Recent reports have suggested that functional outcomes are similar following either amputation or reconstruction of a severely injured lower extremity. The goal this study was to compare two-year direct health-care costs and projected lifetime associated with these two treatment pathways.Two-year were estimated for 545 patients unilateral limb-threatening lower-extremity injury treated at one eight level-I trauma centers. Included in the calculation related (1) initial hospitalization, (2)...

The purpose of the present study was to discover any associations between preoperative variables and occurrence wound complications in surgical treatment calcaneus fractures.Retrospective review.A Level 1 trauma center.One hundred seventy-nine patients, with 190 fractured calcanei, were studied.Each patient underwent open reduction internal fixation for fractures standard techniques.The age, sex, preexisting medical conditions, social history, mechanism injury each recorded. Note made status...

Pelvic fractures may be associated with significant hemorrhage. Although this hemorrhage emanate from the pelvic vasculature, it also secondary to abdominal visceral injury. The purpose of study was determine factors and/or bleeding in hypotensive patients guide appropriate therapeutic intervention sequence for these difficult-to-manage patients.Medical records all (systolic blood pressure < or = 90 mm Hg) seen at a Level I trauma center January 1995 December 1999 were evaluated. Records...

Background: A better understanding of the factors influencing return to work (RTW) after major limb trauma is essential in reducing high costs associated with these injuries. Methods: Patients (n = 423) who underwent amputation or reconstruction threatening lower extremity and were working before injury prospectively evaluated at 3, 6, 12, 24, 84 months. Time first RTW was assessed. For individuals months, percentage time limited performance estimated using Work Limitations Questionnaire....

Background: Little is known about the psychological morbidity associated with limb-threatening injuries. It was hypothesized that a substantial proportion of patients who sustain severe lower-limb injury will report serious distress. Methods: Adult were admitted to one eight level-I trauma centers for treatment an threatening lower limb enrolled during their initial hospitalization. Patients recontacted at three, six, twelve, and twenty-four months after asked complete Brief Symptom...

To determine if age, fracture pattern, systolic blood pressure on arrival, base deficit, or the Revised Trauma Score is predictive of mortality, transfusion requirements, use pelvic arteriography, later complications, injuries associated with ring disruption.Retrospective review a prospectively collected database.All closed disruptions seen between November 1, 1997 and 30, 1999 were included. Predictive variables outcome recorded for each patient. Statistical analysis was used to above...

To measure the failure rate of percutaneous iliosacral screw fixation vertically unstable pelvic fractures and particularly to test hypothesis that fixations in which posterior injury is a vertical fracture sacrum are more likely fail than with dislocations or fracture-dislocations sacroiliac joint.Retrospective review.Level 1 trauma center.All patients admitted between January 1, 1993, December 31, 1998, were identified from registry. Hospital records used identify treated screws....

Background: The understanding of the mortality risk posed by pelvic fracture is incomplete. purposes this study were (1) to compare associated with a conferred other injuries and (2) determine if association varies when combined known factors. Methods: Trauma registry records from two level-I trauma centers examined. Regression analysis was done on 63,033 patients assess odds ratio for compared variables such as age, shock, head injury, abdominal or chest extremity injury. A second carried...

The purpose of this study is to present the early complications percutaneous screw fixation superior pubic ramus fractures and a new classification scheme for fractures.Retrospective.Level 1 trauma center.One hundred twelve patients with pelvic fracture between ages 14 89 years underwent 145 fractures. Eighty-one 107 surgically repaired were followed union. Follow-up averaged 9 months (range 2-52 months). One additional patient who sustained failure 4 days after surgery was included yield...

Stabilization after a pelvic fracture can be accomplished with an anterior external fixator. These devices are uncomfortable for patients and at risk infection loosening, especially in obese patients. As alternative, we recently developed subcutaneous internal fixation technique (ASPIF).We asked if the ASPIF (1) allows definitive stabilization of unstable injuries; (2) is well tolerated by mobility comfort; (3) has acceptable complication rate.We retrospectively reviewed 91 who incurred...

