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To assess the validity of the Injury Impairment Scale for pelvic and lower limb fractures sustained in road traffic accidents, the Expected Injury Impairment Scale score was correlated with the Observed Injury Impairment Scale score for patients who attended the Accident and Emergency department in Nottingham during 1992 and 1993. Seventy-four per cent of the patients had an Observed IIS score equivalent...
This comparative prospective study of mammalian bites attending one urban Accident and Emergency department before the implementation of the Dangerous Dogs Act 1991 and again 2 years later, was to see the effect of the Act on the pattern of injury. The study comprised a simple questionnaire detailing the injury, the implicated species, and the treatment or referral if applicable. In both groups...
[lsquo ]Joy-riding[rsquo ] is the term used, somewhat inappropriately, for the offence of taking a vehicle without the owner's consent. In certain areas, mainly deprived inner-city estates, there has been an increase in this crime. The aim of this study was to investigate its impact on the workload of an inner-city teaching hospital's busy accident and orthopaedic departments. In this prospective...
We have reviewed 4521 patient-years and analysed 185 066 seizures to calculate the incidence of five common fractures in an epileptic population. Only 25.0 per cent of these fractures were known to have occurred during a seizure. When age and sex matched against a [lsquo ]normal population[rsquo ], there was an increased incidence of femoral neck fractures (5.2 [times ]), inter-trochanteric fractures...
Over a two and a half year period, 25 patients presenting to the Glasgow Royal Infirmary underwent emergency thoracotomy for suspected severe chest injuries. Eighteen (72 per cent) were performed in the Accident and Emergency (A[amp ]E) department and seven (28 per cent) in a fully equipped operating theatre after resuscitation. There were 23 men and 2 women. Twenty-three (92 per cent) had been...
The diagnosis of blunt abdominal injuries is one of the most difficult problems in the management of trauma. There is now better understanding of the diagnostic facilities available. Guidelines regarding the use of diagnostic peritoneal lavage, ultrasonography, or computed tomography scanning should be available in the Accident and Emergency department.
We present the results of five patients who underwent resection of heterotopic ossification around the knee following traumatic brain injury. All the patients had improved function and no pain at a minimum of 1 year follow up, irrespective of their preoperative neurological status. Our philosophy for such surgery is outlined and, although the surgical goals may seem small, the outcome for any individual...
Forty elderly patients aged 50-94 years old with unstable intertrochanteric fractures were treated by external fixation at The Central Institute of Orthopaedics, Safdarjang Hospital, New Delhi, India from June 1993 to January 1995. Fracture union was achieved by an average time of 14 weeks in all the patients. Postoperative varus was increased in nine and deep pin-track infection was found in three...
The Belfast and Newcastle simple prognostic scores of outcome after treatment of proximal femoral fractures were recorded shortly after admission on 250 patients. All patients were then followed until discharge, with 87 of those who were the more physically and socially dependent before admission being transferred after surgery for rehabilitation in a geriatric unit. The hospital mortality rate,...
The early vascular response is essential for the normal progress of fracture healing and fracture site blood flow has been shown to reach a peak in the first two weeks after injury. Angiogenesis is an important step in this response as new vessel formation is necessary to vascularize the fracture haematoma and the fracture gap. Changes in serum levels of a low molecular weight endothelial stimulating...
In this study a group of 104 multiply injured patients (mean ISS = 34) was examined for physical status and social reintegration. Essentially it was noted that 76 per cent of all patients were able to return back to work, although this appears to be age dependent. Open fractures of the leg seem to be the dominating prognostic factor for reintegration resulting in a disability rate of between 20...
Rapid evacuation from the scene of injury, the Advanced Trauma Life Support (ATLS) protocol and advancements in medical and surgical practice afford high standards of care for maxillofacial gunshot wounds (GSWs). This series of nine case reports illustrates both the changes that have occurred and the similarities that remain in the management of these wounds since the First World War. It serves...
Ulnar fracture with posterior dislocation of the radial head is thought to be a relatively rare injury. We have recently treated six patients with this posterior Monteggia fracture dislocation. Five of these patients were on long-term corticosteroid therapy. The pathophysiology, treatment and outcome of this complex injury are discussed.
The phenomenon of involuntary defaecation following acute, severe injuries has never been documented before, but has been noted by those who work in major trauma units. The exact cause of the phenomenon is unknown. We prospectively noted 14 patients who involuntarily defaecated in a 3-month period and analysed their clinical findings retrospectively. Involuntary defaecation occurred only in patients...
Horse riding is a dangerous pastime with more accidents occurring per hour than during motor-cycling. Since a prospective survey of horse-related injuries conducted at a major centre in 1971-1972 2 , equestrian groups and the medical profession have encouraged improvements in training and protective riding wear. By conducting a similar study at the same centre 20 years later we hoped to...
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