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Publisher: Elsevier   (Total: 3160 journals)

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Showing 1201 - 1400 of 3160 Journals sorted alphabetically
Growth Factors and Cytokines in Health and Disease     Full-text available via subscription   (Followers: 1)
Growth Hormone & IGF Research     Hybrid Journal   (Followers: 17, 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: 2, SJR: 4.16, CiteScore: 2)
Handbook of Defense Economics     Full-text available via subscription   (Followers: 2)
Handbook of Development Economics     Full-text available via subscription   (Followers: 8)
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: 10)
Handbook of Economic Forecasting     Full-text available via subscription   (Followers: 3)
Handbook of Economic Growth     Full-text available via subscription   (Followers: 3)
Handbook of Environmental Economics     Full-text available via subscription   (Followers: 3)
Handbook of Experimental Economics Results     Full-text available via subscription   (Followers: 6)
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: 13)
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: 4)
Handbook of Industrial Organization     Full-text available via subscription   (Followers: 5)
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: 7)
Handbook of Natural Resource and Energy Economics     Full-text available via subscription   (Followers: 5)
Handbook of Numerical Analysis     Full-text available via subscription   (Followers: 5)
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: 3)
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: 8, 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: 3)
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   (Followers: 2)
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: 43, SJR: 0.237, CiteScore: 1)
Hong Kong Physiotherapy J.     Open Access   (Followers: 14, 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: 18, 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: 54, 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: 13, 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: 5, 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   (Followers: 1, 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: 17)
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: 56, 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: 5, SJR: 0.63, CiteScore: 1)
Information Fusion     Hybrid Journal   (Followers: 2, SJR: 1.832, CiteScore: 7)
Information Processing & Management     Hybrid Journal   (Followers: 417, 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: 476, 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: 6)
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)
Intl. J. of Accounting     Hybrid Journal   (Followers: 1)
Intl. J. of Accounting Information Systems     Hybrid Journal   (Followers: 5, SJR: 0.399, CiteScore: 2)

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Similar Journals
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  [3160 journals]
  • Is prehospital blood transfusion effective and safe in haemorrhagic trauma
           patients' A systematic review and meta-analysis
    • Abstract: Publication date: Available online 21 March 2019Source: InjuryAuthor(s): Tim W.H. Rijnhout, Kimberley E. Wever, H.A.R. Marinus, N. Hoogerwerf, L.M.G Geeraedts, E.C.T.H. Tan BackgroundLife-threatening haemorrhage accounts for 40% mortality in trauma patients worldwide. After bleeding control is achieved, circulating volume must be restored. Early in-hospital transfusion of blood components is already proven effective, but the scientific proof for the effectiveness of prehospital blood-component transfusion (PHBT) in trauma patients is still unclear.ObjectiveTo systematically review the evidence for effectiveness and safety of PHBT to haemorrhagic trauma patients.MethodsCINAHL, Cochrane, EMBASE, and Pubmed were searched in the period from 1988 until August 1, 2018. Meta-analysis was performed for matched trauma patients receiving PHBT with the primary outcomes 24-hour mortality and long-term mortality. Secondary outcome measure was adverse events as a result of PHBT.ResultsTrauma patients who received PHBT with simultaneous use of packed red blood cells (pRBCs) and plasma showed a statistically significant reduction in long-term mortality (OR = 0.51; 95% CI, 0.36–0.71; P 
  • Corrigendum to “Reliability of the classification of proximal femur
           fractures: Does clinical experience matter'” [Injury 49 (1) (2018)
    • Abstract: Publication date: Available online 20 March 2019Source: InjuryAuthor(s): Tom J. Crijns, Stein J. Janssen, Jacob T. Davis, David Ring, Hugo B. Sanchez, the Science of Variation Group
  • Heterologous fibrin sealant potentiates axonal regeneration after
           peripheral nerve injury with reduction in the number of suture points
    • Abstract: Publication date: Available online 19 March 2019Source: InjuryAuthor(s): Ana Paula Silveira Leite, Carina Guidi Pinto, Felipe Cantore Tibúrcio, Arthur Alves Sartori, Antonio de Castro Rodrigues, Benedito Barraviera, Rui Seabra Ferreira Junior, André Luis Filadelpho, Selma Maria Michelin Matheus The use of suture associated with heterologous fibrin sealant has been highlighted for reconstruction after peripheral nerve injury, having the advantage of being safe for clinical use. In this study we compared the use of this sealant associated with reduced number of stitches with conventional suture after ischiatic nerve injury. 36 Wistar rats were divided into 4 groups: Control (C), Denervated (D), ischiatic nerve neurotmesis (6 mm gap); Suture (S), epineural anastomosis after 7 days from neurotmesis, Suture + Fibrin Sealant (SFS), anastomosis with only one suture point associated with Fibrin Sealant. Catwalk, electromyography, ischiatic and tibial nerve, soleus muscle morphological and morphometric analyses were performed. The amplitude and latency values of the Suture and Suture + Fibrin Sealant groups were similar and indicative of nerve regeneration.The ischiatic nerve morphometric analysis in the Suture + Fibrin Sealant showed superior values related to axons and nerve fibers area and diameter when compared to Suture group. In the Suture and Suture + Fibrin Sealant groups, there was an increase in muscle weight and in fast fibers frequency, it was a decrease in the percentage of collagen compared to group Denervated and in the neuromuscular junctions, the synaptic boutons were reestablished.The results suggest a protective effect at the lesion site caused by the fibrin sealant use. The stitches reduction minimizes the trauma caused by the needle and it accelerates the surgical practice. So the heterologous fibrin sealant use in nerve reconstruction should be considered.
  • Jockey injuries during the Siena “Palio”. A 72-year analysis of the
           oldest horse race in Italy
    • Abstract: Publication date: Available online 19 March 2019Source: InjuryAuthor(s): Mattia Fortina, Pietro Maniscalco, Christian Carulli, Luigi Meccariello, Giovanni Battista Colasanti, Serafino Carta IntroductionHorse racing is a hazardous sport. We analyzed the incidence and characteristics of jockey injuries in a typical horse race.MethodsWe analyzed all injuries sustained by 224 jockeys in the last 72 years.ResultsIt was found that in 96.1% of the races there was at least one fall and in 28.6% of the races 50% or more of the jockeys fell. In 43.4% of the falls, the jockey was taken to the emergency room. Comparing the Palio with traditional races in other countries, a higher injury incidence rate was observed for every 100 falls (109.884 vs 27–59) and a lower concussion rate/100 falls (0.97 vs 1.8-7.4).ConclusionThe Palio is one of the most threatening races that continues today. Jockeys are at greater risk for a fall than any other race in the world.
  • Specific stretchers enhance rapid extraction by tactical medical support
           teams in mass casualty incidents
    • Abstract: Publication date: Available online 19 March 2019Source: InjuryAuthor(s): Service Medical du Raid, Paul-Georges Reuter, Chloe Baker, Thomas Loeb ObjectiveIn mass casualty incidents where the threat is on-going, victim evacuation remains a challenge: fast extraction while respecting spinal immobilisation and haemorrhage control. Different devices can be used but their suitability has not been compared.MethodsWe conducted a simulation study comparing eight extraction devices with a randomisation of the order of testing. Five teams, consisting of four officers, evacuated a single victim in five steps: device’s deployment, loading the victim, carrying the victim along a corridor, negotiating a corner passage and a descent by staircase. Primary outcome was the emergency extraction time, from deployment to the first obstacle. Secondary outcomes included ease of transport and victim’s stability, rated from 1 (worst) to 10 (best).ResultsOne hundred and sixty simulations were carried out. The median emergency extraction time was 16.7 [IQR: 11.6–24.9] seconds. The three speediest devices were the “firefighters’ worn”, “snogg” and “flexible tarp”, taking 9.7 [8.1–11.0], 11.7 [10.9–15.4] and 12.2 [11.2–17.9] seconds respectively (p 
  • A Trauma Registry Experience from the Main Referral Center of Honduras: A
           Call for Action
    • Abstract: Publication date: Available online 19 March 2019Source: InjuryAuthor(s): Cristina Rodriguez, Francisco J. Bonilla-Escobar, Catalina Restrepo-Lopera, Anastasia Markovtsova, Marco T. Medina, Juan Carlos Puyana BackgroundHonduras is one of the most violent countries in the world, that said, it has limited epidemiological data to describe the extent of intentional and unintentional injuries. The national and international need for information from the country to develop and inform prevention programs, highlights the need for this research.MethodsA cross-sectional study was carried out on a paper-based injury surveillance system (InSS) coordinated by Honduras’ University Medical School Hospital (UMSH), the main referral medical center in Tegucigalpa-Honduras. Descriptive statistics and bivariate analysis were carried out using data from all registered injuries in 2013.ResultsOf the 17,971 injuries reported, intentional injuries made up 18.14% of all injuries. Interpersonal violence from gun violence, robberies and physical altercations accounted for 14.68%, whilst self-inflicted injuries were 3.46% of injuries with suicide falls and poison intoxication as the most frequent (1.9% and 1.2%, respectively). Sexual harassment was minimally reported (0.27%, n = 48). Unintentional injuries made up 81.79% of the total injuries. The most common causes of non-intentional injuries were falls (38.01%) and road traffic injuries (16.65%) with 35.4% as users of motorcycles. In general, injuries affected mainly men in economically active ages, occurred during the weekend, the modified Kampala trauma score (M-KTS) showed that most of the injuries were mild (range 3 to 11), with 59.59% of the patients with a M-KTS of 9, and an overall mortality rate of 0.65% (n = 117).ConclusionThe description of injuries provides the basis for prevention. The disproportion of unintentional injuries (4:1) seen in a referral hospital in one of the most violent cities in the world, calls the attention for further research on: 1) trauma care logistics and emergency systems, 2) mortality and lethality of intentional injuries, and 2) analysis of the types of unintentional injuries. Further research including the evaluation of interventions and identification of the socioeconomic effects of injuries in the region are required.
  • The Surgical Approach Visualization and Navigation (SAVN) System reduces
           radiation dosage and surgical trauma due to accurate intraoperative
    • Abstract: Publication date: Available online 18 March 2019Source: InjuryAuthor(s): Ying Jiang, Hong-Rui Wang, Pan-Feng Wang, Shuo-Gui Xu ObjectThe intraoperative fluoroscopy has been widely used in modern neuro-spinal surgery due to the overwhelming trend toward minimal-access surgery. However, both patients and surgical personnel were under ionizing-radiation exposure during fluoroscopy usage. Since the fluoroscopy constitutes the vast majority of radiation exposure for both surgeons and patients, the development and improvement of new interventional possibilities are of great importance and interests.Patients and methodsA total of 20 patients were included in the current study, who received thoracic-spinal tumor resection via posterior midline approach. In comparison to the conventional C-Arm mobile fluoroscopy machine, the Surgical Approach Visualization and Navigation (SAVN) System was used to evaluate the effectiveness in reducing radiation.ResultsThe pain intensity and Japanese Orthopedic Association Score were equally ameliorated in patients of two groups. However, compared to C-arm group, the SAVN significantly reduced the screening time from 26.8 + 12.4 to 17.1 + 9.2 sec (36.2% radiation reduction, P 
  • It was not a hip fracture – you were lucky this time – or perhaps not!
