Injury
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A series of 129 patients with closed injuries receiving more than 20 units (1 unit = 500 ml) of blood within the first 48 h of accident was analysed. The transfusion policy included type-specific crossmatched whole blood stored with citrate phosphate-adenine as the main replacement. One unit of fresh whole blood was transfused for every 5 to 6 units of stored blood. ⋯ This serious complication seemed to be associated with large retroperitoneal blood accumulations, the latter possibly acting as an enhancing factor. The mortality rate in the whole series was slightly lower than recorded previously in the literature. Among patients receiving 21 to 39 blood units the mortality was 25 per cent and among those receiving 40 units or more the mortality was 52 per cent.
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In 17 of 148 fractures of the leg (11.5 per cent) we found an isolated fracture of the posterior malleolus of the tibia as a sign of associated injury of the ankle joint. In two cases there was even disruption of the anterior syndesmosis. ⋯ In fracture of the leg of this specific type a radiological examination of the ankle joint in search for a posterior malleolar fracture is needed. If present, instability of the distal tibio-fibular joint must be excluded.
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Comparative Study
External fixation and recovery of function following fractures of the distal radius in young adults.
The functional recovery from Colles' fracture was studied prospectively over a 1-year period in 106 patients randomized to treatment by plaster or external fixation. Although external fixation allows immediate mobilization of the wrist and leads to a much better anatomical result, these factors did not permit any improvement in the wrist's early functional recovery. One year following injury the grip strength of the fixator-treated group was significantly superior to that of the plaster-treated patients.
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The effect of the timing of operative treatment on the mortality and morbidity of a consecutive series of 230 patients with intertrochanteric fractures of the femur has been studied. It was found that the mortality rate was not influenced by the timing of surgical treatment. ⋯ Those patients who underwent early operative treatment had a lower rate of urinary tract infection, but this was partially due to the better general health of these patients. It is concluded that the timing of operative treatment of these fractures is not an important determinant of outcome.
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Nine patients undergoing manipulation of Colles' fractures with varying doses of local anaesthetic injected into the fracture haematoma, were investigated by monitoring the arterial levels of lignocaine. Although the procedure was considered satisfactory by all patients, potentially toxic concentrations of lignocaine were found in the arterial circulation, reaching a maximum after manipulation of the fracture. A mean peak level of 2625 micrograms/l was found when 10 ml of 2 per cent lignocaine was used and a mean peak level of 846 micrograms/l in patients receiving 10 ml of 1 per cent lignocaine.