Annals of the Royal College of Surgeons of England
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Ann R Coll Surg Engl · Mar 2010
Case ReportsCo-existing fractures of the proximal humerus and humeral shaft without shoulder dislocation--a rare injury.
Multiple fractures of the humerus are a rare injury and usually associated with high-energy trauma. We report an unusual injury with co-existing fractures of the proximal humerus and humeral shaft without shoulder dislocation. We discuss our experience in the diagnosis and treatment of a 39-year-old man with co-existing fractures of proximal humerus and ipsilateral humeral shaft with radial nerve deficit. ⋯ At follow-up 1 year after injury, he is back at work and has a good range of shoulder movements. The radial nerve injury is showing signs of recovery. In high-energy trauma to the shoulder, unusual fracture patterns with associated neurovascular deficits may be seen and this case report describes our experience with one such rare injury.
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Ann R Coll Surg Engl · Mar 2010
Training in the practical application of damage control and early total care operative philosophy--perceptions of UK orthopaedic specialist trainees.
Despite improvements in the outcome of individuals sustaining significant injury, the optimum management of fractures in traumatised patients remains an area of debate and publication. There is, however, a paucity of studies regarding the specifics of acquired experience and training of junior orthopaedic surgeons in the practical application of these skills. Our null hypothesis is that, despite alteration in surgical training, the perceived confidence and adequacy of training of UK orthopaedic specialist trainees in the application of damage control orthopaedics (DCO) and early total care (ETC) philosophy is unaffected. ⋯ Despite changes in the training of junior orthopaedic surgeons, trainee-reported confidence and adequacy of training in the practical application of DCO and ETC was high. Exposure to cases overall was, however, seen to be limited and there was a suggestion of disparity between current operative experiences of trainees and that recorded in the national trainee logbook.
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Ann R Coll Surg Engl · Jan 2010
Obesity and recovery from low back pain: a prospective study to investigate the effect of body mass index on recovery from low back pain.
We describe a prospective cohort study to investigate any association between recovery from low back pain and body mass index (BMI) in patients with low back pain undergoing physiotherapy. ⋯ This study demonstrates that BMI does not influence the overall recovery from low back pain in patients undergoing physiotherapy treatment.
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Ann R Coll Surg Engl · Jan 2010
Comparative StudyChanging management of suspected appendicitis in the laparoscopic era.
The aims of this study were to examine the trends in performance of open and laparoscopic appendicectomy at a district general hospital, and to compare the diagnostic outcomes in the two patient groups. ⋯ Laparoscopic appendicectomy is increasingly being performed. Laparoscopy is often used as a diagnostic tool in general surgical patients, particularly women, with lower abdominal pain. In effect, these patients are undergoing diagnostic laparoscopy, with or without appendicectomy. This has resulted in a lower positive appendicectomy rate, but a higher yield of diagnoses other than appendicitis, in the laparoscopic group. Overall appendicectomy rates, however, have remained unchanged.