The Experts below are selected from a list of 5529 Experts worldwide ranked by ideXlab platform
Matthew L Costa - One of the best experts on this subject based on the ideXlab platform.
-
negative pressure wound therapy versus standard dressings for adults with an open lower Limb Fracture the wollf rct
Health Technology Assessment, 2018Co-Authors: Matthew L Costa, Juul Achten, Julie Bruce, Sonia Davis, Susie Hennings, Keith Willett, Stavros PetrouAbstract:Background Open Fractures of the lower Limb occur when a broken bone penetrates the skin and is exposed to the outside environment. These are life-changing injuries. The risk of deep infection may be as high as 27%. The type of dressing applied after surgical debridement could potentially reduce the risk of infection in the open-Fracture wound. Objectives To assess the disability, rate of deep infection, quality of life and resource use in patients with severe open Fracture of the lower Limb treated with negative-pressure wound therapy (NPWT) versus standard wound management after the first surgical debridement of the wound. Design A pragmatic, multicentre randomised controlled trial. Setting Twenty-four specialist trauma hospitals in the UK Major Trauma Network. Participants A total of 460 patients aged ≥ 16 years with a severe open Fracture of the lower Limb were recruited from July 2012 through to December 2015. Patients were excluded if they presented more than 72 hours after their injury or were unable to complete questionnaires. Interventions Negative-pressure wound therapy (n = 226) where an ‘open-cell’ solid foam or gauze was placed over the surface of the wound and connected to a suction pump which created a partial vacuum over the dressing versus standard dressings not involving negative pressure (n = 234). Main outcome measures Disability Rating Index (DRI) – a score of 0 (no disability) to 100 (completely disabled) at 12 months was the primary outcome measure, with a minimal clinically important difference of 8 points. The secondary outcomes were deep infection, quality of life and resource use collected at 3, 6, 9 and 12 months post randomisaton. Results There was no evidence of a difference in the patients’ DRI at 12 months. The mean DRI in the NPWT group was 45.5 points [standard deviation (SD) 28.0 points] versus 42.4 points (SD 24.2 points) in the standard dressing group, giving a difference of –3.9 points (95% confidence interval –8.9 to 1.2 points) in favour of standard dressings (p = 0.132). There was no difference in HRQoL and no difference in the number of surgical site infections or other complications at any point in the 12 months after surgery. NPWT did not reduce the cost of treatment and it was associated with a low probability of cost-effectiveness. Limitations Owing to the emergency nature of the interventions, we anticipated that some patients who were randomised into the trial would subsequently be unable or unwilling to take part. Such post-randomisation withdrawal of patients could have posed a risk to the external validity of the trial. However, the great majority of these patients (85%) were found to be ineligible after randomisation. Therefore, we can be confident that the patients who took part were representative of the population with severe open Fractures of the lower Limb. Conclusions Contrary to the existing literature and current clinical guidelines, NPWT dressings do not provide a clinical or an economic benefit for patients with an open Fracture of the lower Limb. Future work Future work should investigate alternative strategies to reduce the incidence of infection and improve outcomes for patients with an open Fracture of the lower Limb. Two specific areas of potentially great benefit are (1) the use of topical antibiotic preparations in the open-Fracture wound and (2) the role of orthopaedic implants with antimicrobial coatings when fixing the associated Fracture. Trial registration Current Controlled Trials ISRCTN33756652 and UKCRN Portfolio ID 11783.
-
negative pressure wound therapy versus standard dressings for adults with an open lower Limb Fracture the wollf rct
Health Technology Assessment, 2018Co-Authors: Matthew L Costa, Juul Achten, Julie Bruce, Sonia Davis, Susie Hennings, Keith Willett, Stavros PetrouAbstract:Background Open Fractures of the lower Limb occur when a broken bone penetrates the skin and is exposed to the outside environment. These are life-changing injuries. The risk of deep infection may be as high as 27%. The type of dressing applied after surgical debridement could potentially reduce the risk of infection in the open-Fracture wound. Objectives To assess the disability, rate of deep infection, quality of life and resource use in patients with severe open Fracture of the lower Limb treated with negative-pressure wound therapy (NPWT) versus standard wound management after the first surgical debridement of the wound. Design A pragmatic, multicentre randomised controlled trial. Setting Twenty-four specialist trauma hospitals in the UK Major Trauma Network. Participants A total of 460 patients aged ≥ 16 years with a severe open Fracture of the lower Limb were recruited from July 2012 through to December 2015. Patients were excluded if they presented more than 72 hours after their injury or were unable to complete questionnaires. Interventions Negative-pressure wound therapy (n = 226) where an 'open-cell' solid foam or gauze was placed over the surface of the wound and connected to a suction pump which created a partial vacuum over the dressing versus standard dressings not involving negative pressure (n = 234). Main outcome measures Disability Rating Index (DRI) - a score of 0 (no disability) to 100 (completely disabled) at 12 months was the primary outcome measure, with a minimal clinically important difference of 8 points. The secondary outcomes were deep infection, quality of life and resource use collected at 3, 6, 9 and 12 months post randomisaton. Results There was no evidence of a difference in the patients' DRI at 12 months. The mean DRI in the NPWT group was 45.5 points [standard deviation (SD) 28.0 points] versus 