Risk Of Healing Complications Research Articles

Bone stress injuries.

Bone stress injuries, including stress fractures, are overuse injuries that lead to substantial morbidity in active individuals. These injuries occur when excessive repetitive loads are introduced to a generally normal skeleton. Although the precise mechanisms for bone stress injuries are not completely understood, the prevailing theory is that an imbalance in bone metabolism favours microdamage accumulation over its removal and replacement with new bone via targeted remodelling. Diagnosis is achieved by a combination of patient history and physical examination, with imaging used for confirmation. Management of bone stress injuries is guided by their location and consequent risk of healing complications. Bone stress injuries at low-risk sites typically heal with activity modification followed by progressive loading and return to activity. Additional treatment approaches include non-weight-bearing immobilization, medications or surgery, but these approaches are usually limited to managing bone stress injuries that occur at high-risk sites. A comprehensive strategy that integrates anatomical, biomechanical and biological risk factors has the potential to improve the understanding of these injuries and aid in their prevention and management.

The Pre-Loaded Set-Screw in InterTAN Nail: Should It Be Tightened or Not Tightened in Pertrochanteric Hip Fractures.

Background:InterTAN is a specific type of cephalomedullary nail with a twin interlocking de-rotation and compression screw, which has inherent ability of anti-rotation. Whether to tighten or not to tighten the preloaded setscrew to allow or not allow secondary sliding in InterTan nail is controversial in clinical practice.Methods:We retrospectively collected 4 nonunion cases of unstable pertrochanteric femur fractures (AO/OTA-31A2), all were treated with InterTan nail and the preloaded setscrew was tightened in order to prevent further secondary sliding and femoral neck shortening.Results:After 6 months to 2 years follow-up, the fractures showed nonunion in radiography and the patients complained slight to middle degrees of pain, and had to use walking stick assistant in activities of daily life. Tightening the pre-loaded setscrew to prevent postoperative secondary sliding as static constructs might keep the femoral neck length, but lose the opportunity of telescoping for fracture impaction, and take the risk of healing complications, such as fracture nonunion, femoral head cutout or nail breakage.Conclusions:As the harm outweighs benefit, we advocate the preloaded setscrew in InterTan nail should not be tightened in standard-obliquity pertrochanteric hip fractures (AO/OTA-31A1 and A2).

The risk of healing complications in primary teeth with extrusive or lateral luxation-A retrospective cohort study.

Traumatic dental injuries (TDI) in the primary dentition occur frequently. Long-term complications may potentially cause damage to the permanent successor. The aim of this study was to report the risk of pulp necrosis (PN), pulp canal obliteration (PCO), infection-related resorption (IRR), ankylosis-related resorption (ARR) and premature tooth loss (PTL) in primary teeth following extrusion or lateral luxation and to identify risk factors for PN and PTL. This was a retrospective study of 24 patients with 26 extruded primary teeth and 242 patients with 331 primary teeth with lateral luxation. Laterally luxated teeth were left without treatment. Extruded teeth were repositioned. Follow up included examination after 4weeks, 8weeks, 6months, 1year and when the patients were 6years old. The minimum follow up was 1year or until tooth loss. Kaplan-Meier and Aahlen-Johansson tests were used along with Cox regression analysis. The level of significance was 5%. Risk estimated after 3years-Extrusion: PCO 39.8% (95% CI: NA), PN 15.6% (95% CI: 1.5-29.7), IRR 3.8% (95% CI: 0-11.2) and PTL 43.3% (95% CI: 25.5-61.2). All cases of PN and PTL occurred within the first year. Lateral luxation: PCO 41.3% (CI: 95% 35.7-46.9), PN 19.8% CI: 95% (15.3-24.2), IRR 7.0% (95% CI: 4.1-9.8), ARR 1.4% (95% CI: 0-3.3) and PTL 24.8% (95% CI: 18.8-30.8). Risk factors for PN: concomitant crown fracture and patient aged 4years or more. Nearly all teeth (95%) realigned spontaneously within the first year. Nearly all cases of PN and PTL (95.7%) occurred within the first year. The healing potential for laterally luxated teeth was high and more than half of the extruded teeth, which were repositioned after injury, showed long-term survival.

The risk of healing complications in primary teeth with intrusive luxation: A retrospective cohort study.

