Injury
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In Nordic countries penetrating neck injuries (PNIs) are infrequent and management has traditionally been guided by surgeons' preferences. Some form of selective non-operative approach is currently practised in most urban trauma centres. ⋯ Trauma centres managing PNIs infrequently should have an individually tailored management protocol for penetrating neck injury patients. If mandatory exploration is not practised, a systematic physical examination should be the mainstay of diagnostic work up but the threshold for adjunctive studies should be low. Although not evident by the current data, protocol-based management could be useful in decreasing treatment variation and enhancing residency training.
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Multicenter Study
Re-displacement of paediatric forearm fractures: role of plaster moulding and padding.
Re-displacement of paediatric forearm and wrist fractures following manipulation and cast application is a common complication. Poor plaster application technique is an important risk factor for re-displacement. However, there are no reliable and validated objective radiological measurements to differentiate a well-applied plaster cast from a poorly padded and moulded cast. ⋯ Cast index, Padding index and Canterbury index were significantly greater in the re-displacement group as compared to the cases where no re-displacement was seen (p<0.005). Improvement in the plaster application skills as monitored by these indices reduced the re-displacement rate by 50%. We suggest that a high Cast index of more than 0.8, Padding index of more than 0.3 and the combined Canterbury index of 1.1 are important risk factors for re-displacement of these fractures.
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National guidelines recommend that hospitals dealing with acute orthopaedic trauma should have daily, consultant led trauma lists, performed in dedicated trauma theatres. This study examined the availability and organisation of orthopaedic trauma lists in the United Kingdom using a postal survey. ⋯ Twenty-one percent of responding hospitals did not have a dedicated trauma theatre. Our results suggest that most units have a long way to go in meeting national standards regarding the availability of orthopaedic trauma lists.
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Multicenter Study
Incidence, case-fatality rate and clinical pattern of firearm injuries in two cities where arm owning is forbidden.
To review firearm injuries in five hospitals of Douala and Yaounde, both towns of Cameroon, a Sub-Saharan African country where ownership of firearm is forbidden. ⋯ The incidence of firearm injuries in the two largest cities of Cameroon is five to fifty times lower than in many other towns, especially in Western countries. This may be due at least partially, to the current legislation on the ownership of firearm which is very restrictive in this country. Some efforts are however needed to reduce illegal access to weapons and to educate hunters on the safe handling of their gun.
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Multicenter Study
The Injury Severity Score or the New Injury Severity Score for predicting intensive care unit admission and hospital length of stay?
To compare the New Injury Severity Score (NISS) and the Injury Severity Score (ISS) as predictors of intensive care unit (ICU) admission and hospital length of stay (LOS) in an urban North American trauma population and in a subset of patients with head injuries. ⋯ The NISS is a better choice for case mix control in trauma research than the ISS for predicting ICU admission and LOS, particularly among patients with moderate to severe head injuries.