by the British Association of Plastic Reconstructive and Aesthetic Surgery. However, this approach is not used worldwide especially in most developing countries. Based on the aggressive orthoplastic management, orthoplastic experience with Chinese characteristics has been carried out in last 10 years. The clinical data of 41 consecutive patients with severe open fracture (Gustilo IIIb or IIIc) of the limb, who underwent successful surgical debridement, fixation, and soft tissue reconstruction in one stage between January 2008 and April 2019, were retrospectively reviewed. Postoperative indicators, including infection rate and union time, were acquired by a regular follow-up and analyzed. The mean (±SD) age of the patients was 38±16 years. The soft tissue cover was achieved within 72 h. The overall rate of infection was 14.6% (6/41). Sex and the Mangled Extremity Severity Score were associated with infection. The median union time of 40 patients (one amputation) was 32 weeks. The overall rate of infection exhibited a lower tendency in this study. These results indicated that the single-stage radical orthoplastic treatment was an effective and reliable option for reconstructing severe open fractures.

scholarly journals The 'armed concrete' approach: stent-screw-assisted internal fixation (SAIF) reconstructs and internally fixates the most severe osteoporotic vertebral fractures

2020 ◽  
Vol 13 (1) ◽  
pp. 63-68 ◽  
Author(s):  
Daniela Distefano ◽  
Pietro Scarone ◽  
Maurizio Isalberti ◽  
Luigi La Barbera ◽  
Tomaso Villa ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Internal Fixation ◽  
Neurological Complication ◽  
Visual Analog Scale Score ◽  
Vertebral Compression Fractures ◽  
Osteoporotic Vertebral Fractures ◽  
Large Cleft ◽  
Grade 3 ◽  
Global Impression Of Change

BackgroundThe treatment of severe osteoporotic vertebral compression fractures (VCFs) with middle-column (MC) involvement, high fragmentation, large cleft and/or pedicular fracture is challenging. Minimally invasive 'stent-screw-assisted internal fixation' (SAIF) can reduce the fracture, reconstruct the vertebral body (VB) and fix it to the posterior elements.ObjectiveTo assess feasibility, safety, technical and clinical outcome of the SAIF technique in patients with severe osteoporotic VCFs.Methods80 treated vertebrae were analyzed retrospectively. Severe VCFs were characterized by advanced collapse (Genant grade 3), a high degree of osseous fragmentation (McCormack grade 2 and 3), burst morphology with MC injury, pediculo-somatic junction fracture, and/or large osteonecrotic cleft. VB reconstruction was evaluated on postprocedure radiographs and CT scans by two independent raters. Clinical and radiological follow-ups were performed at 1 and 6 months.ResultsSAIF was performed at 28 thoracic and 52 lumbar levels in 73 patients. One transient neurological complication occurred. VB reconstruction was satisfactory in 98.8% of levels (inter-rater reliability 96%, κ=1). Follow-up at 1 month was available for 78/80 levels and at 6 months or later (range 6–24, mean 7.9 months) for 73/80 levels. Significant improvement in the Visual Analog Scale score was noted at 1 and 6 months after treatment (p<0.05). Patients reported global clinical benefit during follow-up (Patient’s Global Impression of Change Scale 5.6±0.9 at 1 month and 6.1±0.9 at 6 months). Fourteen new painful VCFs occurred at different levels in 11 patients during follow-up, treated with vertebral augmentation or SAIF. Target-level stability was maintained in all cases.ConclusionsSAIF is a minimally invasive, safe, and effective treatment for patients with severe osteoporotic VCFs with MC involvement.

scholarly journals Combined Dorsal and Ulnarward Carpometacarpal Dislocation Associated with Open Fracture of the Base of First Metacarpal and Severe Degloving Injury

2017 ◽  
Vol 2017 ◽  
pp. 1-4
Author(s):  
Ali J. Electricwala ◽  
Jaffer T. Electricwala
Keyword(s):  
Internal Fixation ◽  
Functional Outcome ◽  
Closed Reduction ◽  
Rare Case ◽  
Open Fracture ◽  
Kirschner Wires ◽  
Degloving Injury ◽  
The Right ◽  
High Index Of Suspicion