           A prospective study of clinical outcomes in patients with low-energy
           pelvic fractures and hip contusions
    • Abstract: Publication date: Available online 18 March 2019Source: InjuryAuthor(s): Glenn Larsson, Ulf Strömberg, Cecilia Rogmark, Anna Nilsdotter IntroductionPrehospital and hospital emergency care guidelines have been developed for patients with suspected hip fracture. Initial radiography can identify a number of patients with other injuries, generally pelvic fractures and hip contusions. Little is known about the prognosis for these patients.The aim of this study is twofold: i) to investigate the injury pattern of patients assessed in prehospital emergency care as suffering from a suspected hip fracture and ii) to compare clinical outcomes between patients with verified hip fracture (HF) and those with other hip injuries (OHI).MethodThe study design was prospective. Older patients with suspected HF after low-energy trauma were identified in prehospital emergency care. Injury type was determined by radiological imaging. Comparisons of length of stay, adverse events, repeated prehospital emergency care and mortality were made between verified HF and OHI cases.Results449 patients were included, 400 in the HF and 149 in the OHI group (86 hip contusions, 46 pelvic fractures and 17 other injuries/diseases). The HF group had a significantly longer hospital stay (9.5 days vs. 6.3 for the OHI group; p 
  • Clustering of Morphological Fracture Lines for Identifying
           Intertrochanteric Fracture Classification with Hausdorff Distance–Based
           K-means Approach
    • Abstract: Publication date: Available online 18 March 2019Source: InjuryAuthor(s): Jiantao Li, Shaojie Tang, Hao Zhang, Zhirui Li, Wanyu Deng, Chen Zhao, Lianghui Fan, Guoqi Wang, Jianheng Liu, Peng Yin, Gaoxiang Xu, Licheng Zhang, Peifu Tang ObjectivesThe aim of this study was to develop a systematic three-dimensional (3D) classification of intertrochanteric fractures by clustering the morphological features of fracture lines using the Hausdorff distance–based K-means approach and assess the usefulness of it in the clinical setting.MethodsWe retrospectively analyzed the data of 504 patients with intertrochanteric fractures who underwent closed reduction and intramedullary internal fixation. The morphological fracture lines of all patients extracted from computed tomography were transcribed freehand onto the template. All fracture lines were then clustered into five distinct types using the Hausdorff distance–based K-means clustering method. Five radiographic parameters and four functional parameters were used to evaluate the postoperative functional states and mobilization levels. Postoperative complications were also recorded.ResultsIntertrochanteric fractures were classified into five types: type I (108/504, 21.4%), simple fracture with intact lateral femoral wall and greater trochanter fragment; type II (85/504, 16.9%), simple fracture with intact lateral femoral wall with/without lesser trochanter detachment; type III (147/504, 29.2%), fractures with intertrochanteric crest detachment involving the lesser trochanter and greater trochanter with an intact lateral femoral wall; type IV (113/504, 22.4%), fractures with large intertrochanteric crest detachment and large lesser trochanter and greater trochanter detachment partially involving the lateral femoral wall and less medial cortical support; type V (51/504, 10.1%), a combination of pertrochanteric and lateral fracture line involving the entire lateral femoral wall and lesser trochanter detachment. Parameters of femoral neck–shaft angle and sliding distance of the cephalic nail were significantly different among types. The complication rate generally increased from type I to type V (P = 0.035).ConclusionsThe unsupervised clustering can achieve identification of the type of intertrochanteric fractures with clinical significance. The proposed 3D model classification can be used to describe fracture morphology, predict the possibility of achieving stable reduction and the risk of complications following intramedullary fixation.
  • Clinical observation of C3-type patellar fractures treated by operation
           methods with or without a turned-over patella
    • Abstract: Publication date: Available online 18 March 2019Source: InjuryAuthor(s): Qu-dong Yin, Jian-bing Wang, San-jun Gu, Yong-wei Wu, Yong-jun Rui ObjectiveTo evaluate the clinical efficacy of operation methods with or without a turned-over patella for treatment of C3-type patellar fractures.MethodsA total of 68 patients with C3-type patellar fractures undergoing open reduction and internal fixation were retrospectively selected and treated with a turned-over patella surgery (turned-over patella group, n = 30) or conventional therapy without turning over the patella (conventional group, n = 38). The intraoperative and postoperative indicators of the two groups were assessed and comparatively analyzed.ResultsThe bedridden time was significantly shorter in the turned-over patella group than in the conventional group (P = 0.002), while the range of motion (ROM) of knee joint was significantly higher in the turned-over patella group (P = 0.044). The Lysholm score was slightly higher in the turned-over patella group than in the conventional group, but the difference was not statistically significant (P = 0.055). No significant difference was observed between the two groups in terms of the operation time (P = 0.096), intraoperative blood loss (P = 0.543), time of weight bearing (P = 0.312), fracture healing time (P = 0.272), or complications (P = 1).ConclusionThe turned-over patella operation method exhibited some superiority to conventional reduction-fixation approach for treatment of C3-type patellar fractures in terms of efficacy and safety by enlarging the ROM of the knee joint and promoting functional recovery.
  • A comparative study for the usage of Fidji cervical cages after multilevel
           anterior cervical discectomy and fusion
    • Abstract: Publication date: Available online 18 March 2019Source: InjuryAuthor(s): Ya-peng Wang, Wei Zhang, Ji-long An, Li-chao Lian, Jian Zhang, Ya-peng Sun BackgroundPostoperative dysphagia is one major concern in the treatment for patients with cervical spine spondylosis by using anterior cervical discectomy and fusion (ACDF) with plating and cage system.PurposeTo evaluate the influence of two types of surgery for multilevel cervical spondylotic myelopathy (CSM) on postoperative dysphagia, namely ACDF with cage alone (ACDF-CA) using Fidji cervical cages and ACDF with cage and plate fixation (ACDF-CP).MethodsA retrospective study was performed in 62 consecutive patients with multilevel CSM, including 32 underwent ACDF-CA (group A) and 30 underwent ACDF-CP (group B). All enrolled patients were followed up at 48 hours, 2 months and 6 months postoperatively, when the dysphagia rate, Swallowing-Quality of Life (SWAL-QOL) score and the thickness of prevertebral soft tissue were recorded.ResultsAt 48 hours and 2 months, the dysphagia rate and thickness of prevertebral soft tissue were both significantly lower in group A than in group B, while the SWAL-QOL score of group A was significantly higher than that of group B. No significant difference was observed at 6 months.ConclusionFidji cervical cages could relieve postoperative dysphagia in the treatment of multilevel CSM with ACDF, especially at the first several months postoperatively.
  • Comparison of the postoperative analgesic efficacies of intravenous
           acetaminophen and fascia iliaca compartment block inhip fracture surgery:
           A randomised controlled trial
    • Abstract: Publication date: Available online 16 March 2019Source: InjuryAuthor(s): Norio Yamamoto, Shinichi Sakura, Tomoyuki Noda, Akihiro Nishiyama, Tomoyuki Dan’ura, Yuzuru Matsui, Toshifumi Ozaki BackgroundManaging pain during movement after hip fracture surgery is important for achieving earlier hip mobilisation and for preventing postoperative complications. In the present study, we tested the hypothesis that the fascia iliaca compartment block (FICB) would improve postoperative pain on movement compared with intravenous acetaminophen.MethodsIn this prospective, randomised, controlled, parallel trial, patients were assigned to either the intravenous acetaminophen or the ultrasound-guided FICB group. Visual analog scale (VAS) pain scores were evaluated at 6, 9, 12, 18, 24 h, 2 days, and 7 days postoperatively. The primary outcome was VAS scores on movement at 24 h after surgery. The secondary outcomes were VAS scores on movement at the other time points, VAS scores at rest, the total number of rescue analgesics required and incidence of delirium during the first 24 h postoperatively, potential drug or block-related complications, and the time to first standing.ResultsVAS scores on movement at 24 h after surgery were significantly lower in the FICB group than in the intravenous acetaminophen group [median (the 25th to 75th percentiles), 20 (10–30) vs 40 (30–53); P 
  • Outcomes of Fixation for Periprosthetic Tibia Fractures Around and Below
           Total Knee Arthroplasty
    • Abstract: Publication date: Available online 15 March 2019Source: InjuryAuthor(s): Michael P. Morwood, Sandra S. Gebhart, Nicholas Zamith, Hassan R. Mir IntroductionThe incidence of periprosthetic fractures after total knee arthroplasty (TKA) is rising due to an increasing number of TKAs performed annually and the growing elderly population. Like periprosthetic fractures of the distal femur, periprosthetic tibia fractures are primarily treated with operative fixation; however, there is limited scientific literature that has reported outcomes of periprosthetic tibia fractures treated with modern plating techniques. To our knowledge, this is the largest series of non-intraoperative periprosthetic tibia fractures treated with open reduction internal fixation (ORIF) ever reported.MethodsRetrospective chart review of 4,557 operatively treated tibia fractures with ORIF over a 16-year period at two Level 1 Trauma Centers.Results38 patients with an average follow-up of 15.3 months (range 3-24) were identified. 11 (28.9%) fractures were in the proximal tibia (four with extension into the plateau (Felix 1A) and seven adjacent to the tibial stem (Felix 2A)), six (15.8%) in the midshaft/diaphysis (Felix 3A), and 21 (55.3%) in the distal 1/3rd (metaphysis, Felix 3A). 76.3% (29/38) of fractures united by 6 months following the index procedure, leaving 9 nonunions. The overall re-operation rate was 31.6% (12/38). There were no significant differences in rates of union (p = 1.00), reoperation (p = 0.66), superficial infection (p = 0.66), or deep infection (p = 0.31) in patients treated with single versus dual plating.ConclusionPeriprosthetic tibia fractures are difficult to treat and have a high risk of nonunion and reoperation even with modern plating techniques. Most patients can be treated to union with operative fixation and do not require revision arthroplasty, if the components are stable initially. We recommend dual plating for fractures in the proximal third, and either single plating or nailing for fractures in the middle and distal thirds depending on bone quality, implant positioning, and fracture morphology.Level of EvidenceLevel 4, case-series.
  • Can the Use of Femoral Notch View Alone Decrease Measurement Error of
           Distal Interlocking Screws after Retrograde Femoral Nailing
    • Abstract: Publication date: Available online 15 March 2019Source: InjuryAuthor(s): Boshen Liu, David Zuelzer, Jerad Allen, Shea Comadoll, Joseph R. Hsu, Eric F. Swart, Paul E. Matuszewski ObjectivesDetermine if using different fluoroscopic views of the knee (Notch or Tangential) improves accuracy of screw lengths assessment compared to the standard posteroanterior (PA).Participants and Methods: Orthopaedic surgeons at three ACGME-accredited residency programs were asked via survey to assess screw lengths on PA, femoral notch, and tangential radiographic views.ResultsResponders correctly identified screw length using PA, femoral notch, and medial tangential views at rates of 46.75%, 52.27%, and 44.37% respectively. Respondents detected overall screw length discrepancies most accurately using the femoral notch view (Odds Ratio 1.26; 95% confidence interval: 1.07–1.47; P 
  • Short-term morbidity factors associated with length of hospital stay
           (LOS): Development and validation of a Hip Fracture specific postoperative
           morbidity survey (HF-POMS)
    • Abstract: Publication date: Available online 14 March 2019Source: InjuryAuthor(s): Takawira C. Marufu, Heather L. Elphick, Farah B. Ahmed, Iain K. Moppett BackgroundWe aimed to describe and quantify postoperative complications in the older hip fracture population, develop and validate a hip fracture postoperative morbidity survey tool (HF–POMS).MethodsA prospective clinical observation study of patients (≥ 70 years) admitted for emergency hip fracture surgery, was conducted across three English National Health Service hospitals. Outcome data items were developed from the Postoperative Morbidity Survey (POMS), Cardiac-POMS, hip fracture postoperative literature and orthogeriatric clinical team input. Postoperative outcome data were collected on days 1, 3, 5, 8 and 15; 341 patients participated.ResultsA 12-domain HF-POMS tool was developed with acceptable construct validity on all HF–POMS days. Patients with high perioperative risk scores as measured by the NHFS and ASA grade were more prone to develop HF–POMS defined morbidities. High morbidity rates occurred in the following domains; renal, ambulation assistance, pain and infectious. Presence of any morbidity on postoperative days 8 and 15 was associated with subsequent length of stay of 3.08 days (95% CI 0.90–5.26, p = 0.005) and 15.81 days (95% CI 13.35–18.27, p = 0.001) respectively. Observed average length of stay was 16.9 days. HF–POMS is a reliable and valid tool for measuring early postoperative complications in hip fracture patients. Additional domains are necessary to account for all morbidity aspects in this patient population compared to the original POMS.ConclusionMany patients remained in hospital for non-medical reasons. HF-POMS may be a useful tool to assist in discharge planning and randomised control trial outcome definitions.
