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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 -
The Veterinary Clinics of North... May 2007Emergency management of distal limb and skull fractures in horses is vital to the successful outcome of these cases. Distal limb fractures, in particular, require... (Review)
Review
Emergency management of distal limb and skull fractures in horses is vital to the successful outcome of these cases. Distal limb fractures, in particular, require careful assessment and counseling of the owner as well as adequate stabilization or coaptation of the fracture. Horses with limb or skull fractures may also have concurrent pain, blood loss, and other fluid losses that can result in shock requiring fluid therapy before definitive treatment of the fracture. Proper emergency fracture stabilization, initial treatment in the field, and patient transport are discussed.
Topics: Animals; Emergencies; Extremities; Fractures, Bone; Horses; Skull Fractures; Splints; Transportation of Patients
PubMed: 17379113
DOI: 10.1016/j.cveq.2006.11.008 -
Equine Veterinary Journal Jan 2019A key focus of the racing industry is to minimise the number of race-day distal limb fractures although no studies have identified risk factors for both fatal and...
BACKGROUND
A key focus of the racing industry is to minimise the number of race-day distal limb fractures although no studies have identified risk factors for both fatal and non-fatal distal limb fractures.
OBJECTIVE
To determine risk factors for race-day distal limb fractures experienced by Thoroughbred racehorses participating in flat racing in Great Britain (GB).
STUDY DESIGN
Retrospective cohort.
METHODS
Information was collected from all flat racing starts occurring on GB racecourses between 2000 and 2013, including horse, race, course, trainer and jockey data for each horse start and race-day injury data as reported by on-course veterinarians. Associations between exposure variables and cases of distal limb fracture were assessed using mixed-effects logistic regression analyses using data from all starts, and turf starts only.
RESULTS
A total of 806,764 starts and 624 cases of distal limb fracture were included, of which 548,571 starts and 379 cases of distal limb fracture occurred on turf surfaces. In both models, increasing firmness of the going, increasing racing distance and horses in their first year of racing were at a higher risk of distal limb fracture while increasing number of previous race starts were protective. Trainer performance was associated with distal limb fracture. Generally, the risk of distal limb fracture increased with increasing horse age. Starts in selling or claiming races or Group 1, Group 3 or claiming races were at higher odds of distal limb fracture in the all starts and turf models, respectively.
MAIN LIMITATIONS
Clinical diagnosis of distal limb fracture and all types of distal limb fracture considered as one outcome.
CONCLUSIONS
This study confirmed previously identified risk factors for distal limb fracture including going, race distance and number of horse starts. Novel risk factors were related to trainer and horse performance, and race type. Identification of at risk groups will help inform interventions to reduce distal limb fracture occurrence in flat racing horses.
Topics: Animals; Breeding; Cohort Studies; Extremities; Fractures, Bone; Horses; Logistic Models; Retrospective Studies; Risk Factors; Running; United Kingdom
PubMed: 29806972
DOI: 10.1111/evj.12968 -
Osteoporosis International : a Journal... Aug 2010This 1-year cohort study of nursing home residents revealed that historical fractures of upper limbs or nonhip lower limbs were associated with hip fracture (hazard...
SUMMARY
This 1-year cohort study of nursing home residents revealed that historical fractures of upper limbs or nonhip lower limbs were associated with hip fracture (hazard ratio = 2.14), independent of activities of daily living (ADL), mobility, dementia, weight, and type of nursing home. Prior nonhip fractures are useful for predicting of hip fracture in institutional settings.
INTRODUCTION
The aim of this study was to evaluate the utility of fracture history for the prediction of hip fracture in nursing home residents.
METHODS
This was a cohort study with a 1-year follow-up. Subjects were 8,905 residents of nursing homes in Niigata, Japan (mean age, 84.3 years). Fracture histories were obtained from nursing home medical records. ADL levels were assessed by caregivers. Hip fracture diagnosis was based on hospital medical records.
RESULTS
Subjects had fracture histories of upper limbs (5.0%), hip (14.0%), and nonhip lower limbs (4.6%). Among historical single fractures, only prior nonhip lower limbs significantly predicted subsequent fracture (adjusted hazard ratio, 2.43; 95% confidence interval (CI), 1.30-4.57). The stepwise method selected the best model, in which a combined historical fracture at upper limbs or nonhip lower limbs (adjusted hazard ratio, 2.14; 95% CI, 1.30-3.52), dependence, ADL levels, mobility, dementia, weight, and type of nursing home independently predicted subsequent hip fracture.
