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Lower limb intracast pressures generated by different types of immobilisation casts

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World Journal of Orthopedics 2017年第2期8卷 170-177页

作者： Salma Chaudhury Alexandra Hazlerigg Anuhya Vusirikala Joseph Nguyen Stuart Matthews trauma Unit John Radcliffe HospitalUniversity of Oxford trauma and orthopaedics Department Royal Berkshire Hospital Hospital for Special Surgery

AIM To determine if complete, split casts and backslabs [plaster of Paris(POP) and fiberglass] generate different intracast pressures and pain. METHODS Increased swelling within casts was modeled by a closed water system attached to an expandable bag placed directly under different types of casts applied to a healthy lower limb. Complete fiberglass and POP casts, split casts and backslabs were applied. Twenty-five milliliter aliquots of saline were injected into the system and the generated intracast pressures were measured using a sphygmomanometer. The subject was blinded to the pressure scores to avoid bias. All casts were applied to the same right limb on the same subject to avoid the effects of variations in anatomy or physiology on intracast pressures. Pain levels were evaluated using the Visual Analogue Score after each sequential saline injection. Each type of cast was reapplied four times and the measurements were repeated on four separate occasions. Sample sizes were determined by a pre-study 90% power calculation to detect a 20% difference in intracast pressures between cast groups. RESULTS A significant difference between the various types of casts was noted when the saline volume was greater than 100 mL(P = 0.009). The greatest intracast pressure was generated by complete fiberglass casts, which were significantly higher than complete POP casts or backslabs(P = 0.018 and P = 0.008 respectively) at intracast saline volumes of 100 mL and higher. Backslabs produced a significantly lower intracast pressure compared to complete POP only once the saline volume within casts exceeded 225 mL(P = 0.009). Intracast pressures were significantly lower in split casts(P = 0.003). Split POP and fiberglass casts produced the lowest intracast pressures, even compared to backslabs(P = 0.009). Complete fiberglass casts generated the highest pain levels at manometer pressures of 75 mm Hg and greater(P = 0.001). Split fiberglass casts had significantly reduced pain levels(P =

关键词： Fracture Pressure Lower limb Plaster of Paris Cast Fiberglass Backslab Compartment syndrome

Neuron-to-vessel signaling is a required feature of aberrant stem cell commitment after soft tissue trauma

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Bone Research 2022年第3期10卷 615-626页

作者： Qizhi Qin Mario Gomez-Salazar Masnsen Cherief Chase A.Pagani Seungyong Lee Charles Hwang Robert J.Tower Sharon Onggo Yuxiao Sun Abhinav Piplani Zhao Li Sowmya Ramesh Thomas L.Clemens Benjamin Levi Aaron W.James Department of Pathology Johns Hopkins UniversityBaltimoreMD 21205USA Center for Organogenesis and trauma Department of SurgeryUniversity of TexasSouthwesternTXUSA Department of Plastic Surgery HarvardCambridgeMA 02138USA Department of orthopaedics Johns Hopkins UniversityBaltimoreMD 21205USA Baltimore Veterans Administration Medical Center BaltimoreMD 21201USA

The functional interdependence of nerves and blood vessels is a well-established concept during tissue morphogenesis, yet the role of neurovascular coupling in proper and aberrant tissue repair is an emerging field of interest. Here, we sought to define the regulatory relationship of peripheral nerves on vasculature in a severe extremity trauma model in mice, which results in aberrant cell fate and heterotopic ossification(HO). First, a high spatial degree of neurovascular congruency was observed to exist within extremity injury associated heterotopic ossification. Vascular and perivascular cells demonstrate characteristic responses to injury,as assessed by single cell RNA sequencing. This vascular response to injury was blunted in neurectomized mice, including a decrease in endothelial proliferation and type H vessel formation, and a downregulation of key transcriptional networks associated with angiogenesis. Independent mechanisms to chemically or genetically inhibit axonal ingrowth led to similar deficits in HO site angiogenesis, a reduction in type H vessels, and heterotopic bone formation. Finally, a combination of single cell transcriptomic approaches within the dorsal root ganglia identified key neural-derived angiogenic paracrine factors that may mediate neuron-to-vascular signaling in HO. These data provide further understanding of nerve-to-vessel crosstalk in traumatized soft tissues, which may reflect a key determinant of mesenchymal progenitor cell fate after injury.

