| 1. |
- Bojan, Alicja J., 1980, et al.
(författare)
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Trochanteric fracture-implant motion during healing - A radiostereometry (RSA) study
- 2018
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Ingår i: Injury-International Journal of the Care of the Injured. - : Elsevier BV. - 0020-1383. ; 49:3, s. 673-679
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Tidskriftsartikel (refereegranskat)abstract
- Cut-out complication remains a major unsolved problem in the treatment of trochanteric hip fractures. A better understanding of the three-dimensional fracture-implant motions is needed to enable further development of clinical strategies and countermeasures. The aim of this clinical study was to characterise and quantify three-dimensional motions between the implant and the bone and between the lag screw and nail of the Gamma nail. Radiostereometry Analysis (RSA) analysis was applied in 20 patients with trochanteric hip fractures treated with an intramedullary nail. The following three-dimensional motions were measured postoperatively, at 1 week, 3, 6 and 12 months: translations of the tip of the lag screw in the femoral head, motions of the lag screw in the nail, femoral head motions relative to the nail and nail movements in the femoral shaft. Cranial migration of the tip of the lag screw dominated over the other two translation components in the femoral head. In all fractures the lag screw slid laterally in the nail and the femoral head moved both laterally and inferiorly towards the nail. All femoral heads translated posteriorly relative to the nail, and rotations occurred in both directions with median values close to zero. The nail tended to retrovert in the femoral shaft. Adverse fracture-implant motions were detected in stable trochanteric hip fractures treated with intramedullary nails with high resolution. Therefore, RSA method can be used to evaluate new implant designs and clinical strategies, which aim to reduce cut-out complications. Future RSA studies should aim at more unstable fractures as these are more likely to fail with cut-out. (C) 2018 Elsevier Ltd. All rights reserved.
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| 2. |
- Buendia, Ruben, 1982, et al.
(författare)
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Bioimpedance technology for detection of thoracic injury
- 2017
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Ingår i: Physiological Measurement. - : IOP Publishing. - 0967-3334 .- 1361-6579. ; 38:11, s. 2000-2014
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Thoracic trauma is one of the most common and lethal types of injury, causing over a quarter of traumatic deaths. Severe thoracic injuries are often occult and difficult to diagnose in the field. There is a need for a point-of-care diagnostic device for severe thoracic injuries in the prehospital setting. Electrical bioimpedance (EBI) is non-invasive, portable, rapid and easy to use technology that can provide objective and quantitative diagnostic information for the prehospital environment. Here, we evaluated the performance of EBI to detect thoracic injuries. Approach: In this open study, EBI resistance (R), reactance (X) and phase angle (PA) of both sides of the thorax were measured at 50 kHz on patients suffering from thoracic injuries (n = 20). In parallel, a control group consisting of healthy subjects (n = 20) was recruited. A diagnostic mathematical algorithm, fed with input parameters derived from EBI data, was designed to differentiate patients from healthy controls. Main results: Ratios between the X and PA measurements of both sides of the thorax were significantly different (p < 0.05) between healthy volunteers and patients with left-and right-sided injuries. The diagnostic algorithm achieved a performance evaluated by leave-one-out cross-validation analysis and derived area under the receiver operating characteristic curve of 0.88. Significance: A diagnostic algorithm that accurately discriminates between patients suffering thoracic injuries and healthy subjects was designed using EBI technology. A larger, prospective and blinded study is thus warranted to validate the feasibility of EBI technology as a prehospital tool.
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| 3. |
- Caragounis, Eva Corina, et al.
(författare)
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CT-lung volume estimates in trauma patients undergoing stabilizing surgery for flail chest.
- 2019
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Ingår i: Injury. - : Elsevier BV. - 1879-0267 .- 0020-1383. ; 50:1, s. 101-8
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Tidskriftsartikel (refereegranskat)abstract
- To estimate and compare lung volumes from pre- and post-operative computed tomography (CT) images and correlate findings with post-operative lung function tests in trauma patients with flail chest undergoing stabilizing surgery.Pre- and post-operative CT images of the thorax were used to estimate lung volumes in 37 patients who had undergone rib plate fixation at least 6 months before inclusion for flail chest due to blunt thoracic trauma. Computed tomography lung volumes were estimated from airway distal to each lung hilum by outlining air-filled lung tissue either manually in images of 5mm slice thickness or automatically in images of 0.6mm slice thickness. Demographics, pain, range of motion in the thorax, breathing movements and Forced Vital Capacity (FVC) were assessed. Total Lung Capacity (TLC) measurements were also made in a subgroup of patients (n=17) who had not been intubated at time of the initial CT. Post-operative CT lung volumes were correlated to FVC and TLC.Patients with a median age of 62 (19-90) years, a median Injury Severity Score (ISS) of 20 (9-54), and a median New Injury Severity Score (NISS) of 27 (17-66) were enrolled in the study. Median follow-up time was 3.9 (0.5-5.6) years. Two patients complained of pain at rest and when breathing. Pre-operative CT lung volumes were significantly different (p<0.0001) from post-operative CT lung volumes, 3.51l (1.50-6.05) vs. 5.59l (2.18-7.78), respectively. At follow-up, median FVC was 3.76l (1.48-5.84) and median TLC was 6.93l (4.21-8.42). Post-operative CT lung volumes correlated highly with both FVC [rs=0.75 (95% CI 0.57‒0.87, p<0.0001)] and TLC [rs=0.90 (95% CI 0.73‒0.96, p<0.0001)]. The operated thoracic side showed decreased breathing movements. Range of motion in the lower thorax showed a low correlation with FVC [rs=0.48 (95% CI 0.19‒0.70, p=0.002)] and a high correlation with TLC [rs=0.80 (95% CI 0.51‒0.92, p<0.0001)].Post-operative CT-lung volume estimates improve compared to pre-operative values in trauma patients undergoing stabilizing surgery for flail chest, and can be used as a marker for lung function when deciding which patient with chest wall injuries can benefit from surgery.
