Search

Copyright of Journal of Clinical Nursing in Practice is the property of Journal of Clinical Nursing in Practice (Editorial Board, Shanghai Jiao Tong University Press) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Background Intramedullary nailing (IN) seems to be the best primary surgical treatment for patients with either polyostotic fibrous dysplasia or McCune–Albright syndrome (PFD/MAS) when the femur and tibia are totally affected by fibrous dysplasia (FD) and pain, fracture and deformity are likely to occur. However, other management protocols have been applied in these cases, often leading to disabling sequelae. This study sought to evaluate if IN could also have been effective as a salvage procedure to provide patients with satisfactory results, regardless of the poor results due to the improper treatment previously performed. Materials and methods Twenty-four retrospectively registered PFD/MAS patients with 34 femurs and 14 tibias totally affected by fibrous dysplasia had received various treatments with unsatisfactory results in other institutions. Before the IN performed in our hospital, 3 patients were wheelchair bound; 4 were fractured; 17 limped; and many used an aid for walking. Salvage IN was performed in our hospital at a mean patient age of 23.66 ± 6.06 years (range, 15–37 years). The patients were evaluated before—except for the four fractured ones—and after IN using the validated Jung scoring system, and the data were statistically analyzed. Results The mean length of follow-up after IN was 9.12 ± 3.68 years (range, 4–17 years). The patients’ mean Jung score significantly improved from 2.52 ± 1.74 points before IN to 6.78 ± 2.23 at follow-up (p

Aims: Open lower limb fracture is life-changing, resulting in substantial morbidity and resource demand, while inconsistent outcome-reporting hampers systematic review and meta-analysis. A core outcome set establishes consensus among key stakeholders for the recommendation of a minimum set of outcomes. This study aims to define a core outcome set for adult open lower limb fracture. Methods: Candidate outcomes were identified from a previously published systematic review and a secondary thematic analysis of 25 patient interviews exploring the lived experience of recovery from open lower limb fracture. Outcomes were categorized and sequentially refined using healthcare professional and patient structured discussion groups. Consensus methods included a multi-stakeholder two-round online Delphi survey and a consensus meeting attended by a purposive sample of stakeholders, facilitated discussion, and voting using a nominal group technique. Results: Thematic analysis and systematic review identified 121 unique outcomes, reduced to 68 outcomes following structured discussion groups. Outcomes were presented to 136 participants who completed a two-round online Delphi survey. The Delphi survey resulted in 11 outcomes identified as consensus ‘in’ only. All outcomes were discussed at a consensus meeting attended by 15 patients, 14 healthcare professionals, 11 researchers, and one patient-carer. Consensus was achieved for a four-core outcome set: ‘Walking, gait and mobility’, ‘Being able to return to life roles’, ‘Pain or discomfort’, and ‘Quality of life’. Conclusion: This study used robust consensus methods to establish a core outcome set that should be measured in all future research studies and audits of clinical practice without precluding the measurement of additional outcomes. Cite this article: Bone Joint Res 2023;12(4):294–305.

Background: Intramedullary nailing (IN) seems to be the best primary surgical treatment for patients with either polyostotic fibrous dysplasia or McCune–Albright syndrome (PFD/MAS) when the femur and tibia are totally affected by fibrous dysplasia (FD) and pain, fracture and deformity are likely to occur. However, other management protocols have been applied in these cases, often leading to disabling sequelae. This study sought to evaluate if IN could also have been effective as a salvage procedure to provide patients with satisfactory results, regardless of the poor results due to the improper treatment previously performed. Materials and methods: Twenty-four retrospectively registered PFD/MAS patients with 34 femurs and 14 tibias totally affected by fibrous dysplasia had received various treatments with unsatisfactory results in other institutions. Before the IN performed in our hospital, 3 patients were wheelchair bound; 4 were fractured; 17 limped; and many used an aid for walking. Salvage IN was performed in our hospital at a mean patient age of 23.66 ± 6.06 years (range, 15–37 years). The patients were evaluated before—except for the four fractured ones—and after IN using the validated Jung scoring system, and the data were statistically analyzed. Results: The mean length of follow-up after IN was 9.12 ± 3.68 years (range, 4–17 years). The patients' mean Jung score significantly improved from 2.52 ± 1.74 points before IN to 6.78 ± 2.23 at follow-up (p < 0.05). Ambulation was improved in ambulatory patients and restored in wheelchair users. The complication rate was 21%. Conclusions: Regardless of the high rate of complications, IN may be considered a reliable surgical procedure to salvage a failed treatment in PFD/MAS, with long-lasting satisfactory results achieved in most patients. Trial registration statement: Not applicable. Level of evidence: IV. [ABSTRACT FROM AUTHOR]

Aims: Open lower limb fracture is a life-changing injury affecting 11.5 per 100,000 adults each year, and causes significant morbidity and resource demand on trauma infrastructures. This study aims to identify what, and how, outcomes have been reported for people following open lower limb fracture over ten years. Methods: Systematic literature searches identified all clinical studies reporting outcomes for adults following open lower limb fracture between January 2009 and July 2019. All outcomes and outcome measurement instruments were extracted verbatim. An iterative process was used to group outcome terms under standardized outcome headings categorized using an outcome taxonomy. Results: A total of 532 eligible studies were identified, reporting 1,803 outcomes with 786 unique outcome terms, which collapsed to 82 standardized outcome headings. Overall 479 individual outcome measurement instruments were identified, including 298 outcome definitions, 27 patient- and 18 clinician-reported outcome measures, and six physical performance measures. The most-reported outcome was ‘bone union/healing’ reported in over 50% of included studies, while health-related quality of life was only measured in 6% of included studies. Conclusion: Outcomes reported for people recovering from open lower limb fracture are heterogeneous, liable to outcome reporting bias, and vary widely in the definitions and the measurement tools used to collect them. Outcomes likely to be important to patients, such as quality of life and measures of physical functioning, have been neglected. This systematic review identifies the need to unify outcome measures reported on patients recovering from open lower limb fracture; this may be addressed by creating a core outcome set. Cite this article: Bone Joint Res 2023;12(2):138–146.

