Injury
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Stress fractures of the bowed femoral shaft (SBFs) may be one of the causes of atypical femoral fractures (AFFs). The CT-based finite element method (CT/FEM) can be used to structurally evaluate bone morphology and bone density based on patient DICOM data, thereby quantitatively and macroscopically assessing bone strength. Here, we clarify the pathogenic mechanism of SBFs and demonstrate this new understanding of AFFs through mechanical analysis by CT/FEM. ⋯ Significant tensile stress due to bowing deformity can induce AFFs. SBFs should be considered a novel subtype of AFF, and patients with complaints of thigh pain and femoral shaft bowing deformity must be considered at high risk for AFFs. This project (Ref: AOTAP 13-13) was supported by AOTrauma Asia Pacific.
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Soft tissue defects around the knee joint resulting from trauma or because of wound breakdown after total knee arthroplasty present a challenge in a group of patients that often suffer from other co-morbidities. A pedicled gastrocnemius muscle flap remains a workhorse for this kind of wound. However, where the defect lies in the supero-lateral aspect of the proximal knee area, an alternative solution is required. The distally based pedicled gracilis flap has been described as an option for these cases where free-tissue transfer may not be an option and the pedicled gastrocnemius is not sufficient or has already been used. The purpose of this review is to evaluate the usefulness of this flap in the nine cases in which we have utilized it in our unit. ⋯ The distally based pedicled gracilis flap can be a salvage solution for complex soft tissue defects with exposed knee joint, patella or proximal part of knee or exposed knee prosthesis in cases where a pedicled gastrocnemius muscle is inadequate or the patient is not suitable for a free flap. Evidence Level IV.
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Neurotrauma is a preventable public health problem whose quantum is said to be increasing in Third-World countries. This evaluation was performed to collate data which is needed to guide in designing, implementing, and evaluating public health prevention programmes with respect to neurotrauma. ⋯ Neurotrauma is one of the most common form of trauma at our surgical emergency. Assault and road traffic injury (RTI) were the most common cause of TBI and TSI respectively, with RTI being the most common cause of moderate and severe TBI. The incidence and aetiology of TBI varies according to age and gender.
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Reported surgical treatment for injuries and instabilities of the paediatric cervical spine most commonly involves posterior fusion with internal fixation, usually posterior wiring. ⋯ fusion is avoided, growth disturbances are prevented and spinal motion maintained.
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Trauma remains a leading cause of death and disability in the world, and trauma systems decrease mortality from trauma. We developed the Global Trauma System Evaluation Tool (G-TSET) specifically for use in low- and middle-income countries (LMICs). The Sudan People's Liberation Army (SPLA) in the Republic of South Sudan (RSS) desires a military trauma system (MTS) which allowed us to pilot the G-TSET. ⋯ We piloted a novel trauma system assessment tool for the MTS in the RSS. Qualitatively, we identified gaps in the MTS and provided the medical leadership with a plan for improvement. We anticipate a short-term follow-up to quantify improvement, and we seek to validate this tool for use in other countries.