Injury
-
Multicenter Study
Distal femoral fractures: The need to review the standard of care.
Hip fracture care has evolved, largely due to standardisation of practice, measurement of outcomes and the introduction of the Best Practice Tariff, leading to the sustained improvements documented by the National Hip Fracture Database (NHFD). The treatment of distal femoral fractures in this population has not had the same emphasis. This study defines the epidemiology, current practice and outcomes of distal femoral fractures in four English centres. ⋯ This study demonstrates that the distal femoral and hip fracture populations are similar, and highlights the current disparity in their management. The metrics and standards of care currently applied to hip fractures should be applied to the treatment of distal femoral fractures. Optimal operative treatment and rehabilitation remains unclear, and is in need of further research.
-
Phalangeal neck fractures are uncommon and are almost exclusively seen in children. Most paediatric hand fractures are treated conservatively and an excellent outcome is expected in almost all cases. Paediatric phalangeal neck fractures are different mainly because they are unstable and have a high risk of complications. ⋯ Furthermore, complications such as persistent deformity, nonunion, and avascular necrosis are commonly seen following management of phalangeal neck fractures; such complications are extremely rare in other paediatric hand fractures. The current paper aims to review the diagnosis, classification, management and complications of these fractures in children. The paper also aims to introduce an extended classification of phalangeal neck fractures and to explain the clinical relevance of the extended classification.
-
Review Comparative Study
Compliance with a massive transfusion protocol (MTP) impacts patient outcome.
About 5% of civilian trauma requires massive transfusion. Protocolized resuscitation with blood products to achieve high plasma:RBC ratio has been advocated to improve survival. Our objectives were to measure compliance to our institutional MTP, to identify quality assurance activities that could improve protocol compliance and to determine if protocol compliance was related to patient outcome. ⋯ Measures should be directed towards provider and system factors to improve compliance. In this study, there was an association between survival and higher level of compliance.
-
Randomized Controlled Trial Comparative Study
Lateral versus posterior approach for insertion of hemiarthroplasties for hip fractures: A randomised trial of 216 patients.
Continued debate exists about the merits of the different surgical approaches for arthroplasty of the hip. For hemiarthroplasty to the hip the two most commonly used approaches are lateral and posterior. 216 patients with an intracapsular hip fracture being treated with a cemented hemiarthroplasty were randomised to surgery using either a lateral or posterior approach. ⋯ A subjective assessment of the ease of surgery favoured the lateral approach. In conclusion both surgical approaches appear to produce comparable function outcomes.
-
Penetrating injury may involve the major vessels in the abdomen. Injury to the abdominal inferior vena cava (IVC) is uncommon and is usually caused by gunshot wounds. Mortality from IVC injuries is high and has changed little over time. ⋯ This report concurs with other studies. IVC injury carries a high mortality rate and that this has not improved over several decades. Less aggressive management of some stable patients or stable injuries is proposed by the authors for possible improvement of the mortality rate.