The Experts below are selected from a list of 6210 Experts worldwide ranked by ideXlab platform
Dipan Bose - One of the best experts on this subject based on the ideXlab platform.
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the tolerance of the Femoral Shaft in combined axial compression and bending loading
Stapp car crash journal, 2009Co-Authors: Johan B Ivarsson, Daniel Genovese, James R Bolton, Jeffrey Richard Crandall, Costin D Untaroiu, Dipan BoseAbstract:The likelihood of a front seat occupant sustaining a Femoral Shaft fracture in a frontal crash has traditionally been assessed by an injury criterion relying solely on the axial force in the femur. However, recently published analyses of real world data indicate that Femoral Shaft fracture occurs at axial loads levels below those found experimentally. One hypothesis attempting to explain this discrepancy suggests that Femoral Shaft fracture tends to occur as a result of combined axial compression and applied bending. The current study aims to evaluate this hypothesis by investigating how these two loading components interact. Femoral Shafts harvested from human cadavers were loaded to failure in axial compression, sagittal plane bending, and combined axial compression and sagittal plane bending. All specimens subjected to bending and combined loading fractured midShaft, whereas the specimens loaded in axial compression demonstrated a variety of failure locations including midShaft and distal end. The interaction between the recorded levels of applied moment and axial compression force at fracture were evaluated using two different analysis methods: fitting of an analytical model to the experimental data and multiple regression analysis. The two analysis methods yielded very similar relationships between applied moment and axial compression force at midShaft fracture. The results indicate that posteroanterior bending reduces the tolerance of the Femoral Shaft to axial compression and that that this type of combined loading therefore may contribute to the high prevalence of Femoral Shaft fracture in frontal crashes. Language: en
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the tolerance of the Femoral Shaft in combined axial compression and bending loading
Stapp car crash journal, 2009Co-Authors: Johan Ivarsson, Daniel Genovese, James R Bolton, Jeffrey Richard Crandall, Costin D Untaroiu, Dipan BoseAbstract:The likelihood of a front seat occupant sustaining a Femoral Shaft fracture in a frontal crash has traditionally been assessed by an injury criterion relying solely on the axial force in the femur. However, recently published analyses of real world data indicate that Femoral Shaft fracture occurs at axial loads levels below those found experimentally. One hypothesis attempting to explain this discrepancy suggests that Femoral Shaft fracture tends to occur as a result of combined axial compression and applied bending. The current study aims to evaluate this hypothesis by investigating how these two loading components interact. Femoral Shafts harvested from human cadavers were loaded to failure in axial compression, sagittal plane bending, and combined axial compression and sagittal plane bending. All specimens subjected to bending and combined loading fractured midShaft, whereas the specimens loaded in axial compression demonstrated a variety of failure locations including midShaft and distal end. The interaction between the recorded levels of applied moment and axial compression force at fracture were evaluated using two different analysis methods: fitting of an analytical model to the experimental data and multiple regression analysis. The two analysis methods yielded very similar relationships between applied moment and axial compression force at midShaft fracture. The results indicate that posteroanterior bending reduces the tolerance of the Femoral Shaft to axial compression and that that this type of combined loading therefore may contribute to the high prevalence of Femoral Shaft fracture in frontal crashes.
Sven Young - One of the best experts on this subject based on the ideXlab platform.
