Injury
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The management of ankle fracture in the elderly remains controversial. A review of the early results of open reduction and internal fixation (ORIF) in 74 patients over the age of 70 years (average 76 years) was undertaken to identify the early complications, length of stay, return to pre-injury mobility and residential status. This revealed 1% deep infection, 9% delayed wound healing, 5% malunion, and 3% mortality. ⋯ However, the majority (85%) of patients regained their pre-injury mobility and residential status. We conclude that ORIF of ankle fractures in the elderly carries a significant risk of wound edge necrosis with delayed wound healing but the incidence of deep infection is relatively low. Poor bone quality presents technical difficulties but the majority of patients can expect good outcome.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
PC-Fix and local infection resistance--influence of implant design on postoperative infection development, clinical and experimental results.
Bacterial infection is still one of the main complications after internal fixation of fractures. The design of implants influences local infection resistance. To reduce the development of infections around implants after internal fixation, the vitality of the bone should be preserved to optimize cellular and humoral host defence mechanisms. ⋯ Infection rates in the DCP group were significantly higher than in the PC-Fix group: Of the 38 evaluated animals, 12 with a DCP and 5 with a PC-Fix developed local infection (p=0.022). The new PC-Fix design shows low postoperative infection rates in the clinical setting and lower infection rates than the DCP in the experimental setting. The design is an important step in the process of reducing postoperative infection rates.
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Fractures of the forearm are considered to be a very good indication for plating. Conventional plating is still technically demanding. Extensive animal studies show that there is potential for improvement. ⋯ Other complications included one synostosis, fractures with the implant in situ with adequate trauma involving three bones, and two secondary correction procedures for postoperative malalignment. There were seven refractures occurring at a mean of three weeks after the removal of 150 PC-Fixators (4.7%). This study demonstrated that the technique of using an internal fixator is a simple one for the fixation of forearm fractures, resulting in shorter duration of surgery with a low rate of complications compared with the data reported in the literature on conventional techniques for forearm fracture stabilization.
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Prehospital diagnostic accuracy and risks of transportation associated neurological deterioration for patients with spinal injury remain imprecise. ⋯ Prehospital diagnosis of spinal injury, even by medical teams remains imprecise. Choice of helicopter transport, based purely upon the suspected presence of spinal injury could not be supported.