关键词： aberrant trauma nerves

Outcome of selective CT vs. pan-CT scan in elderly trauma patients: A retrospective cohort study in a level 1 trauma center

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Chinese Journal of traumatology 2021年第5期24卷 249-254页

作者： Hazem Mohamed Kar Teoh Department of trauma and orthopaedics Princess Alexandra Hospital NHS Foundation TrustLondonUnited KingdomUnited Kingdom

There are currently no clear guidelines for use of pan-or selective CT in elderly trauma patients and this subject matter remains *** aim of this study is to compare the outcome of elderly trauma patients in a level 1 trauma centre who required a pan-or selective CT scan on admission.;The trauma Audit Research Network database was reviewed to identify eligible patients(65 years old and older)over a one-year period,from January 2018 to January ***'demographics,mechanism of injury,injury severity score,length of hospital stay(LOS),mortality and type of CT scans done were recorded.;There were 481 patients with the mean age of 80.8 years were evaluated(48.6%male).Among them 232 cases were multiple injuries while 249 were single system *** 235 patients(48.8%)underwent pan-CT in whom 66.8%were multiple injuries;246(51.1%)did selective CT scan in whom 69.5%were single system *** multiple injury patients,performing a pan-CT scan on presentation was associated with lower LOS compared to those who had a selective CT,in which 76.4%patients spent60 days in pan-CT group compared to 64%in selective CT group(p<0.0001).Performing pan-CT was also associated with lower need to repeat CT(p<0.01).In patients with a single system injury,no differences were found in LOS or the need to repeat CT if either pan-CT or selective CT were requested.;We recommend doing pan-CT scan in all elderly patients with multiple system injuries as it decreases the LOS and the need for another CT during hospital *** difference in LOS or need to repeat another CT if pan-CT or selective CT were requested initially in single system *** age and injury severity score are poor predictors for the need to do pan-CT,the mechanism of injury may be helpful.

关键词： Computed tomography Aged Length of stay Wounds and injuries

Intracapsular fracture of the proximal femur in a bilateral above-knee amputee: A case report with technical tips for intraoperative positioning and literature review

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Chinese Journal of traumatology 2022年第5期25卷 306-310页

作者： Aditya Jain Hemant Bansal Samarth Mittal Arvind Kumar Vivek Trikha Primus Super Specialy Hospital New DelhiIndia Department of orthopaedics Jay Prakash Narayan Apex trauma Center All India Institute of Medical SciencesNew DelhiIndia Department of Orthopaedis Hamdard Institute of Medical Sciences&ResearchNew DelhiIndia

Intracapsular fractures of the proximal femur are one of the most common fractures of the lower limbs. Most cases require osteosynthesis with suitable implants, and intraoperative positioning of the patient on the fracture table is a prerequisite to facilitate fracture manipulation, traction, reduction and fluoroscopy assessment. However, positioning the limbs of bilateral above-knee amputees for internal fixation of related proximal femoral fractures is a difficult task, which requires customized inventory for effective limb positioning and fracture manipulation. This study reported a rare case following a crush injury of bilateral lower limb in a road traffic accident, and described some technical tips of acute femoral neck fractures in bilateral above-knee amputation. The patient was managed with immediate guillotine amputation and later secondary wound closure followed by internal fixation of the right-sided femoral neck fracture with multiple cancellous cannulated screws.

