Injury
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Meta Analysis
Prevalence of chronic pain after severe lower limb injury (SLLI): A systematic review and meta-analysis.
Globally, severe lower limb injuries (SLLIs) are the predominant cause of long-term injury related disability and poor functional outcomes. Chronic pain is a major source of this morbidity, but the magnitude of the contribution is not clearly understood. The aim of this systematic review and meta-analysis was to determine the prevalence of chronic pain following SLLIs in civilian and military patients. ⋯ Most people who sustain a SLLI will suffer from chronic pain. Healthcare systems must continue to research interventions that can reduce the incidence and severity of long-term pain and ensure adequate resources are allocated for this common and debilitating complication.
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This study aimed to assess the clinical epidemiological characteristics of children with electrical injuries and discuss the countermeasures for the prevention of electrical injuries in children. ⋯ Male preschoolers accounted for the majority of electrical injury cases, and these accidents mostly happened in household electrical appliances and household battery cars. Overall, it is necessary to improve family electrical safety education and reinforce protective measures against electric injury to children.
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Dislocation of a hip hemiarthroplasty used to treat a hip fracture is a serious complication. The aim of this study was to identify whether a delay in the time from fracture to surgery causes an increase in the rate of post-operative hip dislocation. From a single center, data from intracapsular neck of femur patients treated with hip hemiarthroplasty was collected between October 1986 to August 2021. ⋯ For the 197 patients with no history of a fall, there were 5 (2.5%) dislocations (p=0.036, 95% confidence interval of difference 0.15 to 0.97 for comparison with surgery within two days). For the 399 patients with a delay of more than four days from injury till surgery, there were nine dislocations (2.3%) (p=0.045, 95% confidence intervals of difference 0.20 to 0.89 for comparison with surgery within two days). This study demonstrates an increase in the risk of dislocation for those patients with no history of a fall and those with a delay of more than four days from injury to surgery.
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The indications for reduction and fixation of the posterior malleolus component of rotational ankle fractures have been controversial for nearly a century. This study aims to identify the historical basis for surgical intervention and trace trends in management strategies over time. ⋯ Size-based indications for posterior malleolus fracture fixation are based on Level V evidence from small retrospective case series published nearly one century ago and should be retired. While the size of the posterior malleolus component cannot be ignored, additional factors like fracture morphology and location within the plafond should guide modern surgical indications. Contemporary studies indicate that reduction and fixation of small posterior malleolus fractures (comprising less than 25 % of the articular surface) are associated with improved articular reductions, tibiotalar contact pressures, syndesmotic stability with decreased need for independent fixation of the syndesmosis, and superior postoperative outcomes.
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Due to complex geography and resource constraints, trauma patients are often initially transported to community or rural facilities rather than a larger Level I or II trauma center. The objective of this scoping review was to synthesize evidence on interventions that improved the quality of trauma care and/or reduced healthcare costs at non-Level I or II facilities. ⋯ Our review captured a broad spectrum of trauma QI projects implemented at non-major trauma centers. Educational interventions did result in process outcome improvements and high rates of self-reported improvements in trauma care. Given the heterogeneous capabilities of community and rural hospitals, there is no panacea for trauma QI at these facilities. Future research should focus on patient outcomes like mortality and morbidity, and locally relevant initiatives.