35 research outputs found
Complications in calcaneal fracture surgery and implant removal
No full textThis thesis focuses on postoperative wound complications in calcaneal fracture surgery and implant removal. The extended lateral approach (ELA) in calcaneal fracture surgery is hampered with high rates of postoperative wound infection (POWI) of up to 25%. No placement of a closed suction drain is associated with the occurrence of POWI. Large differences are found between countries and continents in reports on the incidence of wound complications following the ELA in calcaneal fracture surgery. Use of a standardized definition of wound complications for (calcaneal) fracture surgery is of paramount importance, as well as transparent publication on wound complications. The preferred approach in operative treatment of displaced intra articular calcaneal fractures is the sinus tarsi approach, which has similar anatomical reduction, fewer wound complications and a shorter surgical time compared to the ELA. Implant removal of the lower extremity is not a straightforward procedure and high rates of POWI of 14.4% are found. A risk factor for the occurrence of an infection following implant removal is an infection following the index procedure. We performed a large multi-center randomized controlled trial to investigate the effectiveness of a single dose of antibiotic prophylaxis prior to implant removal below the knee. We showed no evidence of efficacy and believe there is no place for routine administration of antibiotic prophylaxis prior to implant removal. In addition, we advise to leave implants in place if there is no indication for implant removal
A structural and mechanical assessment of thrombus analogs formed under physiological pressure and flow
No full textBACKGROUND - The success of the mechanical thrombectomy treatment in acute ischemic stroke is highly dependent on mechanical clot behavior and characteristics like stiffness. This mechanical treatment is tested in clot analogs. Realistic clot analogs could potentially be made in a realistic formation environment. The effects of blood pressure and flow were mimicked in this study. Factors affecting the mechanical behavior of thrombus analogs should be investigated to understand treatment possibilities better.METHODS - First, the effect of blood pressure was mimicked in a static pressure experiment by putting a weight on blood which generates a constant force. The clot analogs were mechanically assessed by unconfined compression testing. The effect of whole blood clot formation under pressure, the effect of different heights, and the effect of different hematocrit levels (a volumetric hematocrit of1%H, 40%H, and 99%H) were investigated. Secondly, fibrin clots are formed by clotting platelet poor plasma on tissue factor under flow, with four different shear rates (shear=0/s, 50/s, 150/s, and 300/s). These clots were assessed by micro-indentation and confocal imaging. RESULTS - A total of 50 clot analogs under static conditions were successfully analyzed. Hyperelastic strain stiffening and visco-elastic behavior was seen in all clots, higher heights resulted in a higher stiffness in strain >60%, and 1%H clots were stiffer than 99%H clots. Furthermore, a total of 43 fibrin clots formed under flow were successfully investigated. It was seen that flow reduced the clotheights, fibers seemed to align with the flow direction, flow reduced the density in the top of the clots, and clots formed under shear had a higher stiffness than similar statically formed clots.CONCLUSION - A range of clot analogs under static conditions and flow were made and tested. The significant differences in mechanical properties and microstructure found can have new implications in thrombectomy research.Biomedical Engineerin
Correction to: Functional outcome following a locked fracture-dislocation of the calcaneus (International Orthopaedics, (2013), 37, 9, (1833-1838), 10.1007/s00264-013-2065-4)
No full textThe published online version contains a mistake in the author list for the name of the author “J. Carel Goslings” was incorrectly presented in the HTML version
The effect of postoperative wound infections on functional outcome following intra-articular calcaneal fractures
No full textThe Author(s) 2015. This article is published with open access at Springerlink.com Introduction High rates of postoperative wound infec-tions (POWI) are reported following the operative treat-ment of calcaneal fractures. This leads to additional therapy, prolonged hospital stay, burden for patients and increased costs. The primary aim of this study is to eval
Influence of Diet on Bowel Function and Abdominal Symptoms in Children and Adolescents with Hirschsprung Disease—A Multinational Patient-Reported Outcome Survey