  • Selective fixation of the medial malleolus in unstable ankle fractures
    • Abstract: Publication date: Available online 11 March 2019Source: InjuryAuthor(s): Thomas H. Carter, Samuel P. Mackenzie, Katrina R. Bell, Marcus A. Hollyer, Emma C. Gill, Deborah J. MacDonald, Andrew D. Duckworth, Timothy O. White BackgroundWhilst the lateral malleolus appears to be crucial in controlling anatomical reduction of the talus, the role of the medial malleolus is less clear. Medial sided complications including infection, damage to local structures and symptomatic hardware are not without morbidity. This study compares the outcomes of patients with bimalleolar or trimalleolar ankle fractures who underwent fibular nail stabilisation with or without medial malleolar fixation.MethodsFrom a prospective single-centre trauma database, we identified 342 patients over a nine-year period who underwent fibular nail insertion to stabilise a bimalleolar or trimalleolar ankle fracture. Isolated lateral malleolar fractures were excluded. Demographic data, clinical outcomes, radiographic evaluation, return to work and sport, and patient reported outcomes, including Olerud-Molander Ankle Score (OMAS), EuroQol-5D (EQ-5D) and Manchester-Oxford Foot Questionnaire (MOXFQ) were collected.ResultsThis study included 247 patients with a mean age of 66.7 years (range, 25–96 years), of whom 200 were female (81%). Medial malleolar fixation was not performed in 54 cases (22%). There was no significant difference between groups with respect to failure of fixation (p = 0.634) or loss of talar reduction (p = 0.157). No patient required surgery for a symptomatic medial malleolar non-union. Medial sided complications occurred in 32 (16%) of the fixation group, of whom 20 (10%) required further surgery. At a mean mid-term follow-up of 4.8 years (range, 8 months – 9 years) there was no significant difference between the non-fixation and fixation groups with respect to the median OMAS (85 vs 80; p = 0.885) or median EQ-5D (0.80 vs 0.81; p = 0.846). Patient satisfaction was not significantly different between the two groups (85/100 vs 87/100; p = 0.410).ConclusionNon-operative management of the medial malleolar component of an unstable ankle fracture treated with a fibular nail may reduce the rate of post-operative complications without compromising the patient reported outcome.
  • The epiphyseal scar joint line distance and age are important factors in
           determining the optimal screw length for medial malleoli fractures
    • Abstract: Publication date: Available online 11 March 2019Source: InjuryAuthor(s): H. Çabuk, Y. İmren, S.S. Dedeoğlu, M.Ç. Kır, S. Gürbüz, H. Gürbüz AimThe screw length is important to achieve a stable fixation for medial malleoli fractures. We aimed to evaluate the optimal screw length for different age groups in surgically treated medial malleoli fractures. The second aim was to identify the utility of the distance of epiphyseal scar to joint line or joint line to medullary space for assessment of screw length.Material method368 X-rays and computed tomography (CT) images of ankle joints were retrospectively evaluated for optimal screw length, epiphyseal scar to joint line distance, joint to medullary space distance. The mean screw length for each decade was calculated. The correlations of screw length with age, screw length with distance of epiphyseal scar to joint line, and screw length with distance of joint line to medullary space were evaluated.ResultsThe optimal screw length was obviously decreased in patients in 61–70 and>70 years old group (p = 0.002). As the distance of epiphyseal scar from joint line was increased, the optimal length of screw was also increased (p = 0.001). The distance of epiphyseal scar from joint line was decreased by age (p = 0.011).ConclusionThe optimal screw length was decreased by age and the epiphyseal scar to joint line distance could be a clue for optimal screw length in medial malleoli fractures.
  • Non-operative functional treatment for acute Achilles tendon ruptures: The
           Leicester Achilles Management Protocol (LAMP)
    • Abstract: Publication date: Available online 11 March 2019Source: InjuryAuthor(s): Randeep S. Aujla, Shakil Patel, Annette Jones, Maneesh Bhatia Objectives: The purpose of this study is to present outcomes and objective measures of assessment for acute Achilles tendon (AT) ruptures treated with an eight-week functional dynamic treatment protocol in a VACOped® boot with immediate full weight bearing mobilisation, the Leicester Achilles Management Protocol (LAMP).Methods: A prospective study of all patients treated with the LAMP with minimum 12-month follow-up was performed. Patients completed the Achilles Tendon Rupture Score (ATRS) and in the latter part of the study, objective measures of the calf muscle girth and heel raise height were obtained.Results: 442 patients were treated with the LAMP. There were nine (2%) re-ruptures in the 442 non-operative treated group of patients throughout the study period. ATRS at twelve months or more were available in 234 patients and objective measures in 77 patients. The mean age was 50 years. The mean ATRS was 75.5 at an average of 23 months post injury. Men had a statistically significant higher ATRS score when compared to women (p 
  • External fixation and percutaneous pinning
    • Abstract: Publication date: Available online 8 March 2019Source: InjuryAuthor(s): Volker Alt, Hamish Simpson
  • Increased perioperative C-reactive protein and decreased postoperative
           albumin is associated with acute posttraumatic osteomyelitis in patients
           with high-energy tibial fractures
    • Abstract: Publication date: Available online 5 March 2019Source: InjuryAuthor(s): Matjaž Groznik, Matej Cimerman, Lara Lusa, Nina Ružić Gorenjec, Alojz Ihan BackgroundEarly diagnosis of acute posttraumatic osteomyelitis (POM) is of vital importance for avoiding devastating complications. Diagnosing POM is difficult due to the lack of a highly specific and sensitive test, such as in myocardial infarct, stroke and intracranial bleeding. Serum inflammatory markers, C-reactive protein (CRP), procalcitonin (PCT), white blood cells (WBC) can support clinical findings but they are not able to differentiate between inflammatory response to infection and the host response to non-infection insult with high specificity and sensitivity.AimThe objectives of the study were to investigate whether the biochemical and immunoinflammatory patient profile could facilitate postoperative monitoring, guide the antibiotic treatment and timing of revision surgery.Patients and methodsThis prospective nonrandomised cohort study included 86 patients after high-energy injury to the shin requiring primary surgical treatment (open or closed reduction and internal fixation of tibial fracture). Values of the biochemical and immunoinflammatory profile were measured on admission (ADD), first postoperative day (POD1) and fourth-postoperative day (POD4).ResultsWe discovered on our sample that the development of POM is associated with increased CRP on ADD, POD1 and decreased albumins on POD4. Further studies are needed to prove that these differences can be useful in diagnosing the risk of infection. The assessment of other important risk factors such as: the extent of soft tissue damage, multiple fractures, transfusion rate, need for conversion primary external fixation to intramedullary (IM) nailing or locking plate fixation can empower our clinical judgment of POM.ConclusionsWe can improve prediction of posttraumatic osteomyelitis by using the perioperative inflammatory biomarker CRP in combination with postoperative albumins levels and other associated independent risk factors.
  • Minimally invasive treatment of old femoral fractures in adults
    • Abstract: Publication date: Available online 4 March 2019Source: InjuryAuthor(s): Xiang Zhang, Wei Shui, Weidong Ni, Zhenming Hu, Wei Huang, Gang Luo, Bo Qiao, Shuquan Guo ObjectiveExtensive incision associated with large-scale callus exfoliation and internal fixation is the common therapeutic approach employed by the majority of orthopaedists in the treatment of old femoral fractures. Inspired by the surgical techniques of intramedullary fixation and reduction by traction, the present study attempted to treat old femoral fractures with minimally invasive methods utilising the principles of biological osteosynthesis (BO).MethodsA retrospective analysis involving 16 patients with old femoral fractures treated with combined traction, small incision, limited callus treatment, reduction by leverage and intramedullary fixation was conducted. The operative effect was evaluated by the operation time, intraoperative blood loss, bone grafting, healing time of fractures during follow-up, VAS score, and Harris hip score.ResultsIntraoperative observation revealed an average operation time of 1.53 ± 0.34 h and average blood loss of 268.13 ± 97.29 ml without bone grafting in all patients. All enrolled patients had outcomes resulting in effective fixation restoration of limb alignment. Of the 16 enrolled patients, 13 patients completed follow-up with an average follow-up time of 7.42 ± 3.29 months. The average healing time for proximal femoral fractures was 3 months. The average healing time of femoral shaft fractures was 4 ± 1.09 months; two of these cases took 4 months to heal, whereas 1 case demonstrated a delayed healing time of 6 months. The VAS score was 1.15 ± 1.70, 1 patient experienced sciatica, and the Harris hip score was 92.92 ± 5.42. There were no complications of malunion, nonunion or infection among any of the patients who completed follow-up.ConclusionsMinimally invasive treatment is feasible for most patients with old femoral fractures of the trochanter and femoral shaft. This finding is consistent with BO principles, thereby providing a possible new method for the treatment of old femoral fractures.
  • Optimizing access and configuration of trauma centre care in New South
    • Abstract: Publication date: Available online 27 February 2019Source: InjuryAuthor(s): David Gomez, Kristian Larsen, Brian J. Burns, Michael Dinh, Jeremy Hsu IntroductionGetting the right patient, to the right place, at the right time is dependent on a multitude of modifiable and non-modifiable factors. One potentially modifiable factor is the number and location of trauma centres (TC). Overabundance of TC dilutes volumes and could be associated with worse outcomes. We describe a methodology that evaluates trauma system reconfiguration without reductions in potential access to care. We used the mature trauma system of New South Wales (NSW) as a model given the perceived overabundance of urban major trauma centres (MTC).MethodsWe first evaluated potential access to TC care via ground and air transport through the use of geographic information systems (GIS) network analysis. Potential access was defined as the proportion of the population living within 60-min transport time from a potential scene of injury to a TC by ground or rotary-wing aircraft. Sensitivity analyses were carried out in order to account for potential pre-hospital interventions and/or transport delays; travel times of 15-, 30-, 45-, 60-, and 90-min were also analyzed. We then evaluated if the current configuration of the system (number of urban MTS in the Sydney basin) could be optimized without reductions in potential access to care using two GIS methodologies: location-allocation and individual removal of MTC.Results86% of the NSW population has potential access to a TC within 60 min ground travel time; potential access improves to 99% with rotary-wing transport. The 1% of the population without potential TC access lives in 48% of the land area (>384,000km2). Utilizing two different methodologies we identified that there was no change in potential access by ground transport after removing 1 or 2 MTC in the Sydney basin at the 30-, 45-, and 60-min transport times. However, 0.02% and 0.5% of the population would not have potential access to MTC care at 15 min after removing one and two MTC respectively.DiscussionRedistribution of the number of MTC in the Sydney basin could be achieved without a significant impact on potential access to care. Our approach can be utilized as an initial tool to evaluate a trauma system where overabundance of coverage is present.
