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Publisher: Elsevier   (Total: 3157 journals)

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Showing 1201 - 1400 of 3161 Journals sorted alphabetically
Graphical Models     Hybrid Journal   (Followers: 3, SJR: 0.454, CiteScore: 2)
Groundwater for Sustainable Development     Full-text available via subscription   (Followers: 3, SJR: 0.329, CiteScore: 1)
Growth Factors and Cytokines in Health and Disease     Full-text available via subscription   (Followers: 1)
Growth Hormone & IGF Research     Hybrid Journal   (Followers: 16, SJR: 1.059, CiteScore: 2)
Gynecologic Oncology     Hybrid Journal   (Followers: 25, SJR: 2.339, CiteScore: 4)
Gynecologic Oncology Reports     Open Access   (Followers: 10, SJR: 0.307, CiteScore: 1)
Gynécologie Obstétrique & Fertilité     Full-text available via subscription   (Followers: 1)
Habitat Intl.     Hybrid Journal   (Followers: 6, SJR: 1.336, CiteScore: 3)
Hand Clinics     Full-text available via subscription   (Followers: 5, SJR: 0.556, CiteScore: 1)
Hand Surgery and Rehabilitation     Full-text available via subscription   (Followers: 4, SJR: 0.358, CiteScore: 1)
Handai Nanophotonics     Full-text available via subscription  
Handbook of Adhesives and Sealants     Full-text available via subscription   (Followers: 2)
Handbook of Agricultural Economics     Full-text available via subscription   (Followers: 3)
Handbook of Algebra     Full-text available via subscription  
Handbook of Analytical Separations     Full-text available via subscription   (Followers: 3)
Handbook of Behavioral Neuroscience     Full-text available via subscription   (Followers: 3)
Handbook of Biological Physics     Full-text available via subscription  
Handbook of Chemical Neuroanatomy     Full-text available via subscription  
Handbook of Clinical Neurology     Full-text available via subscription   (Followers: 2, SJR: 1.007, CiteScore: 2)
Handbook of Clinical Neurophysiology     Full-text available via subscription  
Handbook of Complex Analysis     Full-text available via subscription  
Handbook of Computational Economics     Full-text available via subscription   (Followers: 1, SJR: 4.16, CiteScore: 2)
Handbook of Defense Economics     Full-text available via subscription   (Followers: 1)
Handbook of Development Economics     Full-text available via subscription   (Followers: 7)
Handbook of Differential Equations: Evolutionary Equations     Full-text available via subscription  
Handbook of Differential Equations: Ordinary Differential Equations     Full-text available via subscription  
Handbook of Differential Equations: Stationary Partial Differential Equations     Full-text available via subscription   (Followers: 2)
Handbook of Differential Geometry     Full-text available via subscription  
Handbook of Dynamical Systems     Full-text available via subscription   (Followers: 1)
Handbook of Econometrics     Full-text available via subscription   (Followers: 8)
Handbook of Economic Forecasting     Full-text available via subscription   (Followers: 1)
Handbook of Economic Growth     Full-text available via subscription   (Followers: 2)
Handbook of Environmental Economics     Full-text available via subscription   (Followers: 2)
Handbook of Experimental Economics Results     Full-text available via subscription   (Followers: 4)
Handbook of Exploration and Environmental Geochemistry     Full-text available via subscription   (Followers: 2)
Handbook of Exploration Geochemistry     Full-text available via subscription   (Followers: 1)
Handbook of Ferromagnetic Materials     Full-text available via subscription   (Followers: 1)
Handbook of Game Theory with Economic Applications     Full-text available via subscription   (Followers: 1)
Handbook of Geophysical Exploration: Seismic Exploration     Full-text available via subscription  
Handbook of Health Economics     Full-text available via subscription   (Followers: 10)
Handbook of Immunohistochemistry and in Situ Hybridization of Human Carcinomas     Full-text available via subscription   (Followers: 1)
Handbook of Income Distribution     Full-text available via subscription   (Followers: 2)
Handbook of Industrial Organization     Full-text available via subscription   (Followers: 3)
Handbook of Intl. Economics     Full-text available via subscription  
Handbook of Labor Economics     Full-text available via subscription   (Followers: 14)
Handbook of Law and Economics     Full-text available via subscription   (Followers: 17)
Handbook of Macroeconomics     Full-text available via subscription   (Followers: 6, SJR: 0, CiteScore: 2)
Handbook of Magnetic Materials     Full-text available via subscription   (Followers: 2, SJR: 0.467, CiteScore: 2)
Handbook of Mathematical Economics     Full-text available via subscription  
Handbook of Mathematical Fluid Dynamics     Full-text available via subscription   (Followers: 2)
Handbook of Metal Physics     Full-text available via subscription  
Handbook of Monetary Economics     Full-text available via subscription   (Followers: 5)
Handbook of Natural Resource and Energy Economics     Full-text available via subscription   (Followers: 3)
Handbook of Numerical Analysis     Full-text available via subscription   (Followers: 4)
Handbook of Perception and Action     Full-text available via subscription   (Followers: 2)
Handbook of Petroleum Exploration and Production     Full-text available via subscription   (Followers: 2)
Handbook of Population and Family Economics     Full-text available via subscription   (Followers: 4)
Handbook of Powder Technology     Full-text available via subscription   (Followers: 6)
Handbook of Public Economics     Full-text available via subscription   (Followers: 1)
Handbook of Regional and Urban Economics     Full-text available via subscription   (Followers: 1)
Handbook of Sensors and Actuators     Full-text available via subscription   (Followers: 10)
Handbook of Social Choice and Welfare     Full-text available via subscription   (Followers: 3)
Handbook of Statistics     Full-text available via subscription   (Followers: 7, SJR: 0.102, CiteScore: 0)
Handbook of Surface Science     Full-text available via subscription   (Followers: 4, SJR: 0.193, CiteScore: 0)
Handbook of Systemic Autoimmune Diseases     Full-text available via subscription   (Followers: 2)
Handbook of the Economics of Art and Culture     Full-text available via subscription   (Followers: 1)
Handbook of the Economics of Education     Full-text available via subscription   (Followers: 9, SJR: 0, CiteScore: 2)
Handbook of the Economics of Finance     Full-text available via subscription   (Followers: 6)
Handbook of the Economics of Giving, Altruism and Reciprocity     Full-text available via subscription  
Handbook of the Geometry of Banach Spaces     Full-text available via subscription   (Followers: 1)
Handbook of the History of Logic     Full-text available via subscription   (Followers: 1)
Handbook of Thermal Analysis and Calorimetry     Full-text available via subscription   (Followers: 1)
Handbook of Thermal Conductivity     Full-text available via subscription   (Followers: 4)
Handbook of Vapor Pressure     Full-text available via subscription  
Handbook on the Physics and Chemistry of Rare Earths     Full-text available via subscription   (Followers: 3, SJR: 0.755, CiteScore: 3)
Handbooks of Management Accounting Research     Full-text available via subscription   (Followers: 4)
HardwareX     Open Access  
Harmful Algae     Hybrid Journal   (Followers: 5, SJR: 1.531, CiteScore: 4)
HBRC J.     Open Access   (Followers: 2)
Health & Place     Hybrid Journal   (Followers: 15, SJR: 1.506, CiteScore: 3)
Health Outcomes Research in Medicine     Hybrid Journal   (Followers: 3)
Health Policy     Hybrid Journal   (Followers: 43, SJR: 1.252, CiteScore: 2)
Health Policy and Technology     Hybrid Journal   (Followers: 4, SJR: 0.322, CiteScore: 1)
Health Professions Education     Open Access   (Followers: 3)
Healthcare : The J. of Delivery Science and Innovation     Full-text available via subscription   (Followers: 1)
Hearing Research     Hybrid Journal   (Followers: 11, SJR: 1.35, CiteScore: 3)
Heart & Lung: The J. of Acute and Critical Care     Hybrid Journal   (Followers: 11, SJR: 0.757, CiteScore: 2)
Heart Failure Clinics     Full-text available via subscription   (Followers: 2, SJR: 1.153, CiteScore: 2)
Heart Rhythm     Hybrid Journal   (Followers: 11, SJR: 3.231, CiteScore: 4)
Heart, Lung and Circulation     Full-text available via subscription   (Followers: 9, SJR: 0.599, CiteScore: 1)
HeartRhythm Case Reports     Open Access   (SJR: 0.232, CiteScore: 0)
Heliyon     Open Access   (SJR: 0.355, CiteScore: 1)
Hellenic J. of Cardiology     Open Access   (Followers: 1, SJR: 0.479, CiteScore: 1)
Hematology, Transfusion and Cell Therapy     Open Access   (Followers: 1)
Hematology/Oncology and Stem Cell Therapy     Open Access   (Followers: 4, SJR: 0.532, CiteScore: 1)
Hematology/Oncology Clinics of North America     Full-text available via subscription   (Followers: 6, SJR: 1.282, CiteScore: 3)
Hepatobiliary & Pancreatic Diseases Intl.     Full-text available via subscription   (Followers: 2, SJR: 0.711, CiteScore: 2)
High Energy Density Physics     Hybrid Journal   (Followers: 2, SJR: 0.933, CiteScore: 2)
Hipertensión y Riesgo Vascular     Full-text available via subscription   (SJR: 0.115, CiteScore: 0)
Historia Mathematica     Full-text available via subscription   (Followers: 1, SJR: 0.174, CiteScore: 0)
History of CERN     Full-text available via subscription   (Followers: 1)
History of Neuroscience in Autobiography     Full-text available via subscription   (Followers: 3)
HIV & AIDS Review     Full-text available via subscription   (Followers: 12, SJR: 0.134, CiteScore: 0)
Homeopathy     Hybrid Journal   (Followers: 6, SJR: 0.678, CiteScore: 1)
HOMO - J. of Comparative Human Biology     Hybrid Journal   (Followers: 2, SJR: 0.335, CiteScore: 1)
Hong Kong J. of Nephrology     Open Access   (Followers: 2, SJR: 0.137, CiteScore: 0)
Hong Kong J. of Occupational Therapy     Open Access   (Followers: 42, SJR: 0.237, CiteScore: 1)
Hong Kong Physiotherapy J.     Open Access   (Followers: 13, SJR: 0.183, CiteScore: 0)
Hormigón y Acero     Full-text available via subscription  
Hormones and Behavior     Hybrid Journal   (Followers: 13, SJR: 1.638, CiteScore: 4)
Horticultural Plant J.     Open Access   (Followers: 5)
Hospital Medicine Clinics     Full-text available via subscription   (Followers: 2, SJR: 0.107, CiteScore: 0)
Human Factors in Information Technology     Full-text available via subscription   (Followers: 35)
Human Immunology     Hybrid Journal   (Followers: 17, SJR: 0.856, CiteScore: 2)
Human Movement Science     Hybrid Journal   (Followers: 15, SJR: 0.756, CiteScore: 2)
Human Pathology     Hybrid Journal   (Followers: 26, SJR: 1.304, CiteScore: 3)
Human Pathology : Case Reports     Open Access   (Followers: 2, SJR: 0.136, CiteScore: 0)
Human Resource Management Review     Hybrid Journal   (Followers: 50, SJR: 1.675, CiteScore: 4)
Hydrometallurgy     Hybrid Journal   (Followers: 13, SJR: 1.208, CiteScore: 3)
IATSS Research     Open Access   (SJR: 0.37, CiteScore: 1)
Icarus     Hybrid Journal   (Followers: 74, SJR: 2.037, CiteScore: 3)
ICT Express     Open Access   (SJR: 0.234, CiteScore: 1)
IDCases     Open Access   (SJR: 0.344, CiteScore: 1)
IERI Procedia     Open Access   (Followers: 1)
IFAC-PapersOnLine     Open Access   (SJR: 0.26, CiteScore: 1)
IIMB Management Review     Open Access   (Followers: 9, SJR: 0.24, CiteScore: 1)
IJC Heart & Vessels     Open Access   (Followers: 1)
IJC Heart & Vasculature     Open Access   (Followers: 1, SJR: 0.342, CiteScore: 1)
IJC Metabolic & Endocrine     Open Access   (Followers: 1, SJR: 0.4, CiteScore: 1)
Image and Vision Computing     Hybrid Journal   (Followers: 15, SJR: 0.612, CiteScore: 3)
Imagen Diagnóstica     Full-text available via subscription   (SJR: 0.106, CiteScore: 0)
Imagerie de la Femme     Full-text available via subscription   (Followers: 1, SJR: 0.124, CiteScore: 0)
Immunity     Full-text available via subscription   (Followers: 55, SJR: 13.393, CiteScore: 16)
Immuno-analyse & Biologie Spécialisée     Full-text available via subscription   (Followers: 2)
Immunobiology     Hybrid Journal   (Followers: 9, SJR: 1.1, CiteScore: 3)
Immunology and Allergy Clinics of North America     Full-text available via subscription   (Followers: 6, SJR: 1.132, CiteScore: 3)
Immunology Letters     Hybrid Journal   (Followers: 12, SJR: 1.168, CiteScore: 3)
Immunotoxicology of Drugs and Chemicals: an Experimental and Clinical Approach     Full-text available via subscription   (Followers: 1)
Implantodontie     Full-text available via subscription  
Indagationes Mathematicae     Open Access   (Followers: 1, SJR: 0.685, CiteScore: 1)
Indian Heart J.     Open Access   (Followers: 4, SJR: 0.333, CiteScore: 1)
Indian J. of Medical Specialities     Hybrid Journal   (SJR: 0.118, CiteScore: 0)
Indian J. of Tuberculosis     Full-text available via subscription   (SJR: 0.221, CiteScore: 0)
Indian Pacing and Electrophysiology J.     Open Access   (SJR: 0.273, CiteScore: 0)
Industrial Chemistry Library     Full-text available via subscription   (Followers: 3)
Industrial Crops and Products     Hybrid Journal   (Followers: 6, SJR: 1.091, CiteScore: 4)
Industrial Marketing Management     Hybrid Journal   (Followers: 23, SJR: 1.663, CiteScore: 4)
Industrial Safety Series     Full-text available via subscription   (Followers: 16)
Infant Behavior and Development     Hybrid Journal   (Followers: 14, SJR: 0.784, CiteScore: 2)
