-
Chinese Journal of Traumatology =... 2013To comparatively analyze the medical records of patients with limb fractures as well as rescue strategy in Wenchuan and Yushu earthquakes so as to provide references for... (Comparative Study)
Comparative Study
OBJECTIVE
To comparatively analyze the medical records of patients with limb fractures as well as rescue strategy in Wenchuan and Yushu earthquakes so as to provide references for post-earthquake rescue.
METHODS
We retrospectively investigated 944 patients sustaining limb fractures, including 891 in Wenchuan earthquake and 53 in Yushu earthquake, who were admitted to West China Hospital (WCH) of Sichuan University.
RESULTS
In Wenchuan earthquake, WCH met its three peaks of limb fracture patients influx, on post-earthquake day (PED) 2, 8 and 14 respectively. Between PED 3-14, 585 patients were transferred from WCH to other hospitals outside the Sichuan Province. In Yushu earthquake, the maximum influx of limb fracture patients happened on PED 3, and no one was shifted to other hospitals. Both in Wenchuan and Yushu earthquakes, most limb fractures were caused by blunt strike and crush/burying. In Wenchuan earthquake, there were 396 (396/942, 42.0%) open limb fractures, including 28 Gustilo I, 201 Gustilo II and 167 Gustilo III injuries. But in Yushu earthquake, the incidence of open limb fracture was much lower (6/61, 9.8%). The percent of patients with acute complications in Wenchuan earthquake (167/891, 18.7%) was much higher than that in Yushu earthquake (5/53, 3.8%). In Wenchuan earthquake rescue, 1 018 surgeries were done, composed of debridement in 376, internal fixation in 283, external fixation in 119, and vacuum sealing drainage in 117, etc. While among the 64 surgeries in Yushu earthquake rescue, the internal fixation for limb fracture was mostly adopted. All patients received proper treatment and survived except one who died due to multiple organs failure in Wenchuan earthquake.
CONCLUSION
Provision of suitable and sufficient medical care in a catastrophe can only be achieved by construction of sophisticated national disaster medical system, prediction of the injury types and number of injuries, and confirmation of participating hospitals?exact role. Based on the valuable rescue experiences after Wenchuan earthquake, the rescue was faster, more orderly and effective in Yushu earthquake. Nevertheless, there is still a long way to go in the development of a stronger emergent response to the disasters.
Topics: Adult; Aged; China; Earthquakes; Extremities; Female; Fractures, Bone; Hospitals, Teaching; Humans; Male; Middle Aged; Retrospective Studies
PubMed: 23384865
DOI: No ID Found -
Annals of the Royal College of Surgeons... Oct 2014
Topics: Acetabulum; Ankle; Fracture Fixation, Internal; Fractures, Bone; Humans; Lower Extremity; Traction
PubMed: 25245738
DOI: 10.1308/rcsann.2014.96.7.547a -
Instructional Course Lectures 2011A mangled extremity is defined as a limb with injury to three of four systems in the extremity. The decision to salvage or amputate the injured limb has generated much...
A mangled extremity is defined as a limb with injury to three of four systems in the extremity. The decision to salvage or amputate the injured limb has generated much controversy in the literature, with studies to support advantages of each approach. Various scoring systems have proved unreliable in predicting the need for amputation or salvage; however, a recurring theme in the literature is that the key to limb viability seems to be the severity of the soft-tissue injury. Factors such as associated injuries, patient age, and comorbidities (such as diabetes) also should be considered. Attempted limb salvage should be considered only if a patient is hemodynamically stable enough to tolerate the necessary surgical procedures and blood loss associated with limb salvage. For persistently hemodynamically unstable patients and those in extremis, life comes before limb. Recently, the Lower Extremity Assessment Project study attempted to answer the question of whether amputation or limb salvage achieves a better outcome. The study also evaluated other factors, including return-to-work status, impact of the level of and bilaterality of the amputation, and economic cost. There appears to be no significant difference in return to work, functional outcomes, or the cost of treatment (including the prosthesis) between the two groups. A team approach with different specialties, including orthopaedics, plastic surgery, vascular surgery and trauma general surgery, is recommended for treating patients with a mangled extremity.