  • Humeral shaft non-union in the elderly: Results with cortical graft plus
           stem cells
    • Abstract: Publication date: Available online 27 February 2019Source: InjuryAuthor(s): Giuseppe Toro, Federica Lepore, Giampiero Calabrò, Gabriella Toro, Marco Rossini, Michele Vasso, Alfredo Schiavone Panni Introduction: Humeral shaft is a common site of fracture non-union. Biology and bone quality represent some of the problems that the orthopaedic surgeon has to face up in the elderly. The goals of treatment of humeral shaft non-union are the achievement of mechanical stability and creation of a favourable biologic environment. Bone graft and stem cells are some of the augmentation techniques available to reach these goals.Purpose: Evaluation of the outcomes of humeral shaft non-union in elderly population treated with cortical allograft and stem cells.Material and methods: A cohort of 21 patients with humeral shaft non-union was reviewed. Inclusion criteria were patients aged more than 65 years, with a diagnosis of humeral shaft non-union treated with cortical allograft and stem cells. Primary endpoints were ‘bone healing’ and ‘time-to-union’. Secondary endpoints were shoulder and elbow function and patients’ quality of life with Oxford Shoulder Score (OSS), Constant score and EuroQol-5D (EQ-5D).Results: 6 patients met the inclusion criteria. In 5 of them, the cortical allograft was opposite to a plate, whereas in the other one a “Sandwich” technique was chosen because of large osteolysis. ‘Bone healing’ occurred in all patients after a mean of 3.3 months (range 2–5). In all but two patients, the elbow range of motion was in almost normal range (15–130). The mean OSS was 35.8 (+/− 6.4), whereas the mean Constant was 53.3 (+/− 2.2). The mean EQ-5D index was 0.451 (+/− 0.21).Discussion: Bone healing occurred in all patients, with a time-to-union comparable or even better compared with other series. The use of cortical bone graft provide both stability and biological benefit, whereas stem cells improve the non-union environmental biology. Functional outcomes were lower than other series and patients’ quality of life was similar to Italian elderly women. Conclusion: The use cortical allograft with stem cells is a viable strategy to treat humeral shaft non-union in the elderly.
  • Trajectory of functional outcome and health status after moderate-to-major
           trauma in Hong Kong: A prospective 5 year cohort study
    • Abstract: Publication date: Available online 22 February 2019Source: InjuryAuthor(s): T.H. Rainer, K.K.C. Hung, J.H.H. Yeung, S.K.C. Cheung, Y.K. Leung, L.Y. Leung, W.B. Goggins, H.F. Ho, C.W. Kam, N.K. Cheung, C.A. Graham BackgroundTrauma care systems in Asia have been developing in recent years, but there has been little long-term outcome data from injured survivors. This study aims to evaluate the trajectory of functional outcome and health status up to five years after moderate to major trauma in Hong Kong.MethodsWe report the five year follow up results of a multicentre, prospective cohort from the trauma registries of three regional trauma centres in Hong Kong. The original cohort recruited 400 adult trauma patients with ISS ≥ 9. Telephone follow up was conducted longitudinally at seven time points, and the extended Glasgow Outcome Scale (GOSE) and Short-Form 36 (SF36) were tracked.Results119 out of 309 surviving patients (39%) completed follow up after 5 years. The trajectory of GOSE, PCS and MCS showed gradual improvements over the seven time points. 56/119 (47.1%) patients reported a GOSE = 8 (upper good recovery), and the mean PCS and MCS was 47.8 (95% CI 45.8, 49.9) and 55.8 (95% CI 54.1, 57.5) respectively at five years. Univariate logistic regression showed change in PCS - baseline to 1 year and 1 year to 2 years, and change in MCS - baseline to 1 year were associated with GOSE = 8 at 5 years. Linear mixed effects model showed differences in PCS and MCS were greatest between 1-month and 6-month follow up.ConclusionsAfter injury, the most rapid improvement in PCS and MCS occurred in the first six to 12 months, but further recovery was still evident for MCS in patients aged under 65 years for up to five years.
  • Syndesmotic fixation in unstable ankle fractures: Does early
           post-operative weight bearing affect radiographic outcomes'
    • Abstract: Publication date: Available online 20 February 2019Source: InjuryAuthor(s): K. Al-Hourani, M. Stoddart, T.J.S. Chesser ObjectiveTo analyse whether early post-operative full weight bearing following syndesmotic ankle fixation affected radiographic outcomes suggestive of diastasis.DesignRetrospective comparative cohort study over a two year period.SettingLevel 1 trauma centrePatients/Participants152 consecutive patients sustaining an unstable ankle fracture requiring syndesmotic stabilisation were included. Exclusions were 49 patients who had trimalleolar fixation without syndesmosis screws, one patient who had concomitant ankle and talar fracture. Five patients were lost to follow up and eleven patients were followed up in other centres. A total of 86 patients were analysedInterventionProtected or full weight bearing.Main Outcome MeasurementThe primary outcome measure was early diastasis. The secondary outcomes were late diastasis, wound complications and re-operation. Analysis of variance was used for the predictor variable of weight bearing status. We assumed a priori that p values of less than 0.05 were significant.ResultsMedian age was 36 (IQR 30), with 54 males and 32 females. Median follow up was 12 weeks (IQR 6). There was no significant difference when comparing weight bearing status and change in radiographic measurements intra-operatively compared to 6 and 12 week follow up radiographs (tibiofibular clear space p = 0.799, tibiofibular overlap p = 0.733 and medial clear space p = 0.261).ConclusionAfter surgical stabilization of an unstable syndesmotic injury, full weight bearing did not lead to syndesmotic diastasis in the early post-operative period. Full weight bearing is recommended following ankle fixation which includes syndesmotic fixation.
  • Implant cut-out following cephalomedullary nailing of intertrochanteric
           femur fractures: Are helical blades to blame'
    • Abstract: Publication date: Available online 20 February 2019Source: InjuryAuthor(s): Ishaq Ibrahim, Paul T. Appleton, John J. Wixted, Joseph P. DeAngelis, Edward K. Rodriguez IntroductionImplant cut-out remains a common cause of cephalomedullary nail (CMN) failure and patient morbidity following surgical treatment of intertrochanteric femur fractures. Recent studies have suggested an increased rate of CMN cut-out with helical blades as opposed to lag screws. We compared rates of overall cut-out between helical blades and lag screws and used bivariate and multivariate analysis to determine the role of proximal fixation method among other variables on risk for cut-out. Subgroup analysis was performed on the basis of failure mechanism; superior migration (Fig. 2) versus medial perforation (Fig. 3).MethodsThree-hundred and thirteen patient charts were retrospectively reviewed over an 8-year period; 245 patients were treated with helical blades and 68 with lag screws. Radiographs were reviewed for fracture pattern, Tip-Apex Distance (TAD), Parker’s Ratio (PR) and reduction quality. Rate of implant cut-out was compared between groups and multiple logistic regression was used to analyze the ability of several independent variables to predict implant cut-out.ResultsTwenty cut-outs occurred; 15 with helical blades and 5 with lag screws. No difference in the rate of cut-out was observed between the two groups (p = 0.45). Poor fracture reduction was found to be a significant predictor of implant failure via bivariate and multiple logistic regression analysis (p =
  • Ankle gravity stress view in the seated position: A technical tip
    • Abstract: Publication date: Available online 18 February 2019Source: InjuryAuthor(s): Jorge Briceño, Bonnie Chien, Christopher Miller, Brian Velasco, John Y. Kwon The ankle gravity stress view (GSV) is often utilized to elucidate instability in patients with an apparent, isolated lateral malleolus fracture. While this has been demonstrated to have advantages over the manual external rotation stress test, positioning in the lateral decubitus position can be difficult, uncomfortable and time-intensive. We report a simple and safe technique that allows one to obtain a gravity stress view of the ankle with the patient seated.
  • Elastic intramedullary nailing of the femur fracture in patients affected
           by osteogenesis imperfecta type 3: Indications, limits and pitfalls
    • Abstract: Publication date: Available online 15 February 2019Source: InjuryAuthor(s): Pietro Persiani, Lorena Martini, Filippo Maria Ranaldi, Anna Zambrano, Mauro Celli, Luca Celli, Patrizia D’Eufemia, Ciro Villani IntroductionPatients with Osteogenesis Imperfecta (OI) Type 3 may exhibit both primitive deformities and secondary fracture malunions on a femoral level. The orthopaedic surgeon’s objective is to cure the deformities in order to prevent fractures and to treat the fractures in order to prevent deformities, by using telescopic nails as the gold standard method of fixation. However, the titanium elastic nail (TEN) is indicated as a possible alternative in certain selected cases.Materials and methodsThe Centre for Congenital Osteodystrophy of the Sapienza University of Rome follows 485 patients with osteogenesis imperfecta. For the purpose of this study, we selected 36 patients with OI type 3 (15 females and 21 males), aged between 2 and 10 years old, who were surgically treated for femur fractures with Titanium Elastic Nail (TEN) from January 2007 to December 2009. In 12 cases a single TEN was implanted, while 24 of the cases were treated by implanting 2 TENs with the Sliding Nail (SN) technique. A retrospective evaluation was carried out by analysing the data from the medical charts and dossiers related to pain symptoms, knee and hip Range of Motion (ROM), any possible complications that could cause implant revisions (infections, nail slide failure, nail migration, traumatic events following surgery, delayed consolidation, epiphysiodesis).ResultsAt the 60th post-surgical month, the revision rate was 75%, mostly due to migration, osteolysis, nail slide failure and nail fracture. The Kaplan-Meier's survival curve analysis showed a coefficient of 0.25–60 months (confidence interval −0.31 and 0.81).DiscussionThe percentage of complications and the high rate of revisions recorded in our sample confirm that telescopic nail is the gold standard in the treatment of femoral fractures in patients with OI type 3.ConclusionsIn patients under the age of 4, with narrow medullary canals, low life expectancy, few to nil rehabilitative prospectives or severe comorbidities, the use of TEN may be considered as a less invasive approach compared to telescopic nail surgery, however only temporarily, as it will still most probably require a surgical revision a few years down the line.
  • Adults with polio are at risk of hip fracture from middle age: A
           nationwide population-based cohort study
    • Abstract: Publication date: Available online 14 February 2019Source: InjuryAuthor(s): Chien-Hua Wu, Shih-Wei Huang, Yen-Nung Lin, Chyan-Yeong Wang, Tsan-Hon Liou, Kwang-Hwa Chang BackgroundHaving motor impairment since childhood and being at risk of osteoporosis and falls, adults with polio would be more likely to suffer a hip fracture (HF) and may experience different epidemiological characteristics from the general population.ObjectiveTo estimate the risk and incidence of HF in adults with polio.DesignUsing a national database, we conducted a population-based cohort study. We identified patients with polio using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code of 138. For each patient with polio, we randomly selected five age- and sex-matched control subjects. Those subjects aged
  • Timing of venous thromboprophylaxis in isolated severe pelvic fracture:
           Effect on mortality and outcomes
    • Abstract: Publication date: Available online 14 February 2019Source: InjuryAuthor(s): Elizabeth Benjamin, Alberto Aiolfi, Gustavo Recinos, Kenji Inaba, Demetrios Demetriades Introduction: Optimal timing of pharmacological thromboprophylaxis (VTEp) in patients with severe pelvic fractures remains unclear. The high risk of venous thromboembolic (VTE) complications after severe pelvic fractures supports early VTEp however concern for fracture-associated hemorrhage can delay initiation. Patients with pelvic fractures also frequently have additional injuries that complicate the interpretation of the VTEp safety profiles. To minimize this problem, the study included only patients with isolated severe pelvic fractures.Materials and methods: The Trauma Quality Improvement Program was used to collect patients with blunt severe pelvic fractures (AIS > 3) who received VTEp with unfractionated heparin (UH) or low-molecular-weight heparin (LMWH). Patients with head, chest, spine, and abdominal injuries AIS > 3, or those with angio or operative intervention prior to VTEp were excluded. The study population was stratified according to timing of VTEp, early (48 h). Outcomes included in-hospital mortality and VTE.Results: 2752 patients were included in the study. Overall, 2007 patients (72.9%) received early VTEp, while 745 (27.1%) received late VTEp. LMWH was administered in 2349 (85.4%) and UH in 403 (14.6%).Late VTEp was associated with significantly higher incidence of VTE (4.3% vs. 2.2%, p = 0.004). Logistic regression identified late VTEp as an independent risk factor for VTE (OR 1.93, p = 0.009) and mortality (OR 4.03, p = 0.006). LMWH was an independent factor protective for both VTE and mortality (OR 0.373, p 
  • Genetic variation in mice affects closed femoral fracture pattern outcomes
    • Abstract: Publication date: Available online 13 February 2019Source: InjuryAuthor(s): Michal Bartnikowski, Nicole Bartnikowski, Anna Woloszyk, Romano Matthys, Vaida Glatt The purpose of this study was to determine whether differences in structural and material properties of bone between different mouse strains influence the fracture patterns produced under experimental fracture conditions.Femurs of C57BL/6 (B6), C3H/HeJ (C3H), and DBA/2 (DBA) strains were evaluated using micro-computed tomography (μCT), measurements derived from radiographic images and mechanical testing to determine differences in the geometry and mechanical properties. A fracture device was used to create femoral fractures on freshly sacrificed animals using a range of kinetic energies (∼20–80 mJ) which were classified as transverse, oblique, or comminuted.B6 femurs had the lowest bone volume/total volume (BV/TV) and bone mineral density (BMD), thinnest cortex, and had the most variable fracture patterns, with 77.5% transverse, 15% oblique, and 7.5% comminuted fractures. In contrast, C3H had the highest BV/TV, BMD, and thickest cortices, resulting in 97.5% transverse, 2.5% oblique, and 0% comminuted fractures. DBA had an intermediate BV/TV and thickness of cortices, with BMD similar to C3H, resulting in 92.9% transverse, 7.1% oblique, and 0% comminuted fractures. A binomial logistic regression confirmed that bone morphometry was the single strongest predictor of the resulting fracture pattern.This study demonstrated that the reproducibility of closed transverse femoral fractures was most influenced by the structural and material properties of the bone characteristics in each strain, rather than the kinetic energy or body weight of the mice. This was evidenced through geometric analysis of X-ray and μCT data, and further supported by the bone mineral density measurements from each strain, derived from μCT. Furthermore, this study also demonstrated that the use of lower kinetic energies was more than sufficient to reproducibly create transverse fractures, and to avoid severe tissue trauma. The creation of reproducible fracture patterns is important as this often dictates the outcomes of fracture healing, and those studies that do not control this potential variability could lead to a false interpretation of the results.