42.4 points (SD 24.2 points) in the standard dressing group, giving a difference of -3.9 points (95% confidence interval -8.9 to 1.2 points) in favour of standard dressings (p = 0.132). There was no difference in HRQoL and no difference in the number of surgical site infections or other complications at any point in the 12 months after surgery. NPWT did not reduce the cost of treatment and it was associated with a low probability of cost-effectiveness. Limitations Owing to the emergency nature of the interventions, we anticipated that some patients who were randomised into the trial would subsequently be unable or unwilling to take part. Such post-randomisation withdrawal of patients could have posed a risk to the external validity of the trial. However, the great majority of these patients (85%) were found to be ineligible after randomisation. Therefore, we can be confident that the patients who took part were representative of the population with severe open Fractures of the lower Limb. Conclusions Contrary to the existing literature and current clinical guidelines, NPWT dressings do not provide a clinical or an economic benefit for patients with an open Fracture of the lower Limb. Future work Future work should investigate alternative strategies to reduce the incidence of infection and improve outcomes for patients with an open Fracture of the lower Limb. Two specific areas of potentially great benefit are (1) the use of topical antibiotic preparations in the open-Fracture wound and (2) the role of orthopaedic implants with antimicrobial coatings when fixing the associated Fracture. Trial registration Current Controlled Trials ISRCTN33756652 and UKCRN Portfolio ID 11783. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 73. See the NIHR Journals Library website for further project information.
Stephane Leduc - One of the best experts on this subject based on the ideXlab platform.
-
moderate to severe acute pain disturbs motor cortex intracortical inhibition and facilitation in orthopedic trauma patients a tms study
PLOS ONE, 2020Co-Authors: Marianne Jodoin, Dominique M Rouleau, Benoit Benoit, Stephane Leduc, Georgeyves Laflamme, Camille Larsondupuis, Emilie Sandman, Audrey Bellemare, Catherine Provost, Martine LevesqueAbstract:OBJECTIVE: Primary motor (M1) cortical excitability alterations are involved in the development and maintenance of chronic pain. Less is known about M1-cortical excitability implications in the acute phase of an orthopedic trauma. This study aims to assess acute M1-cortical excitability in patients with an isolated upper Limb Fracture (IULF) in relation to pain intensity. METHODS: Eighty-four (56 IULF patients <14 days post-trauma and 28 healthy controls). IULF patients were divided into two subgroups according to pain intensity (mild versus moderate to severe pain). A single transcranial magnetic stimulation (TMS) session was performed over M1 to compare groups on resting motor threshold (rMT), short-intracortical inhibition (SICI), intracortical facilitation (ICF), and long-interval cortical inhibition (LICI). RESULTS: Reduced SICI and ICF were found in IULF patients with moderate to severe pain, whereas mild pain was not associated with M1 alterations. Age, sex, and time since the accident had no influence on TMS measures. DISCUSSION: These findings show altered M1 in the context of acute moderate to severe pain, suggesting early signs of altered GABAergic inhibitory and glutamatergic facilitatory activities.
-
investigating the incidence and magnitude of heterotopic ossification with and without joints involvement in patients with a Limb Fracture and mild traumatic brain injury
Bone reports, 2019Co-Authors: Marianne Jodoin, Dominique M Rouleau, Stephane Leduc, Camille Larsondupuis, Nadia Gosselin, Erik Therrien, Jeanmarc Chauny, Emilie Sandman, Louis De BeaumontAbstract:Abstract Objectives This study seeks to evaluate the incidence rate of heterotopic ossification (HO) formation in patients afflicted by an isolated Limb Fracture (ILF) and a concomitant mild traumatic brain injury (mTBI). Methods The current study is an observational study including ILF patients with or without a concomitant mTBI recruited from an orthopedic clinic of a Level 1 Trauma Hospital. Patients were diagnosed with a mTBI according to the American Congress of Rehabilitation Medicine (ACRM) criteria. Radiographs taken on average 3 months post-trauma were analyzed separately by two distinct specialists for the presence of HO proximally to the Fracture site (joints or extra joints). Both raters referred to Brooker's and Della's Valle's classification to establish signs of HO. First, analyses were conducted for the full sample. Secondly, a matched cohort was used in order to control for specific factors, namely age, sex, type of injury, and time elapsed between the accident and the analyzed radiograph. Results The full sample included a total of 183 patients with an ILF (94 females; 47.5 years old), of which 50 had a concomitant mTBI and 133 without. Radiographic evidence of HO was significantly higher in patients with an ILF and a mTBI compared to ILF patients (X2 = 6.50; p = 0.01). The matched cohort consisted of 94 participants (i.e.; 47 patients from the ILF + mTBI group and 47 patients from the ILF group). Again, ILF + mTBI patients presented significantly higher rates of HO signs in comparison to ILF patients (X2 = 3.69; p = 0.04). Presence of HO was associated with prolonged delays to return to work (RTW) only in ILF + mTBI patients (F = 4.055; p = 0.05) but not in ILF patients (F = 0.823; p = 0.37). Conclusions Study findings suggest that rates of HO are significantly higher proximally to Fracture sites when ILF patients sustain a concomitant mTBI, even after controlling for factors known to influence HO. Moreover, results show that HO is associated with a prolonged RTW only in ILF patients with a concomitant mTBI but not in ILF-only patients. The impact of mTBI on HO formation warrants further attention to detect early signs of HO, to identify shared physiopathological mechanisms and, ultimately, to design targeted therapies.