Infectio     Open Access   (SJR: 0.133, CiteScore: 0)
Infection, Disease & Health     Open Access   (Followers: 8, SJR: 0.23, CiteScore: 1)
Infection, Genetics and Evolution     Hybrid Journal   (Followers: 5, SJR: 1.278, CiteScore: 3)
Infectious Disease Clinics of North America     Full-text available via subscription   (Followers: 5, SJR: 2.359, CiteScore: 5)
Informatics in Medicine Unlocked     Open Access   (SJR: 0.224, CiteScore: 1)
Information & Management     Hybrid Journal   (Followers: 58, SJR: 1.628, CiteScore: 5)
Information and Computation     Hybrid Journal   (Followers: 4, SJR: 0.504, CiteScore: 1)
Information and Organization     Hybrid Journal   (Followers: 39, SJR: 1.202, CiteScore: 3)
Information and Software Technology     Hybrid Journal   (Followers: 6, SJR: 0.581, CiteScore: 4)
Information Economics and Policy     Hybrid Journal   (Followers: 4, SJR: 0.63, CiteScore: 1)
Information Fusion     Hybrid Journal   (Followers: 2, SJR: 1.832, CiteScore: 7)
Information Processing & Management     Hybrid Journal   (Followers: 353, SJR: 0.92, CiteScore: 4)
Information Processing in Agriculture     Open Access   (SJR: 0.352, CiteScore: 2)
Information Processing Letters     Hybrid Journal   (Followers: 6, SJR: 0.412, CiteScore: 1)
Information Sciences     Hybrid Journal   (Followers: 413, SJR: 1.635, CiteScore: 5)
Information Security Technical Report     Full-text available via subscription   (Followers: 12)
Information Systems     Hybrid Journal   (Followers: 13, SJR: 0.805, CiteScore: 4)
Infosecurity     Full-text available via subscription   (Followers: 11)
Infrared Physics & Technology     Hybrid Journal   (Followers: 12, SJR: 0.54, CiteScore: 2)
Injury     Hybrid Journal   (Followers: 18, SJR: 0.99, CiteScore: 2)
Injury Extra     Open Access   (Followers: 2)
Inmunología     Full-text available via subscription   (Followers: 2)
Innovative Food Science & Emerging Technologies     Hybrid Journal   (Followers: 5, SJR: 1.201, CiteScore: 3)
Inorganic Chemistry Communications     Hybrid Journal   (Followers: 13, SJR: 0.43, CiteScore: 2)
Inorganica Chimica Acta     Hybrid Journal   (Followers: 9, SJR: 0.485, CiteScore: 2)
Insect Biochemistry and Molecular Biology     Hybrid Journal   (Followers: 3, SJR: 1.912, CiteScore: 4)
Instabilities in Silicon Devices     Full-text available via subscription   (Followers: 1)
Insulin     Full-text available via subscription   (Followers: 5)
Insurance: Mathematics and Economics     Hybrid Journal   (Followers: 9, SJR: 1.083, CiteScore: 2)
Integration, the VLSI J.     Hybrid Journal   (Followers: 6, SJR: 0.223, CiteScore: 1)
Integrative Medicine Research     Open Access   (Followers: 3)
Intellectual Economics     Open Access  
Intelligence     Hybrid Journal   (Followers: 7, SJR: 1.633, CiteScore: 3)
Intensive and Critical Care Nursing     Hybrid Journal   (Followers: 31, SJR: 0.611, CiteScore: 2)
Interdisciplinary Neurosurgery     Open Access   (SJR: 0.164, CiteScore: 0)
Interface Science and Technology     Full-text available via subscription  
Intermetallics     Hybrid Journal   (Followers: 22, SJR: 1.568, CiteScore: 4)
Internet Interventions : The application of information technology in mental and behavioural health     Open Access   (Followers: 4, SJR: 1.962, CiteScore: 4)
Interventional Cardiology Clinics     Full-text available via subscription   (Followers: 3, SJR: 0.156, CiteScore: 0)
Intl. Biodeterioration & Biodegradation     Hybrid Journal   (Followers: 1, SJR: 1.086, CiteScore: 4)
Intl. Business Review     Hybrid Journal   (Followers: 10, SJR: 1.012, CiteScore: 3)
Intl. Communications in Heat and Mass Transfer     Hybrid Journal   (Followers: 21, SJR: 1.553, CiteScore: 5)
Intl. Comparative Jurisprudence     Open Access   (Followers: 2)
Intl. Dairy J.     Hybrid Journal   (Followers: 6, SJR: 1.051, CiteScore: 2)
Intl. Economics     Hybrid Journal   (Followers: 3, SJR: 0.451, CiteScore: 1)
Intl. Emergency Nursing     Hybrid Journal   (Followers: 10, SJR: 0.461, CiteScore: 1)
Intl. Geophysics     Full-text available via subscription   (Followers: 3)
Intl. Immunopharmacology     Hybrid Journal   (Followers: 2, SJR: 1.051, CiteScore: 3)
Intl. J. for Parasitology     Hybrid Journal   (Followers: 11, SJR: 1.638, CiteScore: 4)
Intl. J. for Parasitology : Drugs and Drug Resistance     Open Access   (Followers: 4, SJR: 1.556, CiteScore: 4)
Intl. J. for Parasitology : Parasites and Wildlife     Open Access   (Followers: 2, SJR: 1.455, CiteScore: 3)

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Journal Cover
Journal Prestige (SJR): 0.99
Citation Impact (citeScore): 2
Number of Followers: 18  
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0020-1383 - ISSN (Online) 0020-1383
Published by Elsevier Homepage  [3157 journals]
  • Does zoledronate therapy make mandibular bone susceptible to fracture'
           A radiographical and biomechanical study in rats
    • Abstract: Publication date: Available online 6 July 2018Source: InjuryAuthor(s): Mohammad Zandi, Abbas Shokri, Maryam Mousavi, Sanaz Rajaei, Naser Mohammad Gholi Mezerji IntroductionThe aim of this study was to evaluate the effect of zoledronate therapy on susceptibility of mandibular bone to fracture in rats.MethodsFifty rats were randomly allocated to two groups of 25 animals. The rats in group Z received monthly intravenous infusion of 0.06 mg/kg zoledronate for 6 months. The rats in the group C were injected with an equal volume of saline in the same manner. A month after the last zoledronate/saline administration, all 50 rats were euthanized. Using a cone beam computed tomography, the cortical thickness of inferior border of mandible and the mandibular bone mineral density were calculated, and using a three-point bending test, the peak load failure and the ultimate stress of mandibular bone were determined.ResultsThe mean mandibular inferior cortical bone thickness and the mean bone mineral density were significantly larger in zoledronate-treated rats (0.30 ± 0.02 mm and 1045.00 ± 185.79, respectively) compared to control rats (0.21 ± 0.01 mm and 878.66 ± 166.53, respectively). The peak load and the ultimate stress were lower in the zoledronate-treated hemimandibles (84.61 ± 33.62 N and 1.76 ± 0.72 MPa, respectively) compared to the control hemimandibles (98.36 ± 16.5 9 N and 2.03 ± 0.44 MPa, respectively).ConclusionZoledronate therapy reduced the mechanical strength of the mandibles, implying an increased risk of mandibular fracture in rats.
  • Compliance to prehospital trauma triage protocols worldwide: A systematic
    • Abstract: Publication date: Available online 3 July 2018Source: InjuryAuthor(s): Eveline A.J. van Rein, Rogier van der Sluijs, Antoine M.R. Raaijmaakers, Luke P.H. Leenen, Mark van Heijl BackgroundEmergency medical services (EMS) providers must determine the injury severity on-scene, using a prehospital trauma triage protocol, and decide on the most appropriate hospital destination for the patient. Many severely injured patients are not transported to higher-level trauma centres. An accurate triage protocol is the base of prehospital trauma triage; however, ultimately the quality is dependent on the destination decision by the EMS provider. The aim of this systematic review is to describe compliance to triage protocols and evaluate compliance to the different categories of triage protocols.MethodsAn extensive search of MEDLINE/Pubmed, Embase, CINAHL and Cochrane library was performed to identify all studies, published before May 2018, describing compliance to triage protocols in a trauma system. The search terms were a combination of synonyms for ‘compliance,’ ‘trauma,’ and ‘triage’.ResultsAfter selection, 11 articles were included. The studies showed a variety in compliance rates, ranging from 21% to 93% for triage protocols, and 41% to 94% for the different categories. The compliance rate was highest for the criterion: penetrating injury. The category of the protocol with the lowest compliance rate was: vital signs. Compliance rates were lower for elderly patients, compared to adults under the age of 55. The methodological quality of most studies was poor. One study with good methodological quality showed that the triage protocol identified only a minority of severely injured patients, but many of whom were transported to higher-level trauma centres.ConclusionsThe compliance rate ranged from 21% to 94%. Prehospital trauma triage effectiveness could be increased with an accurate triage protocol and improved compliance rates. EMS provider judgment could lower the undertriage rate, especially for severely injured patients meeting none of the criteria. Future research should focus on the improvement of triage protocols and the compliance rate.
  • Influence of the induced membrane filled with syngeneic bone and
           regenerative cells on bone healing in a critical size defect model of the
           rat’s femur
    • Abstract: Publication date: Available online 2 July 2018Source: InjuryAuthor(s): Christoph Nau, Sebastian Simon, Alexander Schaible, Caroline Seebach, Katrin Schröder, Ingo Marzi, Dirk Henrich IntroductionThe induced membrane technique for the treatment of large bone defects consists of a 2-stage procedure. In the first stage, a polymethylmethacrylate (PMMA) cement spacer is inserted into the bony defect of a rat’s femur and over a period of 2-4 weeks a membrane forms that encapsulates the defect/spacer. In a second operation the membrane is opened, the PMMA spacer is removed and the resulting cavity is filled with autologous bone.Since little effort has been made to replace the need for autologous bone this study was performed to elucidate the influence of different stem cells and the membrane itself on bone healing in a critical size femur defect model in rats.Especially the question should be addressed whether the use of stem cells seeded on a β-TCP scaffold is equivalent to syngeneic bone as defect filling in combination with the induced membrane technique.Materials and MethodsA total of 96 male Sprague-Dawley (SD) rats received a 10 mm critical size defect of the femur, which was stabilized by a plate osteosynthesis and filled with PMMA cement. In a second step the spacer was extracted and the defects were filled with syngeneic bone, β-TCP with MSC + EPC or BM-MNC. In order to elucidate the influence of the induced membrane on bone defect healing the induced membrane was removed in half of the operated femurs. The defect area was analysed 8 weeks later for bone formation (osteocalcin staining), bone mineral density (BMD) and bone strength (3-point bending test).ResultsNew bone formation, bone mineral density and bone stiffness increased significantly, if the membrane was kept. The transplantation of biologically active material (syngeneic bone, stem cells on b-TCP) into the bone defect mostly led to a further increase of bone healing. Syngeneic bone had the greatest impact on bone healing however defects treated with stem cells were oftentimes comparable.ConclusionFor the first time we demonstrated the effect of the induced membrane itself and different stem cells on critical size defect healing. This could be a promising approach to reduce the need for autologous bone transplantation with its’ limited availability and donor site morbidity.
  • Fractures of the tibial pilon treated by open reduction and internal
           fixation (locking compression plate-less invasive stabilising system):
           Complications and sequelae
    • Abstract: Publication date: Available online 2 July 2018Source: InjuryAuthor(s): Juan C. Rubio-Suarez, Rafael Carbonell-Escobar, E. Carlos Rodriguez-Merchan, Aitor Ibarzabal-Gil, Enrique Gil-GarayABSTRACTBackgroundThe aim of this study was to evaluate variables that could be related to complications and sequelae in fractures of the tibial pilon treated by open reduction and internal fixation (ORIF) with a locking compression plate-less invasive stabilising system (LCP-LISS).Patients and methodsA total of 137 fractures treated by ORIF in a 7-year period were analysed. The mean follow-up was 3.3 years. We analysed the following variables: age, sex, side, type of fracture, energy of the injury, use of provisional external fixation (EF), time until ORIF, stages of treatment (one or two), surgical approach, type of bone fixation, quality of reduction, use of bone graft, hardware removal, associated fractures (fibula and others), functional results (AOFAS scale), early complications (infection, skin necrosis) and late complications (nonunion, early post-traumatic ankle osteoarthritis [AOA]).ResultsAccording to the AOFAS scale, 30.5% of the results were excellent, 46.7% good, 13.1% fair and 9.7% poor. The rate of infection was 8.7%, and the rate of skin necrosis requiring flap coverage was 15.2%. Furthermore, type 43C3 fractures of the AO classification had a higher rate of skin necrosis and flap coverage. The rate of nonunion was 16.3% (22 cases, 4 aseptic, 18 infected), and the use of a medial plate was related to a higher rate of nonunion than the use of a lateral plate. The rate of early post-traumatic AOA was 13.1%, and open fractures were related to a higher prevalence of nonunion and flap coverage. Both infection and a suboptimal anatomic reduction were related to a higher prevalence of fair and poor results. The anteromedial approach was associated with a higher prevalence of skin necrosis and early post-traumatic AOA than the anterolateral approach.ConclusionOptimal reduction and stable fixation is paramount to diminishing the rate of complications and sequelae after ORIF (LCP-LISS) of these fractures.
