Injury
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Comparative Study
A 2-year experience, management and outcome of 200 clavicle fractures.
Clavicle fractures can cause pain and functional impairment if not managed appropriately. This article evaluates the prevalence of clavicular fractures, estimates the number of cases requiring operative treatment, evaluates whether removal of implant is a frequent necessity and compares the final functional outcome of the operative and non-operative groups. ⋯ The incidence of clavicle fractures was 1.23%. A small number of patients (11.7%) required operative treatment. We recommend surgical management of symptomatic non-union and removal of metal implant for hardware-related irritation.
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Comparative Study
Fracture stabilisation in a polytraumatised African population--a comparison with international management practice.
Fracture management in polytrauma patients has favoured early definitive fracture fixation with some authors advocating a staged management approach in these potentially unstable patients. We aimed to investigate the timing of surgical fracture stabilisation in polytrauma patients with significant orthopaedic injuries in a Level 1 trauma unit in South Africa (RSA) and to compare its performance with Level 1 trauma units in the USA and Europe. ⋯ In a developing country when compared to international trauma centres, less primary definitive fixation was performed in the first 24h.
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The purpose of this study was to describe the results of extra-articular and intra-articular fractures, at the base of the first metacarpal, treated with closed reduction and percutaneous fixation with intermetacarpal Kirschner wires. Outcome was evaluated by experienced pain, functional outcome and radiographic indications for arthritis. In total, 25 patients with unstable fractures at the base of the first metacarpal underwent closed reduction and percutaneous fixation of the fracture. ⋯ The described fixation procedure results in a stable fixation of the fracture fragments, and no secondary dislocation of the fracture occurred. Fractures consolidated within 32 (26-50) days and no new fractures were observed. These results suggest that this technique can be safely used in the treatment of extra-articular fractures as well as intra-articular fractures at the base of the first metacarpal.
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The term 'polytrauma' lacks a universally accepted, validated definition. In clinical trials the commonly applied injury severity based anatomical score cut-offs are ISS > 15, ISS > 17 and a recently recommended AIS > 2 in at least two body regions (2 × AIS > 2). ⋯ 2 × AIS > 2 captured the greatest percentage of the worst outcomes and significantly larger % of the clinically defined polytrauma patients. 2 × AIS > 2 has higher accuracy and precision in defining polytrauma than ISS > 15 and ISS > 17. This simple, retrospectively also reproducible criteria warrants larger scale validation.
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The purpose of this study was to report the medium-term results in 28 patients affected by closed displaced fractures of the neck of the fifth metacarpal bone (boxer's fracture) with an associated severe swelling of the hand, who were treated with percutaneous transverse K-wire pinning, to verify the effectiveness of this surgical treatment. We opted for this treatment in all cases in which malrotation of the fifth finger and volar angulation of the metacarpal head greater than 30° were associated with a severe swelling of the hand. All the patients were reviewed clinically and radiologically at an average of 25 months after surgery. ⋯ The disabilities of the arm, shoulder and hand (DASH) scale had a mean value of 5, and all patients considered their result as good or excellent. We recommend percutaneous transverse pinning in all boxer's fractures in which operative treatment is indicated, especially in patients with severe soft-tissue swelling. The surgical procedure is easy to perform, and surgical results are generally good.