The Experts below are selected from a list of 54 Experts worldwide ranked by ideXlab platform
Faith Sealey - One of the best experts on this subject based on the ideXlab platform.
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symptomatic venous thromboembolism uncommon without thromboprophylaxis after isolated lower limb Fracture the knee to ankle Fracture kaf cohort study
Journal of Bone and Joint Surgery American Volume, 2014Co-Authors: Rita Selby, William H Geerts, Lisa Kaus, Hans J Kreder, Mark Crowther, Faith SealeyAbstract:Background: The prevalence of deep vein thrombosis as demonstrated by routine venography in patients with distal lower-extremity injury requiring cast immobilization or surgery is 10% to 40%. These deep vein thromboses are usually asymptomatic and distal, and the need for thromboprophylaxis in these patients is not known. Methods: We conducted a multicenter prospective cohort study to define the prevalence of symptomatic venous thromboembolism in patients with a tibial, fibular, or ankle Fracture (treated nonoperatively) or a patellar or Foot Fracture (treated operatively or conservatively). Consecutive patients were enrolled at five Ontario, Canada, hospitals within ninety-six hours after injury, and they were followed with a telephone interview at two, six, and twelve weeks. Thromboprophylaxis was not allowed. Suspected venous thromboembolism was investigated in a standardized manner. Results: From August 2002 to June 2005, 1200 patients were enrolled, and a three-month follow-up was completed for 98% of them. Eighty-two percent of the patients were treated with cast or splint immobilization for an average (and standard deviation) of 42 ± 32 days. Overall, seven patients (0.6%; 95% confidence interval [CI] = 0.2% to 1.2%) had symptomatic, objectively confirmed venous thromboembolism. Two of them had proximal deep vein thrombosis; three, calf deep vein thrombosis; and two, pulmonary embolism. There were no fatal pulmonary emboli. Conclusions: Symptomatic venous thromboembolism is an infrequent complication after Fractures of the distal part of the lower limb requiring cast immobilization and managed without thromboprophylaxis. Given these estimates of symptomatic venous thromboembolism, the risk-benefit ratio and cost-effectiveness of routine anticoagulant prophylaxis are unlikely to be favorable for these patients. Level of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Gerald Mcgwin - One of the best experts on this subject based on the ideXlab platform.
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the association between knee airbag deployment and knee thigh hip Fracture injury risk in motor vehicle collisions a matched cohort study
Accident Analysis & Prevention, 2013Co-Authors: Vijal Patel, Russell Griffin, Alan W Eberhardt, Gerald McgwinAbstract:Abstract Introduction In the U.S. alone, an estimated 30,000 knee–thigh–hip (KTH) injuries occur annually in frontal motor vehicle collisions. These Fractures typically occur through occupant contact with the vehicle's knee bolster. Research has suggested that knee airbags (KABs) can mitigate the forces sustained during this contact, resulting in decreased injury risk; however, previous research has been limited by small sample sizes or by occurring in a controlled setting. The objective of the current study is to determine the effectiveness of KABs on KTH Fracture risk using nationally representative, real-world data. Methods Using combined data from the Crash Injury Research and Engineering Network and the National Automotive Sampling Survey, a matched cohort study was conducted among front-seat occupants of vehicles involved in a frontal collision occurring from 2000 to 2009. Occupants exposed to a KAB deployment were matched to occupants with no KAB deployment based on age ±5 years, sex, seatbelt use, vehicle seating position (i.e., driver or front passenger), car vehicle body type, collision impact, and sampling weight. A Cox proportional hazards model was used to calculate risk ratios (RRs) and associated 95% confidence intervals (95% CI) to estimate the association between KAB deployment and lower extremity Fracture risk. Results There was no association between KAB deployment and risk of lower extremity Fracture (RR 0.83, 95% CI 0.52–1.31). A notable pattern in Fracture risk, though not statistically significant, was observed, with a decreased risk of hip (RR 0.72, 95% CI 0.26–1.97) and thigh Fracture (RR 0.81, 95% CI 0.32–2.05), and an increased risk of tibia/fibula (RR 1.23, 95% CI 0.52–2.90) and Foot Fracture (RR 1.96, 95% CI 0.72–5.32). Conclusions The results of the current study suggest that KABs are not associated with the risk of lower extremity Fractures. However, given the small sample size of the current study, it is difficult to definitively say whether the observed injury pattern is representative of the true pattern.
Protect Studygroup - One of the best experts on this subject based on the ideXlab platform.
