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British Journal of Hospital Medicine... Aug 2023Fracture-related infection is a serious complication which can occur following musculoskeletal injury and is associated with significant morbidity. These complications...
Fracture-related infection is a serious complication which can occur following musculoskeletal injury and is associated with significant morbidity. These complications can be challenging to recognise, and experts have provided a clearer definition of fracture-related infection to help with the diagnosis and detection of these infections. This system includes clinical, radiological and laboratory-based diagnostic features which are either confirmatory or suggestive of fracture-related infection. Treatment requires a multifaceted approach with multidisciplinary involvement, and generally a combination of surgical techniques and prolonged antibiotics, the timing and choice of which should be optimised. This article provides an evidence-based review of the British Orthopaedic Association Standards for Trauma for the diagnosis and management of fracture-related infections.
Topics: Humans; Fractures, Bone; Anti-Bacterial Agents; Laboratories; Orthopedics
PubMed: 37646543
DOI: 10.12968/hmed.2022.0545 -
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 -
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 -
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 -
Acta Medica Portuguesa Sep 2021
Topics: Fracture Fixation, Internal; Fractures, Bone; Humans; Ulna; Upper Extremity
PubMed: 34863325
DOI: 10.20344/amp.13444 -
Canadian Family Physician Medecin de... Oct 2018A 2-year-old boy presented to my office 2 days after he started limping. The history, physical examination, and radiology assessment revealed a toddler's fracture (TF)....
A 2-year-old boy presented to my office 2 days after he started limping. The history, physical examination, and radiology assessment revealed a toddler's fracture (TF). I understand that there is considerable variation in practice regarding management of TF. What is the best method to confirm the diagnosis? What method should be used to immobilize the affected limb and for how long? Is follow-up with a pediatric orthopedic surgeon needed? Toddler's fracture, also called or , is a fracture unique to ambulatory infants and young children. It is caused by a twisting injury while tripping, stumbling, or falling. Children usually present limping or refusing to walk. Tenderness at the fracture site is common but is at times hard to elicit in young children. Toddler's fracture is diagnosed clinically and frequently can be documented with radiographs. Treatment of both confirmed TF and presumed TF is conservative with immobilization. A controlled ankle motion boot or a short leg back slab are preferred because they are associated with fewer complications and can be removed by the family or the family physician. For most children, no orthopedic follow-up is needed.
Topics: Child, Preschool; Emergency Medical Services; Fractures, Bone; Humans; Immobilization; Infant; Radiography; Tibia
PubMed: 30315017
DOI: No ID Found -
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 -
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 -
Foot and Ankle Clinics Dec 2015Current clinical concepts are reviewed regarding the epidemiology, anatomy, evaluation, and treatment of pediatric ankle fractures. Correct diagnosis and management... (Review)
Review
Current clinical concepts are reviewed regarding the epidemiology, anatomy, evaluation, and treatment of pediatric ankle fractures. Correct diagnosis and management relies on appropriate examination, imaging, and knowledge of fracture patterns specific to children. Treatment is guided by patient history, physical examination, plain film radiographs and, in some instances, computed tomography. Treatment goals are to restore acceptable limb alignment, physeal anatomy, and joint congruency. For high-risk physeal fractures, patients should be monitored for growth disturbance as needed until skeletal maturity.
Topics: Ankle; Ankle Fractures; Child; Humans
PubMed: 26589088
DOI: 10.1016/j.fcl.2015.07.004