Injury
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In an increasingly cost conscious management of health care, estimating the cost of treatment of distal radial fractures has significant relevance. We studied 100 distal radial fractures, prospectively, from their presentation to eventual discharge. On an average, pound320.50 were spent on each patient during 1997. ⋯ In-patient treatment was seen to account for the bulk of the expenditure. We have identified certain guidelines to improve the primary treatment of these fractures and the possibility of treating them in designated sessions in the day surgery unit. This is likely to reduce the overall cost of treatment of these very commonly sustained fractures though this will need to be proved in a future validated study.
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The records of 324 children who were injured in road traffic accidents (RTA) between January 1992 and December 1995 were reviewed to determine the pattern, severity and outcome of their injuries. This represented 2% of all attendances at the emergency room. Pedestrians represented the largest group of patients. ⋯ In 306 children the ISS was 1-25 with no mortality but significant morbidity. Eighteen patients had an ISS of 26-54 with a 61% mortality rate (11 patients). The highest ISS were found in the group of patients who were passengers in a motor vehicle.
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In clinical practice efforts are made to apply a fixation plate on the side opposite the strongest muscle pull. This achieves an optimal distribution of compression between the fragment ends (principle of tension band plating). This is however frequently impossible for anatomical or surgical reasons. ⋯ Later, it may be an indication of secondary instability. The time at which osteons appear, their number and location provides information on the stability of the osteosynthesis. At a time when indirect fracture reduction and stabilization using minimally invasive techniques and implants is being propagated, additional ways and means must be sought to assess clinically the load on the implants and the risk of implant failure.