Notes

Polymer-Based Resources along with their Applications within Image-Guided Most cancers Treatment.
Most retained guidewires are discovered after the procedure. Despite the introduction of safety measures, guidewire retention still occurs because the checks, alerts, reminders, and additional checklists all solely rely on the operator remembering not to make the mistake. System changes or design modifications to the CVC equipment are needed to prevent guidewire retention, this being at the top of the hierarchy of intervention effectiveness.
Most retained guidewires are discovered after the procedure. Despite the introduction of safety measures, guidewire retention still occurs because the checks, alerts, reminders, and additional checklists all solely rely on the operator remembering not to make the mistake. System changes or design modifications to the CVC equipment are needed to prevent guidewire retention, this being at the top of the hierarchy of intervention effectiveness.
To review a large, multicenter experience to identify the current salvage and amputation rates of these combined injuries and where possible, the variables that predict amputation.

Retrospective.

Nice trauma centers.

199 patients presenting to 9 trauma centers with orthopaedic and vascular injuries resulting in ischemic limbs for whom the orthopaedic service was involved with the decision for salvage vs. amputation.

We reviewed 199 patients, aged 17-85 years. 172 of the injuries were open. Thirty-eight (19%) were treated with amputation upon admission as they were deemed to be unsalvageable. Of the remaining 161 who had attempted salvage, 36 (30%) required late amputation. Closed injuries were successfully salvaged in 25/27 cases (93%). The highest rate of amputation was in tibia fractures with a combined amputation rate of 62%. In those attempted to be salvaged, 21/48 (44%) required amputation. Triptolide The ischemia time for successful salvage was significantly less, p = 0.03. 124 patients had their definitive vascular repair prior to the bony reconstruction. There were 15 vascular complications, of which 13 (86%) had the definitive vascular repair performed prior to the definitive osseous repair, although this was not statistically significant.

In this series of combined orthopaedic and vascular injuries, we found a high rate of acute and late amputations. It is possible that other protocols, such as shunting and stabilizing the osseous injury prior to vascular repair may benefit limb salvage, although this needs more study.

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
To evaluate rates of complications in patients with bilateral femur fractures treated with intramedullary nailing (IMN) during either one single procedure or two separate procedures.

A multicenter retrospective review of patients sustaining bilateral femur fractures, treat with IMN in single or two-stage procedure, from 1998-2018 was performed at ten level-1 trauma centers.

Ten level-1 trauma centers.Patients/Participants 246 patients with bilateral femur fractures.

Intramedullary nailing.

Incidence of complications.

A total of 246 patients were included, with 188 single-stage and 58 two-stage patients. Gender, age, ISS, AIS, secondary injuries, GCS, and proportion of open fractures were similar between both groups. Acute respiratory distress syndrome (ARDS) occurred at higher rates in the two-stage group (13.8% versus 5.9%, p-value = 0.05). When further adjusted for age, gender, ISS, AIS, GCS, and admission lactate, the single-stage group had a 78% reduced risk for ARDS. In-hospital mortality was higher in the single-stage cohort (2.7% compared to 0%), although this did not meet statistical significance (p=0.22).

This is the largest multicenter study to date evaluating the outcomes between single- and two- stage IMN fixation for bilateral femoral shaft fractures. Single-stage bilateral femur IMN may decrease rates of ARDS in polytrauma patients who are able to undergo simultaneous definitive fixation. However, a future prospective study with standardized protocols in place will be required to discern whether single- versus two-stage fixation has an effect on mortality and to identify those individuals at risk.

Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
This systematic review was performed to answer the following questions (1) Does early weightbearing (WB) after ankle fracture (AF) open reduction internal fixation (ORIF) affect outcomes? (2) Does early WB after AF ORIF cause an increase in complications? (3) Does early ankle motion after AF ORIF affect outcomes? (4) Does early ankle motion after AF ORIF cause an increase in complications?

Articles from 1970-2020 were found using the PubMed database.

Level I studies of adult patients with operatively treated ankle fractures were selected. A total of 1,130 cases across 20 studies fit the participant criteria.

Studies were reviewed for data pertaining to the current study questions.

The meta-analysis used logistic regression and standardized mean difference.

Based on current literature, early WB in operative ankle fractures with stable fixation showed no difference in outcomes when compared to delayed WB protocols. Early WB after ORIF did not significantly increase complications. Early ankle motion after AF ORIF did not have significant standardized mean differences between range of motion and immobilization outcomes. Early range of motion before wound healing may lead to an increase in complications (pooled OR 3.11, 95% CI1.64, 5.90), but did not show an increase in infection.

We recommend that early WB at 2 weeks postoperatively can be safely considered for ankle fractures when stable fixation has been obtained. Early ankle motion prior to wound healing is not recommended due to increased wound complications, without improvement in long-term results.

Level I. See Instructions for Authors for a complete description of levels of evidence.
Level I. See Instructions for Authors for a complete description of levels of evidence.
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