69 results match your criteria General Principles of Fracture Care

Harmonization of Osteoporosis Guidelines: Paving the Way for Disrupting the Status Quo in Osteoporosis Management in the Asia Pacific.

J Bone Miner Res 2022 Apr 3;37(4):608-615. Epub 2022 Apr 3.

Centre for Health Technologies, University of Technology, Sydney, NSW, Australia.

In the Asia Pacific (AP) region, osteoporosis and its consequence of fragility fractures are not widely recognized as a major public health problem. Several challenges including underdiagnosis and undertreatment exist. The Asia Pacific Consortium on Osteoporosis (APCO) is a nonpartisan and apolitical organization comprising musculoskeletal experts and stakeholders from both private and public sectors who have united to develop tangible solutions for these substantive challenges. Read More

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Early Outcomes of Pelvic Trauma Patients - Complications, ICU Stay and Treatment Concepts in Two ATLS Compliant Trauma Centers: Germany and Qatar.

Acta Chir Orthop Traumatol Cech 2021 ;88(6):418-422

BG Trauma Center at Ruprecht-Karls-Universität Heidelberg, Ludwigshafen, Germany.

PURPOSE OF THE STUDY Pelvic trauma causes severe threats especially to polytraumatized patients. Not only it is in itself a possible cause for significant bleeding, but it also indicates a high risk for intra-abdominal injuries. The initial treatment of patients with pelvic trauma follows the ATLS principles of priority-oriented treatment. Read More

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January 2022

Damage Control Orthopaedics in Spinal Trauma.

J Am Acad Orthop Surg 2021 Dec;29(24):e1291-e1302

From the Department of Orthopedic Surgery, McMaster University, Hamilton General Hospital, Hamilton, Ontario (Oitment, Thornley, and Pahuta), the Division of Orthopaedic Surgery, Toronto Western Hospital, University Health Network (Jentzsch) and Department of Surgery, University of Toronto (Jentzsch), Toronto, Ontario, Canada, and the Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland (Jentzsch).

There has been a shift in the management of the polytrauma patients from early total care to damage control orthopaedics (DCO), whereby patients with borderline hemodynamic stability may be temporized with the use of external fixators, traction, or splinting with delayed osteosynthesis of fractures. Recently, there has been an increasing trend toward a middle ground approach of Early Appropriate Care for polytrauma patients. The concepts of DCO for the spine are less clear, and the management of trauma patients with combined pelvic ring and spinal fractures or patients with noncontiguous spinal injuries present unique challenges to the surgeon in prioritization of patient needs. Read More

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December 2021

Improving uptake of Fracture Prevention drug treatments: a protocol for Development of a consultation intervention (iFraP-D).

BMJ Open 2021 08 18;11(8):e048811. Epub 2021 Aug 18.

School of Medicine, Keele University, Keele, UK.

Introduction: Prevention of fragility fractures, a source of significant economic and personal burden, is hindered by poor uptake of fracture prevention medicines. Enhancing communication of scientific evidence and elicitation of patient medication-related beliefs has the potential to increase patient commitment to treatment. The mproving uptake of cture revention drug treatments (iFraP) programme aims to develop and evaluate a theoretically informed, complex intervention consisting of a computerised web-based decision support tool, training package and information resources, to facilitate informed decision-making about fracture prevention treatment, with a long-term aim of improving informed treatment adherence. Read More

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Aggressive nutrition therapy in malnutrition and sarcopenia.

Nutrition 2021 04 10;84:111109. Epub 2020 Dec 10.

Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu City, Aichi Prefecture, Japan.

Aggressive nutrition therapy is essential to improve nutrition and function in patients with malnutrition and sarcopenia. Malnutrition and sarcopenia negatively affect functional recovery and activities of daily living. Nutrition improvement is associated with better functional recovery. Read More

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Definitive Surgery Is Safe in Borderline Patients Who Respond to Resuscitation.

J Orthop Trauma 2021 07;35(7):e234-e240

Department of Orthopaedic Surgery, University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Health System (NUHS), Singapore.