Copyright of Journal of Clinical Nursing in Practice is the property of Journal of Clinical Nursing in Practice (Editorial Board, Shanghai Jiao Tong University Press) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aims: This study aims to estimate economic outcomes associated with 30-day deep surgical site infection (SSI) from closed surgical wounds in patients with lower limb fractures following major trauma. Methods: Data from the Wound Healing in Surgery for Trauma (WHiST) trial, which collected outcomes from 1,547 adult participants using self-completed questionnaires over a six-month period following major trauma, was used as the basis of this empirical investigation. Associations between deep SSI and NHS and personal social services (PSS) costs (£, 2017 to 2018 prices), and between deep SSI and quality-adjusted life years (QALYs), were estimated using descriptive and multivariable analyses. Sensitivity analyses assessed the impact of uncertainty surrounding components of the economic analyses. Results: Compared to participants without deep SSI, those with deep SSI had higher mean adjusted total NHS and PSS costs (adjusted mean difference £1,577 (95% confidence interval (CI) -951 to 4,105); p = 0.222), and lower mean adjusted QALYs (adjusted mean difference -0.015 (95% CI -0.032 to 0.002); p = 0.092) over six months post-injury, but this difference was not statistically significant. The results were robust to the sensitivity analyses performed. Conclusion: This study found worse economic outcomes during the first six months post-injury in participants who experience deep SSI following orthopaedic surgery for major trauma to the lower limb. However, the increase in cost associated with deep SSI was less than previously reported in the orthopaedic trauma literature. Cite this article: Bone Jt Open 2022;3(5):398–403.

Xiaowei Li,1,2 Gongming Wang,2 Yingxue He,2 Zhun Wang,1 Mengyuan Zhang1,2 1Department of Anesthesiology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250021, People’s Republic of China; 2Department of Anesthesiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, People’s Republic of ChinaCorrespondence: Mengyuan Zhang, Department of Anesthesiology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250021, People’s Republic of China, Tel +8668776472, Email myzsdslyy@126.comPurpose: The aim of this study was to investigate whether white-cell derived biomarkers could serve as potential markers in prediction of postoperative delirium (POD) after lower limb fracture.Patients and Methods: Elderly patients with surgery for lower limb fracture under non-general anaesthesia were included. Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and platelet-to-white cell ratio (PWR), which were most recently measured preceding surgery and measured within 24h after surgery, were calculated. Delirium was measured with Confusion Assessment Method (CAM) once daily from preoperative day 1 to postoperative day 3 or hospital discharge.Results: The incidence of POD was 32.6% (60/184). Between patients with and those without POD, there were significant differences in preoperative hematological biomarkers (neutrophil count, lymphocyte count, NLR and PWR) and postoperative hematological biomarkers (white cell count, neutrophil count, lymphocyte count, NLR, PLR and PWR). More obvious changes before and after operation for NLR, PLR and C-reactive protein (CRP) were found in patients with POD. Multivariate logistic regression showed that benzodiazepines (OR, 7.912; 95% CI, 1.884– 33.230; p = 0.005), change of CRP (OR, 1.017; 95% CI, 1.007– 1.027; p = 0.001) and postoperative NLR (OR, 1.358; 95% CI, 1.012– 1.823; p = 0.041) were associated with POD. When the changes of NLR, PLR and PWR entered multivariate logistic regression, older age (OR, 1.073; 95% CI, 1.001– 1.149; p = 0.046), benzodiazepines (OR, 6.811; 95% CI, 1.652– 28.081; p = 0.008), greater change of CRP (OR, 1.015; 95% CI, 1.006– 1.023; p = 0.001) and greater change of NLR (OR, 1.266; 95% CI, 1.035– 1.549; p = 0.022) were associated with increased risk of POD. Postoperative NLR had high accuracy to predict POD with area under curve (AUC) of 0.790 (95% CI 0.708 to 0.872).Conclusion: Age, benzodiazepines, postoperative NLR, change of NLR and change of CRP were independent predictable markers for POD in elderly patients undergoing surgery for lower limb fracture under non-general anaesthesia. Early postoperative NLR may help to recognize POD as soon as possible.Keywords: postoperative delirium, anaesthesia method, inflammation, neutrophil-to-lymphocyte ratio, lower limb fracture