Topics: Amputation, Surgical; Amputees; Extremities; Fractures, Bone; Humans; In Vitro Techniques; Limb Salvage; Patient Satisfaction; Soft Tissue Injuries; Treatment Outcome
PubMed: 21553759
DOI: No ID Found -
Swiss Medical Weekly 2012Following elective orthopaedic surgery or the treatment of a fracture, patients are temporarily unable to drive. This loss of independence may have serious social and... (Review)
Review
Following elective orthopaedic surgery or the treatment of a fracture, patients are temporarily unable to drive. This loss of independence may have serious social and economic consequences for the patient. It is therefore essential to know when it is safe to permit such patients to return to driving. This article, based upon a review of the current literature, proposes recommendations of the time period after which patients may safely return to driving. Practical decisions are made based upon the type of surgical intervention or fracture. Swiss legislation is equally approached so as to better define the decision.
Topics: Arthroplasty; Arthroscopy; Automobile Driving; Elective Surgical Procedures; Extremities; Fracture Fixation; Fractures, Bone; Humans; Orthopedic Procedures; Orthopedics; Reaction Time; Safety; Switzerland; Time Factors
PubMed: 23255082
DOI: 10.4414/smw.2012.13716 -
Military Medicine Sep 2018Fractures continue to account for a large proportion of combat-related injuries. The basic tenets of irrigation, debridement, soft tissue care, and vigilant...
Fractures continue to account for a large proportion of combat-related injuries. The basic tenets of irrigation, debridement, soft tissue care, and vigilant monitoring/fasciotomy for acute compartment syndrome persist. Closed management of fractures with splinting or casting is acceptable. If time and facility allow, external fixation of fractures offer many advantages over closed treatment but require knowledge, experience and skill in the safe placement of pins. The care of host nationals presents unique challenges and deployed surgeons must be flexible and resourceful in these situations.
Topics: Compartment Syndromes; Debridement; Extremities; Fracture Fixation; Fractures, Bone; Humans; Military Personnel; Warfare
PubMed: 30189079
DOI: 10.1093/milmed/usy081 -
Pediatric Emergency Care May 2004
Review
Topics: Adolescent; Fractures, Bone; Hand Injuries; Hockey; Humans; Male; Metacarpus; Radiography; Thumb
PubMed: 15123906
DOI: 10.1097/00006565-200405000-00010 -
British Journal of Hospital Medicine... Feb 2024Supracondylar fractures of the distal humerus are the most common fracture around the elbow in children. A thorough initial assessment must be conducted to identify any...
Supracondylar fractures of the distal humerus are the most common fracture around the elbow in children. A thorough initial assessment must be conducted to identify any associated neurovascular injury and carefully documented. The assessment should include a vascular examination of the radial pulse, temperature, colour and capillary refill time. A neurological examination must comment on the motor and sensory function of the radial, median and ulnar nerves. X-rays allow an evaluation of the fracture location and type, and the degree of displacement. Immobilisation in plaster is the gold standard treatment for paediatric supracondylar fracture of the humerus where the degree of displacement is within acceptable parameters. Casting should be followed by orthogonal radiographs and a repeat neurovascular assessment of the limb. Oral analgesia and safety netting information should be provided on discharge, and the child reviewed in a fracture clinic within 1 week of the injury. The British Orthopaedic Association Standards for Trauma and Orthopaedics for supracondylar fractures of the humerus in children are useful for junior orthopaedic and emergency medicine clinicians to refer to when dealing with these injuries.
Topics: Humans; Child; Fractures, Bone; Extremities; Ambulatory Care Facilities; Analgesia; Elbow Joint
PubMed: 38416526
DOI: 10.12968/hmed.2023.0112 -
Clinics in Plastic Surgery Oct 2012The main goal of reconstructive microsurgery must be an optimal functional and esthetic reconstruction meeting the individual trauma site requirements with minimal donor... (Review)
Review
The main goal of reconstructive microsurgery must be an optimal functional and esthetic reconstruction meeting the individual trauma site requirements with minimal donor site morbidity. The authors discuss new microsurgical options for extremity salvage: indications for reconstruction versus amputation, timing of free tissue transfer, reconstruction of soft tissue and bone, and functional muscle transfer. They discuss indications and contraindications for these procedures, along with emphasizing the important points of each.