Objectives: We hypothesize that in adequately resuscitated borderline polytrauma patients with long bone fractures (femur and tibia) or pelvic fractures, early (within 4 days) definitive stabilization (EDS) can be performed without an increase in postoperative ventilation and postoperative complications.

Design: Retrospective cohort study.

Setting: Level 1 trauma center. Read More

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[External fixator: temporary fixation and soft tissue management of the ankle].

Oper Orthop Traumatol 2020 Oct 18;32(5):421-432. Epub 2020 Sep 18.

UniversitätsCentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Carl Gustav Carus, Fetscherstr. 74, 01307, Dresden, Deutschland.

Objective Of Surgery: Joint-spanning transfixation of the ankle joint aims at mostly temporary retention of the reduction, i.e. restoring length and axial alignment and stabilization of the ankle mortise in highly unstable fractures around the ankle and under critical soft tissue conditions. Read More

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October 2020

Core principles for fracture prevention: North American Consensus from the National Osteoporosis Foundation, Osteoporosis Canada, and Academia Nacional de Medicina de Mexico.

Osteoporos Int 2020 Nov 16;31(11):2073-2076. Epub 2020 Jul 16.

Department of Medicine, Division of General Internal Medicine, McGill University, Montreal, Canada.

Core principles for fracture prevention address fundamental concepts for the evaluation and management of patients at risk for fracture. These are intended to form the foundation of clinical practice guidelines and represent a first step toward guideline harmonization.

Introduction: The large number of clinical practice guidelines for osteoporosis and discordance of recommendations has led to confusion among clinicians and patients, and likely contributes to the large osteoporosis treatment gap. Read More

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November 2020

IQ driving QI: the Asia Pacific Consortium on Osteoporosis (APCO): an innovative and collaborative initiative to improve osteoporosis care in the Asia Pacific.

Osteoporos Int 2020 Nov 19;31(11):2077-2081. Epub 2020 Jun 19.

Queen Elizabeth Hospital, Hong Kong, Hong Kong SAR.

Asia Pacific Consortium on Osteoporosis (APCO) comprises of clinical experts from across the Asia Pacific region, uniting to develop solutions to problems facing osteoporosis management and care. The vision of APCO is to reduce the burden of osteoporosis and fragility fractures in the Asia Pacific region.

Introduction: The Asia Pacific (AP) region comprises 71 countries with vastly different healthcare systems. Read More

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November 2020

2019 EULAR points to consider for non-physician health professionals to prevent and manage fragility fractures in adults 50 years or older.

Ann Rheum Dis 2021 01 24;80(1):57-64. Epub 2020 Apr 24.

Section for Outcomes Research, Centre for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria

Objective: To establish European League Against Rheumatism (EULAR) points to consider for non-physician health professionals to prevent and manage fragility fractures in adults 50 years or older.

Methods: Points to consider were developed in accordance with EULAR standard operating procedures for EULAR-endorsed recommendations, led by an international multidisciplinary task force, including patient research partners and different health professionals from 10 European countries. Level of evidence and strength of recommendation were determined for each point to consider, and the mean level of agreement among the task force members was calculated. Read More

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January 2021

Bilateral internal iliac artery embolization for pelvic trauma: Effectiveness and safety.

Am J Surg 2020 08 31;220(2):454-458. Epub 2019 Dec 31.

Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts, General Hospital, Harvard Medical School, Boston, United States. Electronic address:

Introduction: Bilateral internal iliac artery embolization (BIIAE) with temporary embolic materials epitomizes damage-control principles in the treatment of exsanguinating hemorrhage from pelvic trauma. However, instances of ischemic complications have been reported. The aim of our study was to assess safety and effectiveness of BIIAE. Read More

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Timing of major fracture care in polytrauma patients - An update on principles, parameters and strategies for 2020.

Injury 2019 Oct 13;50(10):1656-1670. Epub 2019 Sep 13.

