Patients were categorized based on their definitive treatment: group I, limb salvage; group II, early amputation (< 12 weeks postinjury); group III, late amputation (> 12 weeks postinjury). Injury, treatment, and complication data were extracted from medical records and compared across groups.

Results: We identified 213 consecutive fractures, including 166 (77.9%) treated definitively with limb salvage, 36 (16.9%) with early amputation, and 11 (5.2%) with late amputation. There KPT-330 Transmembrane Transporters inhibitor was no difference in fracture severity among the three groups. Before amputation, group III was more likely to use autograft

and bone morphogenic protein (27.3%), compared with group I (4.8%) and group II (0%), and was more likely to undergo rotational flap coverage (45.5%), compared with group II (0%). Group III patients had the highest average number of revision surgeries and rate BMS202 inhibitor of deep soft tissue infection and were more likely to have osteomyelitis (54.5%) before amputation compared with group I (13.9%) and group II (16.7%).

Conclusion: Patients definitively managed with late amputation were more likely to have soft tissue injury requiring flap coverage and have

their limb salvage course complicated by infection.”
“Aim

Supervised consumption of opioid maintenance treatment (OMT) is standard in many drug centres reducing drug diversion, but is costly. We aimed to determine whether supervised consumption of OMT improved retention and other measures of drug use.

Design

Pragmatic randomized controlled trial comparing 3 months of daily supervised consumption of OMT with 1 month or less Selleck GSI-IX of daily supervised OMT, then daily

unsupervised consumption.

Setting

Four community drug services in the United Kingdom.

Participants

A total of 293 opioid-dependent patients entering OMT.

Measurements

Primary outcome: retention in treatment at 12 weeks. Secondary: retention at 6 months; illicit drug use [Maudsley Addiction Profile (MAP)]; quality of life (SF-12 and MAP); criminality (MAP); and social functioning.

Findings

No significant between-group difference was observed for the primary outcome: 69% (100 of 145) supervised and 74% (109 of 148) unsupervised were retained [odds ratio (OR) = 0.74, 95% confidence interval (CI) = 0.43-1.27]. Per protocol survival analysis suggested that supervised patients were less well retained (hazard ratio for retention = 0.71, 95% CI = 0.51-1.00). Illicit opioid use reduced in both groups and, while not statistically significant by intention-to-treat analysis, favoured unsupervised patients in per protocol analysis (odds of positive opioid screen for supervised versus unsupervised = 2.07, 95% CI = 1.05-4.06). Data on criminal activity also favoured unsupervised patients with 21% supervised patients committing crime versus 9% unsupervised (OR = 3.37, 95% CI = 1.28-8.86).