Injury
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Meta Analysis
Acute Compartment Syndrome: Do guidelines for diagnosis and management make a difference?
The best outcomes following Acute Compartment Syndrome (ACS) are attributed to early diagnosis and treatment. National guidelines were issued in the United Kingdom in 2014 (BOAST 10) to standardise and improve management. We analysed standards of diagnosis and management before and after the introduction of the guidelines. ⋯ There continues to be significant variability in the definitive management of ACS. National guidelines do not appear to make a discernible impact on practice, and additional methods of ensuring safe management of this critical condition seem warranted.
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With an increase in the proportion of older people in the community comes an increase in the demand on emergency medical services (EMS) by elderly patients who have fallen. ⋯ Older falls patients place significant demand on EMS resources in Victoria, Australia, accounting for 9.7% of EMS attendances. Despite high demand, just 3.8% of elderly falls patients received a 'lights and sirens' emergency transport response to hospital. Furthermore, a large number of falls incidents recorded during the study period were repeat falls. Access to alternative pathways of care like GP referral, allied and community health services may benefit this patient group. Development and enrolment into such programs may improve patient outcomes by minimising falls risk and decrease demand on EMS and hospital resources.
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Randomized Controlled Trial Comparative Study
A double-blind, randomized controlled trial of gabapentin vs. placebo for acute pain management in critically ill patients with rib fractures.
Achieving adequate pain control for rib fractures remains challenging; prescription of alternatives to narcotics is imperative to curtail the current opioid epidemic. Although gabapentin has shown promise following elective thoracic procedures, its efficacy in patients with rib fractures remains unstudied. We hypothesized that gabapentin, as compared to placebo, would both improve acute pain control and decrease narcotic use among critically ill patients with rib fractures. ⋯ In this group of critically ill patients with rib fractures, gabapentin did not improve acute outcomes for up to one month of treatment.
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Trochanteric fractures are one of the most common fractures in elderly people. The use of intramedullary nails is an option for their treatment, especially in unstable patterns. Nail breakage is a rarely reported complication. The aim of this study was to determine the prevalence of nail breakage in our center. Secondary objectives are to show the management of this complication in our institution as well as the technical problems, complications and final outcomes of these patients in our hands. ⋯ An insufficient reduction with varus and fracture gaps >5 mm, the use of short nails in unstable patterns with subtrochanteric involvement and patients with certain comorbidities are facts observed that can contribute to the development of delayed or nonunion with subsequent nail breakage. Different salvage treatments, conversion to hip arthroplasty or revision osteosynthesis, may be considered but we think that prevention has to be the best treatment.
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The aim of this study was to evaluate variables that could be related to complications and sequelae in fractures of the tibial pilon treated by open reduction and internal fixation (ORIF) with a locking compression plate-less invasive stabilising system (LCP-LISS). ⋯ Optimal reduction and stable fixation is paramount to diminishing the rate of complications and sequelae after ORIF (LCP-LISS) of these fractures.