-
effects of concomitant mild traumatic brain injury on resuming work after suffering from an isolated Limb Fracture a cohort study
Brain Injury, 2017Co-Authors: Marianne Jodoin, Dominique M Rouleau, Benoit Benoit, Stephane Leduc, Georgeyves Laflamme, Camille Larsondupuis, Nadia Gosselin, Meriem Sabir, Louis De BeaumontAbstract:ABSTRACTBackground: The objective is to explore the effects of concomitant mild traumatic brain injury (mTBI) on return to work (RTW), among patients suffering from an isolated Limb Fracture. This follow-up study included a total of 170 working age subjects with an isolated Limb Fracture, and was conducted in a phone interview approximately 1-year post trauma. 41 had experienced an mTBI and 129 did not. Methods: Data were obtained through a phone interview conducted on average 20.7 months (SD = 9.6 months) post-accident. The main outcome measure was the number of days taken to RTW after the injury. Demographic information was also gathered during the phone interview. Workers’ compensation status was obtained through the hospitals’ orthopaedic clinic data. Results: The mTBI group took on average 329.7 days (SD = 298.0) to RTW after the injury, as opposed to 150.3 days (SD = 171.3) for the control group (p < 0.001). After excluding patients who received workers’ compensation, the mTBI group still missed sig...
-
comorbid mild traumatic brain injury increases pain symptoms in patients suffering from an isolated Limb Fracture
Injury-international Journal of The Care of The Injured, 2017Co-Authors: Marianne Jodoin, Dominique M Rouleau, Benoit Benoit, Stephane Leduc, Nadia GosselinAbstract:Abstract Objectives This study seeks to evaluate the effects of a mild traumatic brain injury (mTBI) on pain in patients with an isolated Limb Fracture (ILF) when compared to a matched cohort group with no mTBI (control group). Patients and methods All subjects included in this observational study suffered from an ILF. Groups were matched according to the type of injury, sex, age, and time since the accident. Main outcome measurements were: Standardized semi-structured interviews at follow-up of a Level I Trauma Center, and a questionnaire on Fracture-related pain symptoms. Factors susceptible to influence the perception of pain, such as age, sex, severity of post-concussive symptoms, and worker compensation were also assessed. Results A total of 68 subjects (36 females; 45 years old) with an ILF were selected, 34 with a comorbid mTBI and 34 without (24/34 with an upper Limb Fracture per group, 71% of total sample). Patients with mTBI and an ILF reported significantly higher pain scores at the time of assessment (mean: 49 days, SD: 34.9), compared to the control group (p Conclusions Results suggest that mTBI exacerbate perception of pain in the acute phase when occurring with an ILF, and were not explained by age, sex, post-concussive symptoms, or worker compensation. Rather, it appears possible that neurological sequelae induced by mTBI may interfere with the normal recovery of pain following trauma.
-
incidence rate of mild traumatic brain injury among patients who have suffered from an isolated Limb Fracture upper Limb Fracture patients are more at risk
Injury-international Journal of The Care of The Injured, 2016Co-Authors: Marianne Jodoin, Dominique M Rouleau, Camille Charleboisplante, Benoit Benoit, Stephane Leduc, Georgeyves LaflammeAbstract:Abstract Objectives This study compares the incidence rate of mild traumatic brain injury (mild TBI) detected at follow-up visits (retrospective diagnosis) in patients suffering from an isolated Limb trauma, with the incidence rate held by the hospital records (prospective diagnosis) of the sampled cohort. This study also seeks to determine which types of Fractures present with the highest incidence of mild TBI. Patients and methods Retrospective assessment of mild TBI among orthopaedic monotrauma patients, randomly selected for participation in an Orthopaedic clinic of a Level I Trauma Hospital. Patients in the remission phase of a Limb Fracture were recruited between August 2014 and May 2015. No intervention was done (observational study). Main outcome measurements: Standardized semi-structured interviews were conducted with all patients to retrospectively assess for mild TBI at the time of the Fracture. Emergency room related medical records of all patients were carefully analyzed to determine whether a prospective mild TBI diagnosis was made following the accident. Results A total of 251 patients were recruited (54% females, Mean age = 49). Study interview revealed a 23.5% incidence rate of mild TBI compared to an incidence rate of 8.8% for prospective diagnosis (χ 2 = 78.47; p 2 = 6.70; p = 0.010). More specifically, patients with a proximal upper Limb injury were significantly more at risk of sustaining concomitant mild TBI (40.6%; 26/64) compared to distal upper Limb Fractures (20.25%; 16/79) (χ 2 = 7.07; p = 0.008). Conclusions Results suggest an important concomitance of mild TBI among orthopaedic trauma patients, the majority of which go undetected during acute care. Patients treated for an upper Limb Fracture are particularly at risk of sustaining concomitant mild TBI.