Trauma & Orthopaedic Surgery, Clarendon Wing, A Floor, Great George Street, Leeds General Infirmary University Hospital, University of Leeds, Leeds, LS1 3EX, UK. Electronic address:

Objectives: Sustained changes in resuscitation and transfusion management have been observed since the turn of the millennium, along with an ongoing discussion of surgical management strategies. The aims of this study are threefold: a) to evaluate the objective changes in resuscitation and mass transfusion protocols undertaken in major level I trauma centers; b) to summarize the improvements in diagnostic options for early risk profiling in multiply injured patients and c) to assess the improvements in surgical treatment for acute major fractures in the multiply injured patient.

Methods: I. Read More

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October 2019

What Factors Are Associated With Outcomes Scores After Surgical Treatment Of Ankle Fractures With a Posterior Malleolar Fragment?

Clin Orthop Relat Res 2019 04;477(4):863-869

D. T. Meijer, B. D. J. G. Deynoot, S. A. Stufkens, G. M. M. J. Kerkhoffs, J. N. Doornberg, Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam, The Netherlands D. T. Meijer, Trauma Unit, Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands I. N. Sierevelt, Slotervaart Center of Orthopedic Research and Education, Department of Orthopaedic Surgery, Medical Centre Slotervaart, Amsterdam, The Netherlands J. C. Goslings, Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands G. M. M. J. Kerkhoffs, Academic Center for Evidence-based Sports Medicine, Amsterdam Collaboration for Health and Safety in Sports, IOC Research Center, Amsterdam, The Netherlands J. N. Doornberg, Flinders University, Adelaide, Australia.

Background: Psychosocial factors, such as depression and catastrophic thinking, might account for more disability after various orthopaedic trauma pathologies than range of motion and other impairments. However, little is known about the influence of psychosocial aspects of illness on long-term symptoms and limitations of patients with rotational-type ankle fractures, including a posterior malleolar fragment. Knowledge of the psychosocial factors associated with long-term outcome after operative treatment of trimalleolar ankle fractures might improve recovery. Read More

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Early management of severe pelvic injury (first 24 hours).

Anaesth Crit Care Pain Med 2019 04 21;38(2):199-207. Epub 2018 Dec 21.

CHRU de Lille, réanimation chirurgicale, pôle d'anesthésie-réanimation, 2 avenue Oscar-Lambret 59037 Lille, France.

Objective: Pelvic fractures represent 5% of all traumatic fractures and 30% are isolated pelvic fractures. Pelvic fractures are found in 10 to 20% of severe trauma patients and their presence is highly correlated to increasing trauma severity scores. The high mortality of pelvic trauma, about 8 to 15%, is related to actively bleeding pelvic injuries and/or associated injuries to the head, abdomen or chest. Read More

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Perceptions and experiences of patients following treatment with single-implant mandibular overdentures: A qualitative study.

Clin Oral Implants Res 2019 Jan 26;30(1):79-89. Epub 2018 Dec 26.

School of Dentistry, Federal University of Goias, Goiania, Brazil.

Objective: This study aimed to explore the perceptions and long-term experiences of edentulous patients rehabilitated with single-implant mandibular overdentures (SIMO).

Methods: Thirteen participants, mean age 65.7 years, 69. Read More

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January 2019

Chinese expert consensus on echelons treatment of pelvic fractures in modern war.

Mil Med Res 2018 06 30;5(1):21. Epub 2018 Jun 30.

Department of Trauma Surgery, Daping Hospital, Army Medical University, ChongQing, 400042, China.

The characteristics and treatment of pelvic fractures vary between general conditions and modern war. An expert consensus has been reached based on pelvic injury epidemiology and the concepts of battlefield treatment combined with the existing levels of military medical care in modern warfare. According to this consensus, first aid, emergency treatment and early treatment of pelvic fractures are introduced in three separate levels. Read More

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Anaesthetic aspects in the treatment of fragility fracture patients.

Injury 2018 Aug 22;49(8):1403-1408. Epub 2018 Jun 22.

North West Anglia Hospitals NHS FT, Bretton Gate, Peterborough, PE3 9GZ, United Kingdom.