  • Systemic leptin administration alters callus VEGF levels and enhances bone
           fracture healing in wildtype and ob/ob mice
    • Abstract: Publication date: Available online 2 July 2018Source: InjuryAuthor(s): Zhisheng Wu, Peng Shao, Crispin R. Dass, Yongzhong Wei IntroductionLeptin's role in bone formation has been reported, however, its mechanism of affecting bone metabolism is remaining unclear. In this study, we aimed to test whether leptin has a positive effect on fracture healing through the possible mechanism of increasing vascular endothelial growth factor (VEGF) expression in callus tissue.MethodsStandardized femur fractures were created in leptin-deficient ob/ob and wildtype C57BL/6 J mice, and recombinant mouse leptin or its vehicle (physiological saline) was administered intraperitoneally during the study. Body weight, radiological, histologic and immunoblotting analyses were performed at different stages of fracture healing.Key findingsThe results showed that leptin treatment led to lower rate of body weight change in both mice genotypes. Radiological and histological analyses showed that the experimental groups had better fracture healing at 14, 21 and 28 days compared to the control groups. Leptin-treated groups had significantly higher VEGF expression in callus compared with the control groups at 2 and 3 weeks post-fracture except normal mice at 2 weeks, and leptin-deficient mice had higher VEGF levels in calluses than normal mice at the same timepoint.ConclusionLow-dose systemically-administered leptin has a positive effect on promoting fracture healing during the latter stages in a clinically-relevant mouse bone fracture model, and increase callus VEGF levels.
  • Nail or plate fixation for A3 trochanteric hip fractures: A systematic
           review of randomised controlled trials
    • Abstract: Publication date: July 2018Source: Injury, Volume 49, Issue 7Author(s): Martyn Parker, Pradyumna Raval, Jan-Erik Gjertsen Continuing controversy exists for the choice of implant for treating A3 trochanteric hip fractures so we undertook a systematic review of randomised controlled trials from the year 2000 onwards that have compared an intramedullary nail with an extramedullary fixation implant for the treatment of these fractures. Data on the occurrence of any fracture healing complications was extracted and the results combined to calculate Peto odd ratio. Nine studies involving 370 fractures were identified. Three studies involving 105 fractures compared an intramedullary nail with a static fixation (condylar, blade or locking plate). Plate fixation was associated with a fivefold increase risk of fracture healing complications (19/52(36.6%) versus 4/53(7.5%), odds ratio 0.14, 95% Confidence intervals 0.04–0.45). Six studies involving 265 fractures compared an intramedullary nail with a sliding hip screw. No statistically significant difference was found in the occurrence of facture healing complications between implants (13/137(9.5%) versus 11/128(8.6%) odds ratio 0.28, 95% Confidence intervals 0.50–2.80). Bases on the evidence to date from randomised trials, the use of fixed nail plates for surgical fixation of this type of fracture cannot be justified. Intramedullary nail fixation and the sliding hip screw have comparable fracture healing complication rates.
  • Mapping of 238 quadrilateral plate fractures with three-dimensional
           computed tomography
    • Abstract: Publication date: July 2018Source: Injury, Volume 49, Issue 7Author(s): Yun Yang, Min Yi, Chang Zou, Zhao-kui Yan, Xin-an Yan, Yue Fang PurposeThe primary goal of this study is to create a frequency map of a series of the quadrilateral plate fractures, explore the characteristics of fracture map and to further propose a new classification.MethodsWe used a consecutive series of 238 quadrilateral plate fractures to create 3-dimensional reconstruction images, which were superimposed and oriented to fit a model hemipelvis template by aligning specific pelvis landmarks. Fracture lines were identified and traced to create a quadrilateral plate fracture map.ResultsFracture location corresponded with fracture line distribution. Of 238 fractures that met the criteria for inclusion, most fractures involved the “A + B” zone (n = 156; 65%), whereas the remaining minority of the fractures involved the “A” zone (n = 59; 25%) and the “B” zone (n = 23; 10%). Correspondingly the incidence of C-type fracture (“A + B”zone) was significantly higher than that of A-type fracture and B-type fracture. Additionally the most common pattern was demonstrated by coexisting fracture lines; nearly half (48%) of the fractures involved the upper section of the quadrilateral plate traversing both zones, 46% traced almost vertically to the arcuate line, and 25% extended to the posterior aspect. Furthermore, the high fracture line intensity (n = 172; 74%) formed a Gun-shaped pattern, which pointed to the ischial tuberosity.ConclusionsThe map shows that the comminution is prone to traverse the quadrilateral plate in the sagittal direction among nearly two-thirds of all fractures. Moreover, Surgically treated quadrilateral plate fractures display very common patterns. The most common pattern is the upper fracture in nearly half of the fractures. Knowledge of these patterns can aid surgeons during diagnosis, preoperative planning, and execution of surgical strategies.
  • Accuracy of sacroiliac screw placement with and without intraoperative
           navigation and clinical application of the sacral dysmorphism score
    • Abstract: Publication date: July 2018Source: Injury, Volume 49, Issue 7Author(s): Alex Quok An Teo, Jing Hui Yik, Sheldon NG Jin Keat, Diarmuid Paul Murphy, Gavin Kane O’Neill IntroductionPercutaneously-placed sacroiliac (SI) screws are currently the gold-standard fixation technique for fixation of the posterior pelvic ring. The relatively high prevalence of sacral dysmorphism in the general population introduces a high risk of cortical breach with resultant neurovascular damage. This study was performed to compare the accuracy of SI screw placement with and without the use of intraoperative navigation, as well as to externally validate the sacral dysmorphism score in a trauma patient cohort.Patients and methodsAll trauma patients who underwent sacroiliac screw fixation for pelvic fractures at a level 1 trauma centre over a 6 year period were identified. True axial and coronal sacral reconstructions were obtained from their pre-operative CT scans and assessed qualitatively and quantitatively for sacral dysmorphism – a sacral dysmorphism score was calculated by two independent assessors. Post-operative CT scans were then analysed for breaches and correlated with the hospital medical records to check for any clinical sequelae.Results68 screws were inserted in 36 patients, most sustaining injuries from road traffic accidents (50%) or falls from height (36.1%). There was a male preponderance (83.3%) with the majority of the screws inserted percutaneously (86.1%). Intraoperative navigation was used in 47.2% of the patient cohort. 30.6% of the cohort were found to have dysmorphic sacra. The mean sacral dysmorphism scores were not significantly different between navigated and non-navigated groups. Three cortical breaches occurred, two in patients with sacral dysmorphism scores>70 and occurring despite the use of intraoperative navigation. There was no significant difference in the rates of breach between navigated and non-navigated groups. None of the breaches resulted in any clinically observable neurovascular deficit.ConclusionThe sacral dysmorphism score can be clinically applied to a cohort of trauma patients with pelvic fractures. In patients with highly dysmorphic sacra, reflected by high sacral dysmorphism scores, intraoperative navigation is not in itself sufficient to prevent cortical breaches. In such patients it would be prudent to consider instrumentation of the lower sacral corridors instead.
  • Single versus double column fixation in transverse fractures of the
           acetabulum: A randomised controlled trial
    • Abstract: Publication date: July 2018Source: Injury, Volume 49, Issue 7Author(s): Mahmoud Fahmy, Mahmoud Abdel Karim, Sherif A. Khaled, Ahmed Hazem Abdelazeem, Walid A. Elnahal, Ashraf Elnahal IntroductionBiomechanical studies have compared fixation methods in transverse acetabular fractures, yet there is not enough clinical data to suggest an optimal fixation method. The aim of this randomized controlled trail was to compare fracture stability in posterior plating alone versus posterior plating and anterior column lag-screw fixation in treatment of transverse and transverse with posterior wall acetabular fractures.MethodsThirty patients were randomized to one of two groups, either posterior fixation alone (single column group), or posterior plating and anterior fixation with percutaneous anterior column screw (double column group). Patients were followed up with serial radiographic assessments documenting any loss of reduction, utilizing Matta’s radiological criteria, measuring the roof arc angles and by measuring any change in the femoral head offset.ResultsFifteen patients were randomized to each group. Mean patient age was 31 years, mean follow up period was 19 months (range 12–24). There was no significant differences between the two groups with regards the quality of post-operative reduction, blood loss, hospital stay and functional score using the modified Merle D'Aubinge and Postel score. The operative time was significantly longer in the double column fixation group (130 min versus 104 min). There was no loss of reduction observed in either of the two groups.ConclusionSingle poster column fixation in transverse and transverse posterior wall fractures showed similar result to double column fixation, in terms of fractures stability in the follow up period, quality of reduction and early functional outcome.
  • Car seat education: A randomized controlled trial of teaching methods
    • Abstract: Publication date: July 2018Source: Injury, Volume 49, Issue 7Author(s): Erin Kuroiwa, Rebecca L. Ragar, Crystal S. Langlais, Angelica Baker, Maria E. Linnaus, David M Notrica ObjectiveTo determine if a less labor-intensive video-based program for teaching car seat installation can be as effective as the traditional didactic lecture component.MethodsThis is a randomized controlled trial of caregivers seeking car seat education. Caregivers were assigned to didactic or video-based social learning classes. The didactic class involved live lecture; the social learning class included a brief lecture and the video, Simple Steps to Child Passenger Safety, utilizing social learning principles. Proficiency in child passenger safety was evaluated pre- and post-class via: (1) 5-question confidence assessment; (2) 15-question knowledge test; and (3) 5-part car seat installation demonstration. Data were analyzed to compare post-class assessment scores between teaching modalities using pre-test scores as covariates, and correlation of participant confidence and knowledge with installation ability.Results526 individuals registered and were randomized. A total of 213 arrived for class with 103 randomized to didactic teaching and 111 to social learning. Didactics and social learning groups showed similar increases in post-class confidence, knowledge, and installation ability. In the pre-class assessment, 16% of participants in each group installed the car seat correctly. After controlling for baseline installation ability, correct post-class car seat installation did not vary between groups (mean difference = 0.001; p = 0.964). Among participants with high scores on the knowledge assessment, only 57% could demonstrate correct car seat installation (rs = 0.160, p = 0.023).ConclusionVideo-based social learning methodology, which requires less time and resources, was as effective in teaching child passenger safety as didactic lecture. Both teaching methods significantly improved proficiency in child passenger restraint. Car seat installation knowledge is only weakly correlated with proper installation ability and proper installation remains a challenge, even after education.
  • Opioid exposure is associated with nonunion risk in a traumatically
           injured population: An inception cohort study
    • Abstract: Publication date: July 2018Source: Injury, Volume 49, Issue 7Author(s): Thomas Buchheit, Robert Zura, Zhe Wang, Samir Mehta, Gregory J. Della Rocca, R. Grant Steen IntroductionCertain common medications are associated with an elevated risk of fracture and recent data suggests that medications can also increase nonunion risk. Medication use is a modifiable nonunion risk factor, but it is unknown whether risk accrues solely to chronic medication use or whether there is also risk inherent to acute use.MethodsMultivariate logistic regression was used in an inception cohort to calculate odds ratios (OR) for fracture nonunion associated with medication use, in context with other risk factors demonstrated to influence nonunion. Patient-level health claims for medical and drug expenses were compiled from a payer database. Patients were included if they had a fracture coded in 2011, with continuous enrollment for 1 month prior to and 12 months after fracture. The database contained demographic descriptors, treatment procedures per CPT codes, co-morbidities per ICD-9 codes, and prescriptions per National Drug Codes. Chronic medication use was defined as ≥30 days of prescription prior to fracture with ≥1 day afterward; acute use was any other prescription.ResultsMost non-analgesic medications were safe in acute or chronic use, but risk of nonunion was elevated for a wide range of analgesics. Overall, 45,085 fractures (14.6% of fractures) affected patients using chronic opioids. Nonunion OR was elevated for acute and chronic use of Schedule 2 opioids including acetaminophen/oxycodone, hydromorphone, oxycodone, and acetaminophen/hydrocodone bitartrate, as well as Schedule 3–5 opioids including tramadol (all, p 
  • Preventing EMS workplace violence: A mixed-methods analysis of insights
           from assaulted medics
    • Abstract: Publication date: July 2018Source: Injury, Volume 49, Issue 7Author(s): Brian J. Maguire, Barbara J. O’Neill, Peter O’Meara, Matthew Browne, Michael T. Dealy ObjectiveTo describe measures that assaulted EMS personnel believe will help prevent violence against EMS personnel.MethodsThis mixed- methods study includes a thematic analysis and directed content analysis of one survey question that asked the victims of workplace violence how the incident might have been prevented.ResultsOf 1778 survey respondents, 633 reported being assaulted in the previous 12 months; 203 of them believed the incident could have been prevented and 193 of them (95%) answered this question. Six themes were identified using Haddon’s Matrix as a framework. The themes included: Human factors, including specialized training related to specific populations and de-escalation techniques as well as improved situational awareness; Equipment factors, such as restraint equipment and resources; and, Operational and environment factors, including advanced warning systems. Persons who could have prevented the violence were identified as police, self, other professionals, partners and dispatchers. Restraints and training were suggested as violence-prevention tools and methodsConclusionsThis is the first international study from the perspective of victimized EMS personnel, to report on ways that violence could be prevented. Ambulance agencies should consider these suggestions and work with researchers to evaluate risks at the agency level and to develop, implement and test interventions to reduce the risks of violence against EMS personnel. These teams should work together to both form an evidence-base for prevention and to publish findings so that EMS medical directors, administrators and professionals around the world can learn from each experience.
