Injury
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Radial nerve palsy associated with humeral shaft fractures is the most common nerve lesion complicating fractures of long bones. The purpose of the study was to review the outcome of surgical management in patients with low energy and high energy radial nerve palsy after humeral shaft fractures. ⋯ The outcome of the radial nerve palsy following humeral fractures is associated to the initial trauma. Palsies that are part of a low energy fracture uniformly recover and therefore primary surgical exploration seems unnecessary. In high energy fractures, neurotmesis or severe contusion must be expected. In this case nerve recovery is unfavourable and the patients should be informed of the poor prognosis and the need of tendon transfers.
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Review Meta Analysis
A meta-analysis of amputation versus limb salvage in mangled lower limb injuries--the patient perspective.
This meta-analysis evaluates the quality of life in post-traumatic amputees in comparison with limb salvage. Studies included in this meta-analysis had a minimum of 24 months of follow-up and used a validated quality-of-life outcome assessment scale (Short Form-36 or Sickness Impact Profile) for physical and psychological outcomes. ⋯ A total of 214 studies were identified; 11 fulfilled the inclusion criteria; thus, 1138 patients were available for meta-analysis (769 amputees and 369 cases of reconstruction). The meta-analysis demonstrated that lower limb reconstruction is more acceptable psychologically to patients with severe lower limb trauma compared with amputation, even though the physical outcome for both management pathways was more or less the same.
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Clinical Trial
Treatment of pertrochanteric fractures with a proximal femur locking compression plate.
Pertrochanteric femoral fractures are one of the most common fractures in old patients. However, fixing pertrochanteric fractures properly is clinically challenging. There are also no routine treatments for this fracture. Here, we report the clinical trial of pertrochanteric fracture treatment with a proximal femur locking compression plate (PFLCP). By recording and analysing the radiographic and clinical results from patients treated with PFLCP, we found that PFLCP could provide three-dimensional fixation mechanical advantages compared with conventional treatments, even in the case of unstable fractures in the osteoporotic bone. ⋯ The PFLCP can be a feasible alternative to the treatment of pertrochanteric fractures. Treatment with a PFLCP can provide good-to-excellent healing for pertrochanteric fractures, with a limited occurrence of complications.
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Polyaxial angle-stable plating is thought to be particularly beneficial in the management of complex intra-articular fractures of the distal radius. The purpose of the present study was to investigate whether the technique provides stability to match that of conventional (fixed-angle) angle-stable constructs. ⋯ The polyaxial two-column plate tested in this study provides a biomechanically sound construct for the management of intra-articular fractures of the distal radius.
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Patients over 65 years of age with suspected hip fracture following low-energy trauma often wait a long time for examinations, X-rays, tests and surgery. There may be a connection between long waiting times and complications, including severe pain, mental confusion, infection, pressure sores, and longer hospital stays. This study examines whether implementing prehospital preoperative procedures might lead to reduced waiting times, less postoperative pain, fewer complications and shorter length of care for this patient group. ⋯ This finding suggests that fast-track care for hip fracture patients can minimise complications, heighten priorities, and decrease overall length of care. Greater awareness of risk factors for hip fracture patients amongst hospital staff leads to improved patient care. Fast-track care may also decrease the workload in A&E and thus release more time for other patients.