CONCLUSIONS
A fracture history at upper or nonhip lower limbs, in combination with other known risk factors, is useful for the prediction of future hip fracture in institutional settings.
Topics: Activities of Daily Living; Aged; Aged, 80 and over; Dementia; Epidemiologic Methods; Extremities; Female; Fractures, Bone; Hip Fractures; Homes for the Aged; Humans; Japan; Male; Nursing Homes; Prognosis; Recurrence
PubMed: 19771487
DOI: 10.1007/s00198-009-1081-0 -
Medicine Nov 2023This study aimed to assess the preventive role of rehabilitation nursing in the formation of deep vein thrombosis (DVT) in the lower limbs after fracture and its effect... (Randomized Controlled Trial)
Randomized Controlled Trial
This study aimed to assess the preventive role of rehabilitation nursing in the formation of deep vein thrombosis (DVT) in the lower limbs after fracture and its effect on the patient's quality of life. Ninety patients with lower limb fractures were randomly divided into a study group (n = 45) and a control group (n = 45). Patients in the control group received routine care postoperatively, whereas patients in the study group received rehabilitation nursing intervention on the same postoperative day. A follow-up examination was conducted after 3 months. The occurrence rate of lower limb DVT (LDVT) complications, hemorheology, quality of life (SF-36) scores, coagulation profile, and nursing satisfaction were compared between the groups. After the intervention, the study group presented with lower extremity DVT and higher hemorheology indices than those of the control group (P < .05). The SF-36 scores of both groups increased, but the increase in SF-36 scores in the study group was more significant (P < .001). The satisfaction level of the patients in the study group with nursing services was higher than that of the control group (P = .004). Coagulation indicators can be effectively adjusted and the occurrence of postoperative complications can be reduced in patients undergoing spine fracture surgery such as DVT via standardized rehabilitation care, thereby improving patients' quality of life and nursing conditions.
Topics: Humans; Quality of Life; Rehabilitation Nursing; Lower Extremity; Fractures, Bone; Venous Thrombosis
PubMed: 38013261
DOI: 10.1097/MD.0000000000036180 -
BioMed Research International 2019The aim of this study was to assess muscle injury associated with upper and lower closed limb fracture using ultrasound, and to develop ultrasound classification...
OBJECTIVE
The aim of this study was to assess muscle injury associated with upper and lower closed limb fracture using ultrasound, and to develop ultrasound classification criteria for muscle injury.
PATIENTS AND METHODS
Thirty patients with limb fracture and muscle injury participated in this study. Ultrasonography was used to assess muscle fibre, hematoma, vascular injury, and diameter growth rate. Injury was classified into three grades according to the ultrasound imaging: scores of less than, equal to, or greater than 9.
RESULTS
Of 30 patients, focal fibre rupture was observed in 11 cases; in 9 cases, the injured area exceeded 30% of the muscle area. Six patients had muscle hematoma (the largest reaching 39 mm); in 4 patients, the hematoma showed a honeycombed pattern. Vascular rupture was observed in 6 patients, of which 2 had decreased main arterial diameter and blood flow. The greatest increase in muscle thickness was 17 mm. Of all patients, 11 showed an increase in the diameter growth rate of the muscle exceeding 50%. In addition, among the 30 patients, 11 patients with scores ranging from 4 to 8 received conservative treatment; 9 patients with scores ranging from 10 to 14 received operative treatment; and 10 patients with scores equal to 9 received either conservative or operative treatment.
CONCLUSIONS
Ultrasonography is useful for diagnosing muscle injury associated with closed limb fracture. The ultrasound classification criteria for muscle injury can be used to assess the severity of injury and guide the decision of treatment.
Topics: Adolescent; Adult; Aged; Extremities; Female; Fracture Healing; Fractures, Bone; Fractures, Closed; Humans; Male; Middle Aged; Muscles; Muscular Diseases; Rupture; Ultrasonography; Young Adult
PubMed: 31309121
DOI: 10.1155/2019/9365291 -
The Journal of Hand Surgery, European... Sep 2023Fractures of the phalanges encompass a wide range of injury patterns with variable articular and soft tissue involvement. The goals of treatment whether conservative or... (Review)
Review
Fractures of the phalanges encompass a wide range of injury patterns with variable articular and soft tissue involvement. The goals of treatment whether conservative or surgical are the restoration of function while limiting the risk of complications. An armamentarium of fixation options allows the surgeon to appropriately treat these fractures with the intention of initiating early postoperative mobilization. Previous publications report variable rates of complications following internal fixation of phalangeal fractures which represents an unsolved problem. It is incumbent on the surgeon to utilize meticulous surgical technique, achieve anatomic reduction with stable fixation and initiate early postoperative mobilization where indicated. In the following text, we review the management of most types of phalangeal fractures, except fracture-dislocations of the proximal interphalangeal joint. These injuries comprise a wide spectrum of presentation; thus, an understanding of anatomical and mechanical principles is integral to achieving a successful outcome.