  • A preliminary study into injuries due to non-perforating ballistic impacts
           into soft body armour over the spine
    • Abstract: Publication date: July 2018Source: Injury, Volume 49, Issue 7Author(s): Rosalind M. Jennings, Chris Malbon, Fiona Brock, Stuart Harrisson, Debra J. Carr The UK Home Office test method for ballistic protective police body armours considers anterior torso impacts to be the worst-case scenario and tests rear armour panels to the same standards as front panels. The aim of this paper was to examine the injuries from spinal behind armour blunt trauma (BABT) impacts. This study used a cadaveric 65 kg, female pig barrel and 9 mm Luger ammunition (9 × 19 mm, FMJ Nammo Lapur Oy) into HG1/A + KR1 soft armour panels over the spine. Injuries were inspected and sections removed for x-radiography and micro-CT assessment.All shots over the spine resulted in deep soft tissue injuries from pencilling of the armour and the shirt worn under the armour. The wounds had embedded fabric debris which would require surgery to remove resulting in increased recovery time over injuries usually seen in anterior torso BABT impacts, which are typically haematoma and fractured ribs. The shot with the deepest soft tissue wound (41 mm) also resulted in a fractured spinous process. Shots were also fired at the posterior and anterior rib area of the pig barrel, for comparison to the spine. Similar wounds were seen on the shots to the posterior rib area while shallower, smaller wounds were seen on the anterior and one anterior rib shot resulted in a single, un-displaced rib fracture. The anatomical differences between pigs and humans would most likely mean that injury to a human from these impacts would be more serious.
  • Trauma system in Greece: Quo Vadis'
    • Abstract: Publication date: July 2018Source: Injury, Volume 49, Issue 7Author(s): Evangelos Anagnostou, Andreas Larentzakis, Pantelis Vassiliu IntroductionImplementation of trauma systems has markedly assisted in improving outcomes of the injured patient. However, differences exist internationally as diverse social factors, economic conditions and national particularities are placing obstacles. The purpose of this paper is to critically evaluate the current Greek trauma system, provide a comprehensive review and suggest key actions.MethodsAn exhaustive search of the – scarce on this subject – English and Greek literature was carried out to analyze all the main components of the Greek trauma system, according to American College of Surgeons’ criteria, as well as the WHO Trauma Systems Maturity Index.ResultsRegarding prevention, efforts are in the right direction lowering the road traffic incidents-related death rate, however rural and insular regions remain behind. Hellenic Emergency Medical Service (EKAB) has well-defined communications and emergency phone line but faces problems with educating people on how to use it properly. In addition, equal and systematic training of ambulance personnel is a challenge, with the lack of pre-hospital registry and EMS quality assessment posing a question on where the related services are currently standing. Redistribution of facilities’ roles with the establishment of the first formal trauma centre in the existing infrastructure would facilitate the development of a national registry and introduction of the trauma surgeon subspecialty with proper training potential. Definite rehabilitation institutional protocols that include both inpatient and outpatient care are needed. Disaster preparedness entails an extensive national plan and regular drills, mainly at the pre-hospital level. The lack, however, of any accompanying quality assurance programs hampers the effort to yield the desirable results.ConclusionDespite recent economic crisis in Greece, actions solving logistics and organising issues may offer a well-defined, integrated trauma system without uncontrollably raising the costs. Political will is needed for reforms that use pre-existing infrastructure and working power in a more efficient way, with a first line priority being the establishment of the first major trauma centre that could function as the cornerstone for the building of the Greek trauma system.
  • Editorial Board/Publication Information
    • Abstract: Publication date: July 2018Source: Injury, Volume 49, Issue 7Author(s):
  • Corrigendum to “Traumatic skull fractures in children and adolescents: A
           retrospective observational study” [Injury 49 (2018) 219–225]
    • Abstract: Publication date: July 2018Source: Injury, Volume 49, Issue 7Author(s): Hongwei Wang, Yue Zhou, Jun Liu, Lan Ou, Jianda Han, Liangbi Xiang
  • Outcomes of tibia shaft fractures caused by low energy gunshot wounds
    • Abstract: Publication date: July 2018Source: Injury, Volume 49, Issue 7Author(s): Charles A. Su, Mai P. Nguyen, Jeffrey A. O’Donnell, Heather A. Vallier BackgroundThe purpose of this project was to compare the rates of infections, nonunions, malunions, and secondary operations in tibia fractures resultant from low energy GSWs versus those seen in open and closed tibia fractures resultant from blunt trauma. A secondary objective was to assess the utility of using the traditional Gustilo-Anderson classification system for open fractures to describe fractures secondary to low energy GSW.MethodsA retrospective review of 327 patients with tibia shaft fractures was conducted at our level I trauma center. Patients underwent a variety of interventions depending on their injury. Standard fixation techniques were utilized. Outcome measures include: mechanism of injury, rates of superficial and deep infection, nonunion, malunion, and secondary operations.ResultsDeep infection after low energy GSW tibia fractures was uncommon and seen in only 2.3% of patients. Rates of infection after low energy GSWs were similar to low and high energy closed tibia fractures resultant from blunt trauma, but significantly less than that seen in open type II (25%, p 
  • Predictors of lower health-related quality of life after operative repair
           of diaphyseal femur fractures in a low-resource setting
    • Abstract: Publication date: July 2018Source: Injury, Volume 49, Issue 7Author(s): John M. Ibrahim, Devin Conway, Billy T. Haonga, Edmund N. Eliezer, Saam Morshed, David W. Shearer BackgroundLittle data exists on the negative impact of orthopaedic trauma on quality of life (QOL) in low- and middle-income countries (LMICs). The goal of this study is to investigate the factors associated with lower QOL after operative fixation of femoral shaft fractures in adult patients in a low-resource setting.MethodsThis prospective cohort study followed 272 factures in adults undergoing operative fixation for diaphyseal femur fractures at Tanzania. Patient demographics, injury characteristics, treatment modalities, and functional outcomes up to 1-year post-operatively were evaluated for association with 1-year post-operative EQ-5D QOL scores via univariate linear regression analysis.ResultsEQ-5D values were significantly lower at 1 year than at baseline (0.941 vs 0.991, p 
  • Immediate weight bearing after plate fixation of fractures of the tibial
    • Abstract: Publication date: Available online 28 June 2018Source: InjuryAuthor(s): M. Williamson, E. Iliopoulos, A. Jain, W. Ebied, A. Trompeter BackgroundProximal articular fractures of the tibia are commonly stabilised with internal fixation using plates and screws. There is a lack of evidence and conflicting guidelines as to the most suitable post-operative rehabilitation regime including weight bearing status. There are numerous physiological and socioeconomic benefits of early weight bearing after orthopaedic surgery, but concerns remain around loss of fracture reduction. Therefore, the aim of this study is to investigate whether the weight bearing status after tibial plateau plate fixation is associated with any loss of reduction or articular collapse.MethodsWe retrospectively analysed data from our prospectively collected major trauma centre database. All tibial plateau fractures that required open reduction and internal fixation with plate and screws were included. The immediate post-operative weight bearing status of these patients was recorded. Group I consisted of those patients that were either non-weight bearing or touch weight bearing for the first six post-operative weeks. Group II consisted of patients who were instructed to weight bear fully (as tolerated) immediately after the operation. Radiographs were taken on day one post-operation, at six weeks and at three months and analysed for fracture displacement and joint depression or loss of fixation.ResultsA total of 90 patients were included in the study. Group I (non-weight bearing or touch weight bearing) consisted of 60 patients (67%). Group II (full weight bearing as tolerated) consisted of 30 patients (33%). The follow up radiographs demonstrated no failure of fixation in either study group. One patient from the weight bearing group had>1 mm joint depression (4 mm) identified at the first follow up, which did not progress.ConclusionsThis study shows immediate post-operative full weight bearing does not affect the fixation or cause articular collapse up to three months after surgery and thus we propose that patients should be allowed to weight bear immediately after surgical stabilisation of tibial plateau fractures. This will enable patients to benefit from the positive effects on fracture healing of early weight bearing post-surgery and avoid the complications of non-weight bearing without loss of fixation or articular collapse.
  • Hip fractures in the non-elderly—Who, why and whither'
    • Abstract: Publication date: Available online 25 June 2018Source: InjuryAuthor(s): Cecilia Rogmark, Morten Tange Kristensen, Bjarke Viberg, Sebastian Strøm Rönnquist, Søren Overgaard, Henrik Palm Nonelderly hip fracture patients have gathered little scientific attention, and our understanding of the group may be biased by patient case-mix and lack of follow-up. Preconceptions may thwart adequate investigation of bone health and other comorbidities. This literature review focusses on who these patients between 20 and 60 years are, how to treat them and how to evaluate the outcome.2–11% of the hip fractures occur in non-elderly, equally common in men and women. Every second to forth patient smoke, have chronic diseases, and abuse alcohol. Poor self-rated health, sleep disturbances, low cognitive function and education are associated with increased hip fracture risk in young adults. Bone health is poorly investigated, but literature suggest young patients to have lower bone mineral density regardless of trauma mechanism.Studies contradict on whether surgery within 8–12 h reduce the risk of avascular necrosis in femoral neck fractures (FNF). Based on rationality, surgery ought to be performed promptly, in order to reduce pain and permit rehabilitation. There is no convincing support from the existing literature to use open reduction. Good reduction is mandatory, preferably using a closed reduction technique. The failure rate following internal fixation of displaced FNF in younger patients can be as high as 59%. In some cases a displaced FNF is better treated with a primary arthroplasty; in case of rheumatoid arthritis or osteoarthritis for example. Complications after extracapsular fractures vary from 6 to 23%.The relatively few studies looking at functional outcome in non-elderly use a multitude of outcome measures, precluding comparisons. Many non-elderly patients seem not to fully recover.While some non-elderly hip fracture patients are healthy individuals sustaining high energy trauma, others have low-energy fractures and comorbidities including reduced bone strength (either as a primary or secondary condition). i.e. non-delaying medical optimization, proper surgical technique, bone health investigation and secondary fracture prevention is necessary. Younger hip fracture patients are at risk of permanent loss of function, and negative socioeconomic and psychological consequences. High-energy trauma does not exclude the presence of osteopenia. A hip fracture in adulthood and middle-age is very seldom caused by bad luck only!
  • Letter to the editor regarding “Minimally invasive plate osteosynthesis
           has equal safety to reamed intramedullary nails in treating
           Gustilo-Anderson type I, II and III-A open tibial shaft fractures”
    • Abstract: Publication date: Available online 22 June 2018Source: InjuryAuthor(s): Ahmet Imerci, Nevres Hurriyet Aydogan
  • Volar Plating in Distal Radius Fractures: A Prospective Clinical Study on
           Efficacy of Dorsal Tangential Views to Avoid Screw Penetration
    • Abstract: Publication date: Available online 22 June 2018Source: InjuryAuthor(s): Minke Bergsma, Job N. Doornberg, Robin Duit, Aimane Saarig, David Worsley, Ruurd Jaarsma, Lleyton Hewitt Study Group PurposeThe purpose of this prospective cohort study of patients treated with volar plating for distal radius fractures is to evaluate the efficacy (defined as detection rate, or the ability to detect dorsally protruding screws) of additional dorsal tangential views (DTV) after obtaining standard anteroposterior (AP) and elevated lateral views by evaluating the change in intraoperative strategy in 100 patients.Materials and Methods100 patients aged 18 years and older undergoing volar plating for acute extra- or intra- articular distal radius fractures were prospectively enrolled. Intraoperative fluoroscopy views, including AP, elevated lateral and DTV were obtained. Intraoperative –screw– revision frequency for dorsal screw protrusion, screw position relative to volar plate and to dorsal compartment, and screw lengths were evaluated.ResultsAdditional DTV led to a change of intraoperative management in 31 of 100 (31%) of patients. A total of 35 out of 504 screws (6.9%) were changed. Screws in the two most radial screws in the plate were at the highest risk of being revised; 16 (46%) screws in most radial position and nine (26%) screws in the 2nd from radial position were revised. Furthermore, five (14%) screws in both the 2nd from ulnar and most ulnar screw holes were revised after DTV. No screws were revised in the central hole. The average length of revised screws was 21 mm (range, 12 to 26 mm), and these were changed to an average length of 18 mm (range, 10 to 22 mm).ConclusionIn this prospective series of 100 patients, obtaining additional DTV is found to be efficient as it led to change in intraoperative strategy in one-third of patients. We concur with previous pilot studies that DTV, after obtaining conventional AP and elevated lateral views, is advised to avoid dorsally protruding screws, which could minimize the potential for iatrogenic extensor tendon rupture after volar plating for distal radius fractures. Diagnostic accuracy of DTV is subject of a subsequent prospective cohort study with post-operative CT to serve as the reference standard.Level of EvidenceDiagnostic II
  • Clinical research in fragility fractures
    • Abstract: Publication date: Available online 22 June 2018Source: InjuryAuthor(s): M A Fernandez, M L Costa The Fragility Fracture Network is coordinating international initiatives to promote collaborative research, multidisciplinary care, and the secondary prevention of fragility fractures. This review discusses the use of national audit processes and the collection of common outcomes to facilitate research, as well as the key role played by patient and public involvement, and strategies to overcome research barriers.
  • Anaesthetic aspects in the treatment of fragility fracture patients
    • Abstract: Publication date: Available online 22 June 2018Source: InjuryAuthor(s): S.M. White, N.B. Foss, R Griffiths As longevity increases globally, the number of older, frailer, comorbid patients requiring fragility fracture surgery will increase. Fundamentally, anaesthesia should aim to maintain these patients’ pre-fracture cognitive and physiological trajectories and facilitate early (ie day 1) postoperative recovery. This review describes the 10 general principles of anaesthesia for fragility fracture surgery that best achieve these aims: multidisciplinary care, ‘getting it right first time’, timely surgery, standardisation, sympathetic anaesthesia, avoiding ischaemia, sympathetic analgesia, re-enablement, data collection and training.