We report a rare case of dislocation of second to fourth carpometacarpal (CMC) joints of the right hand with combined dorsal and ulnarward displacement of the second to fourth digits and fracture of the shaft of the first metacarpal associated with degloving injury. These injuries were diagnosed early and treated successfully with closed reduction and internal fixation using Kirschner wires. The functional outcome was good at follow-up at 5 years. A high index of suspicion is required to successfully diagnose and treat this condition.

scholarly journals A clinical study of surgical management of paediatric humeral supracondylar fracture

2019 ◽  
Vol 5 (6) ◽  
pp. 1088
Author(s):  
Ajay Kumar ◽  
Karthik Padmanabhan
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Open Fracture ◽  
Supracondylar Fracture ◽  
Cubitus Varus ◽  
Inexpensive Method ◽  
Follow Up Study ◽  
Elbow Injuries ◽  
K Wires

<p class="abstract"><strong>Background:</strong> Injury to the supracondylar region of the humerus and complete displacement of the fragments occurs in many of the cases when children usually fall while playing. This is most common fracture seen in children, makes up to 60% of all elbow injuries. Early intervention results in excellent reduction and avoids complications. Concomitant vascular and nerve damages may occur. Open reduction and internal fixation is a helpful option for the treatment of supracondylar facture of humerus in children.</p><p class="abstract"><strong>Methods:</strong> Forty children who presented with displaced supracondylar fracture of the humerus were treated with open reduction and internal fixation with Kirschner (K) wires after thorough pre-operative investigation during the course of the study. Children below the age of 13 were selected irrespective of the sex.<strong></strong></p><p class="abstract"><strong>Results:</strong> Good results were obtained in 60% of the patients, fair in 30% and poor in 10%. The poor results were due to the open fracture and in two cases the patient presented very late to the hospital. Complications such as nerve injuries, vascular injuries, infections were noticed in the study. Four patients had cubitus varus and twelve patients had flexion loss on follow-up study.</p><p class="abstract"><strong>Conclusions:</strong> Open reduction and internal fixation with K wire is an easy, simple, inexpensive method, which has good outcome.</p>

Outcome of Open Long Bone Fractures in Dogs Stabilized with Linear External Skeletal Fixator

2021 ◽  
Author(s):  
Tejpal Singh ◽  
Ashwani Kumar ◽  
Rahul Kumar Udehiya ◽  
Kirandeep Kaur Gill ◽  
Tejinder Singh Rai ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Open Fracture ◽  
Bone Fractures ◽  
Open Fractures ◽  
Long Bone ◽  
Type I ◽  
Group Iii ◽  
Long Bone Fractures ◽  
Group I ◽  
Tract Infections

Background: External skeletal fixator (ESF) has been recommended as biological method to stabilize open fracture as it does not involves the wound site, besides protecting adjacent soft tissue structures. Considering the advantages of ESF, this study was envisaged with an objective to study the outcome of open fractures of radius-ulna and tibia-fibula stabilized with linear ESF in dogs.Methods: This study included 17 dogs suffering from open long bone fractures of radius-ulna and tibia-fibula, divided into three groups; linear ESF type I or II (group I, n=8) and type III (group II, n=3). In group III (n=6), open fractures were initially treated using conservative methods i.e management of open wound till complete healing followed by delayed internal fixation using intramedullary pin or bone plating.Result: Majority of the open fractures of radius-ulna and tibia-fibula were transverse (64.71%), involving distal third diaphysis (47.06%) in heavy weight (54.55%), 1-3 year old (64.71%), non-descript (35.29%), male (88.23%) dogs due to automobile accidents (58.82%). Neutrophilic (81.47±4.45%) leukocytosis (24610±2461.88 per cumm) and elevated levels of alkaline phosphatase and creatine kinase were observed. Staphylococcus spp. was the common isolated bacteria sensitive to Gentamicin, Cefotaxime, Tobramycin, Amikacin and Neomycin. High per cent fractures (83.33%) in group III had acceptable functional outcome as compared to fractures treated with linear ESF (55.55%) in groups I and II. Osteomyelitis due to pin tract infections was the major complication (8/11; 72.7%) recorded in ESF groups (Group I and II) that lead to delayed and/or nonunion. Weight bearing score improved markedly after removal of the ESF frame. In conclusions, immediate fixation of the long bone fracture using linear ESF in the presence of open contaminated / infected wounds leads to unacceptable outcome. Poor animal compliance, pin tract discharge, osteomyelitis, delayed union and nonunion are major complications associated with linear ESF. Conservative management of the open fracture wound using standard treatment for 2-3 weeks till complete wound healing followed by internal fixation with intramedullary pin or bone plate is recommended for open long bone fractures in dogs.