  • Optimising the tip-apex-distance in trochanteric femoral fracture fixation
           using the ADAPT-navigated technique, a longitudinal matched cohort study
    • Abstract: Publication date: Available online 13 February 2019Source: InjuryAuthor(s): Jan Herzog, Robert Wendlandt, Sebastian Hillbricht, Rainer Burgkart, Arndt-Peter Schulz IntroductionThe annual incidence of proximal femoral fractures is 100–150/100,000 and continues to increase with an aging population. Cut-out of hip screws after fracture fixation has been quoted as 8% in the literature. The tip-apex distance (TAD) is the strongest predictor for cut-out after operative fracture stabilisation.The aim of this study was to evaluate the novel ADAPT system (Adaptive Positioning Technology, Stryker, USA), a navigation device for intramedullary nailing of trochanteric fractures and its effect on optimising the TAD. This is the first clinical study to evaluate this new technology.MethodsThe study group of 36 consecutive patients with a pertrochanteric fracture underwent intramedullary nailing for fracture fixation using ADAPT technology, while the matched control group underwent conventional Gamma-3-nailing. Matching criteria included fracture classification, gender and age. We measured the operative time and the postoperative TAD in anteroposterior (AP) and lateral radiographs of the 72 patients.ResultsThe mean TAD using ADAPT was 16.9 mm (range 8.4–33.7 mm) compared with 24.9 mm (range 14.6–40.2 mm) in the reference group treated without ADAPT. Using the ADAPT system significantly improved (p 
  • Medial sustainable nail versus proximal femoral nail antirotation in
           treating AO/OTA 31-A2.3 fractures: Finite element analysis and
           biomechanical evaluation
    • Abstract: Publication date: Available online 12 February 2019Source: InjuryAuthor(s): Jiantao Li, Lin Han, Hao Zhang, Zhe Zhao, Xiuyun Su, Jianfeng Zhou, Chen Li, Peng Yin, Ming Hao, Kun Wang, Gaoxiang Xu, Lihai Zhang, Licheng Zhang, Peifu Tang ObjectivesUsing finite element analysis and biomechanical tests, the biomechanical behaviors of Medial Sustainable Nail (MSN) and Proximal Femoral Nail Antirotation (PFNA) were compared for the fixation of fracture type of AO/OTA 31-A2.3.MethodsFinite element software Abaqus 6.14 was used to conduct axial loading of 2100 N and we analyzed the von Mises stress distribution and the model displacement of two implant models. Biomechanical tests were separately conducted in the axial stiffness test and axial cyclical loading test on a mechanical testing machine.ResultsThe results indicate that von Mises stress of MSN was lower than that of PFNA, and the model displacement in the MSN group was lower than that in the PFNA group. In the axial stiffness tests, MSN group was stiffer than PFNA construct. With respect to the axial load to ultimate failure, the PFNA construct exhibited higher loads exceeding 4000 N while the MSN construct withstood 3313.8 ± 92.8 N. Specifically, F10mm was 2178.6 ± 133.2 N of the MSN group and 1822.6 ± 93.1 N of the PFNA group (P = 0.001). Additionally, X2100N was 9.8 ± 0.5 mm of the MSN group and 11.7 ± 0.7 mm of the PFNA group (P = 0.002). The MSN group exhibited superior performances in terms of the mean value of the vertical displacement, frontal rotation angle, and lateral rotation angle.ConclusionsThe results indicated that the MSN construct might exhibit a better biomechanical performance when compared with that of the PFNA in reducing displacement and anti-varus in fracture type of AO/OTA 31-A2.3.
  • Prospective outcome analysis following tenodesis of the long head of the
           biceps tendon along with locking plate osteosynthesis for proximal humerus
    • Abstract: Publication date: Available online 10 February 2019Source: InjuryAuthor(s): F. Greve, M. Beirer, M. Zyskowski, M. Crönlein, M. Müller, S. Pesch, S. Felix, P. Biberthaler, A. Buchholz, C. Kirchhoff BackgroundFractures of the proximal humerus are often associated with lesions of the long head of the biceps (LHB) tendon. This often leads to prolonged shoulder pain. Hence, many surgeons decide to perform a tenodesis of the LHB tendon simultaneous to ORIF. The purpose of this study was to evaluate the postoperative outcome after interlocking plate fixation and biceps tenodesis for treating proximal humerus fractures.Methods56 patients (38 females, 18 male) suffering from proximal humerus fractures who underwent surgery were retrospectively included. 26 of these 56 patients (19% Neer II, 38% Neer III, 43% Neer IV) were treated with simultaneous tenodesis of the LHB tendon when ORIF using interlocking plate fixation was performed. 30 patients (17% Neer II, 40% Neer III, 43% Neer IV) served as control group receiving only interlocking plate fixation. The patients were asked to complete the Munich Shoulder Questionnaire (MSQ) for evaluation of postoperative shoulder function. Results of the Disabilities of the Arm, Shoulder and Hand (DASH) Score and Shoulder Pain and Disability Index (SPADI) were calculated from the MSQ. Patients were clinically evaluated for a positive O’Brien test and Popeye sign.ResultsThe tenodesis group demonstrated significant superior outcome regarding the MSQ (mean 90.47 points vs. 79.41 points, p = 0.006), DASH Score (mean 4.2 points vs. 16.81 points, p = 0.017) and SPADI (mean 94.59 points vs. 83.56, p = 0.045). Flexion, external rotation and the capability of throwing a soft ball were significantly improved in the tenodesis group compared to the control group. The O’Brien test as indicator for lesions of the LHB was positive in fewer patients of the tenodesis group (2/26, vs. 21/30, p = 0.001). There was no significant difference of a positive Popeye Sign.ConclusionOur results show evidence of an improved shoulder function when a simultaneous tenodesis of the LHB tendon is performed during treatment of proximal humerus fractures using interlocking plate fixation.
  • Displaced intrarticular fractures of the calcaneus: Orif through an
           extended lateral approach
    • Abstract: Publication date: Available online 8 February 2019Source: InjuryAuthor(s): Roberto Buzzi, Niccolò Sermi, Felicia Soviero, Stefano Bianco, Domenico A. Campanacci Introduction: Displaced intra-articular calcaneal fractures (DIACF) represent a challenging and controversial issue in traumatology. Conservative treatment has been recommended to avoid surgical problems and complications. The final result, however, is often a painful malunioun of the calcaneus with peroneal impingement. Surgical treatment is gaining acceptance since it offers a chance to restore bone anatomy improving function as long as complications are avoided.Material and method: We reviewed a series of 59 DIACF treated by a single surgeon during a 9 years period. A clinical and radiological follow-up was obtained in 44 cases (74,6%) (average of 5,5 years; range 2–9). There were 29 males and 15 females with an average age of 54 years (range 25–74). Patients were operated through an extended l-shaped lateral approach and fixation was achieved with lag screws and plate. Outcome measures method included the AOFAS score, the Maryland Foot Score, the Foot Function Index and the SF-36.Results: The average AOFAS score was 80,5 points. The result was excellent in 18 cases (40,9%), good in 14 cases (31,8%), fair in 10 cases (22,7%) and poor in 2 (4,6%). The mean score for pain was 33,5/40 points, for function 40/50 and for alignment 7/10. Pain was absent in 17 cases (38%), 19 patients (43%) had no functional limitations and 11 (25%) could walk on uneven ground without difficulties. The average FFI score was 25/100 points. The average MFS score was 89/100 points. Subtalar motion was reduced. Reconstruction of the calcaneus was anatomic in 20 cases (45,5%) with an improved clinical outcome. Eight patients (17%) had minor wound healing complications. Three patients (6,8%) required a subtalar arthrodesis after the procedure.Conclusions: Ostheosytesis through an extended lateral approach restored bone morphology with a reasonable complications rate. The clinical results were good but a normal function and complete subtalar motion were rarely achieved.
  • A prospective randomized trial of 100 patients using trochanteric support
           plates; worth their mettle'
    • Abstract: Publication date: Available online 7 February 2019Source: InjuryAuthor(s): James Haddon, Robert Buciuto, Lars G. Johnsen Background and purposeTo compare the radiological and clinical results of sliding hip screw (SHS) fixation with or without a Trochanteric Support Plate (TSP) on unstable three-or-more-part trochanteric fractures.MethodsA randomized prospective non blinded study of one hundred patients with trochanteric fractures; Evans-Jensen type 3, 4 and 5, reduced and fixed with SHS. Patients were randomized into two study groups; with or without TSP supplementation (‘TSP’ and ‘NoTSP’ groups). Radiologic measurements of the hip in the frontal plane (primary outcome), including fracture movement, nonunion and loss of fixation were measured, as well as pain, ambulation, mobility, institution residence, complications and death, twelve months post operatively (secondary outcomes).ResultsAt one-year follow-up four patients in the TSP and ten patients in the NoTSP group had either died or been lost in follow-up. Within this period, forty-three fractures healed and three had a loss of fixation in the TSP group; thirty-nine fractures healed and one had a loss of fixation in the NoTSP group.Frontal X-rays showed fracture subsidence on average 1 mm less in the TSP group compared to the NoTSP group.This difference was negligible, as was the difference in all subgroups, in fixation failure/cutout, modified Merle d’Aubigne Postel scores (measuring function and pain), institution residence, complications and death between the groups.InterpretationThis study cannot confirm that TSP has any beneficial effects on unstable three-or-more-part trochanteric fractures. If any effect at all, the difference is most likely slight and clinically irrelevant.