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cost utility analysis of intramedullary nailing and skeletal traction treatment for patients with Femoral Shaft fractures in malawi
Acta Orthopaedica, 2021Co-Authors: Linda Chokotho, Claire A Donnelley, Sven Young, Brian C Lau, Nyengo Mkandawire, Janerik GjertsenAbstract:Background and purpose - In Malawi, both skeletal traction (ST) and intramedullary nailing (IMN) are used in the treatment of Femoral Shaft fractures, ST being the mainstay treatment. Previous studies have found that IMN has improved outcomes and is less expensive than ST. However, no cost-effectiveness analyses have yet compared IMN and ST in Malawi. We report the results of a cost-utility analysis (CUA) comparing treatment using either IMN or ST.Patients and methods - This was an economic evaluation study, where a CUA was done using a decision-tree model from the government healthcare payer and societal perspectives with an 1-year time horizon. We obtained EQ-5D-3L utility scores and probabilities from a prospective observational study assessing quality of life and function in 187 adult patients with Femoral Shaft fractures treated with either IMN or ST. The patients were followed up at 6 weeks, and 3, 6, and 12 months post-injury. Quality adjusted life years (QALYs) were calculated from utility scores using the area under the curve method. Direct treatment costs were obtained from a prospective micro costing study. Indirect costs included patient lost productivity, patient transportation, meals, and childcare costs associated with hospital stay and follow-up visits. Multiple sensitivity analyses assessed model uncertainty.Results - Total treatment costs were higher for ST ($1,349) compared with IMN ($1,122). QALYs were lower for ST than IMN, 0.71 (95% confidence interval [CI] 0.66-0.76) and 0.77 (CI 0.71-0.82) respectively. Based on lower cost and higher utility, IMN was the dominant strategy. IMN remained dominant in 94% of simulations. IMN would be less cost-effective than ST at a total procedure cost exceeding $880 from the payer's perspective, or $1,035 from the societal perspective.Interpretation - IMN was cost saving and more effective than ST in the treatment of adult Femoral Shaft fractures in Malawi, and may be an efficient use of limited healthcare resources.
Linda Chokotho - One of the best experts on this subject based on the ideXlab platform.
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cost utility analysis of intramedullary nailing and skeletal traction treatment for patients with Femoral Shaft fractures in malawi
Acta Orthopaedica, 2021Co-Authors: Linda Chokotho, Claire A Donnelley, Sven Young, Brian C Lau, Nyengo Mkandawire, Janerik GjertsenAbstract:Background and purpose - In Malawi, both skeletal traction (ST) and intramedullary nailing (IMN) are used in the treatment of Femoral Shaft fractures, ST being the mainstay treatment. Previous studies have found that IMN has improved outcomes and is less expensive than ST. However, no cost-effectiveness analyses have yet compared IMN and ST in Malawi. We report the results of a cost-utility analysis (CUA) comparing treatment using either IMN or ST.Patients and methods - This was an economic evaluation study, where a CUA was done using a decision-tree model from the government healthcare payer and societal perspectives with an 1-year time horizon. We obtained EQ-5D-3L utility scores and probabilities from a prospective observational study assessing quality of life and function in 187 adult patients with Femoral Shaft fractures treated with either IMN or ST. The patients were followed up at 6 weeks, and 3, 6, and 12 months post-injury. Quality adjusted life years (QALYs) were calculated from utility scores using the area under the curve method. Direct treatment costs were obtained from a prospective micro costing study. Indirect costs included patient lost productivity, patient transportation, meals, and childcare costs associated with hospital stay and follow-up visits. Multiple sensitivity analyses assessed model uncertainty.Results - Total treatment costs were higher for ST ($1,349) compared with IMN ($1,122). QALYs were lower for ST than IMN, 0.71 (95% confidence interval [CI] 0.66-0.76) and 0.77 (CI 0.71-0.82) respectively. Based on lower cost and higher utility, IMN was the dominant strategy. IMN remained dominant in 94% of simulations. IMN would be less cost-effective than ST at a total procedure cost exceeding $880 from the payer's perspective, or $1,035 from the societal perspective.Interpretation - IMN was cost saving and more effective than ST in the treatment of adult Femoral Shaft fractures in Malawi, and may be an efficient use of limited healthcare resources.
Weihsiu Hsu - One of the best experts on this subject based on the ideXlab platform.
