ABSTRACT
Tibial plateau fractures are often complex injuries that result from high-energy trauma affecting the articular congruity of the knee. Managing tibial plateau fractures can be challenging because of severe depression of the subchondral cancellous bone and concomitant cartilage injury. Bone substitutes are commonly used to fill such defects as part of the surgical treatment of tibial plateau fractures. We describe three cases of tibial plateau fractures managed with a synthetic bone substitute (b.Bone™, GreenBone ORTHO S.p.A Faenza, Italy) with a highly interconnected and porous 3D structure to mimic the hierarchical architecture and morphology of natural human bone.
ABSTRACT
PURPOSE: Reamer-irrigator-aspirator (RIA) is an innovative device that its indications have recently been expanded to the management of long bone infections. METHODS: In this narrative review, we summarise the most important studies in the field and we present the current open questions pertaining to the use of RIA in the management of osteomyelitis of long bones. RESULTS: The relevant literature is sparse and low quality. Nevertheless, the use of RIA for infected cases has yielded promising outcomes in specialised centres. Technical aspects that merit special attention in osteomyelitis of long bones are its inapplicability in small diameter long bones, the inadequate debridement of wide metaphyseal areas and the potential bleeding sequelae. The use of RIA in open fracture management to reduce infection risk has not gained acceptance. The antibiotic impregnated nails and rods constitute a complimentary strategy for the management of infections. CONCLUSIONS: The use of RIA for the management of long bone infections is an innovative and promising strategy. High quality studies are needed to shed light in its efficacy compared to conventional methods of management of osteomyelitis of long bones.
Subject(s)
Debridement/instrumentation , Osteomyelitis/therapy , Therapeutic Irrigation/instrumentation , Bone Transplantation/methods , Evidence-Based Medicine , Fractures, Bone/complications , Fractures, Bone/microbiology , Fractures, Bone/physiopathology , Humans , Osteomyelitis/complications , Osteomyelitis/physiopathology , Tissue and Organ Harvesting/instrumentation , Treatment OutcomeABSTRACT
PURPOSE: Paediatric trauma is the leading cause of mortality in children. Paediatric trauma resuscitation is the first and foremost step towards a successful treatment and subsequent recovery. Significant advances have taken place in the last years in relation to this field of trauma care. METHODS: In this narrative review, we attempt to summarise the recent development in the concepts of fluid resuscitation, massive transfusion, permissive resuscitation, management of coagulopathy and use of tranexamic acid, literature pertaining to implementation of transfusion protocols in the paediatric population and education related to the paediatric trauma resuscitation. RESULTS/CONCLUSIONS: The current evidence although emerging is still sparse and high-quality studies are needed to shed more light on most of the above domains of resuscitation.
