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1.
Background
Retained hemothorax (RH) is relatively common after chest trauma and can lead to empyema. We hypothesized that patients who have surgical fixation of rib fractures (SSRF) have less RH and empyema than those who have medical management of rib fractures (MMRF).Methods
Admitted rib fracture patients from January 2009 to June 2013 were identified. A 2:1 propensity score model identified MMRF patients who were similar to SSRF. RH, and empyema and readmissions, were recorded. Variables were compared using Fisher exact test and Wilcoxon rank–sum tests.Results
One hundred thirty-seven SSRF and 274 MMRF were analyzed; 31 (7.5%) had RH requiring 35 interventions; 3 (2.2%) SSRF patients had RH compared with 28 (10.2%) MMRF (P = .003). Four (14.3%) MMRF subjects with RH developed empyema versus zero in the SSRF group (P = .008); 6 (19.3%) RH patients required readmission versus 14 (3.7%) in the non-RH group (P = .002).Conclusions
Patients with rib fractures who have SSRF have less RH compared with similar MMRF patients. Although not a singular reason to perform SSRF, this clinical benefit should not be overlooked. 相似文献2.
3.
Background
Although tension-band wiring is the most widely used technique to fix patellar fractures, metal implant-related complications including implant failure and postoperative pain are very common and additional procedures are often necessary to treat the complications. The purpose of this study is to evaluate a totally metal-free technique using a transosseous suturing method and to compare it with the traditional fixation technique.Method
A total of 25 patients (mean age of 59.60 years) with displaced patellar fractures treated by a transosseous suturing technique were compared with a 1:1 matched historical control group that underwent modified tension-band-wire fixation. Union time, union rate, operation time, number of procedures, mean hospitalisation days and complications were compared between cases and controls.Results
Union time (8.43 ± 2.92 vs. 8.64 ± 2.82 weeks) and operation time (69.00 ± 19.31 vs. 64.89 ± 14.27 min) were not different between the two groups. Mean hospitalisation days (4.04 ± 1.40 vs. 5.76 ± 1.50 days; P < 0.001), number of procedures and the frequency of complications were significantly lower in the transosseous suturing group.Conclusion
The transosseous suturing technique is safe and effective in the transverse or comminuted fractures of the patella. The complication rate is significantly lower than with the tension-band-wiring technique. 相似文献4.
Emmanuel M. Illical Dana J. FarrellPeter A. Siska Andrew R. EvansGary S. Gruen Ivan S. Tarkin 《Injury》2014
Objectives
To compare elbow range of motion (ROM), triceps extension strength, and functional outcome of AO/OTA type A distal humerus fractures treated with a triceps-split or -sparing approach.Design
Retrospective review.Setting
Two level one trauma centres.Patients
Sixty adult distal humerus fractures (AO/OTA 13A2, 13A3) presenting between 2008 and 2012 were reviewed. Exclusion criteria removed 18 total patients from analysis and three patients died before final follow-up.Intervention
Patients were divided into two surgical approach groups chosen by the treating surgeon: triceps split (16 patients) or triceps sparing (23 patients).Main outcome measurements
Elbow ROM and triceps extension strength testing were completed in patients after fractures had healed. All patients were also given the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire.Results
Compared to the triceps-split cohort, the triceps-sparing cohort had greater elbow flexion (sparing 143 ± 7° compared to split 130 ± 12°, p = 0.03) and less extension contracture (sparing 6 ± 8° compared to split 23 ± 4°, p < 0.0001). Triceps strength compared to the uninjured arm also favoured the triceps-sparing cohort (sparing 88.9 ± 28.3% compared to split 49.4 ± 17.0%, p = 0.007). DASH scores were not statistically significant between the two cohorts (sparing 14.5 ± 12.2 compared to split 23.6 ± 22.3, p = 0.333).Conclusions
A triceps-sparing approach for surgical treatment of extra-articular distal humerus fractures can result in better elbow ROM and triceps strength than a triceps-splitting approach. Both approaches, however, result in reliable union and similar functional outcome.Level of evidence
Level III. 相似文献5.
