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In a recent retrospective study we have shown that pre-morbid medical conditions (PMC) were present in 39 per cent of UK injured patients with complete records. In view of the incidence of incomplete documentation, it could be argued that this figure was artificially high. The aim of this study therefore was to carry out a detailed investigation in one UK centre to ascertain the incidence of PMC...
The purpose of this study was to evaluate the influence of additional, extracranial injuries and subsequent neurological complications in the intensive care unit on the functional outcome after head injury with extradural haematoma. The retrospective analysis included 139 adult patients with acute extradural haematomas admitted to the intensive care unit. Fifty-seven patients (41 per cent) were...
Assessment of the age of 59 men and 29 women undergoing intramedullary nailing of femoral shaft fractures in two Birmingham units revealed two peaks of incidence, in the 3rd and 8th decades. Road traffic accidents (RTAs) accounted for much of the younger, mostly male, peak; whilst falls and pathological fractures predominated in patients over 40 years old. The mean age for RTAs was 27.9 years.Functional...
Adult respiratory distress syndrome (ARDS) and multiple organ failure (MOF) are severe complications often seen in multiply injured patients. Following injury, overstimulation of host defence mechanisms can result in a systemic inflammatory response causing widespread organ injury. Inflammatory cytokines, polymorphonuclear leukocyte (PMNL) activation and endothelial-leukocyte interactions are the...
This study aimed to evaluate complications following interlocking nailing for acute femoral fractures. Fifty patients underwent interlocking nailing for acute femoral fractures. There were 23 men and 27 women with an average age of 61 years (range, 16-96). There were 48 closed fractures and two open fractures. Nine patients had associated injuries. Forty-eight fractures were treated by closed...
Adult respiratory distress syndrome (ARDS) followed by multi-system organ failure (MSOF) in trauma victims carries a mortality in excess of 50 per cent. An early feature is an increase in systemic capillary permeability causing extravasation of plasma proteins and water leading to interstitial oedema. Expansion of the interstitial space slows the diffusion of oxygen across the lungs and impairs...
We present a new method for the treatment of extensively comminuted (AO type C3) fractures following high-velocity injuries with associated-soft tissue damage. This method uses conventional plates but preserves the biological environment of the fracture. Unlike interlocking nailing this procedure is also applicable for juxta-articular fractures and does not require sophisticated instrumentation...
Knee pain is the commonest complication of intramedullary nailing of the tibia. In a study of 169 patients with tibial diaphyseal fractures treated by the Grosse-Kempf nail we found a 56.2 per cent incidence of nail-related anterior knee pain. Fractures were classified using the AO, Tscherne, and Gustilo systems. Information concerning the type of skin incision, approach to the patellar tendon,...
Limb lengthening is usually performed using external fixation, distraction callus being formed by corticotomy and slow distraction. Experimental studies have suggested that the periosteum is the most important tissue in neogenesis and that the medulla does not appear to be a major contributor. In order to reduce long treatment times some surgeons have combined external fixation with nailing. The...
Trauma is the major cause of morbidity and mortality under the age of 35 years in the UK. Reports including the Royal College of Surgeons' report of the Working Party on The Management of Patients with Major Injuries and the UK Multiple Trauma Outcome Study , depend on accurate and complete documentation. Inadequate records make assessment of severity of injury and quality of care almost...
The purpose of this study was to introduce the principles of initial hospital assessment and treatment of injured patients, tailored to the facilities and resources available in Nigeria. A 3-day didactic and laboratory course was presented by four trauma surgeons. The didactic session stressed the initial assessment and treatment of injured patients. The caprine laboratory taught the performance...
The Colles' fracture is one of the most common fractures presenting to orthopaedic departments. The value of remanipulation is controversial, yet a significant proportion of fractures are seen to be displaced at 1 week after manipulation. Delaying manipulation of these fractures by 1 week from the date of injury allows management on an elective basis and the initial swelling to subside, theoretically...
It is estimated that between 4 and 18 per cent of all sports injuries involve the maxillofacial region. Among the various sporting activities, gymnastics has been rated as a high-injury risk discipline. The aim of this study was to document the extent and type of oral, maxillofacial and general injuries among gymnasts. The majority of injuries occurred during training and the severity of the injury...
Trauma guidelines recommend a skull X-ray (SXR) in most children with a head injury. As a result, a large number of patients attending Accident and Emergency (A&E) departments with a head injury receive an SXR. We believe that most of these are unnecessary and contribute little to management, as a skull fracture is a poor predictor of intracranial injury in children with blunt head injury and...
We looked at 94 patients who had sustained a tibial fracture and related the length of time to union with whether they had taken a nonsteroidal anti-inflammatory drug (NSAID). We found that those patients who had received an NSAID as part of their treatment had an increase in the length of time to union by a mean of 7.6 weeks (P = 0.0003), from 16.7 weeks to 24.3 weeks.This could not be explained...
Osteomyelitis following intramedullary (IM) nailing of a long-bone fracture can be difficult to cure. Most surgeons would remove the old IM nail, over ream the medullary canal, and insert a further nail. IM nails which have a central cavity provide a dead space in which soft tissue can collect. The tissue in the cavity may act as medium for bacterial regrowth and may therefore play a significant...
Markedly displaced fractures of the surgical neck of the humerus can be extremely difficult to treat both non-operatively and operatively. A new internal fixation device is described, of which the main advantage is that it is inserted from the elbow and there are no incisions around the shoulder. It was developed primarily for the treatment of markedly displaced fractures of the surgical neck of...
A retrospective analysis of 112 consecutive patients with recent tibial fractures treated in sheffield hospitals was undertaken to determine which characteristics of the patient, the fracture and the fixation system influenced treatment outcome.Success was defined as treatment to bony union with acceptable angulation and shortening, using the fixator alone. All other outcomes were regarded as failures...
Twenty-two patients with comminuted intra-articular distal radial fractures were treated at a delayed stage by the mini-AO external fixator in a semi-invasive manner. This followed a failure of non-operative treatment with an average delay of 2 months (3 weeks to 8 months). The indications for treatment were loss of position, painful malunion, and displacement of intra-articular fragments more than...
Gustilo Grade III open fractures of the tibia continue to provide a real challenge to the surgeon to achieve bony union, an intact soft tissue envelope and a functioning limb. There is no consensus on the initial management of the soft tissues. In particular, the indications for primary or delayed closure or serial debridement remains controversial.We present a consecutive series of 17 Grade IIIb...
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