J Trauma
-
To determine the magnitude of the discrepancy in injury death rates between urban and rural counties and which types of injury deaths contribute most to this discrepancy. ⋯ Age-adjusted unintentional injury death rates are higher in the rural counties of Nebraska, even though death rates for the four other leading causes of death (heart disease, cancer, cerebral vascular disease, and pneumonia) and intentional injury are lower. Although farm machinery-related deaths have the largest percentage difference between rural and urban counties, motor vehicle-related deaths are the major contributor to the unintentional injury death rate discrepancy in rural Nebraska.
-
One hundred eight femoral shaft fractures in one hundred six adults were treated by closed intramedullary interlocked nailing. Ninety-two fractures were severely comminuted and 16 fractures were segmental. The procedures were done with the patients in the supine position. ⋯ There were two postoperative complications, which did not ultimately affect the clinical results. No infections or delayed unions were observed. Closed intramedullary interlocked nailing seems to be the treatment of choice for comminuted and segmental fractures of the femoral shaft provided that all the technical details are followed by the surgeon.
-
The pin-bone interface is the weakest link in the mechanical stability of external skeletal fixation. In this investigation, a canine model was used to characterize the nature of cortical bone reactions at the pin-bone interface. Unilateral external fixators were applied to the tibiae of 61 dogs using six tapered cortical half-pins. ⋯ In inherently unstable oblique osteotomies, and less in stable rigidly fixed transverse osteotomies, immediate postoperative weight bearing caused bone thread resorption and adverse cortical bone remodeling at the entry cortex of external fixation half-pins. The unicortical loosening of half-pins that became evident during the first month of fixation obviously represents a consequence of micromotion and local bone yielding failure caused by high dynamic stresses of the pin-bone interface. Effective precautions should be taken to reduce such stresses.