Background: Lower limb trauma is the most common injury sustained in motorcycle crashes. There are limited data describing this cohort in Australia and limited international data establishing costs due to lower limb trauma following motorcycle crashes.Methods: This retrospective cohort study utilised administrative hospitalisation data from Queensland, Australia from 2011-2017. Eligible participants included those admitted with a principal diagnosis coded as lower extremity or pelvic fracture following a motorcycle crash (defined as the index admission). Multiply injured motorcyclists where the lower limb injury was not coded as the primary diagnosis (i.e. principal diagnosis was rather coded as head injury, internal organ injures etc.) were not included in the study. Hospitalisation data were also linked to clinical costing data. Logistic regression was used to determine risk factors for 30-day readmission. Costing data were compared between those readmitted and those who weren't, using bootstrapped t-tests and ANVOA.Results: A total of 3342 patients met eligibility, with the most common lower limb fracture being tibia/fibula fractures (40.8%). 212 participants (6.3%) were readmitted within 30-days of discharge. The following were found to predict readmission: male sex (OR 1.84, 95% CI 1.01-1.94); chronic anaemia (OR 2.19, 95% CI 1.41-3.39); current/ex-smoker (OR 1.60, 95% CI 1.21-2.12); emergency admission (OR 2.77, 95% CI 1.35-5.70) and tibia/fibula fracture type (OR 1.46, 95% CI 1.10-1.94). The most common reasons for readmission were related to ongoing fracture care, infection or post-operative complications. The average hospitalisation cost for the index admission was AU$29,044 (95% CI $27,235-$30,853) with significant differences seen between fracture types. The total hospitalisation cost of readmissions was almost AU$2 million over the study period, with an average cost of $10,977 (95% CI $9,131- $13,059).Conclusions: Unplanned readmissions occur in 6.3% of lower limb fractures sustained in motorcycle crashes. Independent predictors of readmission within 30 days of discharge included male sex, chronic anaemia, smoking status, fracture type and emergency admission. Index admission and readmission hospitalisation costs are substantial and should prompt health services to invest in ways to reduce readmission. [ABSTRACT FROM AUTHOR]

Objective: To observe the effects of general anesthesia combined with femoral nerve and sciatic nerve block on postoperative awakening quality, stress response and cognitive function in patients with lower limb fractures. Methods: 103 patients with lower limb fractures who were treated in our hospital from July 2020 to July 2021 were aelected, and they were divided into control group（51cases, general anesthesia） and observation group（52 cases, general anesthesia combined with femoral nerve and sciatic nerve block）according to the double color ball method. The changes of hemodynamics, postoperative awakening quality, stress response and cognitive function in two groups were observed, and the perioperative adverse reactions in two groups were recorded. Results: The heart rate（HR）and mean arterial pressure（MAP） in the two groups after induction anesthesia（T2） time points were lower than those before anesthesia（T1）. There was no significant difference in the incidence of adverse reactions between the two groups（P>0.05）. HR and MAP in the observation group were lower than those in the control group from immediately（T3） to 60min（T5） after laryngeal mask（P<0.05）. The awakening time in the observation group was shorter than that in the control group, and the incidence of agitation was lower than that in the control group（P<0.05）. The adrenaline（E） and cortisol（Cor） in the two groups in the anesthesia awakening period were higher than those in the anesthesia maintenance period, but the observation group was lower than the control group（P<0.05）. The scores and total scores of visual space and execution, memory, naming, attention, language, abstraction, directional force and delayed recall in the observation group were higher than those in the control group（P<0.05）. Conclusion: General anesthesia combined with femoral nerve and sciatic nerve block for patients with lower limb fracture can stabilize hemodynamics, improve postoperative awakening quality, reduce stress response and influence on cognitive function. [ABSTRACT FROM AUTHOR]

The incidence of open tibia/fibula fractures in the elderly is increasing, but current national guidelines focus on the aggressive treatment of high-energy injuries in younger patients. There is conflicting evidence regarding whether older age affects treatment provision and outcomes in open fractures. The aim of this study was to determine if elderly patients are sustaining a different injury to younger patients and how their treatment and outcomes differ. This may have implications for future guidelines and verify their application in the elderly.In this retrospective single centre cohort study (December 2015–July 2018), we compared the injury characteristics, operative management and outcomes of elderly (≥65 years) and younger (18–65 years) patients with open tibia/fibula fractures. An extended cohort examined free flap reconstruction.In total, 157 patients were included. High-energy injuries were commoner in younger patients (88% vs 37%; p

Telemedicine is the combination of technologies and activities that offer new remote ways of medical care. The Sm@rtEven application project is a remote assistance service that follows patients affected by lower limb fractures surgically treated at Galeazzi Orthopedic Institute (Milan, Italy). The Sm@rtEven application aims to evaluate the clinical conditions of patients treated for lower limb fracture after discharge from hospital using remote follow-up (FU). The project is not a substitute for traditional clinical consultations but an additional tool for a more complete and prolonged view over time. The Sm@rtEven application is installed on patients' smartphones and is used daily to communicate with healthcare personnel. In the first protocol, patients had to complete different tasks for 30 days, such as monitoring the load progression on the affected limb, the number of steps during the day, and body temperature and completing a questionnaire. A simplified protocol was proposed due to the pandemic and logistical issues. The revised protocol enrolled patients after more than 30 days of their operation, prioritized the rehabilitation phase, and required patients to use the app for fewer days. After an initial phase of correct use, a reduction in patient compliance was gradually reported in the first protocol. However, patient compliance in the second protocol remained high (96.25%) in the recording of all the required parameters. The Sm@rtEven application has proven to be a valuable tool for following patients remotely, especially during the pandemic. Telemedicine has the same value as traditional clinical evaluations, and it enables patients to be followed over long distances and over time, minimizing any discomfort. [ABSTRACT FROM AUTHOR]

