BackgroundConservative treatment of simple elbow dislocations can lead to complications such as persisting pain and restricted joint mobility. The current aim was to identify patients with deteriorated outcome after conservative treatment and to investigate a possible association with initial joint (in)stability.MethodsSixty-eight patients (mean age 37.1 ± 17.2 years) with simple elbow dislocations received conservative treatment. After closed reduction, joint stability was tested by varus and valgus stress under fluoroscopy. According to the findings under fluoroscopy, three different groups of instability could be identified: (1) slight instability (joint angulation <10°; n = 49), (2) moderate instability (angulation ≥10°; n = 19) and (3) gross instability. Patients with gross instability (re-dislocation under stability testing) were treated with primary surgical ligament repair and therefore excluded from this study. Additionally, MRIs and radiographs were analysed regarding warning signs of instability such as the drop sign and joint incongruence. Main outcome parameters were the Mayo Elbow Performance Score (MEPS), range of motion (ROM), complications and revision rates.ResultsAfter 40.7 ± 20.4 months, the overall MEPS was excellent (94.2 ± 11.3) with a trend of slightly worse clinical results in group 2 (95.8 ± 9.0 vs. 90.0 ± 15.2 points; p = 0.154). In group 1, significantly more patients achieved an excellent result regarding the MEPS scoring system (77.6 vs. 52.6 %; p = 0.043) and elbow extension was significantly worse in group 2 (5.3 ± 9.9° vs. 1.4 ± 3.0°; p = 0.015). Seven treatment complications occurred in group 2 (36.8 %) compared with two in group 1 (4.1 %, p < 0.0001). Six patients (8.8 %) needed secondary surgery with an 8.4-fold higher risk for revision surgery in group 2 (p = 0.007). The presence of a positive drop sign or joint incongruence led to higher odds ratio (OR) for complications (OR = 15.9) and revision surgery (OR = 10.3).ConclusionsThis study demonstrates that patients with moderate joint instability after simple elbow dislocation have a significantly worse clinical outcome, more complications and a higher need for secondary revision surgery following conservative treatment compared to patients with slight elbow instability.
Study design: Prospective, observational study of 20 spinal cord-injured (SCI) patients with chronic pressure ulcers (PUs) using Medihoney. Objectives: To determine the effects of Medihoney by bacterial growth, wound size and stage of healing in PUs. Methods: We treated 20 SCI adult patients with chronic PUs using Medihoney. In all, 7 patients (35%) were female, and 13 (65%) were male. The average patient age was 48.7 years (30-79). In all, 6 patients (30%) were tetraplegic and 14 (70%) were paraplegic. Also, 5 patients (25%) had grade IV ulcers and 15 patients (75%) had grade III ulcers according to the National Pressure Ulcer Advisory Panel. Results: After 1 week of treatment with Medihoney, all swabs were void of bacterial growth. Overall 18 patients (90%) showed complete wound healing after a period of 4 weeks, and the resulting scars were soft and elastic. No negative effects were noted from the treatment using Medihoney. No blood sugar level derailment was documented. Conclusion: The medical-honey approach to wound care must be part of a comprehensive conservative surgical wound-care concept. Our study indicates the highly valuable efficacy of honey in wound management and infection control as measured by bacterial growth, wound size and healing stage.
Bacterial adherence to surfaces is determined by a variety of factors such as temperature, the presence of nutrients, the absence of host defense systems and the configuration of the covered surface. In vivo, adherence to non-biological surfaces is also influenced by the microenvironment, especially plasma proteins, promoting biofilm formation.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.