关键词： Femoral neck fractures Bilateral amputee Above-knee amputation Intraoperative positioning Surgical management

Biomechanical analysis of tension band wiring （TBW） of transverse fractures of patella

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Chinese Journal of traumatology 2016年第5期19卷 255-258页

作者： Mohammed Ali Jan Kuiper Joby John trauma and orthopaedics North Cumbria NHS Trust UK The Robert Jones and Agnes Hunt orthopaedics Hospital Oswestry UK University Hospitals of Nottinghamshire UK

目的紧张乐队配线通常为简单横向的破裂的固定被使用。流行配置是平行 Kirschner 电线(K 电线) 和在垂直地面向的 figure-of-8 放的一个不锈钢电线环。我们与中途的横向的破裂使用了髌的一个木模型并且比较了固定的四种不同类型的方法... 详细信息

目的紧张乐队配线通常为简单横向的破裂的固定被使用。流行配置是平行 Kirschner 电线(K 电线) 和在垂直地面向的 figure-of-8 放的一个不锈钢电线环。我们与中途的横向的破裂使用了髌的一个木模型并且比较了固定的四种不同类型的方法。第一构造与电线的一扭曲有垂直 figure-of-8。第二与电线的二扭曲包含了垂直 figure-of-8。第三是有当最后一个与在邻近的角落放的电线的二扭曲有水平 figure-of-8 时，在邻近的角落放的电线的二扭曲的垂直 figure-of-8。在电线破裂的点的 Interfragmentary 压缩在周期的装载上为每构造以及永久排水量被测量。在有在角落的二电线扭曲的水平取向的 figure-of-eight 的结果放置在 63% 改进了 interfragmentary 压缩(p p = 0.01；Fishers 准确测试) 。在周期的装载以后的永久破裂排水量是 67% 与水平 figure-of-eight 构造(p t 测试) 更低。把电线扭曲放在角落和 figure-of-8 的水平放置的结论改进构造的稳定性。

关键词：髌横向的破裂紧张乐队配线 Biomechanical 分析

A comparative analysis of distal locked and unlocked long proximal femoral nail antirotation (PFNA-II) in the fixation of stable intertrochanteric fractures

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Chinese Journal of traumatology 2023年第2期26卷 111-115页

作者： Atmananda Hegde Vikrant Khanna Prajwal Mane Chethan Shetty Nitin Joseph Department of orthopaedics Kasturba Medical CollegeMangaloreManipal Academy of Higher Education(MAHE)ManipalKarnatakaIndia Department of trauma Kalyani HospitalGurugramIndia Department of Community Medicine Kasturba Medical CollegeMangaloreManipal Academy of Higher Education(MAHE)ManipalKarnatakaIndia

Purpose:Long proximal femoral nail anti-rotation (PFNA-II) is a preferred implant in recent years for fixation of pertrochanteric fractures,especially in osteoporotic *** purpose of this study is to prospectively investigate the effect of distal locking in long PFNA-II fixation of stable intertrochanteric ***:A total of 58 patients with isolated stable intertrochanteric fractures and treated in our hospital during the study period of 2017–2019 by distal locked or unlocked long PFNA-II fixation were included in this *** who had multiple injuries or open fractures were *** were 40 female and 18 male patients,with 33 affecting the left side and 25 the right *** them,31 belonged to the distal locked group (group A) and 27 to the unlocked group (group B).Surgical procedures and implants used in both groups were similar except for the distal locking of the *** data (age,gender,fracture side,etc.) showed no significant difference between two groups (allp > 0.05).The intraoperative parameters like operative time,radiation exposure and follow-up parameters like functional and radiological outcomes were recorded and *** tests like the independent samplest-test Fischer’’s exact and Chi-square test were used to analyze ***:The distribution of the fractures according to AO/OTA classification and 31A1.2 type of intertrochanteric fractures were most common in our *** the included fractures united and the average functional outcome in both groups were good and comparable at the end of one *** operative time (mL,107.1 ± 12.6vs.77.0 ± 12.0,p < 0.001) and radiation exposure (s,78.6 ± 11.0vs.40.3 ± 9.3,p < 0.001) were significantly less among the patients in group *** consolidation,three months after the operative procedures,was seen in a significantly greater proportion of patients in group B (92.6%vs.67.7%,p = 0.025).Hardware irritation because of distal locking bolt was excl

关键词： Intertrochanteric fractures Hip fractures Proximal femoral nail Distal locked Unlocked intramedullary nail Intramedullary nail

Disseminated cysticercosis incidentally diagnosed in a patient of low backache:A case report and concise review of literature

