Injury
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Acetabular fractures in the elderly are associated with high levels of morbidity and mortality. Despite advances in operative techniques, there remains a cohort of elderly, extremely frail patients with comminuted fractures who are considered unfit for surgery and are treated conservatively. We aim to assess mortality, mobility and radiological outcomes one-year post injury in this challenging cohort. ⋯ Conservative management of this cohort is associated with poor outcomes and current operative solutions are unsuitable for this frail cohort of patients. Future developments should focus on minimising surgical insult and allowing weight bearing mobilisation to maximise the rehabilitation potential in this frail cohort.
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The purpose of this study was to examine risk factor and temporal associations between acute care hospitalization and post-discharge home injury falls in a population-based analysis sample of community dwelling older adults. ⋯ Older adults have an increased risk of falling at home after being discharged from an acute care hospitalization, with highest risk occurring during the 90-day post-discharge period. Special consideration should be given to assessing hospital-associated changes in fall risk among geriatric patients prior to discharge directly home. Discharge planning should include efforts to reduce home fall risk during the period of transition from hospital care.
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The extrication of patients following a road traffic collision is among the basic procedures in emergency medicine. Thus, extrication is a frequently performed procedure by most of the emergency medical services worldwide. The appropriate extrication procedure depends on the patient's current condition and accompanying injuries. A rapid extrication should be performed within a few minutes, and the cervical spine (at least) should be immobilized. To our knowledge, the scientific literature and current guidelines do not offer detailed recommendations on the extrication of injured patients. Thus, the aim of the current study is to compare the effectiveness of spinal stabilization during various out-of-hospital extrication procedures. ⋯ In case of a suspected cervical spine injury, guided self-extrication seems to be the best option. If the patient is not able to perform self-extrication, using a rescue boa might reduce cervical spinal movement compared to the traditional extrication procedure. Since promising results are shown in the case of extrication using a patient transfer sheet that has already been placed below the driver, future developments should focus on novel vehicle seats that already include an extrication device.
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To evaluate intraoperative and early postoperative clinical outcomes using the Nice knot as an auxiliary reduction technique in displaced comminuted patellar fractures. ⋯ The sliding, self-stabilizing Nice knot was associated with reduced surgical time, decreased intraoperative blood loss, and satisfactory postoperative outcomes in the treatment of displaced patellar fractures. Future studies are needed to ensure the generalizability of these findings to additional patient populations at other institutions.
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Traumatic pneumorrhachis (PR) is a rare entity. There are only a few single cases published in English literature. In most of these cases PR was accidentally found during CT-diagnostics and remained asymptomatic. The exact pathogenesis of traumatic PR has not been conclusively clarified. It is assumed, that a sudden increase in thoracic pressure causes air to escape the alveoli and migrates along the fasciae towards the spinal canal. In this study we reviewed the patients of our clinic for 13 years. Eight Patients with traumatic PR could be detected. This study represents the biggest account of traumatic PR in literature and gives a hint for the diagnostic and therapeutical regimen. ⋯ Traumatic PR remains a rare entity. It can be diagnosed with CT an MRT-scans. It needs no specific initial therapy besides the therapy of the underlying injuries. The prognosis of traumatic epidural PR is good and determined by the accompanying injuries. In cases of elevated paraclinical infection parameters one has to consider the development of spondylodiscitis in areas of PR.