Topics: Amputation, Surgical; Amputation, Traumatic; Bone Transplantation; Debridement; Extremities; Fractures, Bone; Humans; Limb Salvage; Microsurgery; Muscle, Skeletal; Replantation; Risk Assessment; Soft Tissue Injuries; Surgical Flaps; Time-to-Treatment
PubMed: 23036299
DOI: 10.1016/j.cps.2012.08.003 -
Veterinary Surgery : VS Feb 2014To evaluate clinical outcome of dogs with appendicular osteosarcoma (OSA) treated with stereotactic radiosurgery (SRS) and subsequent internal fixation of a pathologic...
OBJECTIVE
To evaluate clinical outcome of dogs with appendicular osteosarcoma (OSA) treated with stereotactic radiosurgery (SRS) and subsequent internal fixation of a pathologic fracture.
STUDY DESIGN
Retrospective case series.
ANIMALS
Dogs with spontaneous-occurring appendicular OSA (n = 6).
METHODS
Medical records (May 2002-January 2008) of dogs that had SRS for appendicular OSA were reviewed. Dogs were included if they had a pathologic fracture either before or after SRS and were treated with internal fixation. Signalment, history, physical examination findings, clinicopathologic data, diagnostic imaging findings, biopsy results, surgical complications, number of surgeries, adjuvant therapy, development of metastatic disease and cause of death were recorded.
RESULTS
Six dogs met the inclusion criteria. Two dogs had a pathologic fracture at admission and 4 dogs developed a fracture after SRS with a mean ± SD time to fracture development of 6.25 ± 1.65 months. The first 3 fractures were repaired using an open approach and the latter three using minimally invasive percutaneous osteosynthesis (MIPO). Infection occurred in 5 dogs and implant failure in 3. Limb function was subjectively assessed as good in all dogs when the implants were stable and infections were subclinical. Survival times ranged from 364-897 days; 1 dog was lost to follow-up.
CONCLUSIONS
Fracture repair using internal fixation should be considered a viable limb-sparing alternative for pathologic fractures that have been treated with SRS.
Topics: Animals; Bone Neoplasms; Dog Diseases; Dogs; Extremities; Female; Fracture Fixation, Internal; Fractures, Bone; Male; Osteosarcoma; Radiosurgery; Retrospective Studies; Treatment Outcome
PubMed: 24393054
DOI: 10.1111/j.1532-950X.2014.12082.x -
Journal of Orthopaedic Trauma Mar 2018In 16 years of conflict, primarily in Iraq and Afghanistan, wounded warriors have primarily been subjected to blast type of injuries. Evacuation strategies have led to... (Review)
Review
In 16 years of conflict, primarily in Iraq and Afghanistan, wounded warriors have primarily been subjected to blast type of injuries. Evacuation strategies have led to unprecedented survival rates in blast-injured soldiers, resulting in large numbers of wounded warriors with complex limb trauma. Bone and soft tissue defects have resulted in increased use of complex reconstructive algorithms to restore limbs and function. In addition, in failed salvage attempts, advances in amputation options are being developed. In this review, we summarize state-of-the-art limb-salvage methods for both soft tissue and bone. In addition, we discuss advances in diagnostic methods with development of personalized clinical decision support tools designed to optimize outcomes after severe blast injuries. Finally, we present new advances in osteointegrated prostheses for above-knee amputations.
Topics: Amputation, Surgical; Armed Conflicts; Blast Injuries; Extremities; Fractures, Bone; Humans; Limb Salvage; Plastic Surgery Procedures; Soft Tissue Injuries
PubMed: 29461402
DOI: 10.1097/BOT.0000000000001121