Background: To determine the clinical outcomes following fibula nail fixation and to identify the indication for the use of fibula nails in lower limb fractures. Methods: Retrospective study of adult patients from 2 major trauma centers (MTCs) and 9 trauma units (TUs) who underwent fibula nail fixation for AO/OTA 44 fractures between January 1, 2018, and October 31, 2020. Outcome measures included infection, metalwork complications, nonunion or malunion, time to union, and length of inpatient hospital stay. Results: Ninety-five patients were included, with a mean age of 66 years; 57.9% of patients were female. The average body mass index was 30. Sixty-nine patients (72.6%) sustained a Weber B and 24 (27.4%) sustained a Weber C fracture. In addition, 26.3% were open fractures and all patients had soft tissue compromise affecting the lateral malleolus. The calculated infection rate for fibula nail was 4.2% and metalwork complication rate was 5.2%. The nonunion and malunion rate was 8.4% and rate of removal of hardware was 2.1%. The average time to union was 12.5 weeks, and length of inpatient stay was 9.4 days (SD 10). Conclusion: This multicenter study demonstrates that use of a fibula nail appears to be a safe approach to treating patients who have a physiologically higher risk of surgery, poor skin condition, and a complex fracture pattern. Level of Evidence: Level III, case-control study. [ABSTRACT FROM AUTHOR]

Background: Diabetic patients usually experience neuropathic pain and have a decreased response to opioids. Fractures are acute conditions and as such, they are very painful. No data is available related to fracture and postoperative pain in diabetics. Aim: This study was conducted to evaluate postoperative pain and analgesics requirement among diabetic and nondiabetic patients undergoing lower limb fracture surgery and the effect of glycosylated hemoglobin (HbA1c) on the postoperative pain. Setting and Design: This was a prospective observational study, conducted on 80 patients comprising of nondiabetic and diabetic, scheduled for elective lower limb fracture surgery under spinal anesthesia. Materials and Methods: HbA1c was done in all the patients who were included in the study. Postoperative Visual Analog Scale (VAS) and analgesic consumption were assessed by an anesthesiologist blinded to the diabetic or nondiabetic status of the patients. VAS was assessed every 2nd hourly, for 24 h and rescue analgesia was given if the VAS was ≥4 and record was maintained. Sedation scores and adverse effects were also recorded postoperatively. Statistical Analysis: The Chi-square test was used for the analysis of categorical variables and Student's t-test was used for continuous variables. Results: Diabetic group of patients had a significantly high VAS score with P ≤ 0.05. Rescue analgesics requirement was significantly different in two groups with diabetic patients requiring more supplementation of analgesia with a P = 0.025. The overall patient satisfaction was lesser in diabetic group (P = 0.004). There was statistically significant correlation between glycosylated hemoglobin and VAS at 2nd, 16th, 18th, 20th, 22nd, and 24th h. Conclusion: Postoperative pain and analgesic requirement was significantly higher in diabetic patients with lower limb fracture. Glycosylated hemoglobin had good correlation with higher VAS. [ABSTRACT FROM AUTHOR]

Objective: To investigate the study of influences of dexmedetomidine combined with sevoflurane anesthesia on stress response, hemodynamics and its myocardial protective effects in patients with lower limb fracture. Methods: 116 patients with lower limb fracture were selected. They were divided into control group (n=58) and observation group (n=58) according to the random stratified sampling method, the control group was given dexmedetomidine combined with propofol during anesthesia, the observation group was given dexmedetomidine combined with sevoflurane during anesthesia, hemodynamic indexes, stress response indexes, myocardial indexes, postoperative pain and adverse reactions were compared between the two groups. Results: The heart rate (HR), mean arterial pressure (MAP) of the observation group were lower than those of the control group on the time point of during extubating (T2) ~ 10min after extubation T4 (P<0.05). There was no difference in the incidence of adverse reactions between the two groups (P>0.05). The cortisol (Cor), epinephrine (E) of the two groups were higher than those of before operation 1d after operation, but the observation group was lower than that of the control group (P<0.05). The creatine kinase (CK), lactate dehydrogenase (LDH), cardiac troponin (cTnI) in the observation group were lower than those of the control group 1d after operation (P<0.05). The visual analogue scale (VAS) scores of the observation group were all lower than those of the control group 6 h after operation, 12 h after operation, 24 h after operation (P<0.05). Conclusion: Dexmedetomidine combined with sevoflurane anesthesia can stabilize the hemodynamics of patients with lower limb fracture, reduce the body stress response and postoperative pain, which can also play a certain role in myocardial protection at the same time. [ABSTRACT FROM AUTHOR]

Telemedicine is the combination of technologies and activities that offer new remote ways of medical care. The Sm@rtEven application project is a remote assistance service that follows patients affected by lower limb fractures surgically treated at Galeazzi Orthopedic Institute (Milan, Italy). The Sm@rtEven application aims to evaluate the clinical conditions of patients treated for lower limb fracture after discharge from hospital using remote follow-up (FU). The project is not a substitute for traditional clinical consultations but an additional tool for a more complete and prolonged view over time. The Sm@rtEven application is installed on patients’ smartphones and is used daily to communicate with healthcare personnel. In the first protocol, patients had to complete different tasks for 30 days, such as monitoring the load progression on the affected limb, the number of steps during the day, and body temperature and completing a questionnaire. A simplified protocol was proposed due to the pandemic and logistical issues. The revised protocol enrolled patients after more than 30 days of their operation, prioritized the rehabilitation phase, and required patients to use the app for fewer days. After an initial phase of correct use, a reduction in patient compliance was gradually reported in the first protocol. However, patient compliance in the second protocol remained high (96.25%) in the recording of all the required parameters. The Sm@rtEven application has proven to be a valuable tool for following patients remotely, especially during the pandemic. Telemedicine has the same value as traditional clinical evaluations, and it enables patients to be followed over long distances and over time, minimizing any discomfort.

