Injury
Patients above the age of 60 with displaced femoral neck fractures are treated by hemiarthroplasty in Singapore because of our low life expectancy. This study evaluates the morbidity and mortality of 110 such patients operated on in our department between January 1990 and December 1992. It has clinical significance because of the rapidly ageing population of Singapore. The mean age was 78 years...
In an attempt to establish some principles for the use of strain gauges in monitoring fracture healing, four strain gauges were fastened onto the most proximal pin of a Shearer external fixator applied to a hardwood fracture model. Compression and bending loads were applied and the strain data were obtained. The results show that the location of the strain gauge on the circumference of the pin has...
Ten cases of experimental atrial rupture were created in five pigs by cutting into both atria. The defects measured approximately 3.0 1.0 cm. Bleeding was stopped by applying a tangential clamp and the defect in the atrium was sealed with fibrin glue (mean volume 2.0 ml, range 1.5-2.5 ml) with a mean fibrin concentration of 23 mg/ml. The mean pressures in the atria were 11 cmH 2 O in...
We report the results of 75 patients with type C intra-articular fracture of the distal humerus treated operatively by two methods and followed up for a mean period of 48.2 months. Minimal osteosynthesis and joint immobilization was used in 21 cases while the remaining 54 patients were treated according to AO recommendations. Good or excellent results were found in 38 per cent after minimal osteosynthesis...
We report nine rare cases of painful bipartite patella following injury to the knee, in seven non-athletic adults. Patients suffered with persistent anterior knee pain and localized tenderness over the superolateral aspect of the patella for an average of 2 years following injury. The clinical, radiographic and arthroscopic findings are described. Excision of the accessory bipartite fragment resulted...
Although clinical and experimental evidence favours early enteral feeding in the critically injured, provision of such enteral feeds can be difficult. Gastric feeds are often not tolerated and may lead to aspiration. An intolerance of gastric feeds leads to a cumulative energy and protein deficit and may result in the initiation of expensive parenteral nutrition (TPN). An alternative and under-utilized...
Subcutaneous emphysema affecting a limb in isolation is rare. Three cases of subcutaneous emphysema caused by a sucking wound of the limb are presented. Differentiation from infection with a gas-forming organism is imperative. This distinction can be made if a number of factors are taken into consideration. These include, concise knowledge of the history and mechanism of injury, and in particular,...
Excellent clinical results can be obtained with non-operative treatment of humeral shaft fractures. In certain patients, operative stabilization is the treatment of choice. This study was initiated to determine the results of non-operative treatment in relation to multiple fractures and being overweight. From 1985 to 1992 we treated 35 humeral shaft fractures in 34 patients by non-operative methods...
Four passengers of a People Carrier in a single vehicle motor accident sustained severe left upper limb trauma, when the vehicle rolled onto the near side. These injuries were directly attributable to the large glass interface between patient and road. The glass windows shattered on contact, providing no protection and in effect created a secondary injury mechanism. We advocate both the use...
This paper analyses the medical records of 5024 injured persons treated and operated on at the Surgical Clinic of the Clinical Hospital in Osijek, during the war against Croatia (1991 and 1992). There were 1653 (33.0 per cent) admitted, while the rest were treated as out-patients. Of the admitted patients 82.7 per cent (1372) had limb injuries. In 760 (15.0 per cent) of the wounded, 1320 limb fractures...
With increasing violence in our society, the number of gunshot fractures is likely to increase. Fourteen femoral fractures caused by gunshot injuries were treated with statically locked intramedullary nailing within 8 h of injury. Three patients had concomitant femoral arterial injuries. At follow-up (average 22 months) the results were assessed using a standardized grading system. Thirteen fractures...
We report six injuries resulting from the participation in a watersport previously unreported in the literature.
We reviewed 22 486 consecutive autopsy reports in a single District General Hospital, from 1953 to 1992. Five hundred and eighty-one patients with fractures of the proximal femur (hip fracture) were identified. Causes of death were correlated with timing of surgery and change of clinical practice. Thromboembolic and haemorrhagic potential were analysed. The principal causes of death after hip...
The change in knowledge resulting from formal training in trauma management on two different courses was examined. Seventy-four doctors and a control group were included in this prospective study over a 2-year period. They represented participants on two Advanced Trauma Life Support (ATLS) courses and four induction courses for junior doctors in Accident and Emergency (A&E) departments. The...