Injury
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Review
The ATLS(®) classification of hypovolaemic shock: A well established teaching tool on the edge?
Uncontrolled bleeding is the leading cause of shock in trauma patients and delays in recognition and treatment have been linked to adverse outcomes. For prompt detection and management of hypovolaemic shock, ATLS(®) suggests four shock classes based upon vital signs and an estimated blood loss in percent. Although this classification has been widely implemented over the past decades, there is still no clear prospective evidence to fully support this classification. ⋯ Considering these potential deficits associated with the ATLS(®) classification of hypovolaemic shock, an online survey among 383 European ATLS(®) course instructors and directors was performed to assess the actual appreciation and confidence in this tool during daily clinical trauma care. Interestingly, less than half (48%) of all respondents declared that they would assess a potential circulatory depletion within the primary survey according to the ATLS(®) classification of hypovolaemic shock. Based on these observations, a critical reappraisal of the current ATLS(®) classification of hypovolaemic seems warranted.
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To detect whether external factors (time of day, day of week, month and season, lunar phases) influence incidence and outcome of severely injured trauma patients. ⋯ There are clear differences in incidence but not in outcome of the patients due to external factors.
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Multicenter Study Comparative Study
Comparison of outcomes after triceps split versus sparing surgery for extra-articular distal humerus fractures.
To compare elbow range of motion (ROM), triceps extension strength, and functional outcome of AO/OTA type A distal humerus fractures treated with a triceps-split or -sparing approach. ⋯ Level III.
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Randomized Controlled Trial
Comparison between two different platelet-rich plasma preparations and control applied during anterior cruciate ligament reconstruction. Is there any evidence to support their use?
To compare the clinical, analytical and graft maturation effects of two different platelet-rich plasma (PRP) preparations applied during anterior cruciate ligament (ACL) reconstruction. ⋯ II.
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Following pelvic fracture in females of childbearing age, the question of whether or not natural pregnancy and childbirth can occur is often asked by both patients and clinicians. The following is a systematic review of the literature examining caesarean section rate in patients with prior pelvic fracture. ⋯ Patients with prior pelvic fracture undergo caesarean section at a rate greater than those without prior pelvic fracture. The cause for this is not entirely understood but seems to be related at least in part to patient and obstetrician bias rather than solely due to the pelvic fracture and cephalopelvic disproportion.