Background: Lower limb trauma in emergency settings often leads to pain management challenges. Traditional methods, primarily non-steroidal anti-inflammatory drugs (NSAIDs) and opioids, have limitations. This study explores the efficacy of epidural analgesia in emergency for lower limb trauma patients (ELETRA) as an alternative for managing pain in lower limb trauma patients upon arrival in emergency care., Objectives:  This study primarily focuses on determining ELETRA's effectiveness in reducing pain for patients with lower limb trauma upon arrival. It also aims to evaluate ELETRA's influence on decreasing stress and shortening hospital stays compared to traditional pain management approaches., Methods: This study was executed as a prospective, parallel-design, randomized controlled trial in the emergency department of a tertiary care teaching hospital. The interventions were performed in a dedicated induction room adjacent to the emergency operating theater. The trial was registered in the Clinical Trial Registry of India with registration number CTRI/2022/08/044699 dated 16/08/2022. Participants were 18- to 50-year-old patients with lower limb injuries, classified under American Society of Anesthesiologists (ASA) class 1 or 2. Participants were randomized into two groups: one receiving ELETRA and the other standard pain control treatment. The effectiveness of pain relief was measured through a visual analog scale (VAS), and hemodynamic parameters, adverse effects, levels of acute phase reactants, and stress hormones were also measured along with patient satisfaction., Results: The study enrolled 356 participants with lower limb injuries. After excluding participants lost following the intervention, data from 157 individuals in Group A and 160 in Group B were analyzed. Group A's success rate for analgesia (VAS < 2) was 92.35% (n = 145), significantly higher than Group B's 75.62% (n = 121) (p < 0.001). The commonest side effect was hypotension (5.73%) in Group A and nausea in Group B (7.5%). C-reactive protein (CRP) levels rose to 104.71 ± 8.99 mg/dL in Group A and 192.58 ± 9.23 mg/dL in Group B; the difference was statistically significant. Serum cortisol levels were also higher in Group B (67.18 ± 9.21) compared to Group A (44.72 ± 6.14) at one week. Group B had a longer hospital stay, averaging 12.24 ± 4.81 days, against Group A's 10.19 ± 4.91 days., Conclusion: ELETRA is a safe and effective alternative for pain management in lower limb trauma patients in emergency settings. It reduces pain, improves patient satisfaction, and has a favorable impact on stress responses., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Jain et al.)

Introduction: External fixation devices are commonly used in orthopaedic surgery to manage a range of pathologies. In this patient population, there is currently no consensus on optimal rehabilitation techniques. There exists a large variation in practice, with a limited understanding of how these affect treatment outcomes., Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, a systematic review was conducted of Allied and Complementary Medicine Database (AMED), Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, PEDro, and COCHRANE databases, grey literature sources and forward and backward searching of included articles. Studies were selected following rigorous screening with predefined inclusion criteria. Data quality was assessed using validated appraisal tools. Articles were synthesised by rehabilitation type and descriptive analysis was subsequently performed., Results: From 1,156 articles identified, 18 were eligible for inclusion. The overall quality was low, with clinical commentaries and case studies being the most common study type. Studies were synthesised by rehabilitation type, the most common themes being gait re-education, strengthening, therapy-assisted, active exercises and weight-bearing exercises., Conclusion: There is a lack of high-quality evidence to support meaningful recommendations and guide rehabilitation practices for this patient cohort. Further research for patients being treated in external fixation, especially related to the potential effects of physical rehabilitation on bone healing, return of strength, mobility and independent function is likely to have transferability within wider orthopaedic populations., Clinical Significance: This systematic review is unable to provide clinical recommendations due to the poor quality of the available literature. However, it is hoped this paper will provide a foundation for further research to improve rehabilitation for patients being treated with external fixation., How to Cite This Article: Pawson JR, Church D, Fletcher J, et al . Rehabilitation Techniques for Adults Undergoing External Fixation Treatment for Lower Limb Reconstruction: A Systematic Review. Strategies Trauma Limb Reconstr 2024;19(1):45-55., Competing Interests: Source of support: Nil Conflict of interest: None, (Copyright © 2024; The Author(s).)

Objective: Through the analysis of the effect of combined spinal and epidural anesthesia on white blood cell (WBC), albumin (ALB), C-reactive protein (CRP), procalcitonin (PCT) in lower extremity fracture surgery, to explore the application value of combined spinal and epidural anesthesia in the operation of lower limb fracture. Methods: From December 2018 to October 2019, 88 elderly patients with hip fracture operation were selected and divided into observation group (n=48) and control group (n=40) according to different anesthesia methods. The control group received general anesthesia, while the observation group received combined spinal and epidural anesthesia. WBC, CRP, ALB and PCT were used as observation indicators, combined with postoperative pain and intraoperative anesthesia to the response of combined spinal and epidural anesthesia in lower limb fracture operation. Results: The resting pain scores of the observation group at 4 h, 24 h and 48 h after operation in the observation group were significantly lower than those of the control group (P<0.05). The sensory block time, block time and pain recovery time of the observation group were significantly lower than those of the control group (P<0.05). There were no significant differences in WBC and ALB compared between the observation group and the control group at 1 and 7 d after operation (P>0.05). The serum CRP and PCT levels in the observation group were significantly lower than those in the control group at 1 and 7 d after operation (P<0.05). Conclusion: The application of combined spinal-epidural anesthesia anesthesia in lower limb fracture surgery does not affect the expression of WBC and ALB, but can reduce the blood concentration of CRP and PCT, it can improve the anesthetic effect, play a analgesic role, prolong the postoperative painless time, so that promoting the recovery of patients. [ABSTRACT FROM AUTHOR]

