Injury (INJURY)

Publications in this journal

• Article: High failure rate of trochanteric fracture osteosynthesis with proximal femoral locking compression plate.

  Wirtz C, Abbassi F, Evangelopoulos DS, Kohl S, Siebenrock KA, Krüger A
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  ABSTRACT: INTRODUCTION: Stable reconstruction of proximal femoral (PF) fractures is especially challenging due to the peculiarity of the injury patterns and the high load-bearing requirement. Since its introduction in 2007, the PF-locking compression plate (LCP) 4.5/5.0 has improved osteosynthesis for intertrochanteric and subtrochanteric fractures of the femur. This study reports our early results with this implant. METHODS: Between January 2008 and June 2010, 19 of 52 patients (12 males, 7 females; mean age 59 years, range 19-96 years) presenting with fractures of the trochanteric region were treated at the authors' level 1 trauma centre with open reduction and internal fixation using PF-LCP. Postoperatively, partial weight bearing was allowed for all 19 patients. Follow-up included a thorough clinical and radiological evaluation at 1.5, 3, 6, 12, 24, 36 and 48 months. Failure analysis was based on conventional radiological and clinical assessment regarding the type of fracture, postoperative repositioning, secondary fracture dislocation in relation to the fracture constellation and postoperative clinical function (Merle d'Aubigné score). RESULTS: In 18 patients surgery achieved adequate reduction and stable fixation without intra-operative complications. In one patient an ad latus displacement was observed on postoperative X-rays. At the third month follow-up four patients presented with secondary varus collapse and at the sixth month follow-up two patients had 'cut-outs' of the proximal fragment, with one patient having implant failure due to a broken proximal screw. Revision surgeries were performed in eight patients, one patient receiving a change of one screw, three patients undergoing reosteosynthesis with implantation of a condylar plate and one patient undergoing hardware removal with secondary implantation of a total hip prosthesis. Eight patients suffered from persistent trochanteric pain and three patients underwent hardware removal. CONCLUSIONS: Early results for PF-LCP osteosynthesis show major complications in 7 of 19 patients requiring reosteosynthesis or prosthesis implantation due to secondary loss of reduction or hardware removal. Further studies are required to evaluate the limitations of this device.
  Injury 03/2013;
• Article: Clinical applications of growth factors in bone injuries: Experience with BMPs.

  Ronga M, Fagetti A, Canton G, Paiusco E, Surace MF, Cherubino P
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  ABSTRACT: The management of open fractures and delayed or non unions continue to be complicated by high rates of treatment failure and significant patient disability and dissatisfaction. The use of bone morphogenetic proteins (BMPs) in the treatment of these injuries has been assessed by several authors. BMPs induce the process of bone healing by recruiting bone-forming cells to the area of lesion. The use of BMP currently has two FDA-approved indications: treatment of open tibial fractures treated with intramedullary fixation and treatment of tibia long bone non-union. Despite this limited target, off-label BMP use continues to push the spectrum for new applications. This review describes the current evidence for the use of BMPs in open fractures and non-unions.
  Injury 02/2013;
• Article: ‘Ideas and Innovations’ Parallel twin blade technique for scar revision

  Naresh Kumar, M. Wilson, and R.J. Newman
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  ABSTRACT: -
  Injury 02/2013; 30(3):224-22.
• Article: Fresh osteochondral allograft is a suitable alternative for wide cartilage defect in the knee.

  Giorgini A, Donati D, Cevolani L, Frisoni T, Zambianchi F, Catani F
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  ABSTRACT: Abstract INTRODUCTION: There are several surgical options to restore a wide osteochondral defect in the knee. Fresh osteochondral allografts are usually considered a poor alternative due to their difficulties in surgical application. The aim of this work is first to present our experience including the surgical technique and the functional results of patients receiving fresh osteochondral allograft to restore major knee lesions, then, to compare our results with other results presented in literature. METHODS: Between 2006 and 2011, we treated 11 patients with osteochondral lesion of the knee (Outerbridge IV°). The average lesion size was 10.3 cm(2) (range 3-20 cm(2)). The average age was 34 years (range 18-66). Patients were followed from 12 to 55 months (average of 26.5) through clinical examination, X-ray film and MRI every 3 months for the first year, then every 6 months. RESULTS: The treatment was successful in 10 patients showing pain regression and mean IKDC subjective score improvements from 27.3 to 58.7. The IKDC objective score also improved of at least one class for each patient except the who failed. The radiographs show good osteointegration in all cases but one. CONCLUSIONS: Fresh allograft is an effective therapy for osteochondral defects repair because it allows functional recovery in a considerable number of patients. This technique obtains better results in lesion smaller than 8 cm(2). However larger lesion show good results. Level of evidence: Therapeutic study, Level IV.
  Injury 01/2013; 44(Suppl 1):S16-20..
• Article: Bias towards dementia: are hip fracture trials excluding too many patients? A systematic review.

