Injury
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Randomized Controlled Trial Comparative Study
Prospective randomised controlled trial of nanocrystalline silver dressing versus plain gauze as the initial post-debridement management of military wounds on wound microbiology and healing.
Recent conflicts have been characterised by the use of improvised explosive devices causing devastating injuries, including heavily contaminated wounds requiring meticulous surgical debridement. After being rendered surgical clean, these wounds are dressed and the patient transferred back to the UK for on-going treatment. A dressing that would prevent wounds from becoming colonised during transit would be desirable. The aim of this study was to establish whether using nanocrystalline silver dressings, as an adjunct to the initial debridement, would positively affect wound microbiology and wound healing compared to standard plain gauze dressings. ⋯ This is the first randomised controlled trial to report results from an active theatre of war. Performing research under these conditions poses additional challenges to military clinicians. Meticulous debridement of wounds remains the critical determinant in wound healing and infection and this study did not demonstrate a benefit of nanocrystaline silver dressing in respect to preventing wound colonisation or promoting healing, these dressings do however seem to significantly reduce the unpleasant odour commonly associated with battlefield wounds.
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Randomized Controlled Trial Comparative Study
Closed reduction and internal fixation for intertrochanteric femoral fractures is safer and more efficient using two fluoroscopes simultaneously.
The purpose of the study was to assess whether using two fluoroscopes simultaneously in closed reduction and internal fixation of a stable intertrochanteric fracture reduces radiation and operation time. Patients who sustained a stable intertrochanteric femoral fracture were operated in our institution with closed reduction and internal fixation. They were randomly allocated to be operated with the assistance of one or two fluoroscopes. ⋯ Working simultaneously with two fluoroscopic devices is safer for the medical team in the operating theatre, because it decreases the patient's radiation exposure, wound exposure time, and anaesthesia time. It saves operating room time and fluoroscopy personnel during the operation. When operating on hip fractures that are planned to be reduced and fixated, we recommend working with two fluoroscopes simultaneously.
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Traumatic soft tissue defect is a common issue for the trauma surgeon. The aim of this study was to evaluate the use of a dermal regeneration template (DRT) associated to a split-thickness skin graft (STSG) to cover severe traumatic wounds involving exposure of deep functional structures. ⋯ Eighteen months' follow-up demonstrated that DRT reconstruction is a simple, reliable, efficient tool to treat complex traumatic soft tissue defects.
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Comparative Study
Comparing Femoral Version After Intramedullary Nailing Performed by Trauma-Trained and Non-Trauma Trained Surgeons: Is There a Difference?
As with some procedures, trauma fellowship training and greater surgeon experience may result in better outcomes following intramedullary nailing (IMN) of diaphyseal femur fractures. However, surgeons with such training and experience may not always be available to all patients. The purpose of this study is to determine whether trauma training affects the post-operative difference in femoral version (DFV) following IMN. ⋯ Post-operative version or percentage of DFV >15° did not significantly differ following IMN of diaphyseal femur fractures between surgeons with and without trauma fellowship training. However, prospective data that removes the inherent bias that the more complex cases are left for the traumatologists are required before a definitive comparison is made.
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This study aims to characterise the injuries and surgical management of British servicemen sustaining bilateral lower limb amputations. ⋯ Our findings detail the severe nature of these injuries together with the massive surgical and resuscitative efforts required to firstly keep patients alive and secondly reconstruct and prepare them for rehabilitation.