Injury
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The purpose of this study was to compare imaging modalities in the diagnosis of occult radial head and neck fractures and to assess the diagnostic value of ultrasound in diagnosing occult fractures of the radial head and neck. The study included 193 patients (101 male, 92 female) who were referred by trauma surgeons from January 2011 to July 2014 and presented with history of acute elbow trauma. The mean age of the patients was 37 years (range 15-82 years); 95 right and 98 left elbows were included in the study. ⋯ In conclusion, ultrasound imaging proved to be an effective method for diagnosing occult fractures of the radial head or neck when initial radiograms showed only intraarticular effusion. Ultrasound imaging is a cost-effective, easy-to-use and radiation-free method. For these reasons we recommend it for early detection of occult fracture in the emergency room.
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Distal tibial fractures with intra-articular involvement during childhood are injuries with potentially severe complications if not treated promptly. Daily clinical practice indicates that sole use of plain radiographs may lead to misdiagnosis and subsequent erroneous selection of suitable treatment. The role of computed tomography (CT) in the classification and treatment decision of these injuries is unclear. This study aims to determine whether CT evaluation is required in the management of these fractures. ⋯ Computed tomography lead to changes in fracture classification and treatment decision. Treatment decision changed for 24 patients after CT evaluation. Treatment decision in patients with SH III and IV did not change significantly opposed to patients with transitional fractures, where CT scan had major impact on treatment decision. Despite the irradiation of immature skeleton and higher cost containment, this study indicates that patients with transitional distal tibial fractures as well as patients with displaced SH III and IV fractures must undergo CT examination in order to make accurate diagnosis and select the appropriate treatment.
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Traumatic brain injury (TBI) is divided into primary and secondary brain injury. Primary brain injury occurs at the time of injury and is the direct consequence of kinetic energy acting on the brain tissue. Secondary brain injury occurs several hours or days after primary brain injury and is the result of factors including shock, systemic hypotension, hypoxia, hypothermia or hyperthermia, intracranial hypertension, cerebral oedema, intracranial bleeding or inflammation. ⋯ The lungs and urinary tract were the most common sites of infection. In conclusion, elevated inflammatory markers (white blood cell count and CRP) and hyperglycaemia are associated with secondary brain injury. The lack of routine use of intracranial pressure (ICP) monitoring may explain the high mortality rate and the occurrence of secondary stroke in patients with TBI.
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Acromioclavicular (AC) joint dislocations usually occur in a young active population as a result of a fall on the shoulder. Rockwood divided these dislocations into six types. Optimal treatment is still a matter of discussion. Many operative techniques have been developed, but the main choice is between open and minimally-invasive arthroscopic procedures. The aim of this study was to compare two different surgical methods on two groups of patients to find out which method is superior in terms of benefit to the patient. The methods were evaluated through objective and subjective scores, with a focus on complications and material costs. ⋯ Both methods offer many advantages with satisfying evaluated scores. K-wires with FiberTape(®) offer a shorter period for complete recovery and a significantly more cost-effective outcome, whereas the TightRope System(®) offers shorter operative procedure, better cosmetic result and avoidance of intraoperative fluoroscopy.
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Randomized Controlled Trial
The effect of ankle brace type on braking response time-A randomised study.
The question whether or not a patient with an ankle brace should drive a car is of obvious importance because brake response time (BRT) is considered one of the most important factors for driving safety. ⋯ In conclusion, right-sided ROM restricting ankle braces involve significant impairment of BRT in healthy participants. No such prolonged BRT was found for an elastic ankle bandage or the ligament brace.