The article presents current data about the risk factors of main lower limb fractures (LLFs) of different localization (femur, tibia and foot). It has been shown that the most studies examine epidemiology and risk factors for hip fractures, but information about the risk factors for other LLFs is insufficient and controversial. It has been demonstrated that in addition to factors of age and sex, the road traffic accidents, sports, inadequate physical activity, injuries, falls and previous fractures play the important role in the development of LLFs. Also some diseases (systemic osteoporosis, large joints osteoarthritis, rheumatoid arthritis, dementia, epilepsy, alcoholism, parkinsonism, cancer, obesity and cataract) can influence the LLFs risk. Administration of some drugs, in particular, hypnotic and sedative, as well as antidepressants, antipsychotic drugs and glucocorticoids, is the additional risk factor for LLFs. Almost all types of fractures in women are associated with low bone mineral density, which is more defined at femoral neck than at spine or peripheral skeleton, but part of fractures associated with osteoporosis is small and ranges from 10 to 44 %. The assessment of risk factors should necessarily be carried out in routine clinical practice in patients with LLFs, since it affects not only their incidence, but also the prognosis of treatment of these patients.

Copyright of Practical Pharmacy & Clinical Remedies is the property of Editorial Department of Practical Pharmacy & Clinical Remedies and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective To study the changes of bone mineral density ( BMD) and its significance in patients after lower limb fracture operation． Methods One hundred and two lower limb fracture patients at the Department of Orthopedics，the First Affiliated Hospital of Dalian Medical University from October 2014 to October 2017，were admitted to the study，including 55 males and 47 females． They were from 20 to 60 years old，with an average of 43. 5 ±12. 5 years． Among those，84 cases were unilateral fracture，18 cases were bilateral fractures． There were 22 cases of open injury and 80 cases of close injury． The operations were performed in 2 hours to 7 days after the fracture． They were followed up at the 1，2，3，6，and 12 months after the operation． BMD of the both calcaneus was measured using ultrasonic bone densitometry． BMD of the both calcaneus was measured in 39 healthy outpatients at the same period，and the average was used as the control． The change of BMD after fractures was observed，and the influencing factors were analyzed． Results 1) BMD of the patients with unilateral lower limb fracture decreased rapidly from 1 to 3 months． The decrease was slow in the period from 3 to 6 months，and the lowest point was at the end of 6 months after the operation． BMD increased slowly from 6 to 12 months，but it was still lower at 12 months than at the level of preinjury． Comparing the BQI value among the healthy limb，the affected limb，and the controls in 1，2，3，6，and 12 months after the operation group，the difference was statistically significant，and the difference between any two groups was statistically significant ( P < 0. 05) ． ( 2) in patients with unilateral lower limb fractures，the BQI value ins male was higher than that in females，but the difference was not statistically significant ( P > 0. 05) ． ( 3) There was not significant difference of BMD of the healthy limb and the affected limb between the different anatomic sites of single side fracture ( P > 0. 05) ． BMD of the unilateral fracture was higher than that of bilateral fracture，and the difference was statistically significant ( P < 0. 05) in 2，3，6，and 12 months after the operation． ( 4) BMD in Gustilo-Anderson type Ⅲ of the open injury was significantly different compared with that of the close injury in 2，3，6， and 12 months after operation ( P < 0. 05) ． BMD in Gustilo-Anderson type I and II of open injury was not statistically different compared to the closed injury ( P > 0. 05) ． Conclusion In the healing process of lower limb fracture，BMD of the lower limb decreases rapidly in 1 － 3 months，slowly in 3 － 6 months，and increases slowly in 6 － 12months． It may be related to the decrease of limb activity，the decrease of mechanical stress，and the degree of soft tissue injury around the fracture． Anatomical site of fracture and gender may have no significant influence on the changes of BMD． It is necessary to have early exercise and combination drug therapy in order to prevent the decrease of BMD and the occurrence of disused osteoporosis．` [ABSTRACT FROM AUTHOR]

Objective: To analyze the analgesic effect of combined spinal epidural anesthesia (CSEA) and lumbar plexus-sciatic nerve blocks (LPSB) on the elderly patients with lower limb orthopedic surgery. Methods: 158 cases of elderly patients with surgical treatment of lower limb fracture in our hospital were chosen. The patients were randomly divided into two groups (combined spinal epidural anesthesia was performed in the combined spinal epidural anesthesia (CSEA) group and the lumbar plexus and sciatic nerves were blocked in the lumbar plexus-sciatic nerve blocks (LPSB) group. The onset of sensory-motor block, success in providing adequate anesthesia, hemodynamic changes, first analgesic request time and VAS socrewere recorded. Results: One patient in the CSEA group and three patients in the LPSB group required general anesthesia due to failed block of each patient were observed. There was no significant differences in the success of providing adequate anesthesia between two groups. The onset of sensory-motor block and the first analgesic request time were significantly later in the LPSB group than CSEA group. However, the duration of analgesia in the LPSB group were longer than CSEA group, the VAS score in LPSB group was significantly lower than CSEA group. Conclusions: The lumbar plexus-sciatic nerve blocks could provide effective unilateral anesthesia and offer a beneficial alternative to combined spinal epidural anesthesia in patients undergoing lower limb orthopedic surgery. [ABSTRACT FROM AUTHOR]

