Injury
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The Pauwels classification for the femoral neck fracture is still broadly used in literature and clinical practise. However, this classification has never been tested for its reliability in terms of inter-observer agreement. We assessed whether or not it is reliable to use the Pauwels classification in pre-operative planning. ⋯ The inter-observer agreement was calculated using the multi-rater Fleiss' kappa. The Pauwels classification showed an inter-observer agreement of κ0.31 (0.01). Classification of intra-capsular hip fractures according to the Pauwels classification using the Pauwels angle is unreliable and its use should be avoided.
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Traumatic knee dislocations are uncommon yet serious injuries that historically have had variable prognosis. The evaluation and management of traumatic knee dislocations remains controversial. Appropriate early management has been shown to have a significant impact on long term functional outcome. ⋯ The dislocated knee is an under diagnosed injury which relies on a high index of clinical suspicion on presentation of any knee injury. There is now a degree of consensus regarding need for surgery, timing of surgery, vascular investigations, surgical techniques and rehabilitation protocols. Vigilant monitoring for neurovascular complications, appropriate investigations and early involvement of surgeons with a specialist interest in knee ligament surgeries is the key to successful management of these difficult injuries.
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The study aim was to determine the outcome, in relation to military service in UK military combat amputees. ⋯ This study is the first to report the outcomes, with regards to return to work, of the UK military amputees injured in Afghanistan and Iraq Soldiers are surviving more severe and complex injuries than before and the majority are able to return successfully to military work. SF-36 PCS scores improve significantly with rehabilitation, and while MCS scores remain constant, the initial assessments are comparable with a normal population.
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Patients with proximal femoral fractures present a difficult problem to health care systems in view of their complex presentations and co-morbidities. Traditionally, the focus of outcome measurement for this patient group has been on mortality and surgical implant success. Increasing recognition of the need to diversify outcome measurements has led to the creation and use of a number of outcome scales. We sought to examine how these scales are being used in the current literature. ⋯ There is no single unifying scale in widespread use for proximal femoral fracture patients. We would recommend the validation of commonly used scales for this population, and would advise the use of scales from more than one category to assess outcome.