Injury
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Access to specialised trauma care is an important measure of trauma system efficiency. However, few data are available on access to integrated trauma systems. We aimed to describe access to trauma centres (TCs) in an integrated Canadian trauma system and identify its determinants. ⋯ In an integrated, mature trauma system, we observed high access to TCs. However, problems in access were observed for the elderly, women and in urban areas where there are many non-designated hospitals. Access to trauma care should be monitored as part of quality of care improvement activities and pre-hospital guidelines for trauma patients should be applied uniformly throughout the province.
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Proximal fractures of femur represent an important cause of hospitalization, morbidity and mortality for elderly patients. Femoral intramedullary nailing is an option to achieve a stable osteosynthesis but the breakage is a rare complication. The aim was to determinate the prevalence, causes, management and functional outcomes of this patients in our hands. ⋯ To the best of our knowledge, this study represents the largest series of cases of trochanteric nail breakage due to material fatigue. This complication is rare (0.88%) that can foresee in unstable fractures with delayed union. The type of salvage should be individualized showing acceptable functional outcome in our series.
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The purpose of this study was to identify risk factors present at the time of injury that predict poor functional outcomes and heterotopic ossification (HO) in open periarticular elbow fractures. ⋯ Prognostic level IV.
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Comparative Study
A comparison of actual and theoretical treatments of glenoid fractures.
There is no consensus on the operative treatment of glenoid fractures. The purpose of this study was to see whether there was a difference between how patients with a glenoid fracture would receive treatment according to theoretical operative indications based on the measurement of computed tomography (CT) scans and radiographs and the treatment they actually received in our institutions. ⋯ Therapeutic, level III.
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The detection of occult or unpredictable injuries in motor vehicle crashes (MVCs) is crucial in correctly triaging patients and thus reducing fatalities. The purpose of the study was to develop a metric that indicates the likelihood that an injury sustained in a MVC would require management at a Level I/II trauma centre (TC) versus a non-trauma centre (non-TC). ⋯ The analysis indicated that the TSMAIS is not solely correlated with AIS severity and therefore it captures other important aspects of injury such as predictability and trauma system capabilities. The TS and TSMAIS can be useful in advanced automatic crash notification (AACN) research for the detection of highly unpredictable injuries in MVCs that require direct transport to a TC.