Injury
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According to the National Hip Fracture Database (NHFD), in 2018 31.4% of patients with displaced intracapsular neck of femur (NOF) fracture who, National Institute for Health and Care Excellence (NICE) viewed eligible for total hip replacement (THR), received this operation. We aimed to identify the compliance of performing THR for those patients in our unit and identify the reasons for proceeding with the alternative type of surgery. ⋯ Level III.
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Tibial shaft fractures are a commonly encountered challenge presented to orthopaedic trauma surgeons. Intramedullary nailing (IMN) is often the treatment of choice and whilst effective, complications of delayed and/or non-union can cause significant morbidity and necessitate additional operative procedures. The use of Poller screws during IMN are a recognised way of aiding fracture reduction, however the clinical benefits of this are debated. This study evaluated the outcome of tibial shaft fractures treated with IMN with or without the addition of Poller screws. ⋯ The addition of Poller screws appear to be a safe and effective adjunct in the treatment of tibial shaft fractures via IMN. Further prospective randomised trials are needed to fully elucidate both the role and potential benefits of Poller screw augmentation in acute lower limb fracture management.
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Floating knee injuries are complex high velocity injuries with a simultaneous breach of skeletal integrity both above and below the knee joint. Intraarticular fractures, severe comminution, soft tissue insult, associated other skeletal and systemic injuries have been the most common factors influencing the outcome. With our previous experience we framed a conglomerated comprehensive classification, which includes important prognosticating factors that influences the outcome. Aim of this study is to analyse the efficacy of this classification system for floating knee injury by studying the duration of hospitalisation, number of procedures required for completion of treatment, prognosticating functional outcomes and complications. ⋯ Conglomerated comprehensive classification using prognostic factors and existing standard classifications enables better prognostication of these complex floating knee injuries. Identifing and addressing these factors and modifiers included in this classification system will surely improve the outcome. A multicentric study will validate this classifaction in a better way.
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To compare the clinical outcomes of external fixator + elastic stable intramedullary nail (EF+ESIN) vs. external fixator (EF) in the treatment for open tibial shaft fracture in overweight adolescents. ⋯ EF+ESIN is a safe and alternative choice for selected overweight adolescents with open tibial shaft fracture.
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Patients presenting with hemodynamic instability associated with pelvic fractures continue to have very high mortality and surgeons continue to seek damage control strategies that may improve survival. Strategies usually require massive transfusion, immediate pelvic stabilization and another adjunctive maneuver's such as angioembolization or preperitoneal pelvic packing to prevent hemorrhagic death. ⋯ Based on several animal models and an increasing number of publications, many US level I trauma centers have now opted to use REBOA in carefully selected patients showing signs of near cardiac arrest from non-compressible torso hemorrhage. Description of the current advances in aortic occlusion using catheter-based technology in the setting of severe shock for non-compressible torso hemorrhage from pelvic ring fracture is the purpose of this report.