Marianne Jodoin - One of the best experts on this subject based on the ideXlab platform.
-
moderate to severe acute pain disturbs motor cortex intracortical inhibition and facilitation in orthopedic trauma patients a tms study
PLOS ONE, 2020Co-Authors: Marianne Jodoin, Dominique M Rouleau, Benoit Benoit, Stephane Leduc, Georgeyves Laflamme, Camille Larsondupuis, Emilie Sandman, Audrey Bellemare, Catherine Provost, Martine LevesqueAbstract:OBJECTIVE: Primary motor (M1) cortical excitability alterations are involved in the development and maintenance of chronic pain. Less is known about M1-cortical excitability implications in the acute phase of an orthopedic trauma. This study aims to assess acute M1-cortical excitability in patients with an isolated upper Limb Fracture (IULF) in relation to pain intensity. METHODS: Eighty-four (56 IULF patients <14 days post-trauma and 28 healthy controls). IULF patients were divided into two subgroups according to pain intensity (mild versus moderate to severe pain). A single transcranial magnetic stimulation (TMS) session was performed over M1 to compare groups on resting motor threshold (rMT), short-intracortical inhibition (SICI), intracortical facilitation (ICF), and long-interval cortical inhibition (LICI). RESULTS: Reduced SICI and ICF were found in IULF patients with moderate to severe pain, whereas mild pain was not associated with M1 alterations. Age, sex, and time since the accident had no influence on TMS measures. DISCUSSION: These findings show altered M1 in the context of acute moderate to severe pain, suggesting early signs of altered GABAergic inhibitory and glutamatergic facilitatory activities.
-
investigating the incidence and magnitude of heterotopic ossification with and without joints involvement in patients with a Limb Fracture and mild traumatic brain injury
Bone reports, 2019Co-Authors: Marianne Jodoin, Dominique M Rouleau, Stephane Leduc, Camille Larsondupuis, Nadia Gosselin, Erik Therrien, Jeanmarc Chauny, Emilie Sandman, Louis De BeaumontAbstract:Abstract Objectives This study seeks to evaluate the incidence rate of heterotopic ossification (HO) formation in patients afflicted by an isolated Limb Fracture (ILF) and a concomitant mild traumatic brain injury (mTBI). Methods The current study is an observational study including ILF patients with or without a concomitant mTBI recruited from an orthopedic clinic of a Level 1 Trauma Hospital. Patients were diagnosed with a mTBI according to the American Congress of Rehabilitation Medicine (ACRM) criteria. Radiographs taken on average 3 months post-trauma were analyzed separately by two distinct specialists for the presence of HO proximally to the Fracture site (joints or extra joints). Both raters referred to Brooker's and Della's Valle's classification to establish signs of HO. First, analyses were conducted for the full sample. Secondly, a matched cohort was used in order to control for specific factors, namely age, sex, type of injury, and time elapsed between the accident and the analyzed radiograph. Results The full sample included a total of 183 patients with an ILF (94 females; 47.5 years old), of which 50 had a concomitant mTBI and 133 without. Radiographic evidence of HO was significantly higher in patients with an ILF and a mTBI compared to ILF patients (X2 = 6.50; p = 0.01). The matched cohort consisted of 94 participants (i.e.; 47 patients from the ILF + mTBI group and 47 patients from the ILF group). Again, ILF + mTBI patients presented significantly higher rates of HO signs in comparison to ILF patients (X2 = 3.69; p = 0.04). Presence of HO was associated with prolonged delays to return to work (RTW) only in ILF + mTBI patients (F = 4.055; p = 0.05) but not in ILF patients (F = 0.823; p = 0.37). Conclusions Study findings suggest that rates of HO are significantly higher proximally to Fracture sites when ILF patients sustain a concomitant mTBI, even after controlling for factors known to influence HO. Moreover, results show that HO is associated with a prolonged RTW only in ILF patients with a concomitant mTBI but not in ILF-only patients. The impact of mTBI on HO formation warrants further attention to detect early signs of HO, to identify shared physiopathological mechanisms and, ultimately, to design targeted therapies.
