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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 -
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 -
Medicine Jun 2023Fracture is a global public health disease. Bone health and fracture risk have become the focus of public and scientific attention. Observational studies have reported...
Fracture is a global public health disease. Bone health and fracture risk have become the focus of public and scientific attention. Observational studies have reported that tea consumption is associated with fracture risk, but the results are inconsistent. The present study used 2-sample Mendelian randomization (MR) analysis. The inverse variance weighted method, employing genetic data from UK Biobank (447,485 cases) of tea intake and UK Biobank (Genome-wide association study Round 2) project (361,194 cases) of fractures, was performed to estimate the causal relationship between tea intake and multiple types of fractures. The inverse variance weighted indicated no causal effects of tea consumption on fractures of the skull and face, shoulder and upper arm, hand and wrist, femur, calf, and ankle (odds ratio = 1.000, 1.000, 1.002, 0.997, 0.998; P = .881, 0.857, 0.339, 0.054, 0.569, respectively). Consistent results were also found in MR-Egger, weighted median, and weighted mode. Our research provided evidence that tea consumption is unlikely to affect the incidence of fractures.
Topics: Humans; Genome-Wide Association Study; Mendelian Randomization Analysis; Upper Extremity; Wrist; Fractures, Bone; Tea; Polymorphism, Single Nucleotide
PubMed: 37266651
DOI: 10.1097/MD.0000000000033542 -
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 -
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 -
Acta Medica Portuguesa Sep 2021
Topics: Fracture Fixation, Internal; Fractures, Bone; Humans; Ulna; Upper Extremity
PubMed: 34863325
DOI: 10.20344/amp.13444 -
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 -
American Family Physician Oct 2003Lower extremity stress fractures are common injuries most often associated with participation in sports involving running, jumping, or repetitive stress. The initial... (Review)
Review
Lower extremity stress fractures are common injuries most often associated with participation in sports involving running, jumping, or repetitive stress. The initial diagnosis can be made by identifying localized bone pain that increases with weight bearing or repetitive use. Plain film radiographs are frequently unrevealing. Confirmation of a stress fracture is best made using triple phase nuclear medicine bone scan or magnetic resonance imaging. Prevention of stress fractures is most effectively accomplished by increasing the level of exercise slowly, adequately warming up and stretching before exercise, and using cushioned insoles and appropriate footwear. Treatment involves rest of the injured bone, followed by a gradual return to the sport once free of pain. Recent evidence supports the use of air splinting to reduce pain and decrease the time until return to full participation or intensity of exercise.
Topics: Fractures, Stress; Humans; Lower Extremity; Risk Factors
PubMed: 14596439
DOI: No ID Found -
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 Dec 2023Fractures of the fingers and metacarpal bones are the most common fracture type in the upper limb, with an incidence of 114 to 1483 per 100 000 persons per year. The... (Review)
Review
BACKGROUND
Fractures of the fingers and metacarpal bones are the most common fracture type in the upper limb, with an incidence of 114 to 1483 per 100 000 persons per year. The clinical importance of closed finger and metacarpal fractures is often underestimated; inadequate diagnostic and therapeutic measures may result in serious harm. This review concerns the basic elements of the diagnosis and treatment of finger and metacarpal fractures.
METHODS
This review of the incidence, diagnosis and treatment of finger and metacarpal fractures is based on pertinent publications retrieved by a selective search of the literature.
RESULTS
The main focus of treatment lies on restoration of hand function in consideration of the requirements of the individual patient. The currently available evidence provides little guidance to optimal treatment (level II evidence). Although most closed fractures can be managed conservatively, individualized surgical treatment is advisable in comminuted fractures and fractures with a relevant degree of torsional malposition, axis deviation, or shortening, as well as in intra-articular fractures. Minimally invasive techniques are, in principle, to be performed wherever possible, yet open surgery is sometimes needed because of fracture morphology. Postsurgical complication rates are in the range of 32-36%, with joint fusion accounting for 67-76% of the complications. 15% involve delayed fracture healing and pseudarthrosis.
CONCLUSION
Individualized treatment for finger and metacarpal fractures can improve patients' outcomes, with major socioeconomic and societal benefits. Further high-quality studies evaluating the relative merits of the available treatments are needed as a guide to optimized therapy.
Topics: Humans; Metacarpal Bones; Fractures, Bone; Hand Injuries; Fracture Fixation, Internal; Upper Extremity; Treatment Outcome
PubMed: 37963039
DOI: 10.3238/arztebl.m2023.0226