Yifan YangJason B. Young M.D. Pharm.D. Carol R. SchermerGarth H. Utter M.D. M.Sc. 《American journal of surgery》2014
Background
The effectiveness of the nonsteroidal anti-inflammatory drug ketorolac in reducing pulmonary morbidity after rib fractures remains largely unknown.Methods
A retrospective cohort study was conducted spanning January 2003 to June 2011 assessing pneumonia within 30 days and potential adverse effects of ketorolac among all patients with rib fractures who received ketorolac <4 days after injury compared with a random sample of those who did not.Results
Among 202 patients who received ketorolac and 417 who did not, ketorolac use was associated with decreased pneumonia (odds ratio, .14; 95% confidence interval, .04 to .46) and increased ventilator-free days (difference, 1.8 days; 95% confidence interval, 1.1 to 2.5) and intensive care unit–free days (difference, 2.1 days; 95% confidence interval, 1.3 to 3.0) within 30 days. The rates of acute kidney injury, gastrointestinal hemorrhage, and fracture nonunion were not different.Conclusions
Early administration of ketorolac to patients with rib fractures is associated with a decreased likelihood of pneumonia, without apparent risks. 相似文献6.
Amanda R. MillerCharles R. St. Hill M.D. Susan F. EllisRobert C.G. Martin M.D. Ph.D. 《American journal of surgery》2013
Background
Few studies have evaluated the health-related quality-of-life (QOL) changes in patients following major liver resection for malignancy.Methods
QOL parameters were recorded prospectively at baseline (preoperative), and through 6 months of follow-up using various instruments.Results
Major complications occurred in 10 of 41 patients. At the initial outpatient visit, patients reported decreased global QOL with increased fatigue compared with baseline, which normalized at 6 weeks' follow-up and remained stable at 6 months. Those with major complications reported increased severity of pain over baseline at initial follow-up and at 6 months. Patients anemic at the time of discharge had worse physical QOL at 6 weeks, but levels similar to nonanemic patients at 3 months.Conclusions
Major complications are associated with increased reporting of pain persisting at 6 months. Attention to pain control, especially among patients with major complications, may improve QOL after major hepatic resection. 相似文献7.
Hwan Mo Lee Si Young Park Soon Hyuck Lee Seung Woo Suh Jae Young Hong 《The spine journal》2012,12(11):998-1005
Background context
Most osteoporotic vertebral compression fractures (OVCFs) can be treated conservatively. Recently, kyphoplasty has become a common treatment for painful osteoporotic compression fractures and has shown numerous benefits, such as early pain control and height restoration of the collapsed vertebral body. In spite of being a simple procedure, numerous complications related to kyphoplasty have been reported. Moreover, there is limited evidence to support its superiority.Purpose
To compare the clinical outcomes of patients with OVCF according to different treatment modalities and identify clinical risk factors related to failure of conservative treatment of OVCF.Study design
A prospective study consisting of a review of case report forms.Patients sample
We prospectively enrolled 259 patients who had one or two acute painful OVCFs confirmed by magnetic resonance imaging. All patients were treated conservatively in the initial 3 weeks. Kyphoplasty was performed in 91 patients who complained of sustained back pain and disability in spite of conservative treatment for the initial 3 weeks.Outcome measures
Pain score using visual analog scale (VAS) and the Oswestry Disability Index (ODI).Methods
Participants were stratified according to age, sex, level and number of fractures, bone mineral density, body mass index (BMI), collapse rates, and history of spine fractures. Pain scores using VASs were assessed at 1 week and at 1, 3, 6, and 12 months.Results
A total of 259 patients were enrolled, and 231 patients (82 of 91 patients in the kyphoplasty group [KP] and 149 of 168 patients in the conservative treatment group) completed the 1-year follow-up. About 65% of patients were treated successfully with conservative treatment. Risk factors for failure of 3 weeks of conservative treatment were older age (older than 78.5 years), severe osteoporosis (t score less than −2.95), overweight (BMI more than 25.5), and larger collapse rates (more than 28.5%). There were significant reductions in VAS and ODI scores in both groups at each follow-up assessment. At the first month, better clinical results were observed in KP. However, there were no significant differences in outcome measures between the two groups at 3, 6, or 12 months. Thirteen subsequent compression fractures (five in KP and eight in the conservative treatment group) occurred during the 1-year follow-up period.Conclusion
Both treatments of OVCF showed successful clinical results at the end of the 1-year follow-up period. Kyphoplasty showed better outcomes in the first month only. Given these results, prompt kyphoplasty should not be indicated in the case of a patient with OVCF that has no risk factors for failure with conservative treatment. Rather, a trial of conservative, 3-week treatment would be beneficial. 相似文献8.