-
effects of concomitant mild traumatic brain injury on resuming work after suffering from an isolated Limb Fracture a cohort study
Brain Injury, 2017Co-Authors: Marianne Jodoin, Dominique M Rouleau, Benoit Benoit, Stephane Leduc, Georgeyves Laflamme, Camille Larsondupuis, Nadia Gosselin, Meriem Sabir, Louis De BeaumontAbstract:ABSTRACTBackground: The objective is to explore the effects of concomitant mild traumatic brain injury (mTBI) on return to work (RTW), among patients suffering from an isolated Limb Fracture. This follow-up study included a total of 170 working age subjects with an isolated Limb Fracture, and was conducted in a phone interview approximately 1-year post trauma. 41 had experienced an mTBI and 129 did not. Methods: Data were obtained through a phone interview conducted on average 20.7 months (SD = 9.6 months) post-accident. The main outcome measure was the number of days taken to RTW after the injury. Demographic information was also gathered during the phone interview. Workers’ compensation status was obtained through the hospitals’ orthopaedic clinic data. Results: The mTBI group took on average 329.7 days (SD = 298.0) to RTW after the injury, as opposed to 150.3 days (SD = 171.3) for the control group (p < 0.001). After excluding patients who received workers’ compensation, the mTBI group still missed sig...
-
comorbid mild traumatic brain injury increases pain symptoms in patients suffering from an isolated Limb Fracture
Injury-international Journal of The Care of The Injured, 2017Co-Authors: Marianne Jodoin, Dominique M Rouleau, Benoit Benoit, Stephane Leduc, Nadia GosselinAbstract:Abstract Objectives This study seeks to evaluate the effects of a mild traumatic brain injury (mTBI) on pain in patients with an isolated Limb Fracture (ILF) when compared to a matched cohort group with no mTBI (control group). Patients and methods All subjects included in this observational study suffered from an ILF. Groups were matched according to the type of injury, sex, age, and time since the accident. Main outcome measurements were: Standardized semi-structured interviews at follow-up of a Level I Trauma Center, and a questionnaire on Fracture-related pain symptoms. Factors susceptible to influence the perception of pain, such as age, sex, severity of post-concussive symptoms, and worker compensation were also assessed. Results A total of 68 subjects (36 females; 45 years old) with an ILF were selected, 34 with a comorbid mTBI and 34 without (24/34 with an upper Limb Fracture per group, 71% of total sample). Patients with mTBI and an ILF reported significantly higher pain scores at the time of assessment (mean: 49 days, SD: 34.9), compared to the control group (p Conclusions Results suggest that mTBI exacerbate perception of pain in the acute phase when occurring with an ILF, and were not explained by age, sex, post-concussive symptoms, or worker compensation. Rather, it appears possible that neurological sequelae induced by mTBI may interfere with the normal recovery of pain following trauma.
-
incidence rate of mild traumatic brain injury among patients who have suffered from an isolated Limb Fracture upper Limb Fracture patients are more at risk
Injury-international Journal of The Care of The Injured, 2016Co-Authors: Marianne Jodoin, Dominique M Rouleau, Camille Charleboisplante, Benoit Benoit, Stephane Leduc, Georgeyves LaflammeAbstract:Abstract Objectives This study compares the incidence rate of mild traumatic brain injury (mild TBI) detected at follow-up visits (retrospective diagnosis) in patients suffering from an isolated Limb trauma, with the incidence rate held by the hospital records (prospective diagnosis) of the sampled cohort. This study also seeks to determine which types of Fractures present with the highest incidence of mild TBI. Patients and methods Retrospective assessment of mild TBI among orthopaedic monotrauma patients, randomly selected for participation in an Orthopaedic clinic of a Level I Trauma Hospital. Patients in the remission phase of a Limb Fracture were recruited between August 2014 and May 2015. No intervention was done (observational study). Main outcome measurements: Standardized semi-structured interviews were conducted with all patients to retrospectively assess for mild TBI at the time of the Fracture. Emergency room related medical records of all patients were carefully analyzed to determine whether a prospective mild TBI diagnosis was made following the accident. Results A total of 251 patients were recruited (54% females, Mean age = 49). Study interview revealed a 23.5% incidence rate of mild TBI compared to an incidence rate of 8.8% for prospective diagnosis (χ 2 = 78.47; p 2 = 6.70; p = 0.010). More specifically, patients with a proximal upper Limb injury were significantly more at risk of sustaining concomitant mild TBI (40.6%; 26/64) compared to distal upper Limb Fractures (20.25%; 16/79) (χ 2 = 7.07; p = 0.008). Conclusions Results suggest an important concomitance of mild TBI among orthopaedic trauma patients, the majority of which go undetected during acute care. Patients treated for an upper Limb Fracture are particularly at risk of sustaining concomitant mild TBI.
Dominique M Rouleau - One of the best experts on this subject based on the ideXlab platform.