A technique for percutaneous placement of cannulated screws in the acetabulum is presented. Surgical described, and fluoroscopic imaging techniques used to guide screw are also illustrated. The was limit soft tissue dissection three patients. Results examples

To measure the failure rate of percutaneous iliosacral screw fixation vertically unstable pelvic fractures and particularly to test hypothesis that fixations in which posterior injury is a vertical fracture sacrum are more likely fail than with dislocations or fracture-dislocations sacroiliac joint.Retrospective review.Level 1 trauma center.All patients admitted between January 1, 1993, December 31, 1998, were identified from registry. Hospital records used identify treated screws....

A technique for closed reduction and percutaneous screw fixation of fractures the iliac wing fracture-dislocations sacro-iliac joint is presented. Twenty-seven pelvic were treated with attempted followed by fixation. Closed failed in two patients. In other twenty-five, to within one centimeter residual displacement was obtained, stabilization percutaneously placed cannulated screws. Complications included dislodgment a from superior pubic ramus patient, partial cut-out along inner cortex...

The purpose of this study was to determine the prevalence posttraumatic stress disorder among patients seen following an orthopaedic traumatic injury and identify whether injury-related or demographic variables are associated with disorder.Five hundred eighty who had sustained trauma completed a Revised Civilian Mississippi Scale for Posttraumatic Stress Disorder questionnaire. Demographic data were collected analyze potential disorder.Two ninety-five respondents (51%) met criteria diagnosis...

To develop a system of quantification shoulder girdle injuries that stratifies their severity and to assess the association between associated nonbony head, thorax, great vessels.Retrospective review.Level I trauma center.Trauma registry data from all patients who required admission hospital October 1995 through January 2008, specifically with injuries. Excluded were isolated burns late effects injuries.Not applicable.The patterns injury severe, nonorthopaedic (head, thoracic, vessel). Also,...

Controversy exists regarding the effect of operative treatment on mortality after acetabular fracture in elderly patients. Our hypothesis was that would confer a benefit compared with nonoperative even adjusting for comorbidities associated death.Retrospective study.Three University Level I Trauma Centers.All patients aged 60 years and older fractures treated from 2002 to 2009 were included study. Four hundred fifty-four identified an average age 74 years. Sixty-seven percent study group...

To present the functional outcomes of elderly patients treated with percutaneous acetabular surgery and compare them those traditional open reduction internal fixation in previously published series.Retrospective.University level I trauma center.All aged 60 older screw for fractures from 1994 to 2007 were included. Seventy-nine consecutive identified. Thirty-six died before obtained, leaving 43 our study group. Functional obtained 35 (81.3%) at an average 6.8 years after index...

Objective The purpose of this study is to compare a cephalomedullary nail that uses piriformis fossa starting point one trochanteric point, in the treatment high-energy proximal femur fractures young patients. Our hypothesis was would result less blood loss than point. Design Prospective, randomized. Setting Level 1 trauma center. Patients Thirty-four consecutive patients aged between 18 and 50 years who sustained subtrochanteric, intertrochanteric, or ipsilateral femoral neck/shaft fracture...

Detection of hemoperitoneum in patients with pelvic fracture and hemodynamic instability is important to determine the need for laparotomy versus angiography. The use ultrasound (FAST [Focused Assessment Sonography Trauma]) evaluation after blunt abdominal trauma has become widespread. However, its sensitivity specificity remain poorly defined. purpose this study was FAST detection an increased risk hemorrhage.The medical records all admissions our Level I center from November 2003 February...

We describe our early operative experience with a new pelvic reduction frame and the standard of fractures ring which we achieved in first 35 consecutive patients, 34 acute one nonunion. The pre-operative immediate post-operative radiographs were measured, using two methods, to find maximum radiological displacement fracture quality according criteria Tornetta Matta. There 19 vertical shear 16 compression injuries. mean age patients was 33.5 years (10 59) delay surgery 4.6 days (0 16) time...

The literature on pelvic ring disruptions is based largely nonstandardized and nonvalidated radiographic outcomes. A thorough review of the revealed only 3 described methods for measuring displacement 1 frequently used grading system displacement. We aimed to test reliability these previously published measurement system.Five separate observers measured standardized pre- postoperative anteroposterior, inlet, outlet views 25 patients with surgically treated Tile B C fractures. readers their...