Browsing by Subject "trauma"
Now showing 1 - 6 of 6
- Results Per Page
- Sort Options
Item FRACTURE OF THE FAR CORTEX DURING LARGE FRAGMENT SCREW INSERTION: A POORLY DESCRIBED MEANS OF SQUANDERING SCREW HOLES AND PLACING PLATE FIXATION AT RISK(2014-03) Ming, Bryan; Collinge, CoryPurpose (a): Design: Retrospective study of patient records and plain radiographs to determine the incidence and characteristics of iatrogenic fracture caused by screws themselves while using large fragment screw fixation Methods (b): Setting: Level II regional trauma center and tertiary referral center. Patients: Single surgeon cohort of patients treated surgically for acute fractures or fracture nonunions using large fragment plate and screw fixation. Methods: Retrospective cohort retrieved from an experienced fellowship-trained orthopedic traumatologist’s billing database. Demographics, injury, and treatment details were obtained from patient’s medical and radiographic records. Results (c): Seven instances of iatrogenic unicortical fracture of the distant cortex while using large fragment screw fixation was found in 246 cases, representing 3% incidence. Five were recognized and treatment altered by redrilling and applying a screw in a different trajectory (4), and in one case a plate was revised to a longer plate. In the two other cases, the fracture may have been unrecognized as the screw was left in situ. Conclusions (d): Unicortical fracture of the distant cortex around the pilot hole during screw insertion is poorly described iatrogenic complication, occurring in 3% of our cases where large fragment plate fixation was utilized. This circumstance suggests a few potential problem scenarios. First, some of these cases were unrecognized and the risk of treatment failure may be increased by loss of a screw’s purchase or by creation of a significant stress riser. Second, when the cases were recognized, measures were taken to improve stability, which included simply changing a screw’s axis, but also by revision by extending a plate in one case. Vigilant analysis of radiographs (both intraoperative and postoperative), focus on proper technique with placement of large fragment screws, and awareness of treatment options in the face of this uncommon complication can help minimize the impact of far cortical fracture.Item Geographic Analysis of Trauma Readmissions in North Texas(2016-12-01) Sanchez, Derick J.; Gwirtz, Patricia A.; Berg, Rance E.; Singh, MeharvanDue to the high cost and increased risk of mortality associated with unplanned patient readmissions, research has been aimed to identify risk-factors in patients with high hospital utilization and recidivism. The primary aim of this study was to characterize readmissions across multiple institutions in patients initially admitted to a single urban Level I trauma center. Analysis was carried out to test the hypothesis that a patient’s geographic location of residence can be used to predict readmission rates. Data was queried from a regional database that is comprised of more than 150 hospitals in the North Texas region. Patient ZIP code and county of residence were analyzed using binary logistic regression to determine significance of predictability of readmission by patient geography. Additional variables such as demographics, diagnosis, Elixhauser comorbidities, and insurance were also analyzed to create a full clinical and geographic regression model describing patterns in readmissions.Item Heterotopic Ossification: A Recurrence Model and Novel Approach to NSAID Prophylaxis(2018-05) Juarez, Jessica K.; Reeves, Rustin E.; Rickards, Caroline A.; Wenke, Joseph C.; Rivera, Jessica C.; Gwirtz, Patricia A.Heterotopic ossification (HO) describes aberrant bone formation in soft tissue such as joints and muscle tissue, and is a complication of traumatic injury. The pathogenesis of HO is poorly understood, however, a common complication is chronic inflammation, which is also implicated in the osteogenic cascade. The current standard of care for trauma-patients with HO is excision and administering prophylactic radiation therapy and systemic non-steroidal anti-inflammatory drugs (NSAID). Treatments are based on several factors, including severity of trauma and ectopic bone formation potential. Systemic NSAID delivery reduces the inflammatory response but interferes with wound healing, and results in gastritis which can contribute to patient non-compliance. Following excision, HO recurrence is also a possibility. We hypothesized that local NSAID delivery would prevent primary ectopic bone formation when delivered at the time of injury in a rat tibialis anterior, and that local NSAID delivery would prevent recurrent HO following excision of established HO. The major findings of this study were that 1) locally delivered NSAIDs did not prevent primary HO when delivered at the time of injury, and 2) recurrence of HO was not observed in either the control or NSAID treatment groups following excision of established HO. We conclude that local NSAID delivery at the time of induction does not prevent primary HO formation. Additionally, recurrence is not observed in either control or treatment groups following partial excision of established bone treated with locally delivered NSAIDs. However, bone volume reduction is observed four weeks following NSAID delivery in both treatment and control groups. Further investigation into treatment timing, treatment dose, and delivery vehicle is warranted for both primary HO prevention and recurrence following excision.Item Is There a Relationship Between Impulsiveness, Risk Perception, Alcohol Problems, Race/Ethnicity, and Alcohol-Related Injury Type?