As longevity increases globally, the number of older, frailer, comorbid patients requiring fragility fracture surgery will increase. Fundamentally, anaesthesia should aim to maintain these patients' pre-fracture cognitive and physiological trajectories and facilitate early (ie day 1) postoperative recovery. This review describes the 10 general principles of anaesthesia for fragility fracture surgery that best achieve these aims: multidisciplinary care, 'getting it right first time', timely surgery, standardisation, sympathetic anaesthesia, avoiding ischaemia, sympathetic analgesia, re-enablement, data collection and training. Read More

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Wartime Soft Tissue Coverage Techniques for the Deployed Surgeon.

Mil Med 2018 09;183(9-10):e247-e254

Department of Surgery, University of Nevada School of Medicine, 1701 W Charleston Blvd, Suite 490, Las Vegas, NV.

Background: Since the start of the conflict in the Middle East in 2001, military orthopedic surgeons have faced complex orthopedic injuries including high-energy soft tissue wounds, traumatic amputations, and open fractures. Although orthopedic surgeons are well trained in the management of osseous injuries, the treatment of soft tissue injuries can be technically challenging and unfamiliar. Early washout, debridement of devitalized tissue, external fixation of bony injuries, and antibiotic therapy remain the foundation of early wound management. Read More

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September 2018

The principles and practice of open fracture care, 2018.

Chin J Traumatol 2018 Aug 21;21(4):187-192. Epub 2018 Feb 21.

Department of Orthopaedics, Harvard Medical School, Chief Orthopaedic Trauma Service, Massachusetts General Hospital, Boston, MA, USA. Electronic address:

The principles of open fracture management are to manage the overall injury and specifically prevent primary contamination becoming frank infection. The surgical management of these complex injuries includes debridement & lavage of the open wound with combined bony and soft tissue reconstruction. Good results depend on early high quality definitive surgery usually with early stable internal fixation and associated soft tissue repair. Read More

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Perioperative management of external fixation in staged protocols: an international survey.

Eur J Orthop Surg Traumatol 2018 May 7;28(4):565-572. Epub 2018 Feb 7.

Department of Orthopaedic and Trauma Surgery, Luzerner Kantonsspital, 6000, Luzern 16, Switzerland.

Introduction: Despite the frequent use of external fixation, various regimes of antibiotic prophylaxis, surgical technique and postoperative pin care exist and underline the lack of current evidence. The aim of the study was to assess the variability or consensus in perioperative protocols to prevent implant-associated infections for temporary external fixation in closed fractures of the extremities.

Materials And Methods: A 26-question survey was sent to 170 members of the Traumaplatform. Read More

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Multidetector CT of Midfacial Fractures: Classification Systems, Principles of Reduction, and Common Complications.

Radiographics 2018 Jan-Feb;38(1):248-274

From the Section of Trauma and Emergency Radiology, Department of Diagnostic Radiology and Nuclear Medicine (D.D., U.K.B.), and the Division of Plastic Surgery (A.J.N., S.C.D.), R. Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 22 S Greene St, Baltimore, MD 21201; the Division of Trauma and Emergency Imaging, Department of Radiology, Bellevue Hospital/NYU Langone Medical Center, New York, NY (M.P.B.); and the Department of Diagnostic Radiology, University of Miami Leonard M. Miller School of Medicine, Ryder Trauma Center at Jackson Memorial Hospital, Miami, Fla (F.M.).

The advent of titanium hardware, which provides firm three-dimensional positional control, and the exquisite bone detail afforded by multidetector computed tomography (CT) have spurred the evolution of subunit-specific midfacial fracture management principles. The structural, diagnostic, and therapeutic complexity of the individual midfacial subunits, including the nose, the naso-orbito-ethmoidal region, the internal orbits, the zygomaticomaxillary complex, and the maxillary occlusion-bearing segment, are not adequately reflected in the Le Fort classification system, which provides only a general framework and has become less relevant in contemporary practice. The purpose of this article is to facilitate the involvement of radiologists in the delivery of individualized multidisciplinary care to adults who have sustained blunt trauma and have midfacial fractures by providing a clinically relevant review of the role of multidetector CT in the management of each midfacial subunit. Read More

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Effectiveness of sensor monitoring in an occupational therapy rehabilitation program for older individuals after hip fracture, the SO-HIP trial: study protocol of a three-arm stepped wedge cluster randomized trial.

