Background

Due to contamination, open fractures are considered to be dangerous and thereby require proper management. Through a systematic review and meta-analysis, this study compares the literature on pre-debridement and post-debridement cultures derived from such fracture sites.

Methods

Data for this review was collected through various online sources such as dataBASE (EMBASE), medical literature analysis and retrieval system online (MEDLINE) and different citations provided the relevant data.

Results

Twenty articles were included. The desired timing to examine the debridement was six hours post-injury (according to the six-hour rule). Antibiotics including ampicillin, penicillin, cefazolin, cefuroxime, and flucloxacillin were used in some patients. The use of Ancef I as an antibiotic during the starting hours of fracture helps to reduce the chances of infection in 1.4% of the infected patients. The infection rate was 3% in pre-debridement culture, while a 2% infection rate was found in post debridement culture. Gram-negative bacteria were responsible for pre-debridement infection, while gram-positive bacteria were responsible for post-debridement.

Conclusion

The pre-debridement infection rates are reduced as compared to post-debridement when treatment is initiated within a strict time interval and limited to the specific use of antibiotics. Treatment of gram-negative bacteria helps to reduce the bulk of infectious material and thereby reduces the infection rate.

Keywords

Open fractures; Debridement; Pre-debridement; Post-debridement; Meta- analysis; Systematic review.

Aim

The study was aimed to assess the results of treatment for fracture-dislocations of the proximal humerus (PH) within different time frames for optimizing treatment tactics.

Patients and Methods

This retrospective cohort study evaluated clinical outcomes of 25 patients with fracture-dislocations of the PH (15 patients were analyzed for short- and medium-term results, and 10 – for long-term results). The follow-up period ranged from 1 to 9-years. All patients underwent: clinical examination, constant score assessment and shoulder X-ray examination. Clinical, radiological and statistical methods were used for analysis.

Results

Assessment of the degree of initial displacement of tubercles and its impact on the results of treatment showed that significantly better results were obtained in case of displacement no more than 10 mm (p=0.041). Patients with displacement no more than 10 mm had an average score of 68.0±16.1 points (Mean=69.5), while those with displacement of the tubercle(s) exceeding 10 mm had an average score of 49.5±19.5 points (Mean=44). Analysis of the results of treatment showed that the delay in restoring normal anatomy of the PH or avoiding surgical interventions at all led to functional disorders of the shoulder joint. It was also demonstrated that neither patients, nor doctors were satisfied with the outcomes of the unipolar shoulder replacement (USR). Based on the results of the study, we proposed an algorithm for determining the tactics of surgical treatment in cases when a fracture-dislocation of the PH with complete dislocation of the fragment involving the articular surface of the humeral head is diagnosed.

Conclusion

The present study demonstrated some factors affecting the outcomes of treatment for fracture-dislocations of the PH. Current approaches for endoprosthesis replacement in these cases remain debatable and require further investigation.

Keywords

Trauma; Fracture; Shoulder joint; Fracture-dislocation of the proximal humerus.

There are different processes via which a muscle cell can utilize oxygen to make energy that will sustain activity. The type of activity and duration of activity will determine what energy system is used to sustain the activity being done. Aerobic metabolism uses oxygen to sustain the energy demand. Oxygen is obtained from the air we breathe, and then transported to the cells though the myoglobin. Although ambient air only contains 21% oxygen, it is enough to sustain life and energy needs. But what if the muscle cell could instead receive 100% oxygen? The delivery method would be via hyperbaric oxygen therapy (HBO) which supplies oxygen at 100% concentration under a minimum of 1 atmospheric pressure. Atmospheric pressure will affect the outcomes of consuming 100% oxygen. Research supports positive findings on oxygen therapy under pressure and muscle cell recovery but much research still needs to be investigated. One research study revealed detrimental effects of 100% oxygen breathed in consistently for days resulting in comorbidities that did not exist prior to experiment. HBO can pose some risks but if it is applied in a controlled manner, HBO can be a safe option to enhance cellular recovery and cell function.

Keywords

Oxygen; Hyperbaric oxygen therapy; Muscle recovery; Muscle cells; Pure oxygen.