Injury
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Achilles tendon ruptures are becoming more common. Complications after open or minimally invasive surgery are: recurrent rupture (2-8%), wound breakdown, deep infections, granuloma, and fistulas. The authors expose their experience with a personal technique. ⋯ The posterolateral skin incision, not above the tendon, preserves the vascularity of the soft tissues, allows identifying and not accidentally injuring the sural nerve, and prevents the cutaneous scar is overlapped the tendon. In this way is favoured physiological tendon sliding. The preparation of the flap tendon does not weaken the overall strength of the tendon and protects the tendon suture. The tension on sutured stumps is less than being spread over a larger area. In our sample of 8 patients the absence of short-and long-term complications and the rapid functional recovery after surgery suggest that the technique used is safe and effective.
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Despite decline in U.S. traffic fatalities, non-fatal injuries remain a main cause of reduced self-reported health. The authors used a nationally representative survey to examine the long-term (≥1 year) implications of traffic injuries on self-care, depression, mobility, pain and activity domains of a widely used measure assessing Health-Related Quality of Life (HRQOL). ⋯ Traffic injuries are significantly associated with long-term reduced HRQOL. Injured individuals may benefit from early intervention programs to prevent the development of secondary complications and reduced HRQOL.
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Pain has been identified as the dominant factor in patient outcomes. The purpose of this study was to evaluate the degree of pain reported in a large series of acute ankle fractures and to determine what factors are associated with higher pain scores. We prospectively evaluated 457 consecutive patients with acute Weber B supination external rotation ankle fractures upon presentation for pain in 9 areas of the ankle. ⋯ Pain decreased with time from injury. In this evaluation of over 450 patients with Weber B, SE pattern ankle fractures we confirmed previous work in the upper extremity indicating an important difference in the reported pain by ethnicity. In particular, black patients have more pain than white or latino patients given the same injury.
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Current management of undisplaced hip fractures is based on internal fixation. Reported revision rates of 12-17% for this procedure negatively impact on patient morbidity and mortality. The aim of this novel study is to examine if the nutritional status of these patients is associated with failure of internal fixation. ⋯ 16% of fixations failed (18 patients). Patients with fixation-failure had a significantly lower albumin (35g/l vs. 40g/l, p=0.02) and lymphocyte count (0.7×10(9)l vs. 1.4×10(9)l, p≤0.001) than non-failure patients. Lymphocyte count, albumin level and posterior-tilt angle were independent predicators of failure on binary logistic regression analysis. We suggest that routine laboratory tests can be used to identify patients at greatest risk of failure of internal fixation.
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Uncertainty remains regarding the optimum method of anaesthesia for hip fracture surgery. We randomised 322 patients with a hip fracture to receive either general anaesthesia or regional (spinal) anaesthesia. ⋯ There was no notable difference in the outcomes of hospital stay, need for blood transfusion or post-operative complications between groups. 30-day mortality was marginally reduced for spinal anaesthesia 7/164(4.3%) versus 5/158(3.2%) (p=0.57), whilst at 1 year it was less for general anaesthesia 20/163(12.1%) versus 32/158(20.2%) (p=0.05). Within the confines of the limited patient numbers studied we conclude that there are no marked differences in outcome between the two techniques.