  Hebert-Davies J, Laflamme GY, Rouleau D, HEALTH, FAITH investigators
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  ABSTRACT: Patients with hip fractures are older and often present many co-morbidities, including dementia. These patients cannot answer quality of life questionnaires and are generally excluded from trials. We hypothesized that a significant number of patients are being excluded from these studies and this may impact outcomes. This was a two part study; the first analyzing databases of two ongoing large-scale multi-centred hip fracture trials and the second being a systematic review. The FAITH and HEALTH studies were analyzed for exclusion incidence directly related to dementia. The second part consisted of a systematic search of all relevant studies within the last 20 years. In the FAITH study, a total of 1690 subjects were excluded, 375 (22.2%) of which were due to dementia or cognitive impairment. In the HEALTH study, 575 were excluded with dementia/cognitive impairment representing 207 patients (36%). Following the systematic review, 251 articles were identified 17 of which were retained. The overall prevalence of dementia was 27.9% (range 2-51%). Only two studies compared demented and non-demented groups. In these studies significant increases in both mortality and complications were found. In summary, when investigating hip fractures, choosing appropriate objective endpoints is essential to ensure results are also applicable to patients with dementia.
  Injury 12/2012; Injury(43 (12)):1978-84.
• Article: The history of Croatian Trauma Society – A brief overview

  Bakota B, Vlahovic T, Staresinic M, Dobric I, Cicvaric T
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  ABSTRACT: Croatian Trauma Society (CTS) has a 51 year of history and tradition. This article represents a brief overview from the times when it was founded, June 30, 1961 till the present time. It tells us about the idea how, where and when the ‘‘Section for Traumatology’’ was founded, its activities and influence not only to promote patient trauma care but initiation of other societies dealing with traumatized patients as well, including the evolution of the CTS itself. The authors thank to all the contributors that made this article possible.
  Injury 08/2012;
• Article: Benefit of Helicopter Emergency Medical Services on trauma patient mortality in the Netherlands?Hoogerwerf N, Valk JP, Houmes RJ, Christiaans HM, Geeraedts LM Jr, Schober P, de Lange-de Klerk ES, Van Lieshout EM, Scheffer GJ, Den Hartog D.Injury. 2012 Aug 6. [Epub ahead of print] No abstract available.

  Hoogerwerf N, Valk JP, Houmes RJ, Christiaans HM, Geeraedts LM Jr, Schober P, de Lange-de Klerk ES, Van Lieshout EM, Scheffer GJ, Den Hartog D
  Injury 08/2012;
• Article: Valgus intertrochanteric osteotomy and fibular strut graft in the management of neglected femoral neck fracture

  Wasudeo M. Gadegone, Alankar Ambadas Ramteke
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  ABSTRACT: Purpose A prospective study of neglected femoral neck fractures in mostly young patients was conducted to evaluate whether our technique of valgus intertrochanteric osteotomy with fibular strut grafting and osteosynthesis with dynamic hip screw and double-angle side plate can facilitate union with consistent satisfactory clinical outcomes. Methods Forty-one consecutive patients (27 males, 14 females) of neglected femoral neck fractures treated between April 2002 and December 2009 were studied. The average age of patients was 45.41 years (±11.67, range 20–62 years). The average interval since injury was 14 weeks (±10.21, range 4–44 weeks). The cases were evaluated radiographically and clinically. Results The average follow-up period was 32.5 months (±8, range 24–54 months). Radiographically union was seen in 39 patients at the nonunion site. The average time to radiographic union was 16.82 weeks (±3 weeks, range 12–24 weeks). Average Harris Hip Score (HHS) was 19.9 (±7.9, range 10–35) preoperatively and 90.9 (±10.35, range 62–100) at the latest follow-up. At that time clinical outcomes were excellent in 31, good in four, fair in three and poor in three patients. Conclusion Our mechanobiological surgical technique is reproducible with radiographic union achieved in 95.12% cases (39 patients) at the nonunion site and consistent excellent or good functional outcome in 85% of patients over a 32-month average follow-up. We recommend this procedure for neglected femoral neck fractures.
  Injury 01/2012;
• Article: Late formation of heterotopic bone following an adductor origin avulsion injury

  Rajakulendran K, Field RE
  Injury 01/2011; PMID: 22154045.
• Article: Discharge destination following lower limb fracture: Development of a prediction model to assist with decision making.

  Kimmel LA, Holland AE, Edwards ER, Cameron PA, De Steiger R, Page RS, Gabbe B.
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  ABSTRACT: BACKGROUND: Accurate prediction of the likelihood of discharge to inpatient rehabilitation following lower limb fracture made on admission to hospital may assist patient discharge planning and decrease the burden on the hospital system caused by delays in decision making. AIMS: To develop a prognostic model for discharge to inpatient rehabilitation. METHOD: Isolated lower extremity fracture cases (excluding fractured neck of femur), captured by the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR), were extracted for analysis. A training data set was created for model development and validation data set for evaluation. A multivariable logistic regression model was developed based on patient and injury characteristics. Models were assessed using measures of discrimination (C-statistic) and calibration (Hosmer-Lemeshow (H-L) statistic). RESULTS: A total of 1429 patients met the inclusion criteria and were randomly split into training and test data sets. Increasing age, more proximal fracture type, compensation or private fund source for the admission, metropolitan location of residence, not working prior to injury and having a self-reported pre-injury disability were included in the final prediction model. The C-statistic for the model was 0.92 (95% confidence interval (CI) 0.88, 0.95) with an H-L statistic of χ(2)=11.62, p=0.17. For the test data set, the C-statistic was 0.86 (95% CI 0.83, 0.90) with an H-L statistic of χ(2)=37.98, p<0.001. CONCLUSION: A model to predict discharge to inpatient rehabilitation following lower limb fracture was developed with excellent discrimination although the calibration was reduced in the test data set. This model requires prospective testing but could form an integral part of decision making in regards to discharge disposition to facilitate timely and accurate referral to rehabilitation and optimise resource allocation.
  Injury 01/2011; [Epub ahead of print].
• Article: Knife inflicted injuries of the Maxillofacial region: a descriptive record base study

  Meer M, Siddiqi A, Morkel JA, van Rensburg PJ, Zafar S
  Injury 01/2010; 41:77–81.
• Article: Open Superior Shoulder Suspensory Complex Injury

  calafi, yoo
  Injury 01/2009;