BMC Health Serv Res 2017 01 3;17(1). Epub 2017 Jan 3.

Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.

Background: The performance of activities of daily living (ADL) at home is important for the recovery of older individuals after hip fracture. However, 20-90% of these individuals lose ADL function and never fully recover. It is currently unknown to what extent occupational therapy (OT) with coaching based on cognitive behavioral treatment (CBT) improves recovery. Read More

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January 2017

Delivering comprehensive geriatric assessment in new settings: advice for frontline clinicians.

J R Gladman

J R Coll Physicians Edinb 2016 Sep;46(3):174-179

JRF Gladman, Division of Rehabilitation and Ageing, B Floor Medical School, Queen's Medical Centre, Nottingham NG7 2UH, UK, E-mail

Over the decades, as the principles of comprehensive geriatric assessment have been established, there have been attempts to apply its principles to settings other than acute hospital medical wards or the general communitydwelling older population, for example, to other settings where older people with infirmity are found. The purpose of this paper is to describe and reflect upon the application of and evidence for comprehensive geriatric assessment in these new settings and give some advice to clinicians about how to optimise their contributions to these processes. I will state my advice having first discussed intermediate care, emergency surgery (hip fracture), elective surgery, dementia and delirium care, emergency care, cancer care, and the care of residents of care homes (mindful of the irony of calling the latter a new setting, given that geriatric medicine originated in long term care). Read More

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September 2016

Preperitoneal pelvic packing: Technique and outcomes.

Int J Surg 2016 Sep 1;33(Pt B):222-224. Epub 2016 Jul 1.

Rutgers University NJMS, Department of General Surgery, Division of Trauma Surgery and Critical Care, 140 Bergen Street, Suite E 1625, Newark, NJ 07101, USA. Electronic address:

Significant pelvic ring fractures are usually secondary to high-energy trauma, and when associated with other life-threatening injuries and hemodynamic instability, result in high mortality rates ranging from 40 to 60%. The major cause of death during the first 24 h after pelvic trauma is attributed to acute blood loss, with later mortality secondary to multisystem organ failure. In a majority of patients, the source of pelvic bleeding is from disruption of the presacral venous plexus and bony fracture sites, while arterial injury is present in only 10-15%. Read More

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September 2016

Sticker Shock: The Experience of a Health Care Consumer.

David Grande

Ann Fam Med 2016 05;14(3):270-2

Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania

With implementation of the Patient Protection and Affordable Care Act, more Americans are gaining insurance coverage but often have high deductibles and significant out-of-pocket cost sharing. Deductibles routinely exceed $1,000 and often approach $5,000. In this essay, I share our family's experience attempting to navigate urgent medical decisions in a high-deductible health plan. Read More

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Bone fractures: assessment and management.

L Lim P Sirichai

Aust Dent J 2016 Mar;61 Suppl 1:74-81

Department of Oral and Maxillofacial Surgery, Westmead Hospital, Westmead, New South Wales, Australia.

Severe dental traumatic injuries often involve the supporting bone and soft tissues. This article outlines the current concepts in the management of dentoalveolar fractures for the general dental practitioner with case reports to illustrate management principles and techniques. Read More

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Fall rates in hospital rehabilitation units after individualised patient and staff education programmes: a pragmatic, stepped-wedge, cluster-randomised controlled trial.

Lancet 2015 Jun 9;385(9987):2592-9. Epub 2015 Apr 9.

Physiotherapy Department, Monash University, Frankston, VIC, Australia; Allied Health Research Unit, Monash Health, Clayton, VIC, Australia.

Background: Falls are the most frequent adverse events that are reported in hospitals. We examined the effectiveness of individualised falls-prevention education for patients, supported by training and feedback for staff, delivered as a ward-level programme.

Methods: Eight rehabilitation units in general hospitals in Australia participated in this stepped-wedge, cluster-randomised study, undertaken during a 50 week period. Read More

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