-
moderate to severe acute pain disturbs motor cortex intracortical inhibition and facilitation in orthopedic trauma patients a tms study
PLOS ONE, 2020Co-Authors: Marianne Jodoin, Dominique M Rouleau, Benoit Benoit, Stephane Leduc, Georgeyves Laflamme, Camille Larsondupuis, Emilie Sandman, Audrey Bellemare, Catherine Provost, Martine LevesqueAbstract:OBJECTIVE: Primary motor (M1) cortical excitability alterations are involved in the development and maintenance of chronic pain. Less is known about M1-cortical excitability implications in the acute phase of an orthopedic trauma. This study aims to assess acute M1-cortical excitability in patients with an isolated upper Limb Fracture (IULF) in relation to pain intensity. METHODS: Eighty-four (56 IULF patients <14 days post-trauma and 28 healthy controls). IULF patients were divided into two subgroups according to pain intensity (mild versus moderate to severe pain). A single transcranial magnetic stimulation (TMS) session was performed over M1 to compare groups on resting motor threshold (rMT), short-intracortical inhibition (SICI), intracortical facilitation (ICF), and long-interval cortical inhibition (LICI). RESULTS: Reduced SICI and ICF were found in IULF patients with moderate to severe pain, whereas mild pain was not associated with M1 alterations. Age, sex, and time since the accident had no influence on TMS measures. DISCUSSION: These findings show altered M1 in the context of acute moderate to severe pain, suggesting early signs of altered GABAergic inhibitory and glutamatergic facilitatory activities.
-
investigating the incidence and magnitude of heterotopic ossification with and without joints involvement in patients with a Limb Fracture and mild traumatic brain injury
Bone reports, 2019Co-Authors: Marianne Jodoin, Dominique M Rouleau, Stephane Leduc, Camille Larsondupuis, Nadia Gosselin, Erik Therrien, Jeanmarc Chauny, Emilie Sandman, Louis De BeaumontAbstract:Abstract Objectives This study seeks to evaluate the incidence rate of heterotopic ossification (HO) formation in patients afflicted by an isolated Limb Fracture (ILF) and a concomitant mild traumatic brain injury (mTBI). Methods The current study is an observational study including ILF patients with or without a concomitant mTBI recruited from an orthopedic clinic of a Level 1 Trauma Hospital. Patients were diagnosed with a mTBI according to the American Congress of Rehabilitation Medicine (ACRM) criteria. Radiographs taken on average 3 months post-trauma were analyzed separately by two distinct specialists for the presence of HO proximally to the Fracture site (joints or extra joints). Both raters referred to Brooker's and Della's Valle's classification to establish signs of HO. First, analyses were conducted for the full sample. Secondly, a matched cohort was used in order to control for specific factors, namely age, sex, type of injury, and time elapsed between the accident and the analyzed radiograph. Results The full sample included a total of 183 patients with an ILF (94 females; 47.5 years old), of which 50 had a concomitant mTBI and 133 without. Radiographic evidence of HO was significantly higher in patients with an ILF and a mTBI compared to ILF patients (X2 = 6.50; p = 0.01). The matched cohort consisted of 94 participants (i.e.; 47 patients from the ILF + mTBI group and 47 patients from the ILF group). Again, ILF + mTBI patients presented significantly higher rates of HO signs in comparison to ILF patients (X2 = 3.69; p = 0.04). Presence of HO was associated with prolonged delays to return to work (RTW) only in ILF + mTBI patients (F = 4.055; p = 0.05) but not in ILF patients (F = 0.823; p = 0.37). Conclusions Study findings suggest that rates of HO are significantly higher proximally to Fracture sites when ILF patients sustain a concomitant mTBI, even after controlling for factors known to influence HO. Moreover, results show that HO is associated with a prolonged RTW only in ILF patients with a concomitant mTBI but not in ILF-only patients. The impact of mTBI on HO formation warrants further attention to detect early signs of HO, to identify shared physiopathological mechanisms and, ultimately, to design targeted therapies.
-
effects of concomitant mild traumatic brain injury on resuming work after suffering from an isolated Limb Fracture a cohort study
Brain Injury, 2017Co-Authors: Marianne Jodoin, Dominique M Rouleau, Benoit Benoit, Stephane Leduc, Georgeyves Laflamme, Camille Larsondupuis, Nadia Gosselin, Meriem Sabir, Louis De BeaumontAbstract:ABSTRACTBackground: The objective is to explore the effects of concomitant mild traumatic brain injury (mTBI) on return to work (RTW), among patients suffering from an isolated Limb Fracture. This follow-up study included a total of 170 working age subjects with an isolated Limb Fracture, and was conducted in a phone interview approximately 1-year post trauma. 41 had experienced an mTBI and 129 did not. Methods: Data were obtained through a phone interview conducted on average 20.7 months (SD = 9.6 months) post-accident. The main outcome measure was the number of days taken to RTW after the injury. Demographic information was also gathered during the phone interview. Workers’ compensation status was obtained through the hospitals’ orthopaedic clinic data. Results: The mTBI group took on average 329.7 days (SD = 298.0) to RTW after the injury, as opposed to 150.3 days (SD = 171.3) for the control group (p < 0.001). After excluding patients who received workers’ compensation, the mTBI group still missed sig...
