Injury
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Accumulating evidence implicates cerebral fat embolism (CFE) as a causative agent in post-operative confusion (POC). CFE occurs following orthopaedic procedures including, intra-medullary (IM) nailing and total joint arthroplasty (TJA). The incidence of CFE is high (59-100% TJA) and the resulting POC is associated with higher overall complication rates. ⋯ LME are propelled to the brain where they cause disruption via ischemia or by alterations in the blood-brain-barrier - causing cerebral oedema. Prevention of CFE follows established practices for preventing FES and consideration of additional techniques to remove resident fat and reduce IM pressures. When CFE occurs supportive treatment should be established.
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Systematic implementation of guidelines in patients presenting with a fracture increases identification of patients at high risk for subsequent fractures and contributes to a decreased fracture risk. Its effect on prevention of subsequent fractures and on mortality has not been documented. The aim of this study was to determine the impact of the implementation of specific guidelines on the risk of subsequent fractures and mortality in patients presenting with a non-vertebral fracture (NVF). ⋯ Systematic implementation of guidelines for fracture prevention by a dedicated fracture nurse immediately after a NVF is associated with a significant reduction of the 2-year risk of subsequent NVF and mortality.
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The selection of the correct entry point for stabilisation of long bone fractures and particularly of the humérus with intramedullary nailing is of paramount importance. The insertion of a nail from the correct entry point ensures anatomical alignment of the head and the shaft fragment. However, particularly for the humérus, the literature addressing this issue is obscure. ⋯ Anatomical reduction could not be obtained in 3/20 humeri even after applying a force of over 35 N. Our results of an average displacement of 2 mm following nail insertion, supports the significance of the entry point as a cause of loss of reduction at the fracture site post nail insertion. In most cases, anatomical reduction can be corrected with relative small forces, whereas in the rest the correction of the displacement is not feasible even with the application of substantial forces.
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To investigate the month and day of the week of injury in common childhood activities using the National Electronic Injury Surveillance System database. ⋯ These findings can be used to further guide childhood injury prevention programmes/campaigns and especially track improvements after targeted prevention programmes. Public parks and schools should check/correct the status of playground landing surfaces just before the bimodal peaks. Education campaigns reinforcing the need for bicycle helmets could be concentrated immediately before the increase in cycling activity – March on weekends and April/May for weekdays.
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Historical Article
Intramedullary nailing in fracture treatment: history, science and Küntscher's revolutionary influence in Vienna, Austria.
Although the first intermedullary fixation technique was already reported in 1886, successfully inter-medullary nailing did not start until November 1939 when Küntscher's revolutionary technique was applied for the first time. Whereas Küntscher initially stated that his "marrow nail" was suitable for almost every fracture type as well as for other procedures including fixation of osteotomies, joint arthrodesis and pseudarthro-sis treatment he tried to develop an own nail for every possible fracture type through the years. ⋯ Only in Vienna the willingness to seize Küntscher's ideas was high. Therefore, in addition to a historic overview and to fundamental knowledge referring to reamed and unreamed respectively to static and dynamic nailing Küntscher's influence on Viennese researchers is presented in our paper.