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Minerva Anestesiologica Jul 2019Pain is the most common complaint amongst trauma patients throughout the perioperative period. Multimodal analgesia is currently being regarded the mainstay, with... (Review)
Review
Pain is the most common complaint amongst trauma patients throughout the perioperative period. Multimodal analgesia is currently being regarded the mainstay, with regional anesthesia techniques constituting an integral part of it. Ultrasound imaging techniques display a plethora of advantages that have pervaded regional anesthesia practice. In this review, we set out to provide several examples of injuries, to elucidate the precise anatomy of fractured bones (osteotomes), and to elaborate on certain peripheral nerve blocks employed in pain management of trauma patients. Controversies/special considerations pertaining to peripheral nerve blocks also dictate thorough analysis: as such, acute compartment syndrome, acute peripheral nerve injuries, regional anesthesia in awake or anesthetized patients, continuous peripheral nerve blocks, positioning limitations and, finally, ultrasound imaging versus neurostimulation techniques are extensively reviewed.
Topics: Acute Pain; Analgesia; Anesthesia, Conduction; Brachial Plexus; Compartment Syndromes; Emergency Medical Services; Fractures, Bone; Humans; Lower Extremity; Nerve Block; Pain Management; Pain, Postoperative; Patient Positioning; Peripheral Nerve Injuries; Peripheral Nerves; Ultrasonography, Interventional; Upper Extremity
PubMed: 30735016
DOI: 10.23736/S0375-9393.19.13145-8 -
British Journal of Hospital Medicine... Mar 2022An arterial injury is a time-critical emergency and, when associated with a fracture or dislocation, its management requires joint specialist input from orthopaedic and... (Review)
Review
An arterial injury is a time-critical emergency and, when associated with a fracture or dislocation, its management requires joint specialist input from orthopaedic and vascular or plastic surgeons. Initial management involves haemorrhage control and stabilisation of the patient, reduction and splinting of the limb and careful reassessment. With ongoing vascular compromise, urgent surgery is indicated to restore arterial flow and stabilise the skeleton, and this should be performed at a centre with appropriate expertise. This article provides an evidence-based review of the British Orthopaedic Association Standards for Trauma for the diagnosis and management of arterial injuries associated with extremity fractures and dislocations.
Topics: Angiography; Extremities; Fractures, Bone; Humans; Joint Dislocations; Vascular System Injuries
PubMed: 35377208
DOI: 10.12968/hmed.2021.0454 -
Orthopaedics & Traumatology, Surgery &... Feb 2018"Urgent, complete, definitive" treatment still today seems to be an appropriate attitude in many trauma cases. There are, however, several situations in which emergency... (Review)
Review
"Urgent, complete, definitive" treatment still today seems to be an appropriate attitude in many trauma cases. There are, however, several situations in which emergency definitive fixation is not the optimal strategy for all cases of fracture. Temporary fixation has a role to play in the orthopedic "trauma damage control" design comprising successive steps, as applied in multiple trauma, multiple fracture, severe multi-tissue limb lesions and soft-tissue lesions of unpredictable progression. The aim of this study is to define the strategies, indications, principles and limitations of temporary fixation in limb and pelvis fracture.
Topics: Extremities; Fracture Fixation; Fractures, Multiple; Humans; Multiple Trauma; Patient Selection; Pelvic Bones; Soft Tissue Injuries
PubMed: 29197635
DOI: 10.1016/j.otsr.2017.03.032 -
Canadian Medical Association Journal Jan 1960
Topics: Ankle Injuries; Calcaneus; Child; Foot; Fractures, Bone; Humans; Infant; Knee Injuries
PubMed: 13814323
DOI: No ID Found -
Acta Medica Portuguesa Sep 2021
Topics: Fracture Fixation, Internal; Fractures, Bone; Humans; Ulna; Upper Extremity
PubMed: 34863325
DOI: 10.20344/amp.13444 -
Journal of Perioperative Practice May 2022An open fracture is a fracture which communicates with the external environment through a wound in the skin. Severe open fractures are managed by both orthopaedic and... (Review)
Review
An open fracture is a fracture which communicates with the external environment through a wound in the skin. Severe open fractures are managed by both orthopaedic and plastic surgeons to address injuries in both the bone and soft tissue. This review outlines the management of open fractures in the lower limb from the initial patient presentation to operative management (including debridement, skeletal fixation, definitive soft tissue coverage) according to the standards jointly published by the British Orthopaedic Association (BOA) and the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS). Additionally, the decision-making between limb salvage or amputation will be explored. Finally, this review will discuss the patient's postoperative care including wound care and management of potential complications that may arise such as infection, flap failure and fracture non-union.
Topics: Fracture Fixation; Fractures, Open; Humans; Lower Extremity; Retrospective Studies; Soft Tissue Injuries; Tibial Fractures; Treatment Outcome
PubMed: 34214004
DOI: 10.1177/17504589211012150 -
Deutsches Arzteblatt International Nov 2018It is well known that physical abuse of children all too often escapes detection. Fractures are among the potential consequences of physical abuse but are also com- mon... (Review)
Review
BACKGROUND
It is well known that physical abuse of children all too often escapes detection. Fractures are among the potential consequences of physical abuse but are also com- mon in childhood because of accidents. A question frequently addressed to the Medical Child Protection Hotline (Medizini- sche Kinderschutzhotline) is how fractures due to abuse can be distinguished from accidental fractures.
