Injury
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Multicenter Study
The national clinical audit of falls and bone health: the clinical management of hip fracture patients.
The standards of care for older people who present with a fractured neck of femur (#NOF) have been defined by previously published national guidelines. To assess compliance with these standards the Healthcare Commission commissioned the Clinical Effectiveness and Evaluation Unit (CEEU) for the Royal College of Physicians to deliver 'The National Clinical Audit of Falls and Bone Health for Older People'. ⋯ There are currently unacceptable wide variations in the delivery of clinical care to older people presenting with a #NOF. Of concern were the long lengths of time in A&E for many patients and the low level of routine access to pre-operative medical assessment. It is hoped that the launch of joint initiatives between the British Orthopaedic Association and the British Geriatric Society aimed at delivering service improvements in this area should lead to improved outcomes.
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Review
Pelvic ring injuries with haemodynamic instability: efficacy of pelvic packing, a systematic review.
To assess the role of pelvic packing as an emergency therapeutic intervention in pelvic fractures with concomitant haemodynamic instability. ⋯ Haemodynamically unstable pelvic ring injuries are characterised by significant mortality and complications. Pelvic packing, as a part of a damage control protocol, could potentially aid in early intrapelvic bleeding control and provide crucial time for a more selective management of haemorrhage.
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Traumatic brain injuries remain an area of great challenge to both neurosurgeons and neuroanaesthesiologists. The management of these injuries starts at the scene of the accident. However, strategies for preventing secondary brain injury and its sequelae are continuing to evolve. ⋯ The use of isoflurane has been shown to have a neuronprotective effect. Propofol is thought to be the future drug of choice because of its neuroprotective properties, although these still need to be further proven through research. In this review an understanding of the pathophysiology of traumatic brain injury will be outlined in order to understand the effects of pharmacological and nonpharmacological agents on secondary brain injury.
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This study aims to analyse the contribution of various risk factors for the delay of tibial shaft fractures treated by circular external fixator and predicting the high risk fractures for delayed union. 32 extraarticular tibial shaft fractures of 31 adult patients treated with circular external fixator were included. The patients were analysed according to age, energy of trauma, having an open fracture or not, AO classification, obliquity, use of supplementary fixation techniques in surgery, distance of fracture line to neighbouring rings, having a pin-track infection or not, reduction score, and smoking. There were eight delayed unions and two non-unions in our study. ⋯ There was a significant difference in fracture healing time between pin-track-infected patients and the patients who did not have pin-track infection (p=0.037). In conclusion, our results indicate that non-union infection and not using supplementary fixation techniques are the major factors that delay the healing time. Supplementary fixation enhances the reduction rate and a low reduction score is related with the occurrence of a pin-track infection.
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Review Case Reports
"Challenges in the management of fractures in osteopetrosis"! Review of literature and technical tips learned from long-term management of seven patients.
Osteopetrosis is a metabolic disorder with diminished bone resorption due to osteoclastic abnormality. It causes hard and brittle marble bone which fractures easily. Most of these fractures can be treated conservatively. ⋯ There is also a risk of delay in consolidation and non-union owning to impaired bone remodelling. We present an account of seven patients treated for various fracture related problems occurring throughout their life due to this disease. Difficulties encountered during their treatment prompted us to present some general management principles.