-
comorbid mild traumatic brain injury increases pain symptoms in patients suffering from an isolated Limb Fracture
Injury-international Journal of The Care of The Injured, 2017Co-Authors: Marianne Jodoin, Dominique M Rouleau, Benoit Benoit, Stephane Leduc, Nadia GosselinAbstract:Abstract Objectives This study seeks to evaluate the effects of a mild traumatic brain injury (mTBI) on pain in patients with an isolated Limb Fracture (ILF) when compared to a matched cohort group with no mTBI (control group). Patients and methods All subjects included in this observational study suffered from an ILF. Groups were matched according to the type of injury, sex, age, and time since the accident. Main outcome measurements were: Standardized semi-structured interviews at follow-up of a Level I Trauma Center, and a questionnaire on Fracture-related pain symptoms. Factors susceptible to influence the perception of pain, such as age, sex, severity of post-concussive symptoms, and worker compensation were also assessed. Results A total of 68 subjects (36 females; 45 years old) with an ILF were selected, 34 with a comorbid mTBI and 34 without (24/34 with an upper Limb Fracture per group, 71% of total sample). Patients with mTBI and an ILF reported significantly higher pain scores at the time of assessment (mean: 49 days, SD: 34.9), compared to the control group (p Conclusions Results suggest that mTBI exacerbate perception of pain in the acute phase when occurring with an ILF, and were not explained by age, sex, post-concussive symptoms, or worker compensation. Rather, it appears possible that neurological sequelae induced by mTBI may interfere with the normal recovery of pain following trauma.
-
incidence rate of mild traumatic brain injury among patients who have suffered from an isolated Limb Fracture upper Limb Fracture patients are more at risk
Injury-international Journal of The Care of The Injured, 2016Co-Authors: Marianne Jodoin, Dominique M Rouleau, Camille Charleboisplante, Benoit Benoit, Stephane Leduc, Georgeyves LaflammeAbstract:Abstract Objectives This study compares the incidence rate of mild traumatic brain injury (mild TBI) detected at follow-up visits (retrospective diagnosis) in patients suffering from an isolated Limb trauma, with the incidence rate held by the hospital records (prospective diagnosis) of the sampled cohort. This study also seeks to determine which types of Fractures present with the highest incidence of mild TBI. Patients and methods Retrospective assessment of mild TBI among orthopaedic monotrauma patients, randomly selected for participation in an Orthopaedic clinic of a Level I Trauma Hospital. Patients in the remission phase of a Limb Fracture were recruited between August 2014 and May 2015. No intervention was done (observational study). Main outcome measurements: Standardized semi-structured interviews were conducted with all patients to retrospectively assess for mild TBI at the time of the Fracture. Emergency room related medical records of all patients were carefully analyzed to determine whether a prospective mild TBI diagnosis was made following the accident. Results A total of 251 patients were recruited (54% females, Mean age = 49). Study interview revealed a 23.5% incidence rate of mild TBI compared to an incidence rate of 8.8% for prospective diagnosis (χ 2 = 78.47; p 2 = 6.70; p = 0.010). More specifically, patients with a proximal upper Limb injury were significantly more at risk of sustaining concomitant mild TBI (40.6%; 26/64) compared to distal upper Limb Fractures (20.25%; 16/79) (χ 2 = 7.07; p = 0.008). Conclusions Results suggest an important concomitance of mild TBI among orthopaedic trauma patients, the majority of which go undetected during acute care. Patients treated for an upper Limb Fracture are particularly at risk of sustaining concomitant mild TBI.
Benoit Benoit - One of the best experts on this subject based on the ideXlab platform.
-
moderate to severe acute pain disturbs motor cortex intracortical inhibition and facilitation in orthopedic trauma patients a tms study
PLOS ONE, 2020Co-Authors: Marianne Jodoin, Dominique M Rouleau, Benoit Benoit, Stephane Leduc, Georgeyves Laflamme, Camille Larsondupuis, Emilie Sandman, Audrey Bellemare, Catherine Provost, Martine LevesqueAbstract:OBJECTIVE: Primary motor (M1) cortical excitability alterations are involved in the development and maintenance of chronic pain. Less is known about M1-cortical excitability implications in the acute phase of an orthopedic trauma. This study aims to assess acute M1-cortical excitability in patients with an isolated upper Limb Fracture (IULF) in relation to pain intensity. METHODS: Eighty-four (56 IULF patients <14 days post-trauma and 28 healthy controls). IULF patients were divided into two subgroups according to pain intensity (mild versus moderate to severe pain). A single transcranial magnetic stimulation (TMS) session was performed over M1 to compare groups on resting motor threshold (rMT), short-intracortical inhibition (SICI), intracortical facilitation (ICF), and long-interval cortical inhibition (LICI). RESULTS: Reduced SICI and ICF were found in IULF patients with moderate to severe pain, whereas mild pain was not associated with M1 alterations. Age, sex, and time since the accident had no influence on TMS measures. DISCUSSION: These findings show altered M1 in the context of acute moderate to severe pain, suggesting early signs of altered GABAergic inhibitory and glutamatergic facilitatory activities.
