Injury
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The availability of angular-stable plate/screw systems led to a euphoric use of these implants for the treatment of displaced proximal humerus fractures. The high implant costs seem to be justified by a potentially improved outcome. ⋯ Our study showed similar functional results using either plate. Although the PHILOS plate may provide important advantages in specific situations, such as osteoporotic bone, its use as a standard must be carefully judged under the economic aspect of the significant higher implant costs.
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To compare the radiation dose of cervical spine clearance and body CT in a cohort of unconscious, major trauma patients for three different protocols, comparing spiral to multislice CT. To quantify the radiation exposure effect of the protocols on the lifetime cancer risk. ⋯ CT of the trunk (chest, abdomen and pelvis) is associated with the greatest risk of inducing a fatal cancer in the severely injured patient with a GCS less than 9. In our institution the multislice CT protocols expose the patient to less radiation than single slice CT, which is contrary to much of the published work to date. CT scanning the thyroid (or whole cervical spine) still has a marked effect on the cancer risk in cervical clearance. Many centres will relax cervical spinal precautions in unconscious trauma patients if the cervical spine CT with reconstructions is normal. CT of the whole cervical spine may be justified in the unconscious, severely injured patient. In conscious trauma patients, the additional lifetime risk may not justify CT of the whole cervical spine as a routine practice.
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Six men underwent operative management of defects of the humeral head involving at least 40% of the articular surface, following posterior dislocation of the humeral head. The cause of dislocation was a grand mal seizure in three and a fall in three cases. In five cases the dislocation was reduced under general anaesthesia, and in all the posterior dislocation recurred early. ⋯ Radiographs and CT revealed no failures of fixation or of incorporation of the allograft. In four cases the contour and volume of the graft were maintained, but in the two with a bad clinical result, flattening and collapse of the graft and osteoarthrosis were observed. If the procedure fails, prosthetic reconstruction should be simple because the skeletal anatomy has not been distorted.
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Percutaneous vertebral body fixation has been found to provide pain relief and restoration of function for patients with compression fractures. Despite the prevalence of osteoporosis, there are a variety of aetiologies, such as lymphoma, myeloma or metastatic disease that may be responsible for the condition. In these instances, vertebral body biopsy can play an important role in determining fracture aetiology and assist in initiating concurrent medical treatment. ⋯ This study found a 20% prevalence of malignancy in our population, which is higher than other reports in the literature. Eight percent of the patients in this study were ultimately found to have a malignant aetiology behind their compression fracture, while in 18% of the cases the presumed aetiology was not confirmed on pathological examination. Compression fractures can be one of the most common manifestations of osteoporosis, but a variety of other conditions, including neoplastic processes may also be responsible. As a result, we recommend obtaining a vertebral body biopsy prior to every vertebral augmentation procedure.