  • A new method to evaluate the influence of the glenosphere positioning on
           stability and range of motion of a reverse shoulder prosthesis
    • Abstract: Publication date: Available online 5 February 2019Source: InjuryAuthor(s): T. Ingrassia, V. Nigrelli, V. Ricotta, L. Nalbone, A. D'Arienzo, M. D'Arienzo, G. Porcellini PurposeShoulder instability and reduced range of motion are two common complications of a total reverse shoulder arthroplasty. In this work, a new approach is proposed to estimate how the glenoid component positioning can influence the stability and the range of motion of a reverse shoulder prosthesis.Materials and methodsA standard reverse shoulder prosthesis has been analysed. To perform virtual simulation of the shoulder-prosthesis assembly, all the components of the prosthesis have been acquired via a 3D laser scanner and the solid models of the shoulder bones have been reconstructed through CT images. Loads on the shoulder joint have been estimated using anatomical models database. A new virtual/numerical procedure has been implemented using a 3D parametric modelling software to find the optimal position of the glenosphere.ResultsSeveral analyses have been performed using different configurations obtained by changing the glenoid component tilt and the lateral position of the glenosphere, modified through the insertion of a cylindrical spacer. For the analysed case study, it was found that the interposition of a spacer (between the baseplate and the glenoid) and 15° inferior tilt of the glenosphere allow improving the range of motion and the stability of the shoulder.ConclusionsSome common complications of the reverse shoulder arthroplasty could be effectively reduced by a suitable positioning of the prosthesis components. In this work, using a new method based on virtual simulations, the influence of the glenosphere positioning has been investigated. An optimal configuration for the analysed case study has been found. The proposed approach could be used to find, with no in vivo experiments, the optimal position of a reverse shoulder prosthesis depending on the different dimensions and shape of the bones of each patient.
  • Low complication rates in Minimally Invasive Plate Osteosynthesis (MIPO)
           for proximal humeral fractures at 5 years of follow-up
    • Abstract: Publication date: Available online 2 February 2019Source: InjuryAuthor(s): F. Falez, M. Papalia, S. Carbone, A. Teti, F. Favetti, G. Panegrossi, F. Casella, G. Mazzotta Introduction: Purpose of this study was to analyse the medium term follow-up of minimally invasive plate osteosynthesis (MIPO) for proximal humeral fractures in terms of postoperative shoulder function, radiological outcome and complications.Methods: 76 consecutive patients with unstable proximal humeral fractures were treated using locking plate with a minimally invasive antero-lateral approach in two surgical centers. Constant score and radiographic evaluation of 74 patients were available at mean follow up of 5 years (minimum 4 years).Results: Mean Constant score was 74 (range to 28–100). Results were comparable in the two centers. Younger patients registered significantly higher scores (p 
  • Prevention of arthrofibrosis during knee repair by extracorporeal shock
           wave therapy: Preliminary study in rabbits
    • Abstract: Publication date: Available online 2 February 2019Source: InjuryAuthor(s): Yufeng Zhou, Kai Yang IntroductionSurgery or trauma may induce extensive arthrofibrosis around joints and tendon for the restrictive range of motion. Although some approaches were proposed, this problem is not solved satisfactorily. Extracorporeal shock wave therapy (ESWT) has been used for orthopedic, musculoskeletal, and fibrotic disorders. Whether it could prevent the formation of arthrofibrosis during the joint repair is unknown.MethodsIntra-articular adhesions were created in the right knee of the rabbit by cortical bone shaving and subsequent cast immobilization. Arthrofibrosis in the control and ESWT group was evaluated and compared at week 4.ResultsMacroscopic score of arthrofibrosis and contracture angle of the control group are significantly higher. Histologically, the apparent gap between patella and tibia, loose connective tissue, and much less density of the blood vessel are found in the ESWT group.ConclusionsESWT could noninvasively, effectively, and safely prevent the formation of arthrofibrosis during the knee repair.
  • Surgical treatment with cannulated screws for pediatric femoral neck
           fractures: A case series
    • Abstract: Publication date: Available online 2 February 2019Source: InjuryAuthor(s): Vito Pavone, Gianluca Testa, Maria Riccioli, Antonio Di Stefano, Giuseppe Condorelli, Giuseppe Sessa IntroductionFemoral neck fractures are uncommon injuries in children, but the high incidence of long-term complications makes it important clinical entity. Early surgical treatment to achieve optimal results and to avoid a high rate of complications is widely advised. The purpose of this study was to retrospectively analyze the outcome of 8 children who sustained a femoral neck fracture.Patients and methodsThe patients (6 boys and 2 girls with an average age of 9.2 years) were treated within 24 h following admission to hospital by closed reduction and internal fixation. The type of fracture was distinguished according to Delbet’s classification system. The outcome was analyzed using Ratliff’s criteria, and a detailed record of complications was maintained.ResultsAccording Delbet’s classification system, there were 3 type I, 2 type II, 2 type III, and 1 type IV fractures. The average follow-up was 39.2 months (range 8–95). A satisfactory outcome was obtained in 6 (75%) children. Avascular necrosis was the most notable complication, which was reported in the 2 fair outcomes (25%).ConclusionsEarly and aggressive surgical treatment aimed at anatomical reduction result in a satisfactory outcome in pediatric femur neck fractures. Development of avascular necrosis is the main complication.
  • Influence of sutures configuration on the strength of tendon-patch joints
           for rotator cuff tears treatment
    • Abstract: Publication date: Available online 2 February 2019Source: InjuryAuthor(s): Tommaso Ingrassia, Benedetto Lombardo, Vincenzo Nigrelli, Vito Ricotta, Lorenzo Nalbone, Antonio D'Arienzo, Michele D'Arienzo, Giuseppe Porcellini PurposeMassive rotator cuff tears are common in the aging population. The incidence of failed rotator cuff repairs is still quite high, especially in the treatment of full-thickness tears or revision repairs. In this context, natural and synthetic meshes can be used as augmentation scaffolds or as devices to close the gap between a retracted tendon and the bone.The purpose of this work is to evaluate the ultimate tensile strength of different tendon-patch joints in order to consider their use in the treatment of massive cuff tears.Materials and methodsPorcine tendons and a synthetic low-density polypropylene mesh have been used. A preliminary study on the tensile strength of tendons and patches has been performed. Different patch-tendon joints have been studied by modifying the number and the layout of the sutures. For every joint, the tensile test, performed through an electromechanical machine, has been repeated at least twice to obtain reliable data.ResultsExperimental tensile tests on tendons and patches have given good results with very low dispersion data. Mean values of the calculated ultimate tensile stresses are, respectively, about 34 MPa and 16 MPa for tendons and patches. As regards the sutures arrangement, the staggered layout gave, for all joints, a higher tensile strength than the regular (aligned) one. Different ultimate tensile stress values, depending on the sutures number and layout, have been calculated for the joints.ConclusionSynthetic patches could be an interesting option to repair massive cuff tears and to improve, in a significant way, pain, range of motion and strength at time 0, so reducing the rehabilitation time. Obtained results demonstrated that joints with a suitable number and layout of sutures could ensure very good mechanical performances. The failure load of the tendon-patch joint, in fact, is higher than the working load on a healthy tendon.
  • Stentoplasty of calcaneal fractures: Surgical technique and early outcomes
    • Abstract: Publication date: Available online 2 February 2019Source: InjuryAuthor(s): Giuseppe Toro, Francesco Langella, Michele Gison, Gabriella Toro, Antimo Moretti, Antonio Toro, Giovanni Iolascon Calcaneus is the most common site of hindfoot fracture, frequently caused by fall from height or high energy trauma. The therapeutic strategy ranged from non-operative to ORIF (Open Reduction Internal Fixation). Indications for percutaneous fixation include soft tissue damage or relative contraindications to open surgery. Minimally invasive percutaneous calcaneoplasty should be an alternative to ORIF aiming to reach a stable reduction, early functional recovery and short hospital stay. The aim of our study was to evaluate the clinical and radiographic outcomes of calcaneus fractures treated with balloon calcaneoplasty (BCP) by using a new generation vertebral augmentation system, VBS™-Vertebral Body Stent-DePuy Synthes. A total of 10 patients treated with VBS™ system were recruited for the study. Nine fractures were caused by a fall from height and one case by traffic accident. The mean follow-up was 8.9 months (range 2.6–23.1). The fractures were categorized according to Sanders and Essex-Lopresti classifications (5: type II, 3: type III and 2: type IV; 9: “joint depression” type and 1 case “tongue” type). Radiographic measurement (Böhler’s and Gissane’s angles) were evaluated at both pre-operative and immediate postoperative time. The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score as well as a subjective evaluation (Visual Analog Scale, VAS) were used for the clinical assessment at the last follow-up. Mean preoperative Böhler’s angle was 12.3 ± 8.41° (95% CI 6.3–18.3°), whereas mean preoperative Gissane’s angle was 123.66 ± 20.47° (95% CI 109.0–138.3°). At postoperative follow-up mean Böhler’s angle increased to 21.51 ± 4.17° (95% CI 18.5–24.5°; p 
  • Aetiology of trauma-related acute compartment syndrome of the leg: A
           systematic review
    • Abstract: Publication date: Available online 2 February 2019Source: InjuryAuthor(s): Marco Stella, Emmanuele Santolini, Francesca Sanguineti, Lamberto Felli, Giovanni Vicenti, Davide Bizzoca, Federico Santolini BackgroundAcute compartment syndrome (ACS) is characterised by abnormal pressure inside a compartment, resulting in ischemia of muscles and nerves. Most orthopaedic surgeons, especially those who work in major trauma centres, have been or will be facing a case of ACS in their clinical activity.Fortunately, complications related to untreated compartment syndrome have become less frequent thanks to a better understanding of pathogenesis and to early recognition and prompt surgical treatment. The aim of this study is to identify the existing evidence regarding aetiology of trauma-related ACS of the leg.MethodsA systematic review of the literature was undertaken using PubMed Medline, Ovid Medline and the Cochrane library, extended by a manual search of bibliographies. Retrieved articles were eligible for inclusion if they reported data about aetiology of trauma-related compartment syndrome of the tibia.ResultsNinety-five studies that fulfilled the inclusion criteria were identified. By dividing the studies into three groups according to the traumatic aetiology, we were able to classify traumatic ACS as fracture related, soft tissue injury related and vascular injury related. Fracture related was the most represented group, comprising 58 papers, followed by the soft tissue injury related group which includes 44 articles and vascular injury related group with 24 papers.ConclusionsAlthough traditionally ACS has been associated mainly with fractures of tibial diaphysis, literature demonstrates that other localisations, in particular in the proximal tibia, are associated with an increased incidence of this serious condition.The forms of ACS secondary to soft tissues injuries represent an extremely variable spectrum of lesions with an insidious tendency for late diagnosis and consequently negative outcomes. In the case of vascular injury, ACS should always be carefully considered as a priority, given the high incidence reported in the literature, as a result of primitive vascular damage or as a result of revascularisation of the limb.Knowledge of aetiology of this serious condition allows us to stratify the risk by identifying a population of patients most at risk, together with the most frequently associated traumatic injuries.