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Asian Pacific Journal of Tropical Medicine 2012年第7期5卷 582-586页

作者： Mohammad Nasim Akhtar Sharat Agarwal Department of orthopaedics & trauma North Eastern Indira Gandhi Regional Institute of Health & Medical SciencesShillong -793018India

Disseminated cysticercosis is an uncommon presentation of a common *** disseminated cysticercosis is rarely reported in ***,we are reporting a case of asymptomatic disseminated cysticercosis incidentally diagnosed in a patient of low backache. Magnetic resonance imaging of lumbosacral spine and neuroimaging done subsequently during the course of evaluation revealed diffuse cysticercosis involving abdominal,paraspinal,pelvic and gluteal muscles along with *** a disseminated cysticercosis was diagnosed incidentally in this patient of low backache with right sciatica and radiculopathy at L5-S1 prolapsed intervertebral disc and was subsequently managed by L5-S1 interlaminar fenestration and discectomy.

关键词： Disseminated cysticercosis Taenia solium infestation Neurocysticercosis Human cysticercosis

The outcome after using two different approaches for excision of Morton＇s neuroma

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Chinese Medical Journal 2010年第16期123卷 2195-2198页

作者： Adnan A Faraj Acuth Hosur Department of orthopaedics & trauma Airedale General HospitalSteeton Keighley W.Yorkshire BD20 6TD UK

Background The choice for the surgical approach of interdigital neuroma in the foot is *** approach can leave a painful scar on weight bearing area; hence, some prefer dorsal *** aim of the current study was to measure the outcome of interdigital （Morton＇s） neurectomy performed by a single surgeon using dorsal and plantar *** A retrospective review of the patient records of one orthopaedic foot and ankle surgeon identified thirty-six patients （42 feet） who had been treated operatively for a primary, persistently painful interdigital *** mean follow-up was 18 ***, weight bearing, wound problems and rehabilitation period were *** The duration to full weight bearing, return to work, driving and recreational activities were at least one week shorter in the dorsal *** overall satisfaction for surgery was rated as excellent or good in 85% of the thirty six *** problems were more troublesome and common in the plantar *** was residual numbness noticed in twenty feet, the pattern of numbness was quite variable and it was bothersome in only seven *** was one recurrence in the plantar *** Resection of a symptomatic interdigital neuroma through a dorsal or a plantar approach can result in a good *** approach, however, is associated with better rehabilitation and less scar problems.

关键词： Morton's neuroma excision approach outcome complications interdigital

Silver nanoparticle technology in orthopaedic infections

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世界骨科杂志:英文版 2023年第9期14卷 662-668页

作者： Madhan Jeyaraman Naveen Jeyaraman Arulkumar Nallakumarasamy Karthikeyan P Iyengar Vijay Kumar Jain Anish G Potty Ashim Gupta Department of orthopaedics ACS Medical College and HospitalDr MGR Educational and Research InstituteChennai 600077Tamil NaduIndia Department of orthopaedics South Texas Orthopaedic Research InstituteLaredoTX 78045United States Department of trauma and orthopaedics Southport&Ormskirk Hosp NHS Trust SouthportRichmond PR86PNSouthportUnited Kingdom Department of orthopaedics Atal Bihari Vajpayee Institute of Medical SciencesDr Ram Manohar Lohia HospitalDelhi 110001New DelhiIndia Department of Regenerative Medicine Future BiologicsLawrencevilleGA 30043United States Department of Regenerative Medicine BioIntegarteLawrencevilleGA 30043United States

The irrational and prolonged use of antibiotics in orthopaedic infections poses a major threat to the development of antimicrobial *** combat antimi-crobial resistance,researchers have implemented various novel and innovative modalities to curb *** involves doping ions/metals onto the scaffolds to reach the target site to eradicate the infective *** this conno-tation,we reviewed silver nanoparticle technology in terms of mechanism of action,clinical applications,toxicity,and regulatory guidelines to treat ortho-paedic infections.

关键词： Antimicrobial resistance Biofilms Silver Nanoparticles orthopaedics