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effect of fragmentary displacement and morphology in the treatment of comminuted Femoral Shaft fractures with an intramedullary nail
Injury-international Journal of The Care of The Injured, 2014Co-Authors: Shihjie Lin, Chilung Chen, Kuoti Peng, Weihsiu HsuAbstract:Abstract Objective Our study aimed to determine whether the displacement and morphology of a fragment in femur fracture with Arbeitsgemeinschaft fur Osteosynthesefragen/Orthopaedic Trauma Association/32-B/32-C (AO/OTA/32-B/32-C) classification affect the outcomes following closed reduction and internal fixation with an interlocking nail. Design This was a retrospective study. Setting The study was conducted at a Level III trauma centre. Patients A total of 50 consecutive patients presenting Femoral Shaft fracture with AO/OTA-type 32-B/32-C were included in the present study. Interventions Patients were divided into two groups according to the displacement of the fragments. In the large displacement group, patients were further subgrouped according to whether a reversed morphology of the fragment was present. Outcomes measurement The radiographic union score of femur (RUSF), the mean union time and the re-operation rate were assessed. Results The union rate of small- and large-gap groups at 12 months postoperatively was 75.9% and 21.1%, respectively (p = 0.000). The mean union time of those union cases in these two groups was 7.8 and 13.0 months, respectively (p = 0.000). The union rate of the non-reversed and reversed groups at 12 months postoperatively was 30% and 11.1%, respectively (p = 0.179). The mean RUSF at 12 months in the non-reversed and reversed groups was 8.8 and 8.3, respectively (p = 0.590). However, we found that patients presenting a reversed fragment had an increased risk of more than one re-operation (p = 0.030). Conclusions A fragmentary displacement of >1 cm in AO/OTA-type 32-B/32-C Femoral Shaft fracture after nailing affected bone healing. Among the large-gap group patients, an unreduced reverse fragment presented a negative prognostic factor for re-operation. Level of evidence Prognostic level III.
Janerik Gjertsen - One of the best experts on this subject based on the ideXlab platform.
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cost utility analysis of intramedullary nailing and skeletal traction treatment for patients with Femoral Shaft fractures in malawi
Acta Orthopaedica, 2021Co-Authors: Linda Chokotho, Claire A Donnelley, Sven Young, Brian C Lau, Nyengo Mkandawire, Janerik GjertsenAbstract:Background and purpose - In Malawi, both skeletal traction (ST) and intramedullary nailing (IMN) are used in the treatment of Femoral Shaft fractures, ST being the mainstay treatment. Previous studies have found that IMN has improved outcomes and is less expensive than ST. However, no cost-effectiveness analyses have yet compared IMN and ST in Malawi. We report the results of a cost-utility analysis (CUA) comparing treatment using either IMN or ST.Patients and methods - This was an economic evaluation study, where a CUA was done using a decision-tree model from the government healthcare payer and societal perspectives with an 1-year time horizon. We obtained EQ-5D-3L utility scores and probabilities from a prospective observational study assessing quality of life and function in 187 adult patients with Femoral Shaft fractures treated with either IMN or ST. The patients were followed up at 6 weeks, and 3, 6, and 12 months post-injury. Quality adjusted life years (QALYs) were calculated from utility scores using the area under the curve method. Direct treatment costs were obtained from a prospective micro costing study. Indirect costs included patient lost productivity, patient transportation, meals, and childcare costs associated with hospital stay and follow-up visits. Multiple sensitivity analyses assessed model uncertainty.Results - Total treatment costs were higher for ST ($1,349) compared with IMN ($1,122). QALYs were lower for ST than IMN, 0.71 (95% confidence interval [CI] 0.66-0.76) and 0.77 (CI 0.71-0.82) respectively. Based on lower cost and higher utility, IMN was the dominant strategy. IMN remained dominant in 94% of simulations. IMN would be less cost-effective than ST at a total procedure cost exceeding $880 from the payer's perspective, or $1,035 from the societal perspective.Interpretation - IMN was cost saving and more effective than ST in the treatment of adult Femoral Shaft fractures in Malawi, and may be an efficient use of limited healthcare resources.