Intrusive luxation is a frequent injury in the primary dentition. Complications such as ankylosis or pulp necrosis (PN) and infection with periapical inflammation may affect the developing permanent tooth if not diagnosed and treated in time. The aim of this study was to report the risk of PN, pulp canal obliteration (PCO), infection-related resorption (IRR), ankylosis-related resorption (ARR) and premature tooth loss (PTL) in primary teeth following intrusive luxation, and to identify possible risk factors for PN and PTL. A retrospective analysis of a cohort comprising 149 patients 194 intruded primary incisors. No treatment was performed. The follow-up programme included examination after 4weeks, 8weeks, 6months, 1year, and at 6years of age. The minimum follow-up period was 1year or until time of tooth loss. The Kaplan-Meier and Aalen-Johansen methods were employed along with Cox regression analysis. The level of significance was 5%. Risks estimated after 3years: PCO 38.9% (95% CI: 31.8-46.0), PN 24.2% (95% CI: 17.7-30.6), IRR 8.8% (95% CI: 4.5-13.1), ARR 3.6% (95% CI: 1.0-6.2) and PTL 39.4% (95% CI: 31.2-47.5). Most teeth (83.7%) spontaneously re-erupted within the first year. Most complications were diagnosed within the first year. The risk of PN was lowest in patients less than 2years of age. The degree of intrusion or a concomitant crown fracture did not affect the risk of PN or PTL. Over 80% of the intruded primary teeth re-erupted spontaneously. However, nearly one-third of the teeth showed complications such as pulp infection/periapical inflammation or ankylosis, which could potentially affect the development of the permanent incisor. Therefore, patients should be monitored regularly, especially during the first year after injury, to diagnose and treat complications in time.

The risk of healing complications in primary teeth with concussion or subluxation injury-A retrospective cohort study.

Traumatic dental injuries in the primary dentition occur frequently. Long-term complications may potentially cause damage to the permanent successor. The aim of this study was to report the risk of pulp necrosis (PN), pulp canal obliteration (PCO), repair-related resorption (RRR), infection-related resorption (IRR), ankylosis-related resorption (ARR), and premature tooth loss (PTL) in primary teeth following concussion and subluxation injuries, and to identify possible risk factors for PN, PCO, and PTL following subluxation. The study was a retrospective analysis of a cohort comprising 31 patients (36 teeth) with concussion injury and 174 patients (241 teeth) with subluxation injury. No treatment was performed. The follow-up program included examination after 4weeks, 8weeks, 6months, 1year, and when the patients were 6years of age. Minimum follow up was 1year or until the time of tooth loss. Kaplan-Meier and Aalen-Johansen methods and Cox regression analysis. Level of significance was set at 5%. Risk estimated after one year. Concussion: PCO 8.6% (95% CI: 0-17.9), PN 5.7% (95% CI: 0-13.4), PTL 5.6% (95% CI: 0-13.4). Subluxation: PCO 23.2% (95% CI: 17.8-28.6), PN 8.3% (95% CI: 4.8-11.8), IRR 2.6% (95% CI: 0.5-4.6), PTL 9.5% (95% CI: 5.0-14.1). Most complications (95%) were diagnosed within the first year. Most cases of PN (65%) and PTL (85%) were seen in patients aged 4years or more. Primary teeth with concussion or subluxation injury carry a low risk of PN and infection with periapical inflammation, root resorption, and PTL. Nearly all complications were diagnosed within the first year after the injury. The risk of PTL was highest in patients more than 4years of age at the time of injury.

The Impact of Chemotherapy on Complications Associated with Mastectomy and Immediate Autologous Tissue Reconstruction

We performed this study to evaluate the impact of chemotherapy on the outcomes associated with immediate autologous tissue reconstruction (IATR) in the treatment of breast cancer. Patients were divided into two groups: Group 1 received chemotherapy before surgery and Group 2 did not receive chemotherapy. Records were reviewed to identify demographics, comorbidities, histology, and wound healing complications. Groups were compared using Kruskal-Wallis and Fisher exact tests as appropriate. A total of 128 patients were identified: 29 received chemotherapy before surgery (Group 1) and 99 did not receive chemotherapy (Group 2). Group 1 patients were more likely to have diabetes 27 per cent versus 6 per cent (P = 0.005) despite both groups having a mean body mass index of 30. Group 2 patients had less advanced stage disease as expected because they did not receive chemotherapy; 37 per cent of Group 2 patients had stage 0 breast cancer (P < 0.001). The incidence of wound complications was 17 per cent in Group 1 and 12 per cent in Group 2 (P = NS). Preoperative chemotherapy for breast cancer followed by IATR was associated with no increased risk of healing complications. IATR can be offered to patients who require preoperative chemotherapy, and their healing will not be impaired as a result of the chemotherapy.

Alveolar process fractures in the permanent dentition. Part 2. The risk of healing complications in teeth involved in an alveolar process fracture.