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nadroparin or fondaparinux versus no thromboprophylaxis in patients immobilised in a below knee plaster cast protect a randomised controlled trial
Injury-international Journal of The Care of The Injured, 2017Co-Authors: Marlieke M Bruntink, Yannick M E Groutars, Inger B Schipper, R S Breederveld, Wim E Tuinebreijer, R J Derksen, Protect StudygroupAbstract:Abstract Background The immobilisation of the lower leg is associated with deep vein thrombosis (DVT). However, thromboprophylaxis in patients with a below-knee plaster cast remains controversial. We examined the efficacy and safety of nadroparin and fondaparinux to ascertain the need for thromboprophylaxis in these patients. Methods PROTECT was a randomised, controlled, single-blind, multicentre study that enrolled adults with an ankle or Foot Fracture who required immobilisation for a minimum of four weeks. The patients were randomly assigned (1:1:1) to a control group (no thromboprophylaxis) or to one of the intervention groups: daily subcutaneous self-injection of either nadroparin (2850 IE anti-Xa = 0.3 ml) or fondaparinux (2.5 mg = 0.5 ml). A venous duplex sonography was performed after the removal of the cast or earlier if thrombosis was suspected. The primary outcome was the relative risk of developing DVT in the control group compared with that in both intervention groups. This trial is registered at ClinicalTrials.gov , number NCT00881088. Results Between April 2009 and December 2015, 467 patients were enrolled and assigned to either the nadroparin group (n = 154), the fondaparinux group (n = 157), or the control group (n = 156). A total of 273 patients (92, 92, and 94 patients, respectively) were analysed. The incidence of DVT in the nadroparin group was 2/92 (2.2%) compared with 11/94 (11.7%) in the control group, with a relative risk of 5.4 (95% CI 1.2–23.6; p = 0.011). The incidence of DVT in the fondaparinux group was 1/92 (1.1%), yielding a relative risk of 10.8 (95% CI 1.4–80.7; p = 0.003) compared with that in the control group. No major complications occurred in any group. Conclusion Thromboprophylaxis with nadroparin or fondaparinux significantly reduces the risk of DVT in patients with an ankle or Foot Fracture who were treated in a below-knee cast without any major adverse events.
Cassio Clei Da Silva - One of the best experts on this subject based on the ideXlab platform.
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metatarsal transfer associated with microsurgical flap in exposed Foot Fracture a case report and 10 year follow up
Journal of Bone and Joint Surgery American Volume, 2020Co-Authors: Davi De Podesta Haje, Cassio Clei Da SilvaAbstract:Case A 35-year-old female patient presented with an exposed foreFoot Fracture with bone and dermal loss after a vehicular accident. There was a bone defect at the level of the second toe and the third metatarsal. She was treated by second toe resection and second metatarsal transfer to augment the third metatarsal diaphysis ray (nonvascularized, without any soft-tissue envelope) and a microsurgical forearm flap. Conclusion As one option among the reconstruction techniques available for a metatarsal segmental defect, metatarsal transfer associated with a fasciocutaneous radial forearm flap proved to be effective in this patient.
Rita Selby - One of the best experts on this subject based on the ideXlab platform.
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symptomatic venous thromboembolism uncommon without thromboprophylaxis after isolated lower limb Fracture the knee to ankle Fracture kaf cohort study
Journal of Bone and Joint Surgery American Volume, 2014Co-Authors: Rita Selby, William H Geerts, Lisa Kaus, Hans J Kreder, Mark Crowther, Faith SealeyAbstract:Background: The prevalence of deep vein thrombosis as demonstrated by routine venography in patients with distal lower-extremity injury requiring cast immobilization or surgery is 10% to 40%. These deep vein thromboses are usually asymptomatic and distal, and the need for thromboprophylaxis in these patients is not known. Methods: We conducted a multicenter prospective cohort study to define the prevalence of symptomatic venous thromboembolism in patients with a tibial, fibular, or ankle Fracture (treated nonoperatively) or a patellar or Foot Fracture (treated operatively or conservatively). Consecutive patients were enrolled at five Ontario, Canada, hospitals within ninety-six hours after injury, and they were followed with a telephone interview at two, six, and twelve weeks. Thromboprophylaxis was not allowed. Suspected venous thromboembolism was investigated in a standardized manner. Results: From August 2002 to June 2005, 1200 patients were enrolled, and a three-month follow-up was completed for 98% of them. Eighty-two percent of the patients were treated with cast or splint immobilization for an average (and standard deviation) of 42 ± 32 days. Overall, seven patients (0.6%; 95% confidence interval [CI] = 0.2% to 1.2%) had symptomatic, objectively confirmed venous thromboembolism. Two of them had proximal deep vein thrombosis; three, calf deep vein thrombosis; and two, pulmonary embolism. There were no fatal pulmonary emboli. Conclusions: Symptomatic venous thromboembolism is an infrequent complication after Fractures of the distal part of the lower limb requiring cast immobilization and managed without thromboprophylaxis. Given these estimates of symptomatic venous thromboembolism, the risk-benefit ratio and cost-effectiveness of routine anticoagulant prophylaxis are unlikely to be favorable for these patients. Level of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.