  • Tarsometatarsal joint complex injuries: A study of injury pattern in
           complete homolateral lesions
    • Abstract: Publication date: Available online 2 February 2019Source: InjuryAuthor(s): Mauro Cenatiempo, Roberto Buzzi, Stefano Bianco, Giuseppe Iapalucci, Domenico A. Campanacci IntroductionTarsometatarsal joint complex (TMC) is the anatomical structure of midfoot composed by metatarsals, tarsometatarsal (TMT) joints, cuneiforms, cuboid and navicular. TMC lesion are rare but critical since they cause severe disability if misdiagnosed. The knowledge of anatomic pattern of the lesion and biomechanics of the midfoot is the key for a successful diagnosis and treatment.The aim of this study was to review a consecutive series of TMC injuries analyzing preoperative radiograph and CT scan to accurately define the pattern of ligament and bone injuries.Material and methodsWe reviewed a series of 24 complete TMC injuries with homolateral dorsolateral dislocation. The total TMT joints involved were 120. We observed if the lesions were pure ligamentous or fracture-dislocation detecting the extent and the location of fractures. Twenty-nine lesions (24%) were pure dislocations and they were mainly localized in the first and fifth ray. The fracture-dislocations were 91 (76%) and 25 were fractures of the proximal row (cuneiforms and cuboid), 39 of the distal row (metatarsals), 27 of both the distal and proximal row.ResultsProximal fracture had a homogeneous distribution and they were more frequently simple than comminuted. Comminuted fractures were more frequent in the cuboid. In the proximal row, majority of partial articular fractures were localized in the dorsal side. Fracture-dislocations of the distal row were more frequent in the second metatarsal base (100%) and the partial articular fractures were always placed in the plantar side. In TMC injuries fracture-dislocations are more frequent than pure dislocations. Pure dislocations occur more often in the marginal rays that are characterized by weaker ligaments and larger mobility. The second ray, where there is the more stable joint of TMC, was never dislocated with a pure ligamentous lesion.ConclusionsWe suppose that plantar avulsion from the distal row and dorsal compression fracture of the proximal row is consistent with a direct force applied to the forefoot and direct dorsolaterally. The direction of the forces may explain why some fractures occur in the distal row, some in the proximal and some in both rows. The thickness of plantar ligaments may explain the frequency of plantar bone fragment avulsion.
  • A new technique for medial-end comminuted clavicle fractures
    • Abstract: Publication date: Available online 2 February 2019Source: InjuryAuthor(s): Zhenxing Li, Haixiao Liu, Deheng Chen, Chengwang Chen, Yu Zhang, Enxing Xue Fractures of the medial comminuted clavicle are rare injuries but are associated with significant morbidity and mortality. Although rare, such injuries deserve rapid diagnosis and effective treatment to avoid future complications. An optimal, standardized operative treatment has not yet been established. We presented a medial-end comminuted clavicle fracture and demonstrated successful results using a bridging plate technique across the sternum maintaining reduction and achieving union. We aim to provide an alternative technique to fix a displaced periarticular medial clavicle fracture, which we believe is simple, safer and promising.
  • Atypical diaphyseal femoral fractures: Considerations on surgical
    • Abstract: Publication date: Available online 2 February 2019Source: InjuryAuthor(s): Maria Silvia Spinelli, Eleonora Marini, Primo Andrea Daolio, Andrea Piccioli In the last two decades bisphosphonates (BP) has become the mainstream therapy for osteoporosis and the benefit in reducing the incidence of fractures has been well demonstrated in several studies, together with the drug long term (5–10 years) efficacy and safety.A complication of the long-term use of bisphosphonates is a low-energy stress fractures located in the sub-trochanteric region and the femoral shaft called atypical femur fracture (AFF).These stress fractures can be seen on plain radiographs as simple transverse patterns, with unicortical beaking and hypertrophy of the diaphyseal lateral cortex. Usually a localized thigh pain in the prodromal phase may precede the fracture by months. The current surgical treatment of choice for AFFs is intramedullary nailing (IMN). However, the treatment of AFFs is associated with a higher rate of intra-operative and post-surgical complications. This is related to anatomical e biomechanical reasons. Iatrogenic fractures, deformities, medial gap opening, eccentric position of the distal nail tip with anterior cortex perforation, delayed or non-union are frequent complications of this procedure and healing rate of AFFs. The average healing time of almost 8 months for AFFs appeared to be longer than that for typical femoral fractures, which heal at an average of 3–6 months.The purpose of this study is to analyze the different surgical devices and techniques and to advance some considerations that can be useful to diminish the rate of failure and/or complications in the treatment of AFFs in both oncologic and osteoporotic patients.
  • Comparison of artificial neural network and logistic regression models for
           prediction of outcomes in trauma patients: A systematic review and
    • Abstract: Publication date: February 2019Source: Injury, Volume 50, Issue 2Author(s): Soheil Hassanipour, Haleh Ghaem, Morteza Arab-Zozani, Mozhgan Seif, Mohammad Fararouei, Elham Abdzadeh, Golnar Sabetian, Shahram Paydar BackgroundCurrently, two models of artificial neural network (ANN) and logistic regression (LR) are known as models that extensively used in medical sciences. The aim of this study was to compare the ANN and LR models in prediction of Health-related outcomes in traumatic patients using a systematic review.MethodsThe study was planned and conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist. A literature search of published studies was conducted using PubMed, Embase, Web of knowledge, Scopus, and Google Scholar in May 2018. Joanna Briggs Institute (JBI) checklists was used for assessing the quality of the included articles.ResultsThe literature searches yielded 326 potentially relevant studies from the primary searches. Overall, the review included 10 unique studies. The results of this study showed that the area under curve (AUC) for the ANN was 0.91, (95% CI 0.89–0.83) and 0.89, (95% CI 0.87–90) for the LR in random effect model. The accuracy rate for ANN and LR in random effect models were 90.5, (95% CI, 87.6–94.2) and 83.2, (95% CI 75.1–91.2), respectively.ConclusionThe results of our study showed that ANN has better performance than LR in predicting the terminal outcomes of traumatic patients in both the AUC and accuracy rate. Using an ANN to predict the final implications of trauma patients can provide more accurate clinical decisions.
  • Implant-related sepsis in lower limb fractures following gunshot injuries
           in the civilian population: A systematic review
    • Abstract: Publication date: February 2019Source: Injury, Volume 50, Issue 2Author(s): Simon Matthew Graham, Maheshi P. Wijesekera, Maritz Laubscher, Sithombo Maqungo, Michael Held, Nando Ferreira, William J. Harrison IntroductionThe management of long bone lower limb fractures secondary to gunshot wounds (GSWs) in the civilian setting are complex and there is currently no consensus regarding the optimal approach to managing such fractures. This study aims to address the relationship of implant related sepsis in fractures secondary to GSWs.MethodsA systematic review of the literature was performed on both Pubmed and Scopus databases that look at fractures caused by GSWs in the lower limb. A total of 14 studies met the inclusion criteria set in this study.ResultsCurrent literature suggests that low and high velocity injuries managed with internal fixation, such as intramedullary nails, may carry a low risk of superficial and deep infection, with no obvious risk of osteomyelitis. However, infection was poorly defined across all studies and no study used a validated scoring system for infection making it difficult to draw any valid conclusion on the rate of infection following internal fixation of lower limb fractures following both high and low velocity GSWs.ConclusionThere is no clear evidence to confirm or refute that internal fixation is the ideal method of management in these complex injuries and guidance is needed due to the high and increasing proportion of patients presenting with these complex injuries worldwide.
  • What is the impact of prehospital blood product administration for
           patients with catastrophic haemorrhage: an integrative review
    • Abstract: Publication date: February 2019Source: Injury, Volume 50, Issue 2Author(s): Sophie Shand, Kate Curtis, Michael Dinh, Brian Burns IntroductionCatastrophic haemorrhage is recognised as the leading cause of preventable death in trauma and is also prevalent in medical and other surgical aetiology. Prehospital blood product transfusion is increasingly available for both military and civilian emergency teams. Hospitals have well-established massive transfusion protocols for the resuscitation of this patient group, however the use and impact in the prehospital field is less understood.AimTo identify and evaluate the current knowledge surrounding prehospital blood product administration for patients with catastrophic haemorrhage.MethodsThe integrative review method included systematic searching of online databases Medline, EMBASE, SCOPUS and CINAHL alongside hand-searching for primary research articles published prior to 19 November 2018. Papers were included if the population studied patients with catastrophic haemorrhage who received prehospital transfusion of blood products. The level of evidence and quality was evaluated using the NHMRC hierarchy of evidence. All identified full text articles were reviewed by all authors.ResultsTwenty-two papers were included in the final analysis, including both civilian (16) and military (6) practice. The earliest publication for prehospital transfusion was 1999, with increasing prevalence in recent years. Findings were extracted and into two main categories; (1) transfusion processes included team staffing, product selection, and criteria for transfusion and (2) transfusion outcomes; transfusion safety, haemoglobin, hospital intervention and mortality.DiscussionThe level of evidence specific to prehospital blood product transfusion is low, with predominantly retrospective methods and rarely sufficient sample sizes to reach statistical significance. Prehospital research is challenged by clinical and logistical variability preventing accurate cohort matching, sample sizes and inconsistent data collection. Evaluation of prehospital transfusion in isolation is also particularly problematic as multiple factors and developments in clinical practice affect patient outcomes and all samples were subject to survival bias.Conclusion The volume and strength of the available evidence prevents accurate evaluation of the intervention and definitive practice recommendations however prehospital transfusion is shown to be logistically achievable and without serious incident. The reviewed evidence broadly supports the translation of recent in-hospital studies, such as PROMTT and PROPPR. Further research specific to prehospital practice is required to guide the development of evidence-based protocols.
  • Immediate weight bearing after plate fixation of fractures of the tibial
    • Abstract: Publication date: February 2019Source: Injury, Volume 50, Issue 2Author(s): Michael Williamson, Efthymios Iliopoulos, Aanchal Jain, Wessam Ebied, Alex Trompeter
  • Intra-medullary Nail Insertion Accuracy: A comparison of the
           Infra-patellar and Supra-patellar approach
    • Abstract: Publication date: February 2019Source: Injury, Volume 50, Issue 2Author(s): Thomas Anderson, Philip Beak, Alex Trompeter
  • Analysis of the relationship between Vitamin D levels and Infection in
           Orthopaedic patients
    • Abstract: Publication date: February 2019Source: Injury, Volume 50, Issue 2Author(s): Alexander Zargaran, Alex Trompeter
  • Increasing capture of patient-reported outcomes in trauma research
    • Abstract: Publication date: February 2019Source: Injury, Volume 50, Issue 2Author(s): Grace Turner, Ameeta Retzer, Anita Slade, Christel McMullan, Derek Kyte, Karen Piper, Tony Belli, Melanie Calvert
  • Evaluation of Costings in the Orthoplastic Management of Open Lower Limb
    • Abstract: Publication date: February 2019Source: Injury, Volume 50, Issue 2Author(s): Youri Peter Alexander Tan, Jason K.F. Wong, Anand Pillai, Angela Ogden, David Pearson, Amanda Brooks, Adam J. Reid
  • Tibial Shaft Fractures and the Montgemerie principles: what constitutes
           reasonable treatment'
    • Abstract: Publication date: February 2019Source: Injury, Volume 50, Issue 2Author(s): Simon Woods
  • Managing pain following injury–Time to change
    • Abstract: Publication date: February 2019Source: Injury, Volume 50, Issue 2Author(s): Peter A. Cameron
  • Editorial Board/Publication Information
    • Abstract: Publication date: February 2019Source: Injury, Volume 50, Issue 2Author(s):
  • Outcome of screw post fixation of neglected posterior cruciate ligament
           bony avulsions
    • Abstract: Publication date: Available online 1 February 2019Source: InjuryAuthor(s): Christina Marie Joseph, Chandrasekaran Gunasekaran, Abel Livingston, Hepsy Chelliah, Thilak Samuel Jepegnanam, P.R.J.V.C. Boopalan BackgroundContrary to acute posterior cruciate ligament (PCL) bony tibial avulsions, surgical management of chronic injuries is technically challenging and appears to be controversial. We sought to assess the outcome of a novel screw post augmentation technique in neglected cases.Methods16 patients were followed up in a tertiary single-center retrospective study. The bony fragment was fixed using a lag screw with a spiked washer and an additional screw post through an open posterior approach. The pre- and postoperative knee range of movement (ROM), laxity, and modified Tegner–Lysholm (TL) scores were compared.ResultsThe median time from injury to surgery was 10 weeks (range, 3–260). The mean clinical follow-up time was 24.25 ± 9.21 months. At the final follow-up, the mean knee ROM flexion was 130° ± 11.55° with no extension lag. 3 patients had grade 1 laxity. The TL grade was predominantly excellent, and the overall median score improved from 76 preoperatively to 95 postoperatively (p 
  • Erratum to “Extended lateral column tibial plateau fractures. How do we
           do it'” [Injury 49 (10) (2018) 1878–1885]
    • Abstract: Publication date: February 2019Source: Injury, Volume 50, Issue 2Author(s): Harm Hoekstra, Jasper Vanhees, Juriaan van den Berg, Stefaan Nijs
  • Corrigendum to “Routine pelvic X-rays in asymptomatic hemodynamically
           stable blunt trauma patients: A meta-analysis” [Injury 49 (11) (2018)
    • Abstract: Publication date: February 2019Source: Injury, Volume 50, Issue 2Author(s): Jessica van Trigt, Niels Schep, Rolf Peters, Carel Goslings, Tim Schepers, Jens Halm
  • Corrigendum to ‘Association between spinal immobilization and survival
           at discharge for on-scene blunt traumatic cardiac arrest: A nationwide
           retrospective cohort study’ [Injury 49 (1) (2017) 124–129]
    • Abstract: Publication date: February 2019Source: Injury, Volume 50, Issue 2Author(s): Yusuke Tsutsumi, Shingo Fukuma, Asuka Tsuchiya, Tatsuyoshi Ikenoue, Yosuke Yamamoto, Sayaka Shimizu, Miho Kimachi, Shunichi Fukuhara
  • Establishing a predictive nomogram for postoperative delirium: Methodology
           is critical
    • Abstract: Publication date: February 2019Source: Injury, Volume 50, Issue 2Author(s): Rui-Juan Guo, Fu-Shan Xue, Liu-Jia-Zi Shao, Li Zheng
  • Regarding reverse total shoulder arhroplasty for the treatment of failed
           fixation in proximal humeral fractures
    • Abstract: Publication date: February 2019Source: Injury, Volume 50, Issue 2Author(s): Katie Hughes, Simon Bellringer, Gareth Chan, Laurence Dodd, Samantha Hook
  • Is early postoperative hypoalbuminemia really a risk factor for acute
           kidney injury after hip fracture surgery'
    • Abstract: Publication date: February 2019Source: Injury, Volume 50, Issue 2Author(s): Rui-Juan Guo, Fu-Shan Xue, Liu-Jia-Zi Shao, Zheng Li
  • Authors’ reply to letter to editor “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: February 2019Source: Injury, Volume 50, Issue 2Author(s): Siddhartha Sharma, Rakesh John, Mandeep S. Dhillon, Kamal Kishore
  • Letter to the Editor regarding “Proposal for the classification of
           peri-implant femoral fractures: Retrospective cohort study”
    • Abstract: Publication date: February 2019Source: Injury, Volume 50, Issue 2Author(s): Ernest Beng Kee Kwek, On behalf of the Singapore Orthopaedic Research CollaborativE (SORCE) Group
  • Letter to the Editor concerning Classification of tibia plateau fracture
           according to the “four-column and nine-segment” by Xiang Yao, Yong Xu,
           Jishan Yuan, Lei Wang, Xingli Fu, Bin Lv, Shengquan Yang, Sheng Meng.