(2006-05-01) Hamann, Cara; Cardarelli, Kathryn; Field, Craig; Fischbach, LoriThis cross-sectional study examined the associations between impulsiveness, risk perception, alcohol problems, race/ethnicity and alcohol-related intentional injury of 1504 White, Black, and Hispanic trauma patients from the emergency department at a Level 1 Trauma center in Dallas, Texas. After controlling for race/ethnicity, age, gender, education, marital status, drug use, and annual frequency of heavy drinking, injury-related alcohol problems within the past 12 months (OR= 1.10, 95% CI 1.02-1.18) had a moderate effect on intentional injury. Impulsiveness (total score, motor, and non-planning) and alcohol problems (total score, physical, interpersonal, social responsibility, and injury) had moderate effects on intentional injury in univariate analyses, but these effects became null in multivariate analyses. Race/ethnicity had a large effect on injury type in all models considered in the study, with Blacks (estimated ORs ranged from 3.06 to 3.54, 95% CIs ranged from 2.08 to 5.18) and Hispanics (estimated ORs ranged from 2.29 to 2.47, 95% CIs ranged from 1.61 to 3.52) having greater odds of intentional in jury in comparison to Whites in univariate and multivariate analyses. Overall, race/ethnicity and injury-related alcohol problems were the only variable of interest that showed effects on intentional injury. Lack of significant results may be partially explained the use of ICD-9 codes to categorize injury type. Future studies should address limitations and alternatives of using ICD-9 codes to evaluate psychological and behavioral factors.Item Pulsatile Perfusion Therapy: A Novel Approach for Improving Cerebral Blood Flow and Oxygenation Under Simulated Hemorrhagic Stress(2018-05) Anderson, Garen K.; Rickards, Caroline A.; Goulopoulou, Styliani; Mallet, Robert T.; Jones, Harlan P.Introduction: Tolerance to both actual and simulated hemorrhage varies between individuals. Low frequency (~0.1 Hz) oscillations in mean arterial pressure (MAP) and brain blood flow (indexed via middle cerebral artery velocity, MCAv), may play a role in tolerance to reduced central blood volume; subjects with high tolerance to simulated hemorrhage induced via application of lower body negative pressure (LBNP) exhibit greater low frequency power in MAP and MCAv compared to low tolerant subjects. The mechanism for this association has not been explored. We hypothesized that inducing low frequency oscillations in arterial pressure and cerebral blood flow would attenuate reductions in cerebral blood flow and oxygenation during simulated hemorrhage. Methods: 14 subjects (11M/3F) were exposed to oscillatory (0.1 Hz, 0.05 Hz) and non-oscillatory (0 Hz) LBNP profiles with an average chamber pressure of -60 mmHg. Each profile was separated by a 5-min recovery. Measurements included arterial pressure and stroke volume via finger photoplethysmography, MCAv via transcranial Doppler ultrasound, and cerebral oxygenation of the frontal lobe (ScO2) via near infrared spectroscopy. Results: No differences were observed between profiles for reductions in MAP (P=0.60) and MCAv (P=0.90). The reduction in ScO2, however, was attenuated (P=0.04) during the oscillatory profiles compared to the 0 Hz profile. A similar attenuation was observed in stroke volume (P [less than] 0.001). Importantly, tolerance was higher during the oscillatory profiles (P=0.03). Discussion: In partial support of our hypothesis, cerebral oxygenation was protected during the oscillatory profiles. While MCAv was similar between conditions, the oscillatory pattern of cerebral blood flow may elicit a shear-stress induced vasodilation, so assessment of velocity may mask an increase in flow. Importantly, more subjects were able to tolerate the oscillatory profiles compared to the static 0 Hz profile, despite similar arterial pressure responses. These findings emphasize the potential importance of hemodynamic oscillations in maintaining perfusion and oxygenation of cerebral tissue during hemorrhagic stress.Item The Relationship of Trauma Readmissions and Insurance Status: Does it Matter?(2015-12-01) Shalwani, Anil A.; Patricia A. Gwirtz; Claire KirchhoffPurpose: Unplanned hospital readmissions in trauma patients, in relation to insurance status, are under-explored. This study tests the hypothesis that patients readmitted following a traumatic injury are publically insured and over the age of 65 years. Methods: The data in this study were collected retrospectively from an urban, Level I trauma center between January 1, 2003 and June 30, 2015 and contains patient encounters obtained from Dallas-Fort Worth Hospital Council (DFWHC). A binary logistic regression of the dichotomous dependent variable readmission was performed (ρ [less than] 0.05, 95% confidence interval). Results: A total of 28,979 encounters and 21,231 patients were analyzed. The overall rate of any readmission was 42.2%. Of the 28,979 total encounters, 21,556 encounters consisted of individuals aged 64 years or younger and 7,423 encounters consisted of individuals aged 65 years or older, with readmission rates of 35.2% and 62.6%, respectively (ρ [less than] 0.000). Of the readmission encounters, 41% were insured through Medicare, 22% were uninsured, 28% were privately insured, and 9% were insured through Medicaid. Falls were found to be the number one cause (29%) of readmissions in this population, with severe sepsis as the number one comorbidity (OR=9.46, ρ [less than] 0.000). Conclusion: This study confirmed our hypothesis and found that older individuals, specifically over the age of 65 years, with Medicare insurance are more likely to be readmitted following traumatic injury and characterized by their vulnerability and tendency to fall. This data highlights the need for hospital-centered education focused towards the elderly population.