Injury
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Displaced paediatric forearm fractures are most often treated by manipulation under anaesthetic, followed by the application of a circumferential Plaster of Paris (POP) splint. Some surgeons choose to split the cast in order to facilitate immediate "spreading" with minimal distress to the patient, should the distal limb become compromised. Usually however, this does not occur, and the cast is completed at a later visit to the plaster room. Time, money and inconvenience could be saved if this modification was not necessary, and the final plaster would be lighter. ⋯ Split POP splints which have not been spread, provide adequate stabilisation and protection of paediatric forearm fractures, and do not routinely require completion.
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Tip-apex distance is a well described method for assessment of screw placement in dynamic hip screw fixation of proximal femoral fracture. A distance of <25mm is associated with a significantly lower rate of cut out of the fixation device. Measurement is frequently performed retrospectively, although there has been no demonstration as to what accuracy the surgeon has of estimating tip-apex distance from image intensifier images, whilst scrubbed in theatre. ⋯ Level of seniority, awareness of the concept of tip-apex distance and use of the concept in clinical practice were each assessed. The accuracy in identifying the correct TAD was 82.5% in consultants, 83.8% in registrars and 71.1% in Senior house officers (SHO). The method was used in clinical practice by 50% of consultants, 89% of registrars and none of the SHOs.
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The eye occupies 0.1% of the total body surface yet it accounts for 8-13% of battle injuries in modern warfare worldwide. Protective eyewear can prevent over 90% of these eye injuries in both military and civilian settings. This study presents an analysis of a military casualty database and describes the proportion and distribution of eye injuries among Israel Defense Force (IDF) Soldiers. ⋯ Despite optimal medical care, the majority of soldiers who sustain eye injuries during military service suffer from substantial disability and most are no longer fit for combat service. A majority are discharged from military service. Protective eyewear could potentially prevent penetrating fragmental wounds which are the most common cause of injury. Further research on optimal orbital protection is critical for both the military and the civilian sectors.
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Meta Analysis
Predictors for moderate to severe paediatric head injury derived from a surveillance registry in the emergency department.
Head injuries are a common complaint among children presenting to the emergency department (ED). This study is part of an ongoing prospective surveillance of head injured children presenting to a paediatric ED. We aim to derive predictors for moderate to severe head injury in our population. ⋯ Involvement in road traffic accident, difficult arousal, base of skull fracture and vomiting are independent predictors for moderate to severe head injury in our paediatric population.
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Multicenter Study Comparative Study
Clinical and functional outcomes and treatment options for paediatric elbow dislocations: Experiences of three trauma centres.
Although elbow dislocations are seen rarely in children, their management remains controversial. In this study, over a 7 years period, we evaluated retrospectively the clinical and functional results of paediatric elbow dislocations managed in three different trauma centres. Pure dislocations and dislocations with associated injuries were evaluated separately. ⋯ From the thirty-four patients that had associated injuries, two (6%) had an excellent, 6 (18%) a good, 10 (29%) a fair and 16 (47%) a poor result. Overall, patients with pure dislocation were found to have a better range of motion compared to patients with dislocation and associated injuries. Prolonged follow ups, and effective rehabilitation programs are required in order to expect good outcomes.