           Injury. 2018 (in press)
    • Abstract: Publication date: February 2019Source: Injury, Volume 50, Issue 2Author(s): Arvind Kumar, Aditya Jain, Vivek Trikha, Samarth Mittal
  • The anterolateral ligament and the deep structures of the iliotibial
           tract: MRI visibility in the paediatric patient
    • Abstract: Publication date: February 2019Source: Injury, Volume 50, Issue 2Author(s): M.C. Liebensteiner, B. Henninger, C. Kittl, R. Attal, J.M. Giesinger, C. Kranewitter PurposeTo assess the visibility of both the anterolateral ligament (ALL) and the deep structures of the iliotibial tract (ITT) by means of MRI in paediatric patients. To determine reproducibility for such measurements.MethodsKnee MRI data from patients aged
  • Infected tibial nonunion in children: Is radical debridement
    • Abstract: Publication date: February 2019Source: Injury, Volume 50, Issue 2Author(s): Gamal Ahmed Hosny, Abdel-Salam Abdel-Aleem Ahmed Nonunion is a devastating complication of tibial fractures with a debilitating effect. Several studies reporting tibial nonunions in adults are available; however, the reports on infected nonunions in children are scarce. The purpose of this study was to evaluate the results of treating paediatric infected tibial nonunion using Ilizarov fixator without radical resection.Materials and methodsThe study included 36 cases with infected nonunion of the tibia with 31 males and 5 females, and an average age of 11.4 years. The mean number of previous operations was 3.5. The duration before presentation averaged 10.4 months. At presentation, 24 cases were draining nonunions, while 12 patients had quiescent sinuses. Preoperative shortening was evident in 31 patients ranging from 1 to12 cm. Six cases had equinus foot deformity. Stiffness of the ankle and/or knee was present in 11 cases. Angular deformity of more than 10° was evident in 13 nonunions. The monofocal compression-distraction was used for 10 cases managed by bloodless technique, and four draining cases managed by limited debridement and compression distraction. Limited debridement and bone transport was used in the remaining cases including proximal chondrodiastasis (two cases), proximal tibial corticotomy (17 cases), and partial osteotomy (three cases).ResultsThe mean follow-up duration was 51.9 months. The external fixation period averaged 5.3 months. Delayed union occurred in three cases treated by repeating compression-distraction. Eventually, union was achieved in all cases. Two cases suffered refracture. Four cases had residual angular deformity of about 5-7°. Infection recurred in one case. ASAMI bone results were excellent in 29 patients, good in three patients, fair in two patients, and poor in two patients. The ASAMI functional results were excellent in 27 cases, good in 5 cases, fair in two cases, and poor in two cases.ConclusionThe Ilizarov method provides a viable treatment method for treating paediatric infected nonunions in a single stage of management. Limited debridement was enough to control infection and achieved good results without radical resection.
  • Open reduction and internal fixation of the posterior malleolus fragment
           frequently restores syndesmotic stability
    • Abstract: Publication date: February 2019Source: Injury, Volume 50, Issue 2Author(s): S.F. Baumbach, V. Herterich, A. Damblemont, F. Hieber, W. Böcker, H. Polzer AimComparison of unfixed, CRIF, and ORIF of the posterior malleolus fragment (PMF) regarding the frequency of trans-syndesmotic fixation and quality of reduction in trimalleolar (equivalent) fractures.Material and MethodsRetrospective registry study. Patients with a trimalleolar (equivalent) ankle fractures were identified within the departments’ fracture database. General demographics, treatment details, and fracture specific details (CT-scans) were assessed. Patients were grouped per the PMF treatment: not addressed, CRIF, ORIF.Results236 patients (53.0 ± 18.3 (range: 18–100) years), 58.1% female were eligible. The mean size of the PMF was 21.4 ± 10.4% (range: 2.7–55.9%), 71.6% were ≤25% of the tibial plafond. PMF fixation: Untreated 48.3%, CRIF 18.6%, ORIF 33.1%. ORIF of the PMF significantly (p 25%). ORIF resulted in a significantly (p 
  • Outcomes of midfoot and hindfoot fractures in multitrauma patients
    • Abstract: Publication date: February 2019Source: Injury, Volume 50, Issue 2Author(s): A.L. Diacon, L.A. Kimmel, R.C. Hau, B.J. Gabbe, E.R. Edwards IntroductionMultitrauma patients suffering hindfoot fractures, including calcaneal and talar fractures, often result in poor outcomes. However, less is known about the outcomes following midfoot fracture in the mutitrauma population. This study aims to describe the epidemiology of midfoot fractures in multitrauma patients and to compare the outcomes of midfoot and hindfoot fractures in this population.MethodsData about multitrauma patients (Injury Severity Score>12) sustaining a unilateral midfoot or hindfoot fracture were obtained from the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR) and from retrospective review of medical records at a major trauma centre. Further outcome data were obtained via a survey using the American Academy of Orthopedic Surgeons Foot and Ankle Score (AAOS FAS) and the 12-item Short Form Health Survey (SF-12).Results122 multitrauma patients were included; 81 with hindfoot fractures and 41 with midfoot fractures. The median ISS (IQR) was 22 (17–29) and 27 (17–24) for the hindfoot and midfoot groups, respectively (p = 0.23). Hindfoot and midfoot fractures were commonly associated with intracranial injuries (80.3%), spine injuries (60.7%), ipsilateral lower extremity injuries (24.6%) and pelvic injuries (16.4%). The mean (SD) time to follow up was 4.5 (±2.7) years. There were no differences in mean SF-12 physical (37.97 vs 35.22, p = 0.33) or mental (46.90 vs 46.67, p = 0.94) component summary scores between the groups. There were no differences in mean AAOS FAS standard scores (69.3 vs 69.1, p = 0.97) or shoe comfort scores (median 40 vs 40 p = 0.18) between the groups.ConclusionFunctional outcomes in multitrauma patients with midfoot or hindfoot fractures were comparable. These findings suggest that midfoot fractures should be treated with the same degree of due diligence as hindfoot fractures in the multitrauma patient.
  • Accidental external rotation of distal interlock jig in retrograde femoral
           nailing can lead to more prominent screws
    • Abstract: Publication date: February 2019Source: Injury, Volume 50, Issue 2Author(s): Boshen Liu, Shea M. Comadoll, Joseph R. Hsu, Paul E. Matuszewski ObjectiveSymptomatic distal interlocking screws in retrograde femoral nailing are common due the difficulties of imaging the trapezoidal femur. Screws appearing to have appropriate length on imaging may possibly be prominent, creating symptoms. Screw trajectory may influence the degree of this radiographic error. We hypothesize that external rotation of screw trajectory will increase measurement error of screw length.DesignRetrospective.SettingUrban Level I Tertiary Trauma Center.Participants283 patients with Computer Tomography (CT) scans of the native knee were retrospectively identified. Simulation was done of the trajectory of an interlock at 20 mm and 40 mm proximal to the nail entry point, which represent common screw positions associated/not associated respectively, with removal. The distance between the radiographic medial cortex and the tip of the transverse screw was calculated (D). The angle (Ψ) between the transverse trajectory and a modified trajectory aimed at the most medial cortex to avoid radiographic measurement error was calculated. Geometric modeling was utilized to calculate the measurement error (D) in the event of accidental external rotation. The angle of the medial slope was also measured (Θ).InterventionReview of CT imaging of normal distal femora.Main Outcome MeasurementsCT measurements of distal femora.ResultsThe mean distance (D) at 20/40 mm was 4.21 [95%CI 4.02–4.402] and 2.03 mm [95%CI 1.78–2.83], respectively (p 
  • Measuring outcomes following tibial fracture
    • Abstract: Publication date: February 2019Source: Injury, Volume 50, Issue 2Author(s): R. Morris, I. Pallister, R.W. Trickett AimThe aim of this study was to determine how outcome is measured following adult tibial fracture in the modern era of functional outcome measurement and patient reported outcomes.MethodsA systematic review of publications since 2009 was performed, looking specifically at acute, adult tibial shaft fractures. Ovid Medline, Embase, PubMed and PsycINFO databases were searched for relevant titles which were then screened by two authors with adjudication where necessary by a third. Relevant articles were reviewed in full and data was extracted concerning the study participants, study design and any measures that were used to quantify the results following fracture. The results were collated and patient reported outcome measures were assessed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) standards.ResultsA total of 943 titles and articles were reviewed, with 117 included for full analysis. A wide range of clinical and radiological “outcomes” were described, along with named clinician- and patient-reported outcome measures. There was considerable heterogeneity and lack of detail in the description of the simplest outcomes, such as union, infection or reoperation. Reported clinician and patient reported outcome measures are variably used. None of the identified patient reported outcome measures have been validated for use following tibial fracture.ConclusionWe recommend definition of a core outcome set for use following tibial fracture. This will standardise outcome reporting following these injuries. Furthermore, there is need for a validated patient reported outcome measure to better assess patient important outcomes in this patient group.
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