Injury
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Although most tibial shaft fractures are expected to heal within 24 weeks, the long-term effects of these injuries on patients in terms of self-reported health status, disability, and pain are largely unknown. ⋯ These results indicate that long-term physical disability remains a problem for many patients following tibial shaft fracture, and they should be considered when providing prognostic information to patients. Further research is required to identify the specific health problems experienced as well as the factors contributing to disability in order to inform post-fracture rehabilitation planning.
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Missed injury in the context of major trauma remains a persistent problem, both from a clinical and medico-legal point-of-view. Estimates of the incidence vary widely, dependent on the precise parameters of the studied population, the definition of missed injury and the extent of follow-up, but may be as high as 38%. The tertiary survey, in which formal repeated examination of the patient is undertaken after initial resuscitation and treatment have taken place, has been suggested as a way of identifying injuries not found at presentation. This paper appraises the concept of the tertiary survey, and also reviews the literature on missed injury in order to identify the risk factors, the types of injury and the reasons for error.
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Multicenter Study
Radiographic outcomes of intertrochanteric hip fractures treated with the trochanteric fixation nail.
Intertrochanteric hip fractures have become more common as the elderly population continues to increase, and surgical stabilisation of these fractures remains a persistent challenge. The purpose of this study was to analyse the ability of a new helical blade device to stabilise intertrochanteric hip fractures, and to further determine which factors are important in implant stability. ⋯ Subtle migration ( approximately 2mm) of the tip of the blade within the femoral head occurred in all fractures, but this did not preclude maintenance of reduction and fracture healing, and was not predicted by fracture type, reduction quality, age, or gender. More telescoping occurred in unstable compared to stable fractures, but this averaged 4mm and did not affect stable fixation or fracture healing. All position changes occurred within the first 6 weeks postoperatively, with no subsequent detectable migration or telescoping. Clinical correlations will be needed in the future to determine the significance of small amounts of migration or differences in telescoping, but this device appears to provide effective fixation in both stable and unstable intertrochanteric hip fractures.
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Multicenter Study Comparative Study
Emergency Medical Service (EMS) systems in developed and developing countries.
To compare patient- and injury-related characteristics of trauma victims and pre-hospital trauma care systems among different developed and developing countries. ⋯ This study provides an early look at international variability in patient mix, process of care, and performance of different pre-hospital trauma care systems worldwide. International efforts should be devoted to developing a minimum standard data set for trauma patients.
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Multicenter Study
The use of recombinant activated factor VII in trauma patients: Experience from the Australian and New Zealand haemostasis registry.
There is increasing use of rFVIIa (eptagog alpha, Novoseven) in injured patients with critical bleeding. The role of rFVIIa is not defined in this group of patients. Registries provide an opportunity to review the patients, reported response and adverse events for rFVIIa. ⋯ The best approach to managing critical bleeding in trauma patients is not agreed. The role of rFVIIa will only be clarified if there is a standardised approach to fluid management and transfusion of blood products. The registry allows tracking of current practice, outcomes and adverse events and will complement present phase 2 and 3 trials.