Background
Assaults with a machete cause compound skull fractures which present as a neurosurgical emergency. We aimed to profile cranial injuries caused by a machete over a 10 year period in a single neurosurgical unit.Materials and methods
Retrospective data analysis of cranial injuries following assault with a machete, admitted to the neurosurgery ward, from January 2003 to December 2012 was performed. Medical records were analyzed for demographics, clinical presentation, CT scan findings, surgical treatment and Glasgow Outcome Scale (GOS) at discharge. Management involved wound debridement with antibiotic cover.Results
Of 185 patients treated 172 (93%) were male. Mean age was 31 ± 11.4 years. Mean GCS on admission was 13 ± 2. Presenting features were focal neurological deficit (48%), brain matter oozing from wounds (20%), and post traumatic seizures (12%). Depressed skull fractures were found in 162 (88%) patients. Findings on CT brain scan were intra-cranial haematoma (88%), pneumocephalus (39%) and features of raised intra-cranial pressure (37%). Thirty-one patients (17%) presented with septic head wounds. One hundred and fifty seven patients (85%) were treated surgically. The median hospital stay was 8 days (range 1–145). The median GOS at discharge was 5 (range 1–5). Twelve patients died within the same admission (6.5%).Conclusion
Machetes cause complex cranial injuries with associated neurological deficit and should be treated as neurosurgical emergency. Timeous intervention and good surgical principles are advocated to prevent secondary infection and further neurological deterioration. 相似文献9.
Adesola C. Akinkuotu Sushma Nuthakki Fariha Sheikh Stephanie M. Cruz Stephen E. Welty Oluyinka O. Olutoye 《American journal of surgery》2015,210(6):1045-1050
Background
We hypothesized that supplemental parenteral nutrition (PN) decreases the need for surgery and mortality associated with necrotizing enterocolitis (NEC).Methods
Single institution retrospective review of all premature, low birth weight infants with NEC from January 2006 to December 2013 was conducted.Results
NEC was identified in 114 premature, low birth weight infants, 59 (51.8%) of which required surgical management. Surgical NEC infants were born younger (25.8 ± 4.0 vs 27.8 ± 3.3 weeks, P = .005) and weighed less at birth (829 ± 281 vs 938 ± 271 g, P = .038) than those managed medically. There was no difference in the use of PN (37.7% vs 31.4%, P = .541) between surgical and medical NEC patients. There was no statistically significant difference in mortality at discharge between patients who had PN at NEC onset and those who did not (31.4% vs 42.6%, P = .294)Conclusion
In this single-center study, supplemental PN at NEC onset does not appear to significantly improve outcomes as demonstrated by rates of surgical intervention and in-hospital mortality. 相似文献10.
Background
Medial malleolus fractures have traditionally been managed using partially threaded screws and/or Kirschner wire fixation. Using these conventional techniques, a non-union rate of as high as 20% has been reported. In addition too many patients complaining of prominent hardware as a source of pain post-fixation. This study was designed to assess the outcomes of medial malleolar fixation using a headless compression screw in terms of union rate, the need for hardware removal, and pain over the hardware site.Setting
Saint Louis University and Mercy Medical Center, Level 1 Trauma Centers, St. Louis, MO.Methods
After IRB approval, we used billing records to identify all patients with ankle fractures involving the medial malleolus. Medical records and radiographs were reviewed to identify patients with medial malleolar fractures treated with headless compression screw fixation. Our inclusion criteria included follow-up until full weight bearing and a healed fracture. Follow-up clinical records and radiographs were reviewed to determine union, complication rate and perception of pain over the site of medial malleolus fixation. Sixty-four ankles were fixed via headless compression screws and 44 had adequate follow-up for additional evaluation.Results
Seven patients had isolated medial malleolar fractures, 23 patients had bimalleolar fractures, and 14 patients had trimalleolar fractures. One patient (2%) required hardware removal due to cellulitis. One patient (2%) had a delayed union, which healed without additional intervention. Ten patients (23%) reported mild discomfort to palpation over the medial malleolus. The median follow-up was 35 weeks (range: 12–208 weeks). There were no screw removals for painful hardware and no cases of non-union.Conclusions
Headless compression screws provide effective compression of medial malleolus fractures and result in good clinical outcomes. The headless compression screw is a beneficial alternative to the conventional methods of medial malleolus fixation. 相似文献11.
