Injury
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Comparative Study
Missed subtle fractures on the trauma-meeting digital projector.
Since the introduction of digital X-rays, many orthopaedic departments have used digital projection systems to display diagnostic images during discussion, there has been no published work directly comparing the sensitivity high resolution diagnostic monitors with standard digital projection systems in the context of orthopaedic injuries. ⋯ This study demonstrates a significant difference in sensitivity between the two display types which may have implications with regard to reducing delays and unnecessary further imaging if clinicians are not aware of this potential limitation. Clinicians, if clinically suspicious of a fracture should always seek to review the images on a validated PACS display device if a fracture is not seen on a non-validated device. Departments should evaluate their current equipment, consider what equipment is available, what is the most suitable equipment for the environment in which it is being used and what the potential implications for patient care may be as a result.
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The influence of alcohol on the outcome after major trauma remains controversial. In several recent studies, alcohol has been associated with neuroprotective effects in head injuries, while others reported negative or no effects on survival and/or the in-hospital stay in major trauma patients (TP). The purpose of this study was to examine the relationship of alcohol with injury characteristics and outcome as well as to analyze possible anti-inflammatory properties in major TP. ⋯ Positive BAC is associated with reduced leukocyte numbers and lowered systemic IL-6 levels at admittance indicating immune-suppressive effects of alcohol in major trauma patients.
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Heterotopic ossification (HO), the formation of bone in soft tissues, is a frequent complication after surgery of the hip and the pelvis. Although the pathophysiological entities responsible for the formation of HO remain largely unclear, muscle trauma is alleged to play a central role in the pathogenic mechanisms underlying HO. However, for this observation, made by many surgeons for decades, no objective evidence has been provided yet. ⋯ According to our data, muscle trauma seems to play an important role in the development of HO after hip surgery. Hence, during surgery, particular care not to injure the surrounding muscular tissue should be taken.
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In a recently published report from the Academy of Medical Royal Colleges, around 20% of clinical practice which encompasses blood science investigations is considered wasteful. Blood tests including liver function tests (LFTs), C-reactive protein (CRP), coagulation screens, and international normalising ratios (INR) are frequently requested for patients who undergo emergency hospital admission. The paucity of guidance available for blood requesting in acute trauma and orthopaedic admissions can lead to inappropriate requesting practices and over investigation. ⋯ Approximate combined total cost of LFT, coagulation/INR, CRP in January £2674.14 and September £1236.19 (-£1437.95, -53.77%). A large decrease was observed in admission requesting and subsequent monitoring (p<0.01) following the implementation. This both significantly reduced cost and venepuncture rates.
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Case Reports
Articular osteotomy of the distal humerus and excision of extensive heterotopic ossification.
Prior case series of corrective osteotomy of substantial intra-articular malunion after a fracture of the distal humerus described concomitant heterotopic ossification in a subset of patient, but only in mild forms. We present our experience in treating two patients with malunited articular fractures of the distal humerus with extensive heterotopic ossification and near ankylosis where the lateral articular fragments were encased in heterotopic bone. Although osteotomy of articular malunion after distal humeral fracture along with excision of extensive HO is challenging and risky due to potential devitalization of the fragments, articular deterioration during the delay to osteotomy, and recurrence of heterotopic bone among other concerns, restoring articular congruity in these patients using articular fracture fragments extracted from heterotopic ossification can lead to improved function of the elbow.