Injury
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Comparative Study
A comparative study of early motion and immediate plaster splintage after internal fixation of unstable fractures of the ankle.
We reviewed 47 patients following operatively treated ankle fracture-dislocation, at an average of 15 months after injury, to assess the outcome of two different postoperative regimens. Of the 47 patients, 27 received early active and passive ankle exercises, and 20 patients received immediate plaster splintage. ⋯ No significant difference was apparent between the two groups on any of the criteria, although the early movement group contained more patients who were completely pain free, had a normal gait and no radiological signs of arthrosis (P < 0.05). This was achieved at the expense of a longer stay in hospital (average 10.2 days versus 7.4 days for plaster splintage) and more ankle swelling.
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CT scan has been used in blunt abdominal trauma with increasing popularity during the last decade. The sensitivity, specificity and accuracy of CT scan in blunt abdominal trauma have been reported to be very high. CT scan has been shown to eliminate the disadvantages of diagnostic peritoneal lavage (DPL) in the diagnosis of retroperitoneal organ injuries and when there are associated major pelvic fractures. ⋯ The sensitivity of CT scan to predict the necessity of operation is 100 per cent, specificity 92 per cent, accuracy 94 per cent, positive predictive value 82 per cent and negative predictive value 100 per cent. We conclude that CT scan is highly reliable in the management of blunt abdominal trauma, especially when retroperitoneal organ injuries are suspected or when there are associated major pelvic fractures. CT scan is also an invaluable tool in selected cases of non-operative management of hepatic trauma.
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Cross-matching and transfusion policies for patients with a fracture of the proximal third of the femur are poorly formulated. A series of 90 patients who underwent operation for such fractures at a district general hospital were evaluated. ⋯ If postoperative transfusion is indicated for haemoglobin levels of less than 9 g/dl, we recommend routine preoperative cross-matching only for patients admitted with trochanteric fractures and haemoglobin levels between 10 and 12 g/dl. This practice is safe and is a potential area for savings in cost and resources.
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The insertion of pleural drains (tube thoracostomy) is associated with serious complications in up to 10 per cent of cases. A safe and efficient technique of tube thoracostomy using the Autosuture Surgiport is described.
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One of the most contentious issues surrounding the prehospital management of the injured is the decision to stabilize on site or to rapidly evacuate the patient. Although there are vociferous proponents for both views, there appears to be little thought given to the rationalization of these decisions, and the subject has only merited lip-service in previous texts. Treatment choices and decisions in the prehospital environment are notoriously difficult to make. ⋯ However, these may be time consuming and, to be of greatest benefit to the patient, a fine balance between resuscitation and evacuation must be drawn. This paper aims to discuss some of the key issues which need to be considered in the prehospital scenario, such as treatment triage, evacuation priorities, mode of transportation and hospital destination. The end result must be to eliminate the medical 'bottleneck' and to afford early and appropriate definitive care to those in most need.