  • Nursing care of fragility fracture patients
    • Abstract: Publication date: Available online 22 June 2018Source: InjuryAuthor(s): Louise Brent, Ami Hommel, Ann Butler Maher, Karen Hertz, Anita J. Meehan, Julie Santy-Tomlinson The challenge of caring for patients with fragility fractures is particularly acute for nursing teams who are in short supply and work with patients following fracture on a 24 h basis, coordinating as well as providing complex care. This paper considers the role of nurses within the orthogeriatric team and highlights the value of effective nursing care in patient outcomes. It explores the nature of nursing for patients with fragility fracture with a focus on the provision of safe and effective care and the coordination of care across the interdisciplinary team. It also highlights the need for specific skills in orthopaedic and geriatric nursing as well as specialist education.
  • Rising to the challenge of fragility fractures
    • Abstract: Publication date: Available online 22 June 2018Source: InjuryAuthor(s): David Marsh, Henrik Palm
  • Hip fracture audit: Creating a ‘critical mass of expertise and
           enthusiasm for hip fracture care’'
    • Abstract: Publication date: Available online 21 June 2018Source: InjuryAuthor(s): Colin Currie The care of frail older people admitted with hip fracture has improved greatly over the last half-century, largely as a result of combined medical care and surgical care and the rise – over the last four decades – of large-scale hip fracture audit.A series of European initiatives evolved. The first national hip fracture audit was the Swedish Rikshöft in the late 1980s, and the largest so far is the UK National Hip Fracture Database (NHFD), launched in 2007. An external evaluation of the NHFD demonstrated statistically significant increases in survival at up to 1 year associated with improved early care: with rising geriatrician involvement and falling delays to surgery, and from which lessons have been learned.Comparable national audits have emerged since in northern Europe and in Australia and New Zealand, and most recently in Spain and Japan. Like the NHFD, these use the synergy of agreed clinical standards and regular – ideally continuous – audit feedback that can prompt and monitor clinical and service developments, often demonstrating both rising quality and improved cost effectiveness.In addition, important benchmarking studies of hip fracture care have been reported from India and China, both of which face huge challenges in providing care of fragility fractures in populations characterised by first-generation mass ageing. The ‘halo effect’ of the impact of growing expertise in hip fracture care on the care of other fragility fractures is noteworthy and now relevant globally.Although many national audits have now published encouraging reports of progress, the details of context and process determinants of the initiation and development of effective hip fracture audit have received relatively little attention.To address this, an extended discussion section – based on the author’s experience of participation in several substantial audits, variously supporting and observing many others, and from his numerous discussions with audit colleagues over the years – may be of value in offering practical advice on some obvious and less obvious practical issues that arise in the setting up of large-scale hip fracture audits in a variety of healthcare contexts.
  • How to prevent the next fracture
    • Abstract: Publication date: Available online 21 June 2018Source: InjuryAuthor(s): Paul Mitchell, Kristina Åkesson During the last decade, policymakers, learned societies, non-governmental organisations (NGOs) and some national alliances of all three of these groups have advocated, developed and implemented systematic approaches to fragility fracture care and prevention in a growing number of countries. This chapter reviews the impact of Orthogeriatric Services (OGS) and Fracture Liaison Services (FLS) on delivery of best practice in secondary fracture prevention. An overview of national and international strategies intended to promote widespread implementation of these service models is also provided.
  • Proliferative and osteogenic differentiation capacity of mesenchymal
           stromal cells: Influence of harvesting site and donor age
    • Abstract: Publication date: Available online 21 June 2018Source: InjuryAuthor(s): Wolf Christian Prall, Maximilian Michael Saller, Anna Scheumaier, Timo Tucholski, Sara Taha, Wolfgang Böcker, Hans Polzer Human mesenchymal stromal cells (hMSCs) are the cellular source of new bone formation and an essential component of autologous bone grafts. Autologous bone graft harvesting is routinely conducted at the iliac crest, although alternative donor sites with lower complication rates are available. Thus, the aim of this study was to compare hMSCs harvested from the iliac crest and the proximal tibia regarding their proliferative and osteogenic differentiation capacity. Furthermore, we investigated the influence of donor age on these biological properties.HMSCs were isolated from iliac crest or proximal tibia bone grafts of 46 patients. Proliferative capacity was assessed by cumulative population doublings, population doubling time, colony forming units and cell proliferation assays. Osteogenic capacity was assessed by quantification of extracellular calcium deposition and marker gene expression levels. The number of hMSCs per gram harvested tissue was determined. Furthermore, the adipogenic and chondrogenic differentiation capacity were quantified using BODIPY and Safranin Orange staining, respectively. Additional analyses were carried out after grouping young (18–49 years) and aged (≥50 years) donors.HMSCs derived from the proximal tibia featured a comparable proliferative and osteogenic differentiation capacity. No significant differences were found for any analysis conducted, when compared to hMSCs obtained from the iliac crest. Furthermore, no significant differences could be revealed when comparing young and aged donors. This was equally true for hMSCs from both donor sites after comparison within the same age group.Our study demonstrates comparable biological properties of hMSCs derived from both donor sites, the iliac crest and the proximal tibia. Furthermore, aging does not alter proliferative and osteogenic differentiation capacity. Consequently, the proximal tibia should be considered more closely as an alternative donor site in patients of all age groups.
  • Physiotherapy following fragility fractures
    • Abstract: Publication date: Available online 21 June 2018Source: InjuryAuthor(s): Monica R. Perracini, Morten Tange Kristensen, Caitriona Cunningham, Cathie Sherrington Physiotherapy can play a vital role in the pathway of care of people after fragility fracture and includes interventions of early mobilisation and prescription of structured exercise programmes for maximising functional recovery and reducing the risk of falls and future fractures. Although the optimal nature of physiotherapist interventions after hip and vertebral fracture requires further investigation in large-scale trials, evidence supports the prescription of high-intensity and extended exercise interventions. This article will overview interventions in the acute and chronic phases after hip fractures, interventions after vertebral fracture and the role of physiotherapy in the prevention of further fractures.
  • Letter to Editor regarding the article by wang et al “Open reduction and
           internal fixation in a one-stage anterior cruciate ligament reconstruction
           surgery for the treatment of tibial plateau fractures: A case report and
           literature review”
    • Abstract: Publication date: Available online 21 June 2018Source: InjuryAuthor(s): Antony Roy, Mohsina Subair
  • Physical injury, health, and well-being: Role of stress perception
    • Abstract: Publication date: Available online 20 June 2018Source: InjuryAuthor(s): Irit Heruti, Sigal Levy, Ronit Avitsur ObjectivePhysical injuries are common occurrences that can have substantial implications for mental health and well-being. Ample studies indicated that increased levels of perceived stress is associated with increased prevalence of general health problems, as well as reduced health-related quality of life. Thus, the goal of the present study was to examine the long-lasting association between bodily injuries and general health. In addition, the role of stress perception in moderating the association between injury and general health was assessed.MethodsTwo-hundred and forty victims of past injury and 251 non-injured participants completed a self-report health inventory questionnaire assessing illness prevalence during the six-month period prior to the study. In addition, they completed the short-form Medical Outcomes Survey (MOS SF-36) questionnaire and the Perceived Stress Scale.ResultsVictims of past injuries reported higher incidences of illness, mainly upper respiratory infections and fever, compared to non-injured participants. In addition, injured participants reported poorer perceived health status, including reduced general health, physical functioning, and health beliefs. Perceived stress levels were similar in injured and non-injured participants, however, correlations between perceived stress and self-reported medical outcomes were stronger in injured participants compared to non-injured controls.ConclusionsPast physical injuries are associated with increased incidence of general health concerns and poorer health-related well-being. Moreover, injured individuals do not report increased stress perception; however, when stressed, injured individuals are more affected and health-related quality of life is reduced. Promoting well-being in individuals who have suffered a significant injury is, thus, a clinical necessity and a pressing social priority. This study highlights the role of stress perception in the association between physical injury and health, and may assist in providing better multi-disciplinary care for the injured.
  • Surgical approaches for open reduction and internal fixation of
           intra-articular distal humerus fractures in adults: A systematic review
           and meta-analysis
    • Abstract: Publication date: Available online 19 June 2018Source: InjuryAuthor(s): Siddhartha Sharma, Rakesh John, Mandeep S. Dhillon, Kamal Kishore BackgroundA number of surgical approaches have been described for open reduction and internal fixation (ORIF) of intra-articular distal humerus (IDH) fractures in adults. However, there is no consensus as to which approach is better in terms of functional outcomes and complications. The purpose of this study was to determine whether the functional outcomes and types and rates of complications are influenced by the choice of surgical approach for ORIF of IDH fractures (AO/OTA types 13 B & C).MethodsA systematic review of literature was performed using the PubMed, EMBASE and Cochrane Database of Systematic Reviews databases. Studies, both prospective and retrospective and comparative or non-comparative, dealing with surgical approaches for ORIF of IDH fractures in adult patients were included. Conference abstracts, studies looking primarily at the results of internal fixation rather than the surgical approach, those including extra-articular distal humeral fractures, pediatric distal humeral fractures (
  • Mapping the continuum of care to surgery following traumatic spinal cord
    • Abstract: Publication date: Available online 18 June 2018Source: InjuryAuthor(s): Sarah Kleemann, Ian Mosley, Mark Fitzgerald BackgroundTraumatic spinal cord injury (SCI) is a devastating injury, frequently resulting in paralysis and a lifetime of medical and social problems. Reducing time to surgery may improve patient outcomes. A vital first step to reduce times is to map current pathways of care from injury to surgery, identify rapid care pathways and factors associated with rapid care pathway times.MethodsA retrospective review of the Alfred Trauma Service records was undertaken for all cases of spinal injury recorded in the Alfred Trauma Registry over a three year period. Patients with an Abbreviated Injury Scale (AIS) code matching 148 codes for spinal injury were included in the study. Information extracted from the Alfred Trauma Registry included demographic, clinical and key care timelines.ResultsOf the 342 cases identified, 119 had SCI. The average age of SCI patients was 52 years, with 84% male. The vast majority of SCI patients experienced multiple concurrent injuries (87%). Median time from injury to surgery was 17 h r 28 min for SCI patients in comparison to 28 h r 23 min for non-SCI patients. Three pathways to surgery were identified following Trauma Centre presentation- transfer to surgery direct from trauma unit (median time to surgery was 4 h 17 min.), via Intensive Care (median time to surgery was 24 h 33 min) and via the ward (median time to surgery 28 h r 35 min.) SCI was independently associated with the fastest pathway - direct transfer from trauma unit to surgery - with 41% of SCI cases transferred directly to surgery from the trauma unit.ConclusionNotwithstanding that the vast majority of SCI patients presented with other traumatic injuries, half of all SCI cases reached surgery within 18 h of injury, with 25% within 9 h. SCI was independently associated with direct transfer to surgery from the trauma unit. SCI patients achieve rapid times to surgery within a complex trauma service. Furthermore, the trauma system is well positioned to implement further time reductions to surgery for SCI patients.
  • Rotational evaluation of humeral shaft fractures with proximal extension
           fixed using the MIPO technique
    • Abstract: Publication date: Available online 18 June 2018Source: InjuryAuthor(s): Caio Zamboni, Jorge Rafael Durigan, Felipe Diaz Pimentel, Jose Octavio Soares Hungria, Marcelo Tomanik Mercadante, Patricia Maria de Moraes Barros Fucs IntroductionDiaphyseal fractures with proximal humeral extension can be treated using a helical model, so it is lateral on the proximal aspect and on the diaphyseal segment in the anterior surface.ObjectiveOur objective was to evaluate possible rotational deviations using minimally invasive plate osteosynthesis (MIPO) and to determine how it affects upper limb function.MethodsWe followed 11 patients for a period of two years. The proximal approach was anterior-lateral, and the distal approach was anterior, dividing the brachial muscle. For rotational evaluation, we used the semi-axial incidence described by Oztuna et al., assessing the degree of retroversion of the humeral head in relation to the elbow. During follow-up, we measured bilateral range of motion, shoulder function (UCLA), and upper limb function (DASH).ResultsFor patients whose final result was an increase in retroversion, there was an average difference of 9°, with an increase in the final difference of external rotation of 3° compared with the other shoulder, and no difference between the final levels of internal rotation. In the patients whose final result was a decrease in retroversion, where the distal fragment was fixed in internal rotation, the difference observed was an average of 6°. These patients had an average decrease of the external rotation of 5° with an increase of the internal rotation by two levels. The final functional scores were “good” and “excellent” in all patients, with a mean UCLA of 31.8 points (28–34) and a mean DASH of 9.11 points (0.83–22.2).ConclusionIn all patients, there was a difference in the humeral head retroversion compared to the contralateral limb, but with little clinical repercussion and good or excellent functional scores.
  • Does skeletal maturity affect pediatric pelvic injury patterns, associated
           injuries and treatment intervention'
    • Abstract: Publication date: Available online 18 June 2018Source: InjuryAuthor(s): Christiane G. Kruppa, Justin D. Khoriaty, Debra L. Sietsema, Marcel Dudda, Thomas A. Schildhauer, Clifford B. Jones IntroductionPediatric pelvic injuries are rare. Due to anatomic differences of the immature pelvis, different injury patterns may occur as compared to adults. The purpose was to analyze the effect of skeletal maturity on pediatric pelvic injury pattern, associated injuries, and treatment intervention.Patients and MethodsNinety children with a pelvic injury receiving treatment at a private orthopaedic practice in association with a Level One Teaching Trauma Center, between March 2002 and June 2011, were retrospectively analyzed. Skeletal maturity was determined as closed triradiate cartilage. Forty-one (46%) were skeletally immature and 49 (54%) were skeletally mature. Mean age was 11.5 years (2–16). Fractures were 23 A2, 1 A3, 4 B1, 44 B2, 16 B3, and 2 C2 according to OTA/AO classification. OTA B and C fractures were 26 LC1 (lateral-compression), 20 LC2, 10 LC3, 4 APC1 (anterior-posterior-compression), 5 APC2, and 1 VS (vertical-shear) injury according to Young and Burgess. Treatment of the pelvic injury was operative in 28 (31%) and non-operative in 62 (69%) of children. Mechanism of injury, Injury Severity Score (ISS), deaths, and associated injuries were recorded.ResultsMore complex and unstable injuries occurred in skeletally mature vs. immature children (p = 0.014). Skeletally mature children had a significantly higher rate of operative intervention (p = 0.009). The ISS in skeletally mature children was higher 25 (1–66) than in skeletally immature children 17 (4–43) (p = 0.013). 84% (41) skeletally mature and 78% (32) skeletally immature children sustained associated injuries. Twenty-two% (11) of all skeletally mature children sustained urinary tract injuries, but only 7% (3) of all skeletally immature children (p = 0.049).DiscussionSkeletally mature children are more likely to sustain more complex injury patterns with a higher rate of operative treatment, to have a higher rate of associated injuries, and to have a higher ISS than immature patients.Level of EvidenceRetrospective comparative study, Level III.
