Injury
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This is an analysis of 52 fractures of the posterior wall of the acetabulum treated operatively and reviewed 2-15 years after injury. In 48 cases the fracture was associated with posterior dislocation of the hip, which was treated by closed reduction soon after the injury. ⋯ A strict correlation was found between accurate reduction of the fracture and the clinical and radiological results, which were excellent or very good in 85 per cent and 87.5 per cent of the patients, respectively. Surgical and late complications were peroneal palsy in four patients, ectopic ossification restricting hip movement in two cases, aseptic necrosis in three, and osteoarthritis in another three cases.
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In a retrospective analysis it was found that not all patients with penetrating bull-gore injuries of the abdomen need exploration by formal laparotomy. A policy of selective conservatism was followed in the management of 18 out of 20 patients with bull-gore injuries of the abdomen in whom peritoneal breach was established either on presentation or by digital exploration of the wound. Formal laparotomy was reserved for specific clinical indications. ⋯ Omental and/or bowel evisceration occurred in 11 out of 18 cases (61 per cent). However, this was not considered an indication for exploration and all 11 cases were treated by simple replacement of omentum or bowel into the abdominal cavity. Penetrating abdominal bull-gore injuries can be managed safely by a policy of selective conservatism, reserving formal laparotomy for specific clinical indications.