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| 4. |
- Caragounis, Eva Corina, et al.
(författare)
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Surgical treatment of multiple rib fractures and flail chest in trauma: a one-year follow-up study
- 2016
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Ingår i: World Journal of Emergency Surgery. - : Springer Science and Business Media LLC. - 1749-7922. ; 11
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Tidskriftsartikel (refereegranskat)abstract
- Background: Multiple rib fractures and unstable thoracic cage injuries are common in blunt trauma. Surgical management of rib fractures has received increasing attention in recent years and the aim of this 1-year, prospective study was to assess the long-term effects of surgery. Methods: Fifty-four trauma patients with median Injury Severity Score 20 (9-66) and median New Injury Severity Score 34 (16-66) who presented with multiple rib fractures and flail chest, and underwent surgical stabilization with plate fixation were recruited. Patients responded to a standardized questionnaire concerning pain, local discomfort, breathlessness and use of analgesics and health-related quality of life (EQ-5D-3 L) questionnaire at 6 weeks, 3 months, 6 months and 1 year. Lung function, breathing movements, range of motion and physical function were measured at 3 months, 6 months and 1 year. Results: Symptoms associated with pain, breathlessness and use of analgesics significantly decreased from 6 weeks to 1 year following surgery. After 1 year, 13 % of patients complained of pain at rest, 47 % had local discomfort and 9 % used analgesics. The EQ-5D-3 L index increased from 0.78 to 0.93 and perceived overall health state increased from 60 to 90 % (p < 0.0001) after 6 weeks to 1 year. Lung function improved significantly with predicted Forced vital capacity and Peak expiratory flow increasing from 86 to 106 % (p = 0.0002) and 81 to 110 % (p < 0.0001), respectively, from 3 months to 1 year after surgery. Breathing movements and range of motion tended to improve over time. Physical function improved significantly over time and the median Disability rating index was 0 after 1 year. Conclusions: Patients with multiple rib fractures and flail chest show a gradual improvement in symptoms associated with pain, quality of life, mobility, disability and lung function over 1 year post surgery. Therefore, the final outcome of surgery cannot be assessed before 1 year post-operatively.
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| 5. |
- Fagevik Olsén, Monika, 1964, et al.
(författare)
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Physical function and pain after surgical or conservative management of multiple rib fractures - a follow-up study
- 2016
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Ingår i: Scandinavian Journal of Trauma Resuscitation & Emergency Medicine. - : Springer Science and Business Media LLC. - 1757-7241. ; 24:128
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Tidskriftsartikel (refereegranskat)abstract
- Background: There is scarce knowledge of physical function and pain due to multiple rib fractures following trauma. The purpose of this follow-up was to assess respiratory and physical function, pain, range of movement and kinesiophobia in patients with multiple rib fractures who had undergone stabilizing surgery and compare with conservatively managed patients. Methods: A consecutive series of 31 patients with multiple rib fractures who had undergone stabilizing surgery were assessed >1 year after the trauma concerning respiratory and physical function, pain, range of movement in the shoulders and thorax, shoulder function and kinesiophobia. For comparison, 30 patients who were treated conservatively were evaluated with the same outcome measures. Results: The results concerning pain, lung function, shoulder function and level of physical activity were similar in the two groups. The patients who had undergone surgery had a significantly larger range of motion in the thorax (p < 0. 01) and less deterioration in two items in Disability Rating Index (sitting and standing bent over a sink) (p < 0.05). Discussion: It is questionable whether the control group is representative since the majority of patients were invited but refused to participate in the follow-up. In addition, this study is too small to make a definitive conclusion if surgery is better than conservative treatment. But we see some indications, such as a tendency for decreased pain, better thoracic range of motion and physical function which would indicate that surgery is preferable. If operation technique could improve in the future with a less invasive approach, it would presumably decrease post-operative pain and the benefit of surgery would be greater than the morbidity of surgery. Conclusions: Patients undergoing surgery have a similar long-term recovery to those who are treated conservatively except for a better range of motion in the thorax and fewer limitations in physical function. Surgery seems to be beneficial for some patients, the question remains which patients.
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