Injury
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Hand and finger injuries account for approximately 4.8 million visits to emergency departments each year. These injuries can cause a great deal of distress for both patients and providers and are often initially encountered in urgent care clinics, community hospitals, and level one trauma centers. Tip amputation injuries vary widely in mechanism, ranging from sharp lacerations to crush injuries that present with varying degrees of contamination. The severity of damage to soft tissue, bone, arteries and nerves is dependent upon the mechanism and guides treatment decision-making. The management algorithm can oftentimes be complex, as a wide variety of providers, including orthopedists, general surgeons, plastic surgeons and emergency physicians, may care for these injuries, depending on location and local culture. We review the common mechanisms for tip amputation and the optimal treatment in adults, based on the severity of the injury, degree of wound contamination, and the facilities available to the provider. ⋯ In the United States, most fingertip amputations in adults are treated with non-replant techniques. However, the precise management of a fingertip injury in adults depends on the degree of injury itself, and a number of operative and non-operative techniques may be successfully employed.
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Hardware removal in healed trochanteric fractures (TF) in the absence of infection or significant mechanical complications is rarely indicated. However, in patients with persistent pain, prominent material and discomfort in the activities of daily living, the implant is eventually removed. Publications of ipsilateral femoral neck fracture after removal of implants from healed trochanteric fractures (FNFARIHTF) just because of pain or discomfort are rare. The purpose of this systematic review of the literature is to report on the eventual risk factors, the mechanisms, the clinical presentation, and frequency, and to pay special emphasis in their prevention. ⋯ The risk factors for FNFARIHTF seem to be preexisisting systemic osteoporosis, local osteoporosis as a result of preloading by the fixation device in the femoral neck, and the removal of hardware from the femoral neck, with reduction of the strength of the neck. The clinical presentation may be obscure as most of the patients complain of hip pain of some days or weeks, and arrive in the hospital walking. Therefore, the attending physician should be alert in order to request the appropriate radiological investigation and if this is not clear CT scan or MRI should be done in order to diagnose promptly these "spontaneous" fractures. Treatment should be replacement surgery in most cases; however, there is some place for internal fixation especially in undisplaced fractures or younger patients. The occurrence of the femoral neck fracture after hardware removal may be prevented with re-osteosynthesis and the use of bone chips or bone substitutes. Finally, the relatively high incidence of this complication should alert orthopaedic surgeons to reduce the removal of hardware in healed trochanteric fractures to very selected cases.
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Hardware removal in healed trochanteric fractures (TF) in the absence of infection or significant mechanical complications is rarely indicated. However, in patients with persistent pain, prominent material and discomfort in the activities of daily living, the implant is eventually removed. Publications of ipsilateral femoral neck fracture after removal of implants from healed trochanteric fractures (FNFARIHTF) just because of pain or discomfort are rare. The purpose of this systematic review of the literature is to report on the eventual risk factors, the mechanisms, the clinical presentation, and frequency, and to pay special emphasis in their prevention. ⋯ The risk factors for FNFARIHTF seem to be preexisisting systemic osteoporosis, local osteoporosis as a result of preloading by the fixation device in the femoral neck, and the removal of hardware from the femoral neck, with reduction of the strength of the neck. The clinical presentation may be obscure as most of the patients complain of hip pain of some days or weeks, and arrive in the hospital walking. Therefore, the attending physician should be alert in order to request the appropriate radiological investigation and if this is not clear CT scan or MRI should be done in order to diagnose promptly these "spontaneous" fractures. Treatment should be replacement surgery in most cases; however, there is some place for internal fixation especially in undisplaced fractures or younger patients. The occurrence of the femoral neck fracture after hardware removal may be prevented with re-osteosynthesis and the use of bone chips or bone substitutes. Finally, the relatively high incidence of this complication should alert orthopaedic surgeons to reduce the removal of hardware in healed trochanteric fractures to very selected cases.
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With nearly 50 years' of development, Injury has become one of the leading journals in its specialty. The aim of this article is to identify, analyze the characteristics of the 100 most cited articles published by the journal to date. ⋯ This study may help researchers to find out the important information on the classic articles and provides useful insights for the authors who want to publish their research in Injury.
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Indication of volar locking plate (VLP) removal after bony healing of distal radius fracture (DRF) is controversial. Studies with various range of removal rate were reported. The purpose of this systematic review was to investigate the frequency and the reasons of hardware removal over the world. We hypothesized that more frequent VLP removal contribute to better clinical outcomes. ⋯ There was a diversity of removal rate and reasons in the studies over the world. High frequent VLP removal did not contribute to better clinical outcomes.