-
effects of concomitant mild traumatic brain injury on resuming work after suffering from an isolated Limb Fracture a cohort study
Brain Injury, 2017Co-Authors: Marianne Jodoin, Dominique M Rouleau, Benoit Benoit, Stephane Leduc, Georgeyves Laflamme, Camille Larsondupuis, Nadia Gosselin, Meriem Sabir, Louis De BeaumontAbstract:ABSTRACTBackground: The objective is to explore the effects of concomitant mild traumatic brain injury (mTBI) on return to work (RTW), among patients suffering from an isolated Limb Fracture. This follow-up study included a total of 170 working age subjects with an isolated Limb Fracture, and was conducted in a phone interview approximately 1-year post trauma. 41 had experienced an mTBI and 129 did not. Methods: Data were obtained through a phone interview conducted on average 20.7 months (SD = 9.6 months) post-accident. The main outcome measure was the number of days taken to RTW after the injury. Demographic information was also gathered during the phone interview. Workers’ compensation status was obtained through the hospitals’ orthopaedic clinic data. Results: The mTBI group took on average 329.7 days (SD = 298.0) to RTW after the injury, as opposed to 150.3 days (SD = 171.3) for the control group (p < 0.001). After excluding patients who received workers’ compensation, the mTBI group still missed sig...
-
comorbid mild traumatic brain injury increases pain symptoms in patients suffering from an isolated Limb Fracture
Injury-international Journal of The Care of The Injured, 2017Co-Authors: Marianne Jodoin, Dominique M Rouleau, Benoit Benoit, Stephane Leduc, Nadia GosselinAbstract:Abstract Objectives This study seeks to evaluate the effects of a mild traumatic brain injury (mTBI) on pain in patients with an isolated Limb Fracture (ILF) when compared to a matched cohort group with no mTBI (control group). Patients and methods All subjects included in this observational study suffered from an ILF. Groups were matched according to the type of injury, sex, age, and time since the accident. Main outcome measurements were: Standardized semi-structured interviews at follow-up of a Level I Trauma Center, and a questionnaire on Fracture-related pain symptoms. Factors susceptible to influence the perception of pain, such as age, sex, severity of post-concussive symptoms, and worker compensation were also assessed. Results A total of 68 subjects (36 females; 45 years old) with an ILF were selected, 34 with a comorbid mTBI and 34 without (24/34 with an upper Limb Fracture per group, 71% of total sample). Patients with mTBI and an ILF reported significantly higher pain scores at the time of assessment (mean: 49 days, SD: 34.9), compared to the control group (p Conclusions Results suggest that mTBI exacerbate perception of pain in the acute phase when occurring with an ILF, and were not explained by age, sex, post-concussive symptoms, or worker compensation. Rather, it appears possible that neurological sequelae induced by mTBI may interfere with the normal recovery of pain following trauma.
-
incidence rate of mild traumatic brain injury among patients who have suffered from an isolated Limb Fracture upper Limb Fracture patients are more at risk
Injury-international Journal of The Care of The Injured, 2016Co-Authors: Marianne Jodoin, Dominique M Rouleau, Camille Charleboisplante, Benoit Benoit, Stephane Leduc, Georgeyves LaflammeAbstract:Abstract Objectives This study compares the incidence rate of mild traumatic brain injury (mild TBI) detected at follow-up visits (retrospective diagnosis) in patients suffering from an isolated Limb trauma, with the incidence rate held by the hospital records (prospective diagnosis) of the sampled cohort. This study also seeks to determine which types of Fractures present with the highest incidence of mild TBI. Patients and methods Retrospective assessment of mild TBI among orthopaedic monotrauma patients, randomly selected for participation in an Orthopaedic clinic of a Level I Trauma Hospital. Patients in the remission phase of a Limb Fracture were recruited between August 2014 and May 2015. No intervention was done (observational study). Main outcome measurements: Standardized semi-structured interviews were conducted with all patients to retrospectively assess for mild TBI at the time of the Fracture. Emergency room related medical records of all patients were carefully analyzed to determine whether a prospective mild TBI diagnosis was made following the accident. Results A total of 251 patients were recruited (54% females, Mean age = 49). Study interview revealed a 23.5% incidence rate of mild TBI compared to an incidence rate of 8.8% for prospective diagnosis (χ 2 = 78.47; p 2 = 6.70; p = 0.010). More specifically, patients with a proximal upper Limb injury were significantly more at risk of sustaining concomitant mild TBI (40.6%; 26/64) compared to distal upper Limb Fractures (20.25%; 16/79) (χ 2 = 7.07; p = 0.008). Conclusions Results suggest an important concomitance of mild TBI among orthopaedic trauma patients, the majority of which go undetected during acute care. Patients treated for an upper Limb Fracture are particularly at risk of sustaining concomitant mild TBI.