Topics: Humans; Fractures, Bone; Extremities; Finger Phalanges; Fracture Dislocation; Joints
PubMed: 37704026
DOI: 10.1177/17531934231185219 -
The Journal of Hand Surgery, European... Sep 2023Peri-articular fractures of the hand are common injuries. Long-term consequences can be relatively innocuous or severely disabling. Due to the specific anatomy of the... (Review)
Review
Peri-articular fractures of the hand are common injuries. Long-term consequences can be relatively innocuous or severely disabling. Due to the specific anatomy of the hand, avulsion fractures are likely more common here than anywhere else in the body and often occur at or near joints. The management of peri-articular fractures of the hand requires consideration of both the articular reduction and the status of ligament and tendon attachments. In general, these fractures can be treated non-operatively. Operative treatment can be percutaneous or open and should be individualized.
Topics: Humans; Hand; Upper Extremity; Intra-Articular Fractures; Fractures, Bone; Neurosurgical Procedures
PubMed: 37704023
DOI: 10.1177/17531934231184132 -
Archives of Internal MedicineWhether limb fracture in elderly men predicts future fracture is unknown.
BACKGROUND
Whether limb fracture in elderly men predicts future fracture is unknown.
METHODS
Electronic health records were examined to determine fracture incidence among men 60 years or older who were members of a large health maintenance organization, experienced no fracture in the past 2 years, and experienced an ankle, hip, humerus, or wrist fracture between July 1, 1997, and August 31, 2001. Proportional hazards models were used to compare risk of new fracture (ankle, hip, humerus, or wrist) between groups. Recurrent fractures of the same type were excluded from analysis.
RESULTS
During the follow-up period (mean duration, 2.4 years), 0.5% of the control subjects without fractures experienced a subsequent ankle fracture; 0.6%, a hip fracture; 0.2%, a humerus fracture; and 0.4%, a wrist fracture. A limb fracture was about 4 times more likely to occur in persons who experienced a previous humerus fracture (relative risk, 3.9; 95% confidence interval, 2.5-6.0), about 3 times more likely to occur in persons who experienced a previous hip fracture (relative risk, 2.8; 95% confidence interval, 1.7-4.5), and about 2 times more likely to occur in persons who experienced a previous wrist fracture (relative risk, 2.2; 95% confidence interval, 1.4-3.5) than in controls. In contrast, persons who experienced a previous ankle fracture had no greater risk of subsequent fracture than nonfracture controls (relative risk, 1.0; 95% confidence interval, 0.5-1.9).
CONCLUSIONS
Among men 60 years or older, a recent hip, humerus, or wrist fracture is a statistically and clinically significant predictor of future limb fracture risk. An increased risk of future fracture is greatest after a humerus fracture and is lowest after a wrist fracture; however, among elderly men, a previous ankle fracture is not an indicator of future fracture risk.
Topics: Aged; Aged, 80 and over; Extremities; Fractures, Bone; Humans; Male; Middle Aged; Osteoporosis; Proportional Hazards Models; Recurrence; Risk Factors
PubMed: 14662628
DOI: 10.1001/archinte.163.22.2741 -
Ultrasound in Medicine & Biology Feb 2019Approximately 6.3 million fractures occur each year in the United States alone. Accurately monitoring the progression of fracture healing is essential to be able to...
Approximately 6.3 million fractures occur each year in the United States alone. Accurately monitoring the progression of fracture healing is essential to be able to advise patients when it is safe to return to normal activity. The most common method used to confirm and monitor fracture healing is the acquisition of multiple radiographic images over the many months required for healing. This imaging method uses large expensive equipment and exposes patients to high levels of ionizing radiation. In the study described here, we tested another technology for monitoring fracture healing that could minimize the need for multiple radiographic images. We tested a piezoelectric transducer fixed to the surface of a bone that uses electromechanical impedance spectroscopy to measure simulated fractures and transmits the measurement data to an acoustic receiver located externally on the skin surface.
Topics: Animals; Disease Models, Animal; Extremities; Fractures, Bone; Image Interpretation, Computer-Assisted; Signal Processing, Computer-Assisted; Swine; Ultrasonography
PubMed: 30553585
DOI: 10.1016/j.ultrasmedbio.2018.09.016