Injury
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Multicenter Study
The new proximal femoral nail antirotation (PFNA) in daily practice: results of a multicentre clinical study.
The treatment of unstable trochanteric femoral fractures is still challenging. The ideal implant should be easy to handle, allow for immediate full weight-bearing postoperatively and should have sufficient purchase in the femoral head/neck-fragment to limit cut-outs due to varus-deviation and rotation. The proximal femoral nail antirotation (PFNA), designed by AO, is an intramedullary device with a helical blade rather than a screw for better purchase in the femoral head and was tested in a clinical study. ⋯ Fifty-six percent of the patients regained the pre-trauma mobility and 18% died within the follow-up period. Forty-six implant-related complications--leading to 28 unplanned re-operations--were recorded, with four acetabular penetrations (three of which were after a new fall on that hip) and seven ipsilateral femoral shaft fractures as the most serious ones. As the joint-penetrations did not resemble the cut-out seen with other implants it is concluded that the PFNA--due to its helical blade--possibly limits the effects of early rotation of the head/neck-fragment in unstable trochanteric fractures and therefore seems currently to be the optimal implant for the treatment of these fractures especially in osteoporotic bone.
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Multicenter Study
Pain prevalence and pain relief in trauma patients in the Accident & Emergency department.
Acute pain in the A&E department (ED) has been described as a problem, however insight into the problem for trauma patients is lacking. ⋯ Acute pain in trauma patients is a significant problem in the ED's. Pain itself does not seem to be treated systematically and sufficiently, anywhere in the cycle of injury treatment in the ED.
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Multicenter Study
The F.A.S.T.E.R. trial. Focused assessment by sonography in trauma during emergency retrieval: a feasibility study.
This feasibility study aimed to establish if retrieval physicians can overcome the transport environment and obtain F.A.S.T. (focused assessment by sonography in trauma) images of suitable quality during patient retrieval in rotary wing aircraft such that diagnostic interpretation of free intra-abdominal fluid or pericardial fluid would be possible. ⋯ This study demonstrates that it is possible for critical care retrieval physicians to obtain adequate ultrasound F.A.S.T. images on patients using a portable ultrasound machine en-route to definitive care, in a rotary wing aircraft.
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Multicenter Study
Do orthopaedic surgeons need a policy on the removal of metalwork? A descriptive national survey of practicing surgeons in the United Kingdom.
Routine metalwork removal, in asymptomatic patients, remains a controversial issue. Current literature emphasises the potential hazards of implant removal and the financial implications encountered from these procedures. However, there is little literature guidance and no published research on current practice. ⋯ Our results demonstrate that most practicing trauma surgeons do comply with the evidence presented in the little literature available. However, we do believe that a general policy for metalwork removal is essential. Such a policy should include guidelines specific to age groups and level of surgeon who should be performing the removal procedure. Such a document would require further validated studies but would eventually serve to steer surgeons in achieving best practice.
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Multicenter Study
A repeat audit of spinal board usage in the emergency department.
An audit of spinal board usage in 2002 was repeated [Malik MHA, Lovell ME. Current spinal board usage in emergency departments across the UK. Int J Care Injured 2003;34:327-9]. ⋯ In 2006, 21% (43% previously) are still leaving patients on spinal boards routinely until radiological evidence provides clearance, 45% will place patients on boards after their arrival even if they were not on one in pre-hospital management (48% previously) and the number of boards the department owns, remained similar. In house audits of usage remained largely unchanged at 22%. We recommend ongoing departmental review of practice.