Background
Partial nephrectomy (PN) for small renal masses provides effective oncologic outcomes. Single-port laparoscopic (SPL) and robotic surgeries are evolving approaches to advance minimally invasive surgery.Objective
To determine the feasibility of laparoscopic and robotic single-port PN.Design, setting, and participants
Since 2007, evaluation of patients undergoing SPL and single-port robotic (SPR) PN at a primary referral center was performed. Patients with small, solitary, exophytic-enhancing renal masses were selected. Patients with a solitary kidney, endophytic or hilar tumors, and previous abdominal and/or kidney surgery were excluded. Perioperative and pathologic data were entered prospectively into an institutional review board (IRB)–approved database.Interventions
Tumor location determined either an open Hasson transperitoneal or retroperitoneal approach. A single multichannel port or Triport provided intra-abdominal access. The Harmonic Scalpel was used for tumor excision under normal renal perfusion. The da Vinci surgical robot was used for SPR cases.Measurements
Patient demographics, perioperative, hematologic, and pathologic data as well as pain assessment using the Visual Analog Pain Scale (VAPS) were assessed.Results and limitations
A total of seven patients underwent single-port PN (SPL = 5, SPR = 2). One patient with a right anterior upper-pole mass required conversion from SPL to standard laparoscopy following tumor excision because of intraoperative bleeding. Pathology revealed six lesions compatible with renal cell carcinoma (RCC) and one benign cyst. One negative frozen section came back focally positive on final histopathology. All other surgical margins were negative. A mean difference of 3.0 ± 2.0 g/dl in hemoglobin was noted in all patients. Minimal pain was noted at discharge following both laparoscopic and robotic single-port surgery (VAPS = 1.7 ± 1.2 vs 1 ± 0.5/10).Conclusions
SPL and SPR PN is feasible for select exophytic tumors. Robotics may improve surgical capabilities during single-port surgery. 相似文献12.
Introduction
The repair of annular ligament after open reduction and internal fixation of radial head fracture could produce the irritation or crepitation during range of motion exercise. The purpose of this study is to evaluate the significance of unrepaired annular ligament during fixation of isolated radial head fractures.Materials and methods
Retrospectively we reviewed the twenty-five patients who underwent surgical fixation with a plate for Mason type 2, 3 isolated radial head fracture without annular ligament repair. All the radial head fracture did not have the associated injuries which could cause the elbow instabilities. The average length of follow-up was 6.9 years. The outcomes were evaluated clinically (range of motions, instabilities, pain VAS, Broberg & Murrey functional rating score, DASH score) and radiographically (bony union, arthritic change, lateral translation of the radial head, humero-ulnar angle with maximum varus stress of elbow, ulnar variance).Results
The range of motions between affected and contralateral side were not significantly different at last follow-up. No one showed the instabilities of elbow. The mean pain VAS, Broberg & Murrey functional rating score, and DASH score were 2.7 ± 0.5, 95.3 ± 2.5, and 14.8 ± 5.3 points respectively. Bony union was observed for all cases. There was no significant difference in the lateral translation of the radial head, humero-ulnar angle with maximum varus stress of elbow, and ulnar variance between the affected and the contralateral arm.Conclusion
The isolated role of the annular ligament seems overestimated. We scrutinize that the annular ligament repair is not essential in the operative treatment of isolated radial head fractures if the lateral collateral ligament is intact. 相似文献13.
