Injury
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Forearm fractures are one of the top three most common fractures in children. Treatment often includes immobilizing the arm in a cast extending above the elbow to help maintain fracture reduction and alignment. Complications from circumferential casting can occur including swelling in the forearm that can lead to neurovascular complications. About 16% of children require splitting of the cast to relieve the increased pressure. Our study investigates the impact the location of the split has on cast bending stiffness in an above elbow cast model. ⋯ To analyze the effect of splitting an above elbow cast on bending stiffness.
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The Best Practice Tariff (BPT) in major trauma awards Major Trauma Centres (MTCs) a financial incentive when predefined standards of care are met. However, no tailored criteria exist with regards to the reimbursement policy in paediatric major trauma. In this study, we aim to examine the utility of the paediatric Major Trauma BPT and identify predictors of additional resource utilisation. ⋯ This study demonstrated that BPT in paediatric major trauma is a valuable reimbursement; however, our findings also unveiled a cohort deemed ineligible for BPT despite the high costs accrued. Re-evaluation of the remuneration criteria of paediatric major trauma networks with an alternative, more inclusive reimbursement policy is needed.
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The phenomenon of extrajudicial "mob justice" and community assault (CA) has been documented in news reports and anecdotes from a number of low- and middle-income countries, but there is little literature on its burden on trauma systems. This study reviews a single center's management of CA victims and compares the spectrum of injuries seen following mob assault with those sustained via other forms of interpersonal violence (IPV). ⋯ CA contributes considerably to the high rates of IPV in a single South African center. Victims of such assaults sustain more severe injury with unique mechanisms and subsequent complications. This evidence supports the need to strengthen local governance and improve law enforcement efforts to prevent such violence.
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Femoral nerve palsy caused by iliacus hematoma is an infrequent diagnosis often missed because of its insidious presentation. However, due to potentially devastating outcomes, prompt recognition and management are essential. ⋯ Although rare, iliacus hematoma syndrome carries significant morbidity. Spontaneous iliacus muscle hematoma should be considered in the differential diagnosis of leg pain in a patient who is on anticoagulation therapy. In patients with an iliacus hematoma and neurology deficit, conservative treatment can be considered initially if there is no progression in the symptoms evident at the time of presentation. However, prompt surgical decompression has been highly recommended in patients with progressive neurological deficits.
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Early hemorrhage control after severe blunt pelvic trauma is life-saving. The aim of this study is to compare the efficacy and outcomes of pre-peritoneal packing (PPP) and Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) with a subsequent hemorrhage control procedure to control life-threatening pelvic hemorrhage in trauma patients. ⋯ Prognostic study, level III.