  • Biomechanical comparison of three different fixation techniques for
           anterior column posterior hemitransverse acetabular fractures using
           anterior intrapelvic approach
    • Abstract: Publication date: Available online 18 June 2018Source: InjuryAuthor(s): Oğuzhan Tanoğlu, Kadir Bahadır Alemdaroğlu, Serkan İltar, Ahmet Özmeriç, Teyfik Demir, Fatma Kübra Erbay ObjectivesThe aim of this study was to biomechanically compare three different fixation methods for the fixation of anterior column posterior hemitransverse type acetabular fracture (ACPHT).MethodsACPHT fracture models were created on twenty-four foam cortical shell artificial hemipelvis models. Three fixation methods were assessed - Group 1: posterior column lag screws over a suprapectineal plate; Group 2: Posterior column lag screws over a suprapectineal plate and an infrapectineal plate; Group 3: A suprapectineal plate and a vertical infrapectineal plate. Stiffness and displacement amounts of fixation methods under dynamic and static axial loading conditions were measured.ResultsIn the dynamic and static tests, Group 3 showed the less stable fixation compared to Group 2. There was no statistically significant difference between the stiffness values of the fixation groups. In the static tests, there was no statistically significant difference between Group 1 and 2, although less displacements were obtained in Group 2.ConclusionsA combination of posterior lag screws over a suprapectineal plate and an infrapectineal plate supporting the pelvic brim along both sides of the linea terminalis resulted in a better fixation construct than a suprapectineal plate accompanying with a vertical infrapectineal plate provide better stability with less fracture displacement.
  • Test characteristics of a drug CAGE questionnaire for the detection of
           non-alcohol substance use disorders in trauma inpatients
    • Abstract: Publication date: Available online 13 June 2018Source: InjuryAuthor(s): Zachary D.W. Dezman, David A. Gorelick, Carl A. Soderstrom BackgroundNon-alcohol substance use disorders (drug use disorders [DUDs]) are common in trauma patients.ObjectiveTo determine the test characteristics of a 4-item drug CAGE questionnaire to detect DUDs in a cohort of adult trauma inpatients.MethodsObservational cross-sectional cohort of 1,115 adult patients admitted directly to a level-one trauma center between September, 1994 and November, 1996. All participants underwent both a 4-item drug CAGE questionnaire and the substance use disorder section of a structured psychiatric diagnostic clinical interview (SCID) (DSM-IIIR criteria), administered by staff unaware of their clinical status. Sensitivity, specificity, positive (PPV) and negative predictive values (NPV), positive (LR+) and negative likelihood ratios (LR-), and the area under the receiver operating curve (AUC) were calculated for each individual question and the overall questionnaire, using SCID-generated DUD diagnoses as the standard. Performance characteristics of the screen were also compared across selected sociodemographic, injury mechanism, and diagnostic sub-groups.ResultsSubjects with DUDs were common (n = 349, 31.3%), including cannabis (n = 203, 18.2%), cocaine (n = 199, 17.8%), and opioids (n = 156, 14.0%). The screen performed well overall (AUC = 0.90, 95% CI: 0.88–0.91) and across subgroups based on age, sex, race, marriage status, income, education, employment status, mechanism of injury, and current/past DUD status (AUCs 0.75–1.00). Answering any one question in the affirmative had a sensitivity = 83.4% (95% CI: 79.1–87.1), specificity = 92.3% (95% CI: 90.2–94.1), PPV = 83.1%, LR+ = 10.8.ConclusionsThe 4-item drug CAGE and its individual questions had good–to–excellent ability to detect DUDs in this adult trauma inpatient population, suggesting its usefulness as a screening tool.
  • Effect of cannulated screws with deep circumflex iliac artery-bone
           grafting in the treatment of femoral neck fracture in young adults
    • Abstract: Publication date: Available online 12 June 2018Source: InjuryAuthor(s): Guanghui Li, Dadi Jin, Xianfang Shao, Zhijun Liu, Jianhui Duan, Raji Akileh, Shousong Cao, Tuoen Liu ObjectivesSurgical treatment of femoral neck fracture in young adults is clinically challenging due to the high incidence of avascular necrosis of femoral head and fracture nonunion. The objective of this study is to evaluate the effectiveness of cannulated screws with deep circumflex iliac artery bone grafting (DCIABG) by comparing to the routinely used method in the treatment of femoral neck fracture in young adults.MethodsFrom March 2006 to December 2012, a total of 185 patients with femoral neck fracture were admitted to the hospital for internal fixation surgery, 103 patients (61 males and 42 females, mean age of 39.1 years) were treated with three cannulated screws with DCIABG (group A), and 82 patients (49 males and 33 females, mean age of 35.5 years) were treated with three cannulated screws without DCIABG (group B).ResultsAll patients were followed up for at least 24 months after the surgery. The patients in group A had a significantly higher Harris Hip Score (p 
  • Cement-augmented sacroiliac screw fixation with cannulated versus
           perforated screws – A biomechanical study in an osteoporotic hemipelvis
    • Abstract: Publication date: Available online 9 June 2018Source: InjuryAuthor(s): J. Hack, A. Krüger, A. Masaeli, R. Aigner, S. Ruchholtz, L. Oberkircher IntroductionCement-augmentation is a well-established way to improve the stability of sacroiliac screw fixation in osteoporosis-associated fragility fractures of the posterior pelvic ring. However, to date little is known about the influence of different techniques of cement augmentation on construct stability. The aim of this study was to evaluate the primary stability of cement-augmented sacroiliac screw fixation with cannulated versus perforated screws under cyclic loading.Materials and MethodsA total of eight fresh-frozen human cadaveric hemipelvis specimens with osteoporosis were used. After generating ventral osteotomies on both sides of the sacrum, each specimen was treated using a cement-augmented cannulated screw on one side and a cement-augmented perforated screw on the other side. Afterwards, axial cyclic loading was performed.ResultsNo statistically significant difference was found between cannulated and perforated screws concerning maximum load (356.25 N versus 368.75 N, p = 0.749), plastic deformation (1.95 mm versus 1.43 mm, p = 0.798) and stiffness (27.04 N/mm versus 40.40 N/mm, p = 0.645).ConclusionsConsidering the at least equivalent results for perforated screws, cement augmentation via perforated screws might be an interesting option in clinical practice because of potential advantages, e.g. radiological control before cement application, reduced risk of cement displacement and time saving.
  • Effects of concentrated growth factors (CGF) on the quality of the induced
           membrane in Masquelet's technique – An experimental study in rabbits
    • Abstract: Publication date: Available online 8 June 2018Source: InjuryAuthor(s): Orkun Yılmaz, Ahmet Özmeriç, Kadir Bahadır Alemdaroğlu, Pınar Celepli, Sema Hücümenoğlu, Özgür Şahin AimsThe aim of the study was to test if the addition of CGF to the Masquelet technique contributes to the quality of the membrane formed surrounding the polymethylmethacrylate (PMMA), in terms of inflammation, proliferation and vasculazition in the Masquelet technique in the early and late phases in a rabbit model.Materials and methodsA critical bone defect of 15 mm was created in radius diaphysis, leaving 3 cm of intact bone to the joint. To mimic the Masquelet technique and to increase stability, a 6-hole 1.5 mm plate with two screws was applied, although it was initialy stable because of the inherently fixed ulna and radius both proximally and distally in the rabbits. Group 1 and Group 3, were soleley treated with the Masquelet technique as control groups, and were sacrificed at 3 and 6 weeks, respectively. Group 2 and Group 4, were treated with the Masquelet technique + CGF prepared from the rabbit blood groups, and were sacrificed at 3 and 6 weeks, respectively. The groups were compared histopathologically and immunohistochemically, in respect of the means of thickness of the membrane and ratio of elastic fibers, membrane vascularization (CD31), inflammation (MAC387), proliferation (Ki67), and presence of stem cells (STRO-1).ResultsThickness of the membrane and CD31 values were significantly higher in Group 4 than Group 3 (p = 0.004 for both). MAC387 was statistically significantly higher in Group 2 compared to Group 1 and Group 4 compared to Group 3 (p = 0.04 for both). Ki67 was significantly higher in Group 2 compared to Group 1 and Group 4 compared to Group 3 (p = 0.05 and p = 0.006, respectively). Proliferation in the membrane was statistically significantly higher in Group 2 compared to Group 1 (p = 0.05). Likewise, the proliferation index of Group 4 was statistically significantly higher than Group 3 (p = 0.06). STRO-1 was significantly higher in Group 2 compared to Group 1 (p = 0036).ConclusionThe addition of CGF to the Masquelet technique contributes to the quality of the membrane formed, in respect of inducing inflammation and proliferation, maintaining vascularization on large diaphyseal bone defects, and increasing the number of stem cells.
  • Radiological indicator of reduction adequacy during ankle syndesmosis
           surgery: A computational cadaveric study
    • Abstract: Publication date: Available online 4 June 2018Source: InjuryAuthor(s): Jun-Young Lee, Jae Hwan Lim, Gu-Hee Jung PurposeWe introduced the intraoperative radiological indicator to assess the reduction adequacy without additional procedure or instrument, and propose the optimal syndesmotic screw trajectory.MethodsThirty adult cadavers (15 males and 15 females) without ankle problems were enrolled and subjected to continuous 0.75 mm-slice computed tomography (CT) scans. CT images were imported into Mimics® software to reconstruct three-dimensional (3D) model of ankle. Using free 360° rotations with magnification, the 3D mutual relationships of ankle syndesmosis were assessed, and the fibular congruency of incisura was evaluated to determine the optimal screw trajectory. By reformatting the CT scanning plane along the screw direction, the coronal relation of ankle syndesmosis was evaluated to verify the distance between the adjacent bones.ResultsThe fibula was placed in the concentric position of fibular incisura in the 20 models (concentric group) and 40 models, in an eccentric position (eccentric group). Despite this variant, all fibulas were changed into the concentric position in the proximal part of syndesmotic footprint, which might be the ideal height for syndesmotic screw in our study. The fibular bisecting screw trajectory associated with the ideal height of screw was parallel to the ground if the tibial tubercle was directed to the superior and nearly vertical to the ground floor (TT view). Through the reformatted scanning plane parallel to the screw, the lateral border of talus was always placed more medial than the lateral border of distal tibia in the coronal image. All models had a perfectly equidistant and parallel joint space except the medial aspect.ConclusionThe lateral border of talus in the TT view was intraoperatively used as the radiological indicator for ankle syndesmosis widening because it was always placed more medial than the lateral border of distal tibia. The optimal syndesmotic screw trajectory was placed around the proximal syndesmotic footprint and parallel to the ground via the TT view.
  • Minimal impact of a care pathway for geriatric hip fracture patients
    • Abstract: Publication date: Available online 4 June 2018Source: InjuryAuthor(s): Massimiliano Panella, Deborah Seys, Walter Sermeus, Luk Bruyneel, Cathy Lodewijckx, Svin Deneckere, An Sermon, Stefaan Nijs, Paulo Boto, Kris Vanhaecht BackgroundAdherence to guidelines for patients with proximal femur fracture is suboptimal.ObjectiveTo evaluate the effect of a care pathway for the in-hospital management of older geriatric hip fracture patients on adherence to guidelines and patient outcomes.DesignThe European Quality of Care Pathways study is a cluster randomized controlled trial.Setting26 hospitals in Belgium, Italy and Portugal.SubjectsOlder adults with a proximal femur fracture (n = 514 patients) were included.MethodsHospitals treating older adults (>65) with a proximal femur fracture were randomly assigned to an intervention group, i.e. implementation of a care pathway, or control group, i.e. usual care. Thirteen patient outcomes and 24 process indicators regarding in-hospital management, as well as three not-recommended care activities were measured. Adjusted and unadjusted regression analyses were conducted using intention-to-treat procedures.ResultsIn the intervention group 301 patients in 15 hospitals were included, and in the control group 213 patients in 11 hospitals. Sixty-five percent of the patients were older than 80 years. The implementation of this care pathway had no significant impact on the thirteen patient outcomes. The preoperative management improved significantly. Eighteen of 24 process indicators improved, but only two improved significantly. Only for a few teams a geriatrician was an integral member of the treatment team.DiscussionImplementation of a care pathway improved compliance to evidence, but no significant effect on patient outcomes was found. The impact of the collaboration between surgeons and geriatricians on adherence to guidelines and patient outcomes should be studied.Trial NCT00962910.
