Perioperative management of acetabular and pelvic fractures: evidence-based recommendations

PURPOSE

The American Academy of Orthopaedic Surgeons does not currently provide clinical practice guidelines for management of PAF. Accordingly, this article aims to review and consolidate the relevant historical and recent literature in important topics pertaining to perioperative management of PAF.

METHODS

A thorough literature review using PubMed, Cochrane and Embase databases was performed to assess preoperative, intraoperative and postoperative management of PAF fracture. Topics reviewed included: time from injury to definitive fixation, the role of inferior vena cava filters (IVCF), tranexamic acid (TXA) use, intraopoperative cell salvage, incisional negative pressure wound therapy (NPWT), intraoperative antibiotic powder use, heterotopic ossification prophylaxis, and pre- and postoperative venous thromboembolism (VTE) prophylaxis.

RESULTS

A total of 126 articles pertaining to the preoperative, intraoperative and postoperative management of PAF were reviewed. Articles reviewed by topic include 13 articles pertaining to time to fixation, 23 on IVCF use, 14 on VTE prophylaxis, 20 on TXA use, 10 on cell salvage, 10 on iNPWT 14 on intraoperative antibiotic powder and 20 on HO prophylaxis. An additional eight articles were reviewed to describe background information. Five articles provided information for two or more treatment modalities and were therefore included in multiple categories when tabulating the number of articles reviewed per topic.

CONCLUSION

The literature supports the use of radiation therapy for HO prophylaxis, early (< 5 days from injury) surgical intervention and the routine use of intraoperative TXA. The literature does not support the routine use of iNPWT or IVCF. There is inadequate information to make a recommendation regarding the use of cell salvage and wound infiltration with antibiotic powder. While the routine use of chemical VTE prophylaxis is recommended, there is insufficient evidence to recommend the optimal agent and duration of therapy.

A novel bipolar electric fence for excluding white-tailed deer from stored livestock feed

Where cattle (Bos taurus) and free-ranging white-tailed deer (Odocoileus virginianus) coexist, they frequently share space and resources, potentially resulting in damage to stores of livestock feed and risk of interspecies disease transmission. Preventing use of stored feed by deer can be an important objective in farm management, depending on amount of damage experienced and perceived risk of disease transmission. Woven wire fences (2.4 to 3.0 m high) are generally considered to be the most effective means for excluding deer. However, rapidly deployable temporary means of excluding deer could be useful, especially during late winter when deer are most physiologically stressed and motivated to consume feed meant for cattle. Thus, the objective of this study was to evaluate a novel 1.2-m-tall electric fence consisting of 4 strands of bipolar tape (not requiring separate ground wires or animal contact with ground) for excluding deer from artificially established feed piles during late winter 2008 in northwestern Minnesota. To induce deer to pause, investigate the fence, and receive negative stimuli before attempting to jump the fence, the bipolar tape was baited with a viscous fluid attractive to deer. The fence was estimated to be >80% effective at reducing deer presence at feed piles (10 treatment sites and 11 control sites) given the late winter to early spring conditions. Despite the efficacy, using the fence as a primary means of protecting stored feed from deer in areas with known disease transmission risk (e.g., presence of bovine tuberculosis) is not recommended because risk could remain unacceptably high if even low numbers of deer access stored feed. Yet, the fence could be effective as immediate protection of stored feed in winter before a more permanent and effective deterrence strategy, such as woven-wire fencing, could be installed during the subsequent summer. The fence would also be effective for reducing deer depredation of stored feed, as well as gardens, small orchards, or other localized or seasonal resources.