Injury
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Fractures of the proximal femur are common in the elderly population. Intramedullary nailing has become the standard treatment for intertrochanteric fractures although several extramedullary implants (e.g. dynamic hip screw (DHS), blade plate, locking compression plate (LCP), etc.) exist. However, despite this being a very common operation in traumatology, there are numerous associated complications. ⋯ The implant was removed and replaced by a total hip arthroplasty with simultaneous grafting of the acetabular defect and strapping of the greater trochanter. The evolution was favourable. We also present a review of the literature and analyze our case.
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Comparative Study
Custom-made antibiotic cement nails: A comparative study of different fabrication techniques.
The management of intramedullary long bone infections remains a challenge. Placement of antibiotic cement nails is a useful adjuvant to the antibiotic treatment of osteomyelitis. However, fabrication of antibiotic cement nails can be arduous. The purpose of this article is to introduce an easy and reproducible technique for the fabrication of antibiotics cement nails. ⋯ Conductively cooling of the cement nail (in cold water) and pre-lubricating the chest tube with mineral oil are 2 tricks that render fabrication of antibiotic nail more efficient, reliable, and practical.
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Pregnant patients involved in trauma pose unique diagnostic and treatment challenges as the physiological and anatomical changes associated with pregnancy, and the need to preserve foetal well-being, result in a number of nuances in the standard resuscitation algorithms. This clinical audit within a busy developing world trauma service describes the spectrum and outcome of pregnant trauma patients. ⋯ In an environment with high rates of interpersonal violence, trauma in pregnancy is not an uncommon occurrence. It is most commonly due to assault and the assailant is known to the victim in the majority of cases. Blunt trauma still predominates in this setting but there is a high incidence of penetrating trauma. Foetal mortality in this group is high and reflects the severity of the trauma experienced.
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The majority of ankle fractures are stable and can be treated without an operation, most commonly with cast immobilisation. Based on concerns regarding the risk of a venous thromboembolic event (VTE) while immobilised, there is currently debate as to whether these patients should receive VTE prophylaxis for the duration of treatment. Rates of pulmonary embolism (PE) in this patient group are unknown. ⋯ Pulmonary embolism is rare following ankle fractures treated without an operation. Patients with multiple co-morbidities are at a higher risk. Based on this evidence, an ankle fracture treated without an operation does not appear to be an indication for routine VTE prophylaxis.