Articles: outcome.
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Recent literature comparing the effectiveness of above-elbow and below-elbow plaster casts appears to suggest that either cast type offers adequate immobilization for distal radius and ulna fractures. The idea that an appropriate mold placed on the cast is the most significant determinant of successful immobilization and, thereby, patient outcome has also been elucidated. The purpose of this study was to compare the effectiveness of above-elbow versus below-elbow fiberglass casts in maintaining distal radius/ulna fracture reduction and to identify factors associated with treatment failures. ⋯ We agree with prior studies suggesting the equal efficacy of below-elbow versus above-elbow casts in distal radius and ulna fracture treatment using either plaster or fiberglass, but wish to emphasize the importance of not only the cast index, but also the ulnar deviation mold (for most dorsally displaced fractures), as measured by the second metacarpal-radius angle.
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Eur J Trauma Emerg S · Oct 2009
Patient selection criteria for primary total hip Arthroplasty in displaced intracapsular hip fractures: Are they appropriate?
This study aims to determine, by outcome analysis, the appropriateness of current criteria employed to select patients for total hip arthroplasty (THA) as the primary treatment for displaced intracapsular hip fracture (DICHF). This study is intended to inform prospective randomised controlled trials investigating the efficacy of THA as a primary treatment. ⋯ If maintaining a high level of activity and independence is the expectation in patients considered for THA for DICHFs, then current selection criteria appear to be appropriate in identifying those capable of returning home, remaining independent and surviving to 1 year compared to the whole DICHF population. With a 75% 3-year survival, the postulated benefit of THA will not be realised in many patients and this needs to be considered. Cost-effectiveness trials are required before broad practice change occurs.
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Background. Geriatric patients, usually defined as being 65 years of age or over, now make up about 10% of the major burn population. Main aim. ⋯ Conclusion. Large burn size was the strongest predictor of mortality among elderly burn patients, followed by the presence of inhalation injury. This study showed that burn patients aged 65 years and over can achieve a good outcome.
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Curr Treat Option Ne · Sep 2009
Current treatment options for depression after mild traumatic brain injury.
Mild traumatic brain injury (MTBI) is the most common neurologic condition in the United States; about 503 of every 100,000 persons visiting the emergency department have this diagnosis. A complex cluster of neurologic signs and symptoms are associated with an acceleration-deceleration mechanism of injury. Unfortunately, many persons do not seek treatment for MTBI. ⋯ Thus, evidence-based treatment of post-MTBI depression is quite limited. Because depressive symptoms can develop as early as 1 week after injury and can be exacerbated by stress, pain, and comorbidities, it seems prudent to begin early interventions focused on managing pain and stress, along with providing psychoeducational and problem-solving therapies. Efficacy studies are needed to determine whether telemedicine approaches, group interventions, or peer counseling may be helpful methods of delivering such interventions during the early months as ways to attenuate the development of a major depressive disorder.