Injury
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Traumatic internal carotid artery pseudoaneurysm (TICAP) is the most common cause of stroke in young adults. The treatment of TICAP with open surgery poses excess risk, thus during last decade endovascular treatment strategies have been applied. ⋯ Endovascular therapy tends to be an effective option for the treatment of TICAP with low morbidity and mortality rates.
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Hip fractures are a significant cause of morbidity and mortality to the increasing elderly population. The Scottish Hip Fracture Audit started in 1993 with national audits from 2002. It was a national prospective audit reporting on clinical standards in hip fracture care and produced an annual report. Due to national funding changes the continual audit was discontinued in 2008. In 2013, the MSK Audit Group published a "snapshot" into a 4 month period of hip fracture care in Scotland. Our purpose was to identify whether there had been an initial improvement in hip fracture care and whether this improvement was sustained with the discontinuation of the annual audit. ⋯ The Scottish Hip Fracture Audit demonstrated improved standards of care until it was discontinued in 2008. The improvement was not sustained throughout all variables with the 2013 audit. With the re-introduction of regular audit, standards once again improved. We would recommend a more regular audit in an effort to not only improve standards of care for patients with a hip fracture but to maintain them.
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Biochemical processes during bone regeneration can be analysed via quantification of peripheral serum cytokine levels. To date, serum levels of cytokines in patients treated with masquelet technique and patients with normal bone healing have not been compared. This comparison is supposed to deliver novel insights into the process of bone regeneration. Our aim was to validate this established method in the monitoring of bone regeneration after non-union treatment in masquelet technique. ⋯ This study shows that successful bone regeneration via masquelet technique only partially imitates cytokine expression of physiological bone healing. High expressions of IGF-1 correspond to a successful masquelet therapy while TGF-ß seems to play a minor role. These results assume that objective analysis of an effective non-union therapy with cytokine expression analysis is possible even with a small number of patients.
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Multicenter Study
High reliability in classification of tibia fractures in the Swedish Fracture Register.
The Swedish Fracture Register (SFR) was started in 2011 and registers fractures of all types, treated either surgically or non-surgically. Twenty-six orthopaedic departments in Sweden are affiliated and a total of 84,000 fractures have been registered. The physician who establishes the diagnosis of the fracture registers and classifies it according to the AO/OTA classification. The accuracy of the classification of fractures is important for the reliability of the data in the SFR. This study aimed to evaluate how accurate the classification of tibia fractures in the register is. ⋯ This study shows that the accuracy of classification of tibia fractures in the SFR was substantial for the AO/OTA type (kappa=0.75) and moderate for the AO/OTA group (kappa=0.56) as defined by Landis and Koch. This degree of accuracy is similar to that in previous studies. We interpret this as meaning that the results of this study demonstrate the high reliability of the data in the SFR and enable the SFR to be used for further scientific analysis.
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Our understanding of the diagnosis and management of distal radius fractures has been a long developed over centuries. There has been a shift in treatment of these very common injuries from closed reduction and casting to internal fixation. ⋯ Today, we have a multitude of treatment options available with varying degrees of evidence to support their use. This review helps to illustrate the lessons we have learned and future directions for treatment.