Background
Cycling is gaining more popularity both as a sport, on and off-road and also as a means of commute. Cycling accidents harbour significant injury risks including fractures. Proximal femoral fractures are uncommonly associated with cycling in the young adult population. The purpose of this study is to describe this unique pattern of injury as well as the outcome of proximal femoral fractures caused by cycling in the young to mid age population.Methods
Study design: retrospective cohort study. 23 fractures in 22 patients were available for analysis. 11 were femoral neck fractures, with six displaced ones, and the rest trochanteric fractures. 21 patients were male patients, and the average age was 42 (range 27–60). All patients but two were operated within 24 h from admission. Radiographic analysis included reduction quality, fracture classification and arthritic changes. Clinical outcome was measured using SF-12 and Oxford hip scores.Results
All fractures healed. Two patients with displaced femoral neck fractures developed avascular necrosis requiring arthroplasty. One patient developed an AVN 2 years after a stable trochanteric fracture but did not require an arthroplasty as of yet. Eight patients required hardware removal due to symptoms. 77% of patients had resumed cycling at the pre-injury level. Mean SF-12 score was 47.1 ± 11.7 for the physical component and 53.7 ± 6.3 for the mental component. Mean oxford hip score as was 40.1 ± 12.2. Radiographic analysis revealed good to acceptable reduction quality. Fracture type, age, cycling type and reduction were not significantly associated with outcome.Conclusion
Proximal femoral fractures caused by cycling in young to mid-aged adults are an emerging pattern of injury. Overall favourable result can be expected in the majority of cases, with displaced femoral neck fractures having a risk for AVN. Further delineation of the exact cause for this phenomenon is required with possible intervention for injury prevention. 相似文献14.
Mette M. Berger Maryse Davadant Christian Marin Jean-Blaise Wasserfallen Christophe Pinget Philippe Maravic Nathalie Koch Wassim Raffoul René L. Chiolero 《Burns : journal of the International Society for Burn Injuries》2010
Background
Pain is a major issue after burns even when large doses of opioids are prescribed. The study focused on the impact of a pain protocol using hypnosis on pain intensity, anxiety, clinical course, and costs.Methods
All patients admitted to the ICU, aged >18 years, with an ICU stay >24 h, accepting to try hypnosis, and treated according to standardized pain protocol were included. Pain was scaled on the Visual Analog Scale (VAS) (mean of daily multiple recordings), and basal and procedural opioid doses were recorded. Clinical outcome and economical data were retrieved from hospital charts and information system, respectively. Treated patients were matched with controls for sex, age, and the burned surface area.Findings
Forty patients were admitted from 2006 to 2007: 17 met exclusion criteria, leaving 23 patients, who were matched with 23 historical controls. Altogether patients were 36 ± 14 years old and burned 27 ± 15%BSA. The first hypnosis session was performed after a median of 9 days. The protocol resulted in the early delivery of higher opioid doses/24 h (p < 0.0001) followed by a later reduction with lower pain scores (p < 0.0001), less procedural related anxiety, less procedures under anaesthesia, reduced total grafting requirements (p = 0.014), and lower hospital costs per patient.Conclusion
A pain protocol including hypnosis reduced pain intensity, improved opioid efficiency, reduced anxiety, improved wound outcome while reducing costs. The protocol guided use of opioids improved patient care without side effects, while hypnosis had significant psychological benefits. 相似文献15.
Ke-Nan Huang Zhi-Fei Xu Ju-Xian Sun Xin-Yu Ding Bin Wu Wei Li Xiong Qin Hua Tang 《The Journal of surgical research》2014
Background
Operative stabilization is frequently used in the clinical treatment of multiple rib fractures (MRF); however, no ideal material exists for use in this fixation. This study investigates a newly developed biodegradable plate system for the stabilization of MRF.Methods
Silk fiber-reinforced polycaprolactone (SF/PCL) plates were developed for rib fracture stabilization and studied using a canine flail chest model. Adult mongrel dogs were divided into three groups: one group received the SF/PCL plates, one group received standard clinical steel plates, and the final group did not undergo operative fracture stabilization (n = 6 for each group). Radiographic, mechanical, and histologic examination was performed to evaluate the effectiveness of the biodegradable material for the stabilization of the rib fractures.Results
No nonunion and no infections were found when using SF-PCL plates. The fracture sites collapsed in the untreated control group, leading to obvious chest wall deformity not encountered in the two groups that underwent operative stabilization.Conclusions
Our experimental study shows that the SF/PCL plate has the biocompatibility and mechanical strength suitable for fixation of MRF and is potentially ideal for the treatment of these injuries. 相似文献16.