No full textIntroduction: This study aimed to understand the influence of diet and nutrition items on gastrointestinal symptoms in patients with Hirschsprung Disease (HD). Method: An online questionnaire was created to obtain patient-reported outcomes using the multinational Holistic Care in Hirschsprung Disease Network. This was distributed in Dutch, English, German, Italian, Polish, and Swedish via patient associations. Information on demographics, the extension of disease, current diet, and the influence of food ingredients on bowel function were obtained. Results: In total, 563 questionnaires were answered by parents or patients themselves. The length of the aganglionic segment was short in 33%, long in 45%, total colonic aganglionosis (TCA) in 11%, and involved the small intestine in 10%. Overall, 90% reported following a mixed diet, and 31% reported taking probiotics, with twice as many patients taking probiotics in the TCA group compared to standard HD. Mealtimes and behaviours around eating were affected by 61%, while 77% had established food items that worsened symptoms, and of these, 80% stated that they had worked these items out themselves. A high-fibre diet was followed by 24% and 18% a low-fibre diet. Symptoms were reported, particularly from dairy in 30%, fruits in 39%, pulses in 54%, and sugar in 48%. Conclusions: This first multinational survey on diet and bowel function in HD reports an association between certain dietary items with gastrointestinal symptoms. This study can support an improved understanding of the interaction between food items and bowel function in children with HD. We suggest a multidisciplinary approach to balance dietary exclusions and support adequate growth, preventing nutrition deficiencies and enhancing quality of life
Correction to: Prophylactic negative pressure wound therapy after lower extremity fracture surgery: a pilot study (International Orthopaedics, (2018), 42, 4, (747-753), 10.1007/s00264-018-3781-6)
No full textThe published online version contain mistake in the author list for the name of the author “J. Carel Goslings” was incorrectly presented in the HTML version
Predicting loss of height in surgically treated displaced intra-articular fractures of the calcaneus
No full textThe goal of calcaneal fracture surgery is to restore its anatomy and good foot function. However, loss of height of the subtalar joint can occur post-operatively, as expressed by a decrease in Böhler's angle (BA). The aim of this study was to identify potential factors associated with a post-operative decrease in BA. All consecutive adult patients treated with open reduction and internal fixation (ORIF) by an extended lateral approach (ELA) between 2000 and 2013 were retrospectively included. Primary outcome was the occurrence of a calcaneal collapse, defined as a postoperative decrease of ≥10° in BA. The BA was measured pre-operatively, directly following surgery and at one year follow-up. Patient characteristics (body mass index, diabetes mellitus, smoking/alcohol/substance abuse, American Society of Anaesthesiologist classification), fracture classification and treatment characteristics: per-operative increase in BA and occurrence of post-operative wound infection (POWI) were collected. A total of 262 patients with 276 calcaneal fractures were included. A calcaneal collapse occurred in 46 cases (17%). The median preoperative BA, per-operative increase in BA and post-operative decrease in BA were, respectively, 2°, 27° and 4°. A calcaneal collapse was seen more often following a per-operative increase of >25° in BA, but no significant association was found (p = 0.056). Uni- and multivariate analysis showed that patients with substance abuse and those with POWI had significantly more calcaneal collapse (p < 0.05). No association was found between substance abuse and the occurrence of POWI (p = 0.293). In nearly one in six patients with an intra-articular calcaneal fracture treated with ORIF by an ELA, a post-operative collapse of ≥10° was found during follow-up. Calcaneal collapse was correlated with the occurrence of a POWI and substance abus
Erratum to: The effect of postoperative wound infections on functional outcome following intra-articular calcaneal fractures
No full textIdentification of Postoperative Step-Offs and Gaps With Broden's View Following Open Reduction and Internal Fixation of Calcaneal Fractures
No full textBACKGROUND: To date, there is no consensus regarding which postoperative imaging technique should be used after open reduction and internal fixation of an intra-articular calcaneal fracture. The aim of this study was to clarify whether Brodén's view is sufficient as postoperative radiologic examination to assess step-offs and gaps of the posterior facet. METHODS: Six observers estimated the size of step-offs and gaps on Brodén's view in 42 surgically treated intra-articular calcaneal fractures. These findings were compared to postoperative CT scans (gold standard). Inter- and intraobserver reliability were calculated and compared using intraclass correlation coefficients (ICCs). RESULTS: An accuracy of approximately 75% for both step-offs and gaps was found in foot and ankle experts. Less experienced observers correctly identified step-offs and gaps in approximately 62% of cases on fluoroscopy and in 48% on radiographs. Interobserver reliability for intraoperative fluoroscopy as well as postoperative radiographs was fair for step-offs, whereas interobserver reliability for gaps was excellent. Intraobserver reliability showed a low level of agreement for intraoperative fluoroscopy, in contrast to postoperative radiographs with excellent agreement for step-offs and good agreement for gaps. CONCLUSION: Our results show that especially for more experienced foot and ankle surgeons, in the majority of fractures, Brodén's view accurately showed step-offs and gaps following open reduction and internal fixation. Interobserver reliability showed a fair level of agreement for step-offs and excellent agreement for gaps. Intraobserver reliability was only enough for radiographs, not for fluoroscopy. LEVEL OF EVIDENCE: Level IV, case series.status: Publishe
