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Introduction
Published in Peter Houpt, Hand Injuries in the Emergency Department, 2023
Immobilization is a necessary intervention after tendon or ligament injury, or in unstable fractures. If immobilization is decided upon, the ‘intrinsic plus’ position is preferred (Figure 1.2). The MCP joints are flexed 90° and the IP joints fully extended. This position is also called ‘position of protection’ and has nothing to do with the functional position. The functional position, as in a ball dressing, is obsolete. Due to the curved position of the IP joints there is a risk of contractures by shortening of the collateral ligaments.
Clinical Evaluation
Published in J. Terrence Jose Jerome, Clinical Examination of the Hand, 2022
There is compelling evidence to implicate biological pathways that underlie aberrant inflammation, vasomotor dysfunction and maladaptive neuroplasticity in the clinical features of CRPS [9]. Women are three to four times more commonly involved; distal radius fractures have been associated with CRPS in 4–39% of cases. It is rare in children but if involved it occurs in the leg. Trauma, fractures and sprains (60%) with prolonged periods of immobilization are the most common inciting factors. There have been no psychological variables that contribute towards CRPS.
Introduction and Review of Biological Background
Published in Luke R. Bucci, Nutrition Applied to Injury Rehabilitation and Sports Medicine, 2020
Ligaments are usually injured by sprains. Healing of sprained ligaments is similar to wound healing, since ligaments are usually vascularized. Hematoma formation and inflammation are followed by relatively slow repair and remodeling phases. Final outcome may take a year or more and usually does not reach previous strength, with reductions of 30 to 50% in tensile strength common. Immobilization decreases the rate and extent of healing, while careful exposure to loads can accelerate ligament healing. Ligaments differ amongst themselves in metabolic rates and healing capabilities.
Treatment approaches of stage III and IV pressure injury in people with spinal cord injury: A scoping review
Published in The Journal of Spinal Cord Medicine, 2023
Carina Fähndrich, Armin Gemperli, Michael Baumberger, Marco Bechtiger, Bianca Roth, Dirk J. Schaefer, Reto Wettstein, Anke Scheel-Sailer
After surgery, immobilization is required.11 Regarding the mattress, there is a weak recommendation of the EPUAP with a strength of evidence B1 to assess the relative benefits of using an air fluidized bed to facilitate healing while reducing skin temperature and excessive hydration in individuals with stage III or IV PIs.2 In contrast, the use of alternating pressure air mattresses varies.2 Moreover, the authors using the Basel Decubitus Concept describe different durations of immobilization after flap surgery. In the 90s, individuals were immobilized for six weeks. Since 2015, an immobilization period of six or four weeks has been used, depending on the person's condition, second reconstruction or diagnosed osteomyelitis.5,11,15,37 Neither the EPUAP nor the DMGP guideline contains recommendation on the duration of immobilization after flap surgery. This also applies to the duration of antibiotic treatment in people with and without osteomyelitis.2,4 New evidence suggests that the duration of antibiotic treatment should be adjusted to the severity of osteomyelitis to reduce the development of antibiotic resistance and avoid early postsurgical complication.38 Furthermore, in the Basel Decubitus Concept bone biopsies are meanwhile taken during the debridement to determine the antibiotic therapy for the specific bacteria.38
Effect of Nighttime on Prehospital Care and Outcomes of Road Traffic Injuries in Asia: A Cross-Sectional Study of Data from the Pan-Asian Trauma Outcomes Study (PATOS)
Published in Prehospital Emergency Care, 2022
Sattha Riyapan, Jirayu Chantanakomes, Bongkot Somboonkul, Sang Do Shin, Wen-Chu Chiang
The primary outcome of this study was survival in the ED compared between the nighttime and daytime groups. Survival in the ED was defined from ED disposition status as RTI patients survived to discharge from ED, survived to refer to another hospital, or survived to admit to inpatient. Survival to discharge was extracted from the hospital discharge status, which included the patients who were treated in the hospital and then discharged or transferred to another healthcare facility. We also compared prehospital interventions, including basic airway management, advanced airway management, oxygen supplementation, and total immobilization. Basic airway management included oropharyngeal or nasopharyngeal airway insertion. Advanced airway management consisted of endotracheal intubation or supraglottic airway insertion. Oxygen supplementation comprised nasal canula, face mask, or bag valve mask ventilation. Total immobilization included C-spine or spinal immobilization, femur traction or immobilization, and bandaging at an active bleeding area. The study identified characteristics of RTI patients at night. Alcohol use and substance abuse data was from both biologic evidence and physician’s report. Low- and middle-income countries were grouped according to the World Bank, such as Thailand, Vietnam, India, and Malaysia (see https://data.worldbank.org/income-level/low-and-middle-income).
Anterior Iliac Spine Avulsion Fracture Treatment Options in Young Athletes
Published in Journal of Investigative Surgery, 2020
Iñigo Anduaga,, Roberto Seijas,, Albert Pérez-Bellmunt, Oriol Casasayas,, Pedro Alvarez,
The conservative option is the most selected treatment modality. It consists of immobilization and anti-inflammatory drugs in the acute phase, followed by rehabilitation. The latter is carried out with exercises ranging from passive mobilization, strength exercises and neuromuscular control of the lower extremity exercises, to continuous running. In the last phase of rehabilitation the athlete must be progressively reintroduced to his or her specific sport practice [7, 10]. The other existing treatment, not so frequently chosen as treatment modality, is surgery. It mainly consists of an open surgical reduction and internal fixation of the avulsion fracture using metal screws, absorbable screws or Kirschner needles, and followed by rehabilitation [1, 5, 6, 10]. However, when comparing both treatment modalities, the present study shows that there is a higher radiological consolidation rate, lower incidence of pain and a better return-to-play at 3 months in patients treated surgically compared to those treated with conservatively. Other studies also report shorter rehabilitation periods and better return-to-play times in surgically treated patients [5, 6, 10].