Copyright of Practical Pharmacy & Clinical Remedies is the property of Editorial Department of Practical Pharmacy & Clinical Remedies and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article presents current data about the risk factors of main lower limb fractures (LLFs) of different localization (femur, tibia and foot). It has been shown that the most studies examine epidemiology and risk factors for hip fractures, but information about the risk factors for other LLFs is insufficient and controversial. It has been demonstrated that in addition to factors of age and sex, the road traffic accidents, sports, inadequate physical activity, injuries, falls and previous fractures play the important role in the development of LLFs. Also some diseases (systemic osteoporosis, large joints osteoarthritis, rheumatoid arthritis, dementia, epilepsy, alcoholism, parkinsonism, cancer, obesity and cataract) can influence the LLFs risk. Administration of some drugs, in particular, hypnotic and sedative, as well as antidepressants, antipsychotic drugs and glucocorticoids, is the additional risk factor for LLFs. Almost all types of fractures in women are associated with low bone mineral density, which is more defined at femoral neck than at spine or peripheral skeleton, but part of fractures associated with osteoporosis is small and ranges from 10 to 44 %. The assessment of risk factors should necessarily be carried out in routine clinical practice in patients with LLFs, since it affects not only their incidence, but also the prognosis of treatment of these patients. [ABSTRACT FROM AUTHOR]

Background & Objectives: Uncontrolled postoperative pain can cause many adverse effects such as tachycardia, hypertension, myocardial ischemia, decreased alveolar ventilation and poor wound healing. In this study we evaluated the preoperative administration of pregabalin in relieving postoperative pain after lower limb orthopedic surgery and reducing the need for opioids and their possible side effects. Methods: This study is a randomized, double-blind clinical trial. It was performed on 60 patients under lower limb surgery in Fatemi Hospital. Patients were randomly allocated to two groups, one group has received a 150 mg pregabalin capsule 2 hours before surgery and the other group has received placebo as a control. In both groups at 2, 6, 12 and 24 hours after surgery, the patients were evaluated and the pain score by a visual analogue scale (VAS), the score of sedation by Ramsay sedation scale and the incidence of nausea and vomiting were recorded in the checklists. Then, the data were analyzed by SPSS v16. P

A descriptive-co relational study was conducted to assess severity of pain, level of anxiety and functional status of patients with lower th rd limb fracture and dislocation after open reduction from 17th September to 3rd Nov 2012. Purposive sampling technique was used to select the subjects for the study. Data was collected by using demographic proforma, Numerical Pain Rating Scale, Beck's Anxiety Inventory and Functional status rating scale. The findings of the study showed that out of sixty samples, majority were males 49 (82%). Majority of the subjects 53(88%) were married. Nature of job revealed that 21 (35%) were laborers. 27 (45%) of the subjects had monthly income between 5001-8000 rupees. 32 (53.3%) had no habits of smoking, alcoholism or tobacco chewing. The findings of the study revealed that on the first post-operative day the mean value of pain (8.70), anxiety (22.85) and functional status scores (49.20) was greater than the pain (1.70), anxiety (11.90) and functional status scores (3.453) of the tenth post-operative day. A significant association was found between functional status and age (p=0.043, 0.05 level of significance).No significant correlation was found between severity of pain, level of anxiety and functional status of these patients. [ABSTRACT FROM AUTHOR]

Copyright of Practical Pharmacy & Clinical Remedies is the property of Editorial Department of Practical Pharmacy & Clinical Remedies and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aims: This study aims to estimate economic outcomes associated with 30-day deep surgical site infection (SSI) from closed surgical wounds in patients with lower limb fractures following major trauma., Methods: Data from the Wound Healing in Surgery for Trauma (WHiST) trial, which collected outcomes from 1,547 adult participants using self-completed questionnaires over a six-month period following major trauma, was used as the basis of this empirical investigation. Associations between deep SSI and NHS and personal social services (PSS) costs (£, 2017 to 2018 prices), and between deep SSI and quality-adjusted life years (QALYs), were estimated using descriptive and multivariable analyses. Sensitivity analyses assessed the impact of uncertainty surrounding components of the economic analyses., Results: Compared to participants without deep SSI, those with deep SSI had higher mean adjusted total NHS and PSS costs (adjusted mean difference £1,577 (95% confidence interval (CI) -951 to 4,105); p = 0.222), and lower mean adjusted QALYs (adjusted mean difference -0.015 (95% CI -0.032 to 0.002); p = 0.092) over six months post-injury, but this difference was not statistically significant. The results were robust to the sensitivity analyses performed., Conclusion: This study found worse economic outcomes during the first six months post-injury in participants who experience deep SSI following orthopaedic surgery for major trauma to the lower limb. However, the increase in cost associated with deep SSI was less than previously reported in the orthopaedic trauma literature. Cite this article: Bone Jt Open  2022;3(5):398-403.

Objectives: Clinical assessment can stratify a patient's probability of having deep venous thrombosis but is insufficient on its own to establish or exclude the diagnosis. D-dimer is a marker of endogenous fibrinolysis and patient with deep vein thrombosis (DVT) can have elevated D-dimer assay. Plasma D-dimer assay can be a useful tool to predict the presence of deep vein thrombosis. Design: This is a prospective study carried out in orthopaedic clinic, Hospital Universiti Sains Malaysia. All patients with lower limb injury requiring cast immobilization treated at orthopedic clinic were included in the study. Materials and methods: Blood samples were taken from patients with clinical evidence of deep vein thrombosis for measurement of plasma D-dimer levels using immuno-turbidimetric STA Liatest D-DI kit (Diagnostica Stago, USA). Color Doppler ultrasound was performed to confirm the diagnosis of deep vein thrombosis. Fisher exact test were used to identify the significant association between D-dimer and color Doppler results. Results: Forty 40 patients who were on cast immobilization due to lower limb fracture were included in the study. Majorities were diagnosed to have fracture of tibia and were put on above knee cast. Eight patients were presented with the clinical evidence of deep vein thrombosis. One patient has evidence of deep vein thrombosis confirmed by positive D-dimer assay and color Doppler ultrasound. Seven patients with negative D-dimer assay were also negative for color Doppler ultrasound. Conclusion: D-dimer assay is a useful and non invasive test which simplifies and provides safe management strategy for exclusion of thrombosis in patients with clinically suspected deep vein thrombosis [ABSTRACT FROM AUTHOR]

Aims: Deep surgical site infection (SSI) is common after lower limb fracture. We compared the diagnosis of deep SSI using alternative methods of data collection and examined the agreement of clinical photography and in-person clinical assessment by the Centers for Disease Control and Prevention (CDC) criteria after lower limb fracture surgery., Methods: Data from two large, UK-based multicentre randomized controlled major trauma trials investigating SSI and wound healing after surgical repair of open lower limb fractures that could not be primarily closed (UK WOLLF), and surgical incisions for fractures that were primarily closed (UK WHiST), were examined. Trial interventions were standard wound care management and negative pressure wound therapy after initial surgical debridement. Wound outcomes were collected from 30 days to six weeks. We compared the level of agreement between wound photography and clinical assessment of CDC-defined SSI. We are also assessed the level of agreement between blinded independent assessors of the photographs., Results: Rates of CDC-defined deep SSI were 7.6% (35/460) after open fracture and 6.3% (95/1519) after closed incisional repair. Photographs were obtained for 77% and 73% of WOLLF and WHiST cohorts respectively (all participants n = 1,478). Agreement between photographic-SSI and CDC-SSI was fair for open fracture wounds (83%; k = 0.27 (95% confidence interval (CI) 0.14 to 0.42)) and for closed incisional wounds (88%; k = 0.29 (95% CI 0.20 to 0.37)) although the rate of photographically detected deep SSIs was twice as high as CDC-SSI (12% vs 6%). Agreement between different assessors for photographic-SSI (WOLLF 88%, k = 0.63 (95% CI 0.52 to 0.72); WHiST 89%; k = 0.61 (95% CI 0.54 to 0.69)); and wound healing was good (WOLLF 90%; k = 0.80 (95% CI 0.73 to 0.86); WHiST 87%; k = 0.57 (95% CI 0.50 to 0.64))., Conclusion: Although wound photography was feasible within the research context and inter-rater assessor agreement substantial, digital photographs used in isolation overestimated deep SSI rates, when compared to CDC criteria. Wound photography should not replace clinical assessment in pragmatic trials but may be useful for screening purposes where surgical infection outcomes are paramount. Cite this article: Bone Joint J  2021;103-B(12):1802-1808.

The incidence of open tibia/fibula fractures in the elderly is increasing, but current national guidelines focus on the aggressive treatment of high-energy injuries in younger patients. There is conflicting evidence regarding whether older age affects treatment provision and outcomes in open fractures. The aim of this study was to determine if elderly patients are sustaining a different injury to younger patients and how their treatment and outcomes differ. This may have implications for future guidelines and verify their application in the elderly. In this retrospective single centre cohort study (December 2015-July 2018), we compared the injury characteristics, operative management and outcomes of elderly (≥65 years) and younger (18-65 years) patients with open tibia/fibula fractures. An extended cohort examined free flap reconstruction. In total, 157 patients were included. High-energy injuries were commoner in younger patients (88% vs 37%; p<0.001). Most were Gustilo-Anderson IIIb in both age groups. Elderly patients waited longer until debridement (21:19 vs 19:00 h) and had longer inpatient stays (23 vs 15 days). There was no difference in time to antibiotics, operative approach or post-operative complications. Despite the low-energy nature of elderly patients' injuries, the severity of soft tissue insult was equivalent to younger patients with high-energy injuries. Our data suggest that age and co-morbidities should not prohibit lower limb reconstruction. The current application of generic guidelines appears suitable in the elderly, particularly in the acute management. We suggest current management pathways and targets be reviewed to reflect the greater need for peri-operative optimisation and rehabilitation in elderly patients., (© 2021 The Authors.)

Thinking of the future and walking back to normal: an exploratory study of patients’ experiences during recovery from lower limb fracture ¶ Admission to hospital following a traumatic lower limb fracture is undoubtedly a stressful life event; however, few studies have detailed this from the patient’s perspective. By exploring patients’ experiences of hospitalization with lower limb trauma, this study aimed to explicate some of the factors impinging on the recovery trajectory. Patients’ perceptions of the events influencing their strategies for coping with stress, hospitalization and temporary incapacity were investigated using a qualitative methodology. A convenience sample of nine patients was recruited from an orthopaedic ward in a district general hospital in Wales. The respondents used health diaries to document their recovery for up to 6 weeks after emergency surgery. These diaries were validated and supplemented by semi-structured interviews. Following their traumatic injuries, our respondents were subjected to a variety of stressors and uncertainties. They coped with this period of uncertainty by positive attempts to gain control over their situations, guided by an over-riding desire to ‘return to normal’ and assisted by the caring attributes of their nurses. From the experiences and events documented, this study was able to identify several stressors which could have been mitigated by optimization of the technical aspects of care, including the management of pain. [ABSTRACT FROM AUTHOR]

Copyright of Der Unfallchirurg is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)