Racial disparities in treatment patterns and clinical outcomes in patients (pts) with HER2+ metastatic breast cancer (MBC).

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 1526-1526
Author(s):  
Adam Brufsky ◽  
Denise Aysel Yardley ◽  
Marianne Ulcickas Yood ◽  
Debu Tripathy ◽  
Peter Andrew Kaufman ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Metastatic Breast ◽  
Stage Iv ◽  
Progression Free Survival ◽  
Population Based ◽  
Treatment Patterns ◽  
History Of ◽  
Observational Cohort ◽  
Grade 3

1526 Background: Data examining prognosis and treatment outcomes for black pts with HER2+ MBC are limited. Methods: registHER is a large, observational cohort of pts (N=1,001) with HER2+ MBC diagnosed w/in 6 mos of enrollment and followed until death, disenrollment, or 6/09 (median follow-up 27 mos). Demographics, treatment patterns, and clinical outcomes were described for black (n=126) and white pts (n=793). Progression Free Survival (PFS) and Overall Survival (OS) were examined. Multivariate analyses adjusted for baseline and treatment factors. Results: Black pts were more likely to be obese (BMI ≥ 30), have diabetes, and a history of cardiovascular disease (CVD) than white pts (Table). Black pts were less likely to have estrogen receptor (ER)/progesterone receptor (PR)+ disease and more likely to present with stage IV MBC. In trastuzumab (T)-treated pts, incidence of cardiac safety events (grade ≥3) was higher in black (13/119 [10.9%]) than white pts (59/746 [7.9%]). Unadjusted median OS (mos) was significantly lower (blacks: 27.1, 95%CI 23.2-32.1; whites: 37.3, 95%CI 34.6-41.1) and median PFS (mos) was lower (blacks: 7.0, 95%CI 5.7-9.7; whites: 10.2, 95%CI 9.3-11.2) in black than white pts. The adjusted OS hazard ratio (HR) for black vs. white was 1.32 (95%CI 1.04, 1.69); the adjusted PFS HR was 1.31 (95% CI 1.07, 1.61). Conclusions: These population-based data show poorer prognostic factors and independently worse clinical outcomes in black vs. white pts, and represent the largest database to date with black pts with HER2+ MBC. Further research is needed to explore the basis for the differences noted in this hypothesis-generating analysis. [Table: see text]

Mechanical thrombectomy using a Solitaire stent retriever in the treatment of pediatric acute ischemic stroke

2019 ◽  
Vol 23 (3) ◽  
pp. 363-368 ◽  
Author(s):  
Bing Zhou ◽  
Xiao-Chuan Wang ◽  
Jun-Yi Xiang ◽  
Ming-Zhao Zhang ◽  
Bo Li ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Balloon Dilation ◽  
Stent Retriever ◽  
National Institutes Of Health ◽  
Clinical Prognosis ◽  
Nihss Score ◽  
Grade 3