To analyze the risk of pulp canal obliteration (PCO), pulp necrosis (PN), repair-related resorption (RRR), infection-related resorption (IRR), ankylosis-related resorption (ARR), marginal bone loss (MBL), and tooth loss (TL) for teeth involved in an alveolar process fracture and to identify possible risk factors. A total of 91 patients with 223 traumatized teeth. The risks of PCO, PN, RRR, IRR, ARR, MBL, and TL were analyzed separately for teeth with immature and mature root development using Kaplan-Meier and Aalen-Johansen methods. Possible risk factors for PN (age, fracture in relation to apex, displacement, gingival injury, degree of repositioning, type of splint, duration of splinting, treatment delay, and antibiotics) were analyzed for mature teeth using Cox regression. The level of significance was 5%. Immature: No severe complications (PN, IRR, ARR, MBL, or TL) were diagnosed during follow up. Mature: Estimated risk after a 10-year follow up: PN: 56% (95% confidence interval (CI): 48.1-63.9), IRR: 2.5% (95% CI: 0-5.1), ARR: 2.1% (95% CI: 0.1-4.1), MBL: 2.4% (95% CI: 0.3-4.4), and TL: 7.8% (95% CI: 0-15.7). The following factors significantly increased the risk of PN in teeth with mature root development: fracture in relation to apex (hazard ratio (HR): 2.6 (95% CI: 0.2 - 5.7), P=0.01), displacement in the horizontal part of the fracture >2mm (HR: 1.8; 95% CI: 1.1-3.2, P=0.03), incomplete repositioning (HR: 2.1 (95% CI: 1.3-3.5), P=0.003), and age >30years (HR: 2.3 (95% CI: 1.1-4.6), P=0.02). The type of splint (rigid or flexible), the duration of splinting (more or less than 4weeks), and the administration of antibiotics did not affect the risk of PN. Teeth involved in alveolar process fractures appear, apart from PN, to have a good prognosis. A conservative treatment approach is recommended.

A clinical audit to identify factors contributing to surgical wound healing complications

This clinical audit investigated the potential effect of a range of factors on wound healing success in a mixed sample of 285 cats and dogs post ovariohysterectomy in a practice that had noticed healing complications in some patients. Patient records over 18 months from 2008-2009 were included in the study. Factors investigated included skin, muscle and subcutaneous suture material, differences between species and age, the use of an Elizabethan collar, post-operative antibiotics and whether the individual veterinary surgeon performing the surgery affected the incidence of healing complications. Statistical testing included risk-ratio analysis, Chi Square test and Fisher's exact test. The use of catgut in muscle and subcutaneous tissue was found to significantly increase the risk of healing complications (p≤0.001). Dogs appeared significantly more at risk from healing complications than cats (p&lt;0.001). When polyglactin 910 was compared with nylon as a skin suture material to assess the risk of healing complications, the findings were insignificant. The effect of age, the use of Elizabethan collars, the veterinary surgeon and the use of post-operative antibiotics on healing complications were insignificant.

The influence of fracture etiology and type on fracture healing: a review of 104 consecutive tibial shaft fractures.

This study was conducted to determine retrospectively the factors which influence fracture healing and risk for nonunion in patients with tibial shaft fractures. One hundred consecutive patients with 104 tibial shaft fractures and a mean age of 40 (14-85) years were reviewed. Fractures were classified according to the AO classification system. There were 22 open fractures and 52 comminuted fractures. Thirty-eight fractures were caused by high-energy trauma. Fracture pattern, soft-tissue condition, level of energy of the trauma, malalignment, and treatment methods were identified. The influence of these factors on the time of hospital stay and sick-leave, delayed union, and nonunion were calculated. Normal healing occurred in 61 fractures with a mean healing time of 17 weeks, delayed union in 27 with a mean of 35 weeks, and nonunion in 16 with a mean of 69 weeks. The relative risk of developing nonunion in open fractures was 8.2 (CI = 2.9-10.5) and 2.9 (CI = 1.2-3.2) in fractures exposed to high-energy trauma. This study showed that the soft-tissue condition and level of trauma energy are good predictors for the development of complications. Considering these risk factors at an early stage in the planning of treatment might reduce the risk of nonunion. ergy level of the trauma, fracture comminution, initial fracture displacement, treatment method, contamination, and associated injuries will influence fracture healing. Conservative treatment has in general been recommended for undisplaced closed or grade I open fractures caused by low-energy trauma [15, 18, 21]. However, conservative treatment of a tibial shaft fracture means immobilization of the lower leg for a long period of time, especially if healing is delayed. Thus, it is important to consider the risk of healing complications when planning the appropriate treatment method in the early stage after the injury. The purpose of this study was to analyze complications such as delayed union and nonunion and to identify factors which affect the healing of tibial shaft fractures.