METHODS
This review is based on pertinent publications retrieved by a search in PubMed and in the Cochrane Data- base, as well as on the authors' experience in a pediatric emergency department with ca. 29 000 consultations per year and in a child protection outpatient clinic with ca. 100 consultations per year.
RESULTS
Fractures due to abuse are especially common among infants; their incidence is estimated at 56.8/100 000 among infants less than six months old and 39.8/100 000 among infants aged 6 to 11 months. In consideration of the age of the child, the type of fracture, the history, and other factors, a high probability of abuse can be suspected in many cases, so that further measures can be initiated.
CONCLUSION
All physicians involved in the care of children (even if only occasionally) should be aware of the major indicators of likely physical abuse and of the available oppor- tunities for counseling and intervention. Failures to diagnose child abuse are associated with high rates of recurrence and mortality.
Topics: Adolescent; Biomechanical Phenomena; Child; Child Abuse; Child, Preschool; Extremities; Female; Fractures, Bone; Humans; Incidence; Infant; Male
PubMed: 30602409
DOI: 10.3238/arztebl.2018.0769 -
BMJ Case Reports Oct 2014In this case study we report a fracture of the lateral process of the talus (LPF) in a snowboarder. The fracture is frequently overlooked initially, due to subtle... (Review)
Review
In this case study we report a fracture of the lateral process of the talus (LPF) in a snowboarder. The fracture is frequently overlooked initially, due to subtle clinical and radiological findings and a low incidence rate. However, LPF are associated with significant morbidity when missed. To address this, we report one case of a patient with a LPF and provide a review of the available literature.
Topics: Adult; Ankle; Ankle Joint; Female; Fracture Fixation, Internal; Fractures, Bone; Humans; Skiing; Talus
PubMed: 25355745
DOI: 10.1136/bcr-2014-204220 -
The Journal of Spinal Cord Medicine Nov 2022To describe patient experiences with fracture prevention and management among persons with spinal cord injuries/disorders (SCI/D).
CONTEXT/OBJECTIVE
To describe patient experiences with fracture prevention and management among persons with spinal cord injuries/disorders (SCI/D).
DESIGN
Qualitative data collected via semi-structured telephone interviews.
SETTING
Veterans Health Administration (VA) SCI/D System of Care.
PARTICIPANTS
Veterans with SCI/D (= 32) who had experienced at least one lower-extremity fracture in the prior 18 months.
INTERVENTIONS
N/A.
OUTCOME MEASURES
Interview questions addressed patients': pre-fracture knowledge of osteoporosis and bone health, diagnosis and management of osteoporosis, history and experiences with fracture treatment, and post-fracture care and experiences.
RESULTS
Participants expressed concerns about bone health and fractures in particular, which for some, limited activities and participation. Participants recalled receiving little information from providers about bone health or osteoporosis and described little knowledge about osteoporosis prevention prior to their fracture. Few participants reported medication management for osteoporosis, however many reported receiving radiographs/scans to confirm a fracture and most reported being managed non-operatively. Some reported preference for surgical treatment and believed their outcomes would have been better had their fracture been managed differently. Many reported not feeling fully included in treatment decision-making. Some described decreased function, independence and/or participation post-fracture.
CONCLUSION(S)
Our results indicate that persons with SCI/D report lacking substantive knowledge about bone health and/or fracture prevention, and following fracture, feel unable and/or hesitant to resume pre-fracture participation. In addition, our findings indicate that individuals with SCI/D may not feel as engaged as they would like to be in establishing fracture treatment plans. As such, persons with SCI/D may benefit from ongoing discussions with providers about risks and benefits of fracture treatment options and consideration of subsequent function and participation, to ensure patients preferences are considered.
Topics: Humans; Spinal Cord Injuries; Fractures, Bone; Osteoporosis; Spinal Cord Diseases; Lower Extremity
PubMed: 33830880
DOI: 10.1080/10790268.2021.1907675 -
British Journal of Hospital Medicine... Nov 2023Patients with wrist pain commonly present to primary care and emergency departments. A detailed history and examination, alongside relevant imaging, will help find the... (Review)
Review
Patients with wrist pain commonly present to primary care and emergency departments. A detailed history and examination, alongside relevant imaging, will help find the correct diagnosis and ensure that patients receive the correct treatment in a timely manner. This article summarises the key points in history and examination and the role of imaging, including suggestions of which modality should be requested. Finally, important acute pathologies are highlighted, including fractures, soft tissue injuries and infection, with examples of their relevant imaging.
Topics: Humans; Wrist; Wrist Joint; Arthralgia; Emergency Service, Hospital; Fractures, Bone
PubMed: 38019207
DOI: 10.12968/hmed.2023.0133