Articles: trauma.
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We retrospectively studied the complications associated with a displaced supracondylar fracture of the humerus in children and its treatment. Between 1978 and 1997, 200 displaced fractures were treated by operative means. In 190 cases closed reduction and percutaneous pinning was performed. ⋯ All recovered without sequelae, except for one case with persistent radial nerve palsy which recovered after a sural nerve interposition graft. Transient neurological problems are common in this fracture. A mini-open procedure is recommended for the ulnar Kirschner wire (K-wire) to prevent iatrogenic ulnar nerve injury.
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Length of stay (LOS) is a key measure of emergency department (ED) throughput and a marker of overcrowding. Time studies that assess key ED processes will help clarify the causes of patient care delays and prolonged LOS. The objectives of this study were to identify and quantify the principal ED patient care time intervals, and to measure the impact of important service processes (laboratory testing, imaging and consultation) on LOS for patients in different triage levels. ⋯ Triage level, investigations and consultations are important independent variables that influence ED LOS. Future research is necessary to determine how these and other factors can be incorporated into a model for predicting LOS. Improved information systems will facilitate similar ED time studies to assess key processes, lengths of stay and clinical efficiency.
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The purpose of this study was to evaluate the diagnostic equivalence, radiation dose, clinical usefulness and radiographic aspects of a low-dose, full-body digital X-ray machine in a busy trauma unit. A digital trauma X-ray machine known as "LODOX" was compared with conventional radiography between June 1999 and November 2001 in the Groote Schuur Hospital Trauma Unit, Cape Town. Digital images of a variety of body regions commonly imaged in trauma were compared for diagnostic image quality in a number of categories with equivalent conventional radiographs. ⋯ FDA approval is awaited. Projected cost is similar to that of flat-panel digital units. This digital unit was felt to be diagnostically substantially equivalent to conventional radiographs, with low-dose full-body imaging, improved workflow, digital technology and long-term cost benefits as potentially favourable contributions to trauma imaging.
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Today most complications of thyroid and parathyroid surgery are related to either metabolic derangements or injury to the recurrent laryngeal nerves. Other complications include superior laryngeal nerve injury, infection, airway compromise, and bleeding. Although the principal goal of thyroid and parathyroid surgery is the prevention of these complications, prompt recognition and intervention will minimize morbidity and provide the patient with the best chance of a satisfactory outcome.
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Neural injuries that occur after total hip arthroplasty (THA) can be classified as involving either the central nervous system or peripheral nerves. Central nervous system changes after THA may be attributed to increased appreciation of fat embolism syndrome associated with THA. Certain maneuvers such as impacting the acetabulum, femoral reaming, and cement pressurization can force marrow fat into the venous system. ⋯ The mechanisms of vascular injury include occlusion associated with preexisting peripheral vascular disease and vascular injury during removal of cement during screw fixation of acetabular components, cages, or structural grafts. Perioperative assessment should include vascular evaluation of patients with absent pulses, previous vascular bypass surgery, or dysvascular limbs. A CT scan should be considered when cement or components extend medially into the pelvis.