Injury
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All victims of major blunt trauma have been said to be at risk of cervical spinal injury. In a prospective study of 410 such patients at our institution, we identified 13 patients (6.12 per cent) with unstable cervical spines. Loss or defect of consciousness following injury (regardless of duration), neurological deficit consistent with cervical cord or nerve root injury and neck tenderness were significantly predictive of an unstable cervical spine. Immediate radiographic investigation of the cervical spine is mandatory in such patients, but may not be required in patients without these signs.
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Since seat belt legislation was introduced in this country in 1983, we have seen an increasing number of patients admitted to our unit for observation following seat belt related sternal fractures. In order to determine the value of routine admission of patients with isolated sternal fracture we have reviewed a series of 104 consecutive patients admitted between February 1983 and February 1990 with this injury. ⋯ No serious complications were observed. These findings suggest that there may be no need to admit these patients solely for observation if their initial clinical condition is satisfactory and there are no abnormalities identified by an anteroposterior chest radiograph and electrocardiography.
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Comparative Study
When should a synthetic casting material be used in preference to plaster-of-Paris? A cost analysis and guidance for casting departments.
An accurate cost analysis of the use of one of the new synthetic casting materials (Cellacast) compared with plaster-of-Paris (Gypsona) was undertaken over a 3-month period in the fracture clinic of Cardiff Royal Infirmary. The mean duration of usage before failure for synthetic forearm, scaphoid and below-knee casts was found to be approximately twice that of plaster casts. The use of synthetic casting materials was found to be cost-effective in situations where there was thought to be a high probability that structural failure of the cast would occur. Guidelines for the use of plaster-of-Paris and synthetic casting materials are presented.
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Eight cases of fracture of the femoral shaft in total hip arthroplasty were treated by a combination of a Küntscher nail and a modified Charnley stem with cement. Radiological union was achieved in all patients at an average of 8 months.