OBJECTIVEMechanical thrombectomy using a Solitaire stent retriever has been widely applied as a safe and effective method in adult acute ischemic stroke (AIS). However, due to the lack of data, the safety and effectiveness of mechanical thrombectomy using a Solitaire stent in pediatric AIS has not yet been verified. The purpose of this study was to explore the safety and effectiveness of mechanical thrombectomy using a Solitaire stent retriever for pediatric AIS.METHODSBetween January 2012 and December 2017, 7 cases of pediatric AIS were treated via mechanical thrombectomy using a Solitaire stent retriever. The clinical practice, imaging, and follow-up results were reviewed, and the data were summarized and analyzed.RESULTSThe ages of the 7 patients ranged from 7 to 14 years with an average age of 11.1 years. The preoperative National Institutes of Health Stroke Scale (NIHSS) scores ranged from 9 to 22 with an average of 15.4 points. A Solitaire stent retriever was used in all patients, averaging 1.7 applications of thrombectomy and combined balloon dilation in 2 cases. Grade 3 on the modified Thrombolysis In Cerebral Infarction scale of recanalization was achieved in 5 cases and grade 2b in 2 cases. Six patients improved and 1 patient died after thrombectomy. The average NIHSS score of the 6 cases was 3.67 at discharge. The average modified Rankin Scale score was 1 at the 3-month follow-up. Subarachnoid hemorrhage after thrombectomy occurred in 1 case and that patient died 3 days postoperatively.CONCLUSIONSThis study shows that mechanical thrombectomy using a Solitaire stent retriever has a high recanalization rate and excellent clinical prognosis in pediatric AIS. The safety of mechanical thrombectomy in pediatric AIS requires more clinical trials for confirmation.

Clinical Value of Computer-Assisted Taylor Three-dimensional External Fixation in the Treatment of Tibiofibular Fracture (Preprint)

2020 ◽  
Author(s):  
Hongfeng Sheng ◽  
Weixing Xu ◽  
Bin Xu ◽  
Hongpu Song ◽  
Di Lu ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Internal Fixation ◽  
External Fixation ◽  
External Fixator ◽  
Theoretical Basis ◽  
New Technology ◽  
Three Dimensional ◽  
Computer Assisted ◽  
Clinical Value

UNSTRUCTURED The retrospective study of Taylor's three-dimensional external fixator for the treatment of tibiofibular fractures provides a theoretical basis for the application of this technology. The paper collected 28 patients with tibiofibular fractures from the Department of Orthopaedics in our hospital from March 2015 to June 2018. After the treatment, the follow-up evaluation of Taylor's three-dimensional external fixator for the treatment of tibiofibular fractures and concurrency the incidence of the disease, as well as the efficacy and occurrence of the internal fixation of the treatment of tibial fractures in our hospital. The results showed that Taylor's three-dimensional external fixator was superior to orthopaedics in the treatment of tibiofibular fractures in terms of efficacy and complications. To this end, the thesis research can be concluded as follows: Taylor three-dimensional external fixation in the treatment of tibiofibular fractures is more effective, and the incidence of occurrence is low, is a new technology for the treatment of tibiofibular fractures, it is worthy of clinical promotion.

Necrosis avascular

2020 ◽  
Vol 63 (2) ◽  
pp. 18-23
Author(s):  
Alejandro Jardón Gómez ◽  
Ana Cristina King ◽  
Carlos Pacheco Díaz
Keyword(s):  
Femoral Head ◽  
Avascular Necrosis ◽  
Femoral Fracture ◽  
Open Fracture ◽  
Clinical Presentation ◽  
Femoral Fractures ◽  
Proximal Femoral Fracture ◽  
Young Population ◽  
Steroid Use

The clinical presentation of a proximal femoral fracture is completely different between young and adult patients. Unlike closed proximal femoral fractures, the incidence of exposed fractures is found in the young population between 15 and 30 years of age. Osteonecrosis of the femoral head is one the complications we can find in this type of fractures. Avascular necrosis (AVN or osteonecrosis) is defined as the interruption of blood supply to the femoral head due to trauma, infectionalcohol or steroid use, resulting in bone necrosis, joint collapse and osteoarthrosis. The treatment will depend on the clinical presentation, age of the patient and when the diagnosis is made. This is a case report of a 16-year-old patient with a gunshot wound on the hip. Surgical cleansing and closed reduction plus internal fixation with a nail in the center of the spine were performed. A 3-year clinical and radiographic follow up was made, observing the evolution of the fracture and the subsequent avascular necrosis that the patient presented. Key words: Proximal femoral fracture; hip; avascular necrosis (AVN, osteonecrosis); open fracture; osteoarthritis.

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