Continuous Intravenous Lidocaine Infusion Versus Placebo for Rib Fracture Analgesia
Rib FracturesThe current cornerstone of pain control for rib fractures is oral and intravenous opioids, especially in the form of patient-controlled analgesia (IV PCA), which are are associated with multiple adverse effects including sedation, respiratory depression, cough suppression, and increased risk of delirium. In the past few decades, intravenous lidocaine infusion (IVL) has emerged as a new tool in the arsenal of multimodal analgesia. Multiple randomized clinical trials have indicated that IVL is overall well tolerated and have shown other beneficial effects such as anti-inflammatory properties. To this date, there have been no published randomized clinical trials (RCT) evaluating the effectiveness of IVL in management of traumatic rib fracture pain. Therefore, the purpose of this study is to evaluate whether IV Lidocaine infusion can provide improved pain control as demonstrated by decreased OME consumption at 24 and 48 hours compared to placebo in adult patients with acute traumatic rib fractures.
ORIF Versus CRIF of Completely Displaced and Rotated Lateral Condylar Fractures of the Humerus in...
Humeral FracturesOpen reduction and internal fixation has been widely used in treating completely displaced and rotated lateral condylar fracture in children and it usually produces good results. Only a few studies reported Closed reduction and internal fixation is an effective treatment for completely displaced and rotated lateral condyle fractures of the humerus, but evidence on its effectiveness and safety is scarce. The aim of the trial was to compare functional and outcome use in patients treated completely displaced and rotated lateral condylar fracture with ORIF versus CRIF.
The PREVENT Trial: a Pragmatic Cluster Randomized Controlled Trial of a Multifaceted Fracture Prevention...
FractureFractures2 moreHip fractures occur nearly twice as often for older adults residing in long-term care as they do in older adults of a similar age still living in other settings. Hip fractures are the leading cause of hospitalization and often result in loss of independence, problems with walking and sometimes death. To address this problem the PREVENT (Person-centered Routine Fracture PrEVENTion in LTC) program was designed for use in long-term care homes. PREVENT uses a tool ("fracture risk calculator") based on a residents electronic health record to capture who is most at risk of fracture due to osteoporosis and falls. The program then trains the health care team including doctors, pharmacists and nurses on the latest recommendations on how to best assist residents and their families in making treatment decisions. The healthcare teams are also given tools that help them stay on track such as templates for ordering medications, strategies to reduce falls and fractures and making care plans. The study will examine if this program is effective for decreasing hip fractures by assigning some homes to receive the PREVENT program (intervention group) and some homes to usual care (control group) and comparing the results.
Antibiotic Use & Open Fracture of the Lower Extremity
Lower Extremity FractureIt is important to recognize the potential for renal injury and be cognizant of this during the management of complex trauma patients. The primary aim of this study is to investigate the necessity of aminoglycoside usage for patients with open lower extremity fractures. Hypothesis: adding aminoglycoside on top of cephalosporin in treating lower extremity fracture will make no significant difference in term of clinical outcomes when compared to cephalosporin alone.
Clinical Trial to Assess the Efficacy of Tranexamic Acid in Reducing Blood Loss in Hip Fracture...
Hip FracturesHip fracture in elderly patients is a pathology with a high economic and health impact on the patient himself and on the National Health System, especially considering the significant aging of the population of the Basque Country. Despite advances, hip fracture remains in the clinical groups with the highest in-hospital mortality. Hip fracture is associated with numerous adverse events and high mortality. Numerous antifibrinolytics, such as tranexamic acid (TXA), have been used to limit bleeding in orthopedic surgery and thus prevent the need for blood transfusion. Numerous studies have shown that the use of tranexamic acid does not increase the risk of thrombosis. It is proposed to carry out clinical research with drugs without commercial interest. A randomized, double-blind clinical trial to assess the efficacy of tranexamic acid in reducing blood loss in elderly patients with hip fracture.
Does Joint Lavage Reduce Intraarticular Inflammation in High-energy Tibial Pilon Fractures?
Post-traumatic; ArthrosisTibial Fractures1 moreHigh-energy tibial pilon fractures have historically been associated with poor outcomes largely due to the elevated risk of severe post-traumatic arthritis. Intraarticular fractures result in a pro-inflammatory hemarthrosis that may further exacerbate the chondral damage that was sustained due to the original injury. This project will study the effect of joint lavage on the concentration of inflammatory cytokines in the ankle following a high-energy tibial pilon fracture and the resultant effect on short-term patient outcomes.
Continuous Lornoxicam Infusion for Orthopaedic Surgery
Closed Non Comminuted Long Bone FracturesPerioperative continuous infusion of lornoxicam would be an effective and safe regimen to reduce the patient controlled morphine consumption after orthopaedic surgery. After ethical approval, 96 patients scheduled for elective orthopaedic fracture surgery under general anaesthesia were randomly allocated to receive placebo, 12-hourly iv lornoxicam 16 mg or lornoxicam 16 mg followed with continuous infusion of 1.3 mg/hr., for 48 hours after surgery (n=32 per group). Anaesthesia was induced with propofol, sufentanil and rocuronium, and was maintained with 0.5-1 minimum alveolar concentration sevoflurane, sufentanil and rocuronium. Postoperative patient controlled morphine analgesia was used. Changes in heart rate, mean blood pressure and sevoflurane minimum alveolar concentration, visual analogue pain scores, and cumulative patient controlled morphine consumptions and blood loss for 48 hours, platelet functions, bone non-union and the presence of adverse effects were recorded.
Safety and Efficacy of the WaisFix100i for Intracapsular Femoral Fracture Fixation
Hip FractureThe purpose of this study is to determine the safety and efficacy of using WaisFix100i device for Intracapsular Femoral Fracture Fixation.
Gene Expression in Lower Extremity Acute Traumatic Compartment Syndrome
Tibial Shaft FractureTibial Plateau FractureThe purpose of this study is to evaluate both genotypic differences and differences in local gene expression in individuals who develop acute traumatic compartment syndrome relative to control patients with at-risk lower extremity fractures who do not develop compartment syndrome.
Diagnostic Performance of Ultrasound for Primary Survey of Traumatic Long Bone Fractures
TraumaLong bone fractures are among the most traumatic patients seen in emergency departments. Using ultrasound to diagnose long bone fractures can reduce the risk of complications occurring During the primary and secondary survey. The diagnosis of long bone fractures is traditionally accomplished through plain radiographs taken at perpendicular angles to each other. Because of the resources required for radiographic capability, X-ray can be inaccessible in rural or remote areas, or in hospital during break time, In settings where a radiography technologist is not present on-site or in patient have conditions do for him limitations movement Using ultrasound machines to do patient examination can be performed earlier of assessment, and at the bedside, reducing diagnostic delays and time to initiation of management. Additional Advantages of Ultrasound include its simplicity, portability, repeatability, and its lack of ionizing radiation. Using ultrasound technology don't need equipment for lead protectors on health care providers, as well as the harmful effects to patients of ionizing radiation and safe to use with pregnant patients in the first and second trimester. However, this technique can be impractical because the training necessary for the use of this technology Diagnosis of long bone fractures in primary assessment can decrease risk of complications such as shock, bleeding, swelling, embolism compartment syndrome, vascular or neurological damage and patient's transposition related change shape and type of a fracture. that complications can lead to life-threatening conditions up to death specifically in geriatric and paediatric Patients