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Ankle Fractures (ankle + fractures)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

Etomidate for Pediatric Sedation Prior to Fracture Reduction

ACADEMIC EMERGENCY MEDICINE, Issue 1 2001
Richard Dickinson MD
Abstract. Objective: While etomidate is reported as a procedural sedative in adults, its use in children has not been extensively reported. The authors describe their experience with etomidate for procedural sedation in children with extremity fractures and major joint dislocations. Methods: This was a retrospective descriptive chart review. The setting was a university-based emergency department (ED) that follows national guidelines for procedural sedation. Subjects were children less than 18 years old who received etomidate prior to fracture reduction or major joint dislocations. Standardized data were abstracted from the medical records, including patient demographics, diagnosis, weight, types and doses of sedative and analgesic agents used, number of boluses of etomidate, attempts at reduction, complications encountered, vitals signs before, during, and after the reduction, disposition, and the time from procedure to discharge. Descriptive statistics calculated included means and proportions with 95% confidence intervals. Results: Fifty-three children received etomidate for fracture reduction. Their mean age was 9.7; 41.5% were females. Indications for reduction included forearm fractures (38), ankle fractures (12), upper arm fractures (2), and hip dislocations (1). In most cases (83%) reduction was successful after one attempt only. The mean initial and total doses of etomidate were 0.20 mg/kg (range, 0.1 to 0.4) and 0.24 mg/kg (range, 0.13 to 0.52), respectively. Thirteen patients required a second bolus of etomidate or midazolam. Thirty-four patients (64%) were discharged from the ED after a mean observation of 94 minutes (range, 35 to 255). There were no major adverse events (95% CI = 0% to 5.7%). One patient reported nausea and one required a fluid bolus for hypotension. One patient receiving multiple sedatives and opioid analgesics was admitted for observation due to prolonged sedation. No patient required assisted ventilation or intubation. Conclusions: These results suggest that etomidate is a safe and effective agent for procedural sedation in children requiring fracture and major joint reductions. [source]

Performance after surgical treatment of patients with ankle fractures , 14-month follow-up

PHYSIOTHERAPY RESEARCH INTERNATIONAL, Issue 2 2003
Gertrud Nilsson RPT
Abstract Background and Purpose Few studies have been published that extensively evaluate physical outcome after ankle fractures. In addition, there is a lack of knowledge of how physical outcome correlates with subjective assessments of symptoms and function after ankle fracture. The purpose of the present study was to investigate outcome after surgical treatment of patients with ankle fracture and to study how well the experience of symptoms and function correlated with the results of clinical physical tests. Method The study used a retrospective cross-sectional study design. Fifty-four patients, aged 17,64 years, were evaluated 14 months post-operatively. Evaluation included a questionnaire containing the Olerud,Molander Ankle Score (OMAS) (Olerud and Molander, 1984) and some additional questions. Patients were also called for a physical and radiographic examination. Results The median OMAS obtained was 75 (range 10,100). Only 10 (19%) of the patients reported complete recovery and 16 (30%) scored ,90, indicating good function. The results of the following clinical tests were correlated with OMAS: loaded dorsal extension; ankle circumference; number of toe and heel rises; and single-limb stance. Those who showed poorer results in physical outcome on the affected side had lower OMAS. No ankles with clear mechanical instability were found, although almost half the patients experienced functional instability that, in turn, was associated with decreased total OMAS. Conclusions Both subjectively scored function and physical performance after surgically treated ankle fractures indicated poor results. One reason for this might be insufficient rehabilitation. Copyright © 2003 Whurr Publishers Ltd. [source]