Injury
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Case Reports
The pinless external fixator--relevance of experimental results in clinical applications.
The pinless external fixator was intended as a stable, temporary, minimally invasive fixator for severe tibial fractures ensuring safer conversion to an intramedullary nail. An in vitro study showed that the pinless fixator was mechanically not as stiff as the conventional AO tubular device, the main problem being low axial stiffness. This study involving initial clinical trials with the pinless fixator on tibial fractures in St. ⋯ The application technique is easy to learn suggesting that the pinless fixator could be an ideal tool for emergency stabilization. The primary application of this fixator leaves all further treatment modalities open (repeated debridements, evaluation of the open fracture). It may also be of particular value to many clinicians working with reamed nails as their only secondary treatment option for open tibial fractures.
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This study describes the effects of 'echelons' on the outcome of victims of the Afghan internal armed conflict in terms of mortality and drain of surgical resources. A group of 1127 victims of war treated at ICRC first aid posts (FAPs) and subsequently referred to a surgical hospital of the International Committee of the Red Cross (group A), and a group of 596 victims who were transported directly from the area where the injury occurred to the hospital (group B) were analysed retrospectively. Mortality in patients treated initially at a FAP and admitted within 6-24 h after injury was slightly lower than in patients admitted directly. ⋯ No differences were found in relation to the incidence of fever, number of units of blood transfused and average stay in