Objective
There is limited information available regarding intravenous (IV) morphine admistration in obese patients in PACU. The aim of this study was to compare two IV morphine titration (IMT) regimen in two surgical centers.Study design
Observational study.Patients
Laparoscopic bariatric surgery in one private (Saint-Grégoire Clinic) and one public (University Hospital of Amiens) surgical center.Methods
A strict and common protocol of IMT was implemented if PACU of both centers according to the recommendations of the French Society of Anaesthesia and Intensive Care. When pain score increased to > 30, IMT was titrated every 5 min in 3 mg increments until pain relief (VAS ≤30 mm). Pain level, dose of morphine (per total and ideal body weight), effectiveness, and side events were recorded.Results
Data were recorded for 159 adult patients (129 women). Mean age and BMI were 42 ± 12 yrs and 43.8 ± 6.9 kg/m2. Ninety-eight patients were eligible for IMT regimen but only 76 patients received IV morphine (47.8 %). Mean dose was 7.3 mg ± 3.5 mg [1–19 mg], (60.4 μg/kg and 115.8 μg/kg). IMT was less frequent, mean dose was greater (8.6 ± 4.2 vs 6.2 ± 2.9 mg) and number of patients with pain relief was higher (73.7 vs 35.6 %) in the public hospital. No severe adverse events have been recorded and there was no difference in both centers regarding these events.Conclusion
Implementation of a IMT regimen in PACU was not associated with effective pain relief after laparoscopic surgery in obese patients. 相似文献17.
Juan Manuel Córcoles Padilla Sergio Bolufer Nadal Krzysztof Kurowski Carlos Gálvez Muñoz José Manuel Rodriguez Paniagua 《Cirugía espa?ola》2014
Introduction
Chest wall deformities/defects and chest wall resections, as well as complex rib fractures require reconstruction with various prosthetic materials to ensure the basic functions of the chest wall. Titanium provides many features that make it an ideal material for this surgery.The aim is to present our initial results with this material in several diseases.Material and methods
From 2008 to 2012, 14 patients were operated on and titanium was used for reconstruction of the chest wall. A total of 7 patients had chest wall tumors, 2 with sternal resection, 4 patients with chest wall deformities/defects and 3 patients with severe rib injury due to traffic accident.Results
The reconstruction was successful in all cases, with early extubation without detecting problems in the functionality of the chest wall at a respiratory level. Patients with chest wall tumors including sternal resections were extubated in the operating room as well as the chest wall deformities. Chest trauma cases were extubated within 24 h from internal rib fixation. There were no complications related to the material used and the method of implementation.Conclusions
Titanium is an ideal material for reconstruction of the chest wall in several clinical situations allowing for great versatility and adaptability in different chest wall reconstructions. 相似文献18.
P. Deras A. Bonnal M. Barbier E. Morau P. Colson 《Annales fran?aises d'anesthèsie et de rèanimation》2013
Objective
To assess the improvement of practices in postoperative analgesia after a cesarean section post implementation of a corrective program.Study design
Prospective impact study.Patients and methods
After obtaining ethics approval, we included all patients undergoing a cesarean section at Montpellier University Hospital during February 2011 (PRE group) and March 2012 (POST group). The patients were interviewed on the fourth day postpartum about pain management and related data was collected from the chart. From March 2011 to February 2012, training sessions were held for the paramedical and medical teams.Results
Sixty patients were included in each group. The two groups were not significantly different. The mean overall numeric rating scale worst pain score between Day 0 and Day 4 in POST group was lower (5.5 ± 2.5 vs. 6.5 ± 2.4 p < 0.01) and impairment during mobilization decreased significantly. Compliance with protocols improved in the POST group: the number of women receiving full analgesia regiment increased from 12% to 68% between PRE and POST period.Conclusion
After an awareness campaign of the paramedical and medical staff, we succeeded in improving significantly the routine use of analgesics regardless of their level. Nevertheless healthcare professionals still seem reluctant to administer opioids. 相似文献19.
20.
Bellal Joseph Viraj PanditHassan Aziz MD Andrew TangNarong Kulvatunyou MD FACS Julie WynnePaul Hsu PhD Terence O'KeeffeLynn Gries MD Randall S. FriesePeter Rhee MD FACS MPH 《The Journal of surgical research》2013