  • Algorithmic treatment of Busch-Hoffa distal femur fractures: A technical
           note based on a modified Letenneur classification
    • Abstract: Publication date: Available online 4 June 2018Source: InjuryAuthor(s): Robinson E. Pires, Vincenzo Giordano, Fabricio Fogagnolo, Richard S. Yoon, Frank A. Liporace, Mauricio Kfuri Treatment of distal femur fractures in the coronal plane can be challenging. Depending on fracture line orientation, topography and associated comminution, decision-making regarding approach and fixation is not straightforward and can result in complications. Therefore, treatment of coronal plane distal femur fractures (Busch-Hoffa fractures) should be approached in a systematic manner, leading to efficient planning and operative execution. Here, we offer a proposed treatment algorithm, guiding treatment, approach and fixation based on the modified Letenneur classification of coronal plane distal femur fractures.
  • Unified classification of open fractures: Based on Gustilo and OTA
           classification schemes
    • Abstract: Publication date: Available online 4 June 2018Source: InjuryAuthor(s): Anuj Agrawal BackgroundThe Orthopaedic Trauma Association (OTA) classification scheme for open fractures has improved precision, validity and reliability over the modified Gustilo classification system. However, it needs to be modified into a simple and practical classification system to gain widespread acceptance and application.Material and methodsWe devised a new “unified” classification of open fractures based on the Gustilo and OTA classification systems. The new classification was tested for interobserver reliability on five different fractures classified by 15 surgeons each using the Krippendorff’s alpha. Preference of surgeons for the Gustilo, OTA and unified classifications was assessed.ResultsThe new classification showed excellent interobserver reliability (α = 0.93). A significantly higher number of surgeons expressed preference for the new over the Gustilo and OTA classifications for routine clinical use.ConclusionThe new “unified” classification of open fractures has good validity, reliability and acceptability, and has the potential to replace all other existing classification systems.
  • Transient retrograde interfragmentary compression technique in AO/OTA type
           33-C distal femur fractures: A surgical technique and short-term
           radiographic follow up results
    • Abstract: Publication date: Available online 4 June 2018Source: InjuryAuthor(s): Yoon Young Choi, Seung Joon Rhee, Jae Yoon Jeong Surgical treatment of AO/OTA type 33-C fractures is a therapeutic challenge despite advances in surgical instruments and techniques. We introduce a novel surgical technique named transient retrograde interfragmentary compression (TRIC) to help intraarticular fragment reduction in AO/OTA type 33-C fracture. We inserted a partial threaded 7.0-cannulated screw with a washer along the transepicondylar axis from the medial femoral epicondyle during the articular block reduction process of AO/OTA type 33-C fractures to strengthen the compressive force between the condylar fragments and to enhance the handling of the articular block fragment in the alignmental correction stage. Following the provisional reduction and fixation using lateral distal femur locking compression plate, TRIC screw was removed. Fifteen AO/OTA type 33-C distal femoral intraarticular fractures of thirteen patients were surgically treated using the TRIC technique. We analyzed the radiographic result of the patients by measuring the horizontal gap and vertical step-off in the postoperative radiographs. Mean horizontal fracture gap was 0.34 mm and mean vertical step-off between bicondylar fragments was 0.63 mm. The median value of the horizontal fracture gap and vertical step off was 0 and 0.46 mm, respectively. Mean time to union in the bicondylar fracture fragment was 9 week. TRIC is considered to be a valuable surgical reduction technique in the treatment of the AO/OTA 33-C type fractures.
  • A Novel Surgical Technique for treatment of Morel-Lavallée Lesion:
           Endoscopic debridement combined with percutaneous cutaneo-fascial suture
    • Abstract: Publication date: Available online 4 June 2018Source: InjuryAuthor(s): Min Liu, Liangle Liu, Xiaosai Zhou, Lifen Wu, Juncheng Wang, Li Qi, Chunyuan Cai Morel-Lavallée lesions are rare, closed degloving soft tissue injuries in which the skin and subcutaneous tissues are traumatic separated from the underlying fascia. There is lack of consensus regarding optimal management of these lesions. After failure of conservative management, operative intervention is imperative. The purpose of this manuscript is to describe a minimally invasive endoscopic method for treatment of Morel-Lavallée Lesions, which achieves the goal of an open surgical debridement.
  • Pain after ortho-plastic reconstruction of lower limb injuries: The
           importance of standardizing analgesic management
    • Abstract: Publication date: June 2018Source: Injury, Volume 49, Issue 6Author(s): Mark C. Kendall, Lucas J. Castro Alves
  • Tetanus ‘Quick Stik’ – is the NHS missing a trick'
    • Abstract: Publication date: June 2018Source: Injury, Volume 49, Issue 6Author(s): T. Welman, A.R. McKean, E. Duggan, S.M. Rahman, L.S.P. Moore, M. Horwitz
  • Fixed angle plate fixation of comminuted patellar fractures
    • Abstract: Publication date: June 2018Source: Injury, Volume 49, Issue 6Author(s): Tyler B. Moore, Bharat R. Sampathi, David P. Zamorano, Martin C. Tynan, John A. Scolaro IntroductionComminuted patella fractures are uncommon and difficult fractures to manage. Multiple treatment modalities have been suggested, with little clinical data to support practice. Recent biomechanical and technical investigations have described successful plate fixation of comminuted patella fractures. The purpose of this study was to evaluate radiographic, clinical and functional outcome of comminuted patella fractures treated with a fixed angle locking plates. We believe stable fixation, which results in successful fracture union and functional recovery, can be achieved with this technique.Materials and methodsA retrospective review was performed at a single regional academic Level 1 trauma hospital. All comminuted patella fractures treated with a fixed angle locking plate (AO/OTA 34C2 and C3) over a six-year period were evaluated. Thirty-six patients were identified. Average length of follow up was 154 weeks (range 12–297 weeks). Twenty patients were available for functional outcome scoring. Primary outcome measures were: Knee Outcome Score (KOS), Lower Extremity Functional Scale (LES) and goniometer measured knee range of motion. Secondary outcomes evaluated the need for additional screw or cerclage fixation, reoperation for any reason, bothersome hardware, infection and nonunion.ResultsAverage KOS = 57.2 (20–74), average LES = 58.9 (15–80). Median extension = 0° (full extension), median flexion = 130°. Supplemental screws were used in 17/36 cases; cerclage used in 2/36 cases. Hardware irritation was noted in 4/20 patients, no patient requested elective hardware removal, one patient had failure of fixation and no nonunions were identified.ConclusionFixed angle plate stabilization of comminuted patella fractures is a viable technique for fracture fixation. Good to excellent return of knee function and low complication rates, including need for hardware removal, can be expected.
  • Characterization of disability following traumatic through knee and
           transfemoral amputations
    • Abstract: Publication date: June 2018Source: Injury, Volume 49, Issue 6Author(s): David J. Tennent, Elizabeth M. Polfer, Nicole M. Sgromolo, Chad A. Krueger, Benjamin K. Potter IntroductionThe purpose of this study is to characterize through knee and transfemoral amputations following severe traumatic injuries.MethodsA retrospective review of all transfemoral and through knee amputations sustained by United States military service members from 1 October 2001 to 30 July 2011 was conducted. Data from the Department of Defense Trauma Registry, the Armed Forces Health Longitudinal Technology Application, inpatient medical records and the Physical Evaluation Board Liaison Offices were queried in order to obtain characteristics related to injury sustained, demographics, treatment, and disability/mental health outcome data.ResultsA total of 1631 amputations in 1315 patients were identified. Of these there were 37 through knee and 296 were transfemoral amputations. Adequate records for detailed analysis were available on 140 and 25 transfemoral and through knee amputations respectively. There were no significant differences in demographic information, injury mechanism, initial injury severity score, or associated injuries, to include contralateral amputations. There was no significant difference in average disability rating (67.9% vs 78.3%, p = 0.46) or number of service members determined to be fully disabled (42.2% vs 28.6% p = 0.33) between the transfemoral and through knee amputation groups. Whereas there was no difference between groups preoperatively, the knee disarticulation group displayed a higher rate of mental health diagnoses post-amputation (96% vs 72%, p 
  • Risk factors associated with amputation in civilian popliteal artery
    • Abstract: Publication date: June 2018Source: Injury, Volume 49, Issue 6Author(s): Michael J. Ramdass, Alyssa Muddeen, Patrick Harnarayan, Richard Spence, David Milne Popliteal artery trauma is uncommon but is associated with a high risk of limb loss depending on the scenario involving blunt or penetrating trauma as well as the severity and extent of injury that has occurred. In our setting there is a significant amount of gang and civilian warfare resulting in Vascular Trauma. There were 32 patients over a decade who sustained traumatic injury to the popliteal artery consisting of 30 males (94%) and 2 females with an age range 16–59 years with a mean of 32. There were 20 cases of penetrating trauma (63%) and 12 cases of blunt trauma (37%). Of the penetrating trauma, 18 were due to gunshot wounds (GSWs) (90%) and 2 stabs. The majority (7/12; 58%) of blunt trauma was due to falls, and 42% (5/12) secondary to motor vehicular accidents (MVAs). In terms of extent of injury, 21 of 32 patients (65%) sustained an isolated popliteal artery injury, whilst 6 (19%) had injury to both the popliteal artery and vein and another 5 (16%) had combined popliteal artery, vein and nerve injuries. There were 14 cases with associated orthopaedic injuries: 7 posterior knee dislocations, 1 fracture/dislocation of the knee, 2 femoral fractures, 2 tibial plateau fractures and 2 tibia/fibula fracture. Methods of repair included 14 reversed vein grafts, 16 polytetrafluoroethylene (PTFE) grafts and 2 primary. The overall amputation rate was 28% (9 patients). Of the penetrating trauma patients 25% required amputations composed of 5 GSWs, 33% of the blunt trauma patients required amputations. It was noted that factors associated with (but not statistically significant) poor outcomes included combined artery/vein injury, artery/vein/nerve injury, concomitant fracture/dislocation and delayed transfer to a Vascular Surgery Unit. The type of graft or repair did not affect outcome. The incidence of popliteal artery trauma was calculated at 2.46 per 100,000 population per year.
  • One year after proximal or distal periprosthetic fracture of the femur
           -two conditions with divergent outcomes'
    • Abstract: Publication date: June 2018Source: Injury, Volume 49, Issue 6Author(s): D. Eschbach, B. Buecking, H. Kivioja, M. Fischer, T. Wiesmann, R. Zettl, L. Oberkircher, J. Barthel, R. Aigner, S. Ruchholtz, C. Bliemel IntroductionArthroplasty of the hip and knee is 1 of the 20 most frequent operations in Germany. Periprosthetic fracture is one of the most feared complications following primary or revision arthroplasty. Present publication aims to analyse differences between patients with periprosthetic fracture around total knee arthroplasty (PFTKA) and patients with periprosthetic fracture around total hip arthroplasty (PFTHA) concerning demographics, clinical course, complications and return to pre-fracture mobility.MethodsProspective single-centre observation study of periprosthetic femoral fractures with stable implants. Present subgroup analysis includes patients with PFTKA and PFTHA. All patients were treated with polyaxial angular stable plates using two standardized techniques: a minimally invasive percutaneous distal insertion technique and a mini-open technique. Data collection included implant- and operation-related information as well as demographics, clinical course, complications and return to pre-fracture mobility. Data were collected during a 12-month follow-up.ResultsWe were able to analyse the data of 73 patients. The PFTKA group had 37 patients with a mean age of 76 ± 10 years; 88% were female. After 1 year, 3 patients in this cohort had died; 68% of survivors had reached their pre-fracture mobility; 22% had undergone operative revisions for various reasons. The PFTHA cohort included 36 patients with a mean age of 80 ± 13 years, 72% were female. After 1 year, 9 patients had died in this cohort, 42% of survivors had reached their pre-fracture mobility. Non-operative complications occurred for 16% in the PFTKA group and 64% in the PFTHA group (p 
  • Pre-operative factors associated with increased mortality in elderly
           patients with a hip fracture: A cohort study in a developing country
    • Abstract: Publication date: June 2018Source: Injury, Volume 49, Issue 6Author(s): Kristian A. Espinosa, Amparo Gómez Gélvez, Liliana P. Torres, María Fernanda García, Omar R. Peña BackgroundHip fractures are a public health problem worldwide, and several factors are involved with post-operative mortality. The aim of this study was to identify the pre-operative factors associated with increased mortality in elderly patients with hip fractures in a developing country during the first post-operative year.MethodsAn ambidirectional cohort study was conducted with patients ≥ 65 years of age who underwent hip surgery due to a hip fracture caused by a fall from a standing position. Socio-demographic data, time to surgery, and comorbidities measured by the Charlson Comorbidity Index (CCI) were recorded. One-year mortality from all causes was the primary outcome, and 30-day and 6-month mortality were the secondary outcomes. Log-rank test was used to evaluate survival, and Cox’s proportional hazard regression was used to detect the factors associated with increased mortality.Results478 patients who underwent hip surgery were included in this study. The mean age was 80.2 ± 9.9, and 297 (62%) were females. There were 150 (31.4%) deaths at the end of the first follow-up year, and the mean of surgical delay was 8.8 days ± 6.4. Patients who underwent surgery during the first 4 days (Log-rank test  4 days (HR 2.72, 95% CI 1.42–5.23, p 0.003), and haemoglobin 
  • Modified Stoppa approach for operative treatment of acetabular fractures:
           10-year experience and mid-term follow-up
    • Abstract: Publication date: June 2018Source: Injury, Volume 49, Issue 6Author(s): Diederik O. Verbeek, Kornelis J. Ponsen, Mark van Heijl, J. Carel Goslings IntroductionThe (modified) Stoppa approach for acetabular fracture surgery has gained significant popularity and early results have been encouraging but clinical outcome at extensive follow-up is scarce. The purpose of this study is to provide an update on our experience with this approach for operative treatment of acetabular fractures and to assess clinical outcome at mid-term follow-up.MethodsIn this retrospective study, all patients treated operatively for an acetabular fracture using the Stoppa approach over a 10-year period were included. Surgery details were reviewed and patients were contacted and requested to return for follow-up. Primary outcome was native hip survivorship, secondary outcome measures included; functional outcome (Merle d’Aubiginé, Harris hip) scores, health-related quality of life (short-form 36) and radiographic outcome (heterotopic ossification, hip osteoarthritis).ResultsForty-five patients received operative fixation for 47 acetabular fractures using the Stoppa approach. Complications requiring surgical intervention were found in one patient (with a vascular lesion) intra-operatively and 3 patients (with wound infections (2) and diffuse bleeding (1)) post-operatively. Follow-up was 83% and 29/39 (74%) native hips survived at mean 59 months (SD 49) postoperatively. Excellent-good functional scores were found in 88% (Merle d’Aubiginé) and 76% (Harris hip) of patients who had retained their native hip. Most (6/8) short-form 36 indices in these patients were comparable to population norms. Of 29 native hips with radiographic follow-up (mean 59 months (SD 49), 4 (86%) had no-minimal radiographic abnormalities.ConclusionThis study confirms that the Stoppa approach is a safe and effective technique for acetabular fracture fixation. Moreover, at mid-term follow-up, this approach is associated with satisfactory results in terms of hip survivorship as well as functional and radiographic outcome. As such, our findings reinforce the notion that this less invasive technique presents a valuable alternative to the ilioinguinal approach for the surgical treatment of acetabular fractures.
  • Long-term patient reported outcomes following acetabular fracture fixation
    • Abstract: Publication date: June 2018Source: Injury, Volume 49, Issue 6Author(s): Diederik O. Verbeek, Jelle P. van der List, Camden M. Tissue, David L. Helfet IntroductionPatient reported outcome scores may be the preferred method to assess clinical results following acetabular fracture fixation. However, in current acetabular fracture research, there is a scarcity of studies using these scores and long-term follow-up is lacking. The aim of this study is to describe long-term patient reported outcomes following acetabular fracture surgery and to evaluate the association between reduction quality and these outcome measures.MethodsPatients who received operative fixation for acetabular fractures (1992–2012) were sent questionnaires (short musculoskeletal functional assessment (SMFA) function index and short form (SF)-12), which was returned by 106 patients (22%) (mean age 51 years, 74% male). Mean follow-up was 11.3 years and hip survivorship 78%. Reduction quality was assessed on postoperative CT or plain pelvic radiography (PXR) (3 patients). Reductions were graded as adequate (CT:
  • A new sign allowing diagnosis in the pathologies of the extensor tendons
           of the hand
    • Abstract: Publication date: June 2018Source: Injury, Volume 49, Issue 6Author(s): A. Leti Acciaro, F. Pilla, G. Colzani, N. Corradi IntroductionThe thorough knowledge of the anatomy of the extensor tendon system of the hand is crucial for clinical examination and detection of tendon injuries. The Juncturae between the EDCII and other extensor tendons presents different incidences, shapes (“r” or “y”) and morphologies (Type I, II, III). The EIP does not receive connection. These characteristics may result in variable effects on extensor tendons during active finger movements. The purpose of this study is to investigate and describe a new sign helping diagnosis for injuries or pathologies of EIP and EDC index finger (EDC II), based on a cadaveric dissection and clinical observation.Materials and methodsThe authors performed a clinical observational study in 520 patients in order to distinctly evaluate by means of inspection and palpation the EIP and EDC II tendons and an anatomical analysis of extensor tendon apparatus of long fingers was then performed in 89 cadaver hands focusing the investigation on the juncturae system.ResultsThe observational studies showed that during the flexion of the III, IV and V fingers, associated to the active extension of the I and II fingers, the EDC of the III, IV and V fingers moved the EDC II in ulnar direction by means of juncturae action. The EIP remained in its position becoming visible and isolated from the migrated EDC II.ConclusionsThis feature allows the distinct clinical evaluation by observation and palpation of both EDC II and EIP tendons and may be helpful in clinical conditions such as diagnosis of tendon lesions, pre-operative planning of EIP transfer and extensor tendon tenolysis associated to soft tissue scar at the second MPj.
  • Injury among adolescents with intellectual disability: A prospective
           cohort study
    • Abstract: Publication date: June 2018Source: Injury, Volume 49, Issue 6Author(s): David White, Lyn McPherson, Nicholas Lennox, Robert S. Ware IntroductionInjury is the leading cause of mortality and morbidity in adolescents worldwide, and injury rates have been shown to be higher among youth with intellectual disability. Despite this, injury among adolescents with intellectual disability remains poorly investigated. This study aimed to identify characteristics associated with injury among adolescents with intellectual disability living in the community.MethodsA cohort of adolescents with intellectual disability living in southern Queensland, Australia was investigated prospectively between January 2006 and June 2010. Personal characteristics were collected via postal questionnaire. Injury information, including mechanism and location of injury, was extracted from general practitioner records. The association between demographic, social and clinical characteristics of participants and episodes of injury was investigated using negative binomial regression.ResultsA total of 289 injuries were recorded from 432 participants over 1627.3 years of study-time. The overall annual injury incidence was 17.5 (95%CI 14.7, 20.9) per 100 person years. Presence of ADHD and less severe disability was associated with increased risk of injury. Down syndrome and reduced verbal communication capacity were associated with decreased risk of injury. Falls accounted for the highest single mechanism of injury (19.0%) with the majority (73.2%) of injuries involving either upper or lower limbs.ConclusionsADHD is a co-morbidity that increases risk of injury among adolescents with intellectual disability. A critical component of injury prevention is avoidance of the great variety of environmental risk factors for injury relevant to this population.
  • High diagnostic accuracy of white blood cell scintigraphy for fracture
           related infections: Results of a large retrospective single-center study
    • Abstract: Publication date: June 2018Source: Injury, Volume 49, Issue 6Author(s): G.A.M. Govaert, P. Bosch, F.F.A. IJpma, J. Glauche, P.C. Jutte, J.V.C. Lemans, K.W. Wendt, I.H.F. Reininga, A.W.J.M. Glaudemans IntroductionWhite blood cell (WBC) scintigraphy for diagnosing fracture-related infections (FRIs) has only been investigated in small patient series. Aims of this study were (1) to establish the accuracy of WBC scintigraphy for diagnosing FRIs, and (2) to investigate whether the duration of the time interval between surgery and WBC scintigraphy influences its accuracy.Patients and methods192 consecutive WBC scintigraphies with 99mTc-HMPAO-labelled autologous leucocytes performed for suspected peripheral FRI were included. The golden standard was based on the outcome of microbiological investigation in case of surgery, or − when these were not available – on clinical follow-up of at least six months. The discriminative ability of the imaging modalities was quantified by several measures of diagnostic accuracy. A multivariable logistic regression analysis was performed to identify predictive variables of a false-positive or false-negative WBC scintigraphy test result.ResultsWBC scintigraphy had a sensitivity of 0.79, a specificity of 0.97, a positive predicting value of 0.91, a negative predicting value of 0.93 and a diagnostic accuracy of 0.92 for detecting an FRI in the peripheral skeleton. The duration of the interval between surgery and the WBC scintigraphy did not influence its diagnostic accuracy; neither did concomitant use of antibiotics or NSAIDs. There were 11 patients with a false-negative (FN) WBC scintigraphy, the majority of these patients (n = 9, 82%) suffered from an infected nonunion. Four patients had a false-positive (FP) WBC scintigraphy.ConclusionsWBC scintigraphy showed a high diagnostic accuracy (0.92) for detecting FRIs in the peripheral skeleton. Duration of the time interval between surgery for the initial injury and the WBC did not influence the results which indicate that WBC scintigraphy is accurate shortly after surgery.
  • Defining degree of aortic occlusion for partial-REBOA: A computed
           tomography study on large animals
    • Abstract: Publication date: June 2018Source: Injury, Volume 49, Issue 6Author(s): Viktor A. Reva, Yosuke Matsumura, Igor M. Samokhvalov, Alexander A. Pochtarnik, Igor S. Zheleznyak, Ekaterina M. Mikhailovskaya, Jonathan J. Morrison IntroductionPartial resuscitative endovascular balloon occlusion of the aorta (P-REBOA) is a modified REBOA technique designed to help ameliorate ischemia-reperfusion injury. The balloon is partially deflated, allowing a proportion of aortic flow distal to the balloon. The aim of this study is to use an ovine model of haemorrhagic shock to correlate the degree of occlusion to several hemodynamic indices.Materials and methodsSix sheep weighing 35–46 kg underwent a controlled venous haemorrhage inside a CT scanner until the systolic arterial pressure (AP) dropped to
  • Viability and functionality of mesenchymal stromal cells loaded on
           collagen microspheres and incorporated into plasma clots for orthopaedic
           application: Effect of storage conditions
    • Abstract: Publication date: June 2018Source: Injury, Volume 49, Issue 6Author(s): Olga Wittig, Dylana Diaz-Solano, José Cardier BackgroundThere is evidence showing that human mesenchymal stromal cells (MSC) seeded on collagen microspheres (CM) and incorporated into platelet rich plasma (PRP) clots induce bone formation. For clinical trials it is very important to establish standardization of storage and shipment conditions to ensure the viability and functionality of cellular products. We investigate the effect of storage temperature and time on the viability and functionality of human MSC seeded on CM and included into PRP clots for using in the further clinical application for bone regeneration.MethodsMSC/CM/PRP clots were stored at room temperature (RT), 4 °C and 37 °C for 12 h, 24 h and 48 h. At each period of time, MSC were evaluated for their viability and functionality.ResultsMSC from MSC/CM/PRP clots maintained at RT and 37 °C for 24 h showed a high viability (90%) and maintained their capacity of proliferation, migration and osteogenic differentiation. In contrast, MSC/CM/PRP maintained to 4 °C showed a significant reduction in their viability and migration capacity. MSC from MSC/CM/PRP clots maintained at RT for 24 h induce osteogenesis in the subcutaneous tissues of mice, after four months of transplantation.DiscussionOur results show that MSC incorporated into CM/PRP clots and maintained at RT can be utilized in bone regeneration protocols during the first 24 h after their processing.
  • Assessment of Reamer Irrigator Aspirator System (RIA) filtrate for its
           osteoinductive potential in a validated animal model
    • Abstract: Publication date: June 2018Source: Injury, Volume 49, Issue 6Author(s): Alex R. Wessel, Brett D. Crist, James P. Stannard, Gregory J. Della Rocca, Aaron M. Stoker, Chantelle C. Bozynski, Cristi R. Cook, Keiichi Kuroki, Carin E. Ahner, James L. Cook PurposePrevious studies indicate that Reamer Irrigator Aspirator (RIA) filtrate contains proteins that have the potential to stimulate bone healing. This study aimed to determine the osteoinductive capabilities of RIA filtrate in a validated in vivo model.MethodsWith Institutional Review Board approval, RIA filtrates from 9 patients were collected. The filtrate was processed to remove cells and inorganic particles. A portion of each sample was set aside for protein analysis while the remainder was lyophilized and prepared for implantation. With Animal Care and Use Committee approval, athymic mice (n = 16; 32 hind limbs) were randomly assigned to 1 of 4 groups (n = 8 limbs per group) for percutaneous gastrocnemius muscle injection of demineralized bone matrix (DBM) (10 mg), lyophilized RIA powder (10 mg), RIA liquid (10 mg of lyophilized RIA powder in 100ul phosphate buffered saline (PBS)), or DBM (10 mg) + RIA liquid (10 mg in 100ul PBS). Radiographs were obtained 2, 4, and 8 weeks after injection. At 8 weeks, mice were sacrificed and the entire gastrocnemius muscle from each hind limb was collected and processed for histologic examination. Histological sections and radiographs were assessed for ossification/calcification. Data were compared for statistically significant (p  0.7) correlations between outcome measures.ResultsThe protein composition of RIA filtrates was consistent among patients and matched previous data. For all groups, radiographic scores were significantly (p 
  • Epidermal growth factor regulates apoptosis and oxidative stress in a rat
           model of spinal cord injury
    • Abstract: Publication date: June 2018Source: Injury, Volume 49, Issue 6Author(s): Anil Murat Ozturk, Murat Celal Sozbilen, Elvin Sevgili, Taner Dagci, Halit Özyalcin, Guliz Armagan Spinal cord injury (SCI) leads to vascular damage and disruption of blood-spinal cord barrier which participates in secondary nerve injury. Epidermal growth factor (EGF) is an endogenous protein which regulates cell proliferation, growth and differention. Previous studies reported that EGF exerts neuroprotective effect in spinal cord after SCI. However, the molecular mechanisms underlying EGF-mediated protection in different regions of nervous system have not shown yet. In this study, we aimed to examine possible anti-apoptotic and protective roles of EGF not only in spinal cord but also in brain following SCI.Twenty-eight adult rats were divided into four groups of seven animals each as follows: sham, trauma (SCI), SCI + EGF and SCI + methylprednisolone (MP) groups. The functional neurological deficits due to the SCI were assessed by behavioral analysis using the Basso, Beattie and Bresnahan (BBB) open-field locomotor test. The alterations in pro-/anti-apoptotic protein levels and antioxidant enzyme activities were measured in spinal cord and frontal cortex.In our study, EGF promoted locomotor recovery and motor neuron survival of SCI rats. EGF treatment significantly decreased Bax and increased Bcl-2 protein expressions both in spinal cord and brain when compared to SCI group. Moreover, antioxidant enzyme activities including catalase, superoxide dismutase (SOD) and glutathione peroxidase (GPx) were increased following EGF treatment similar to MP treatment. Our experiment also suggests that alteration of the ratio of Bcl-2 to Bax may result from decreased apoptosis following EGF treatment. As a conclusion, these results show, for the first time, that administration of EGF exerts its protection via regulating apoptotic and oxidative pathways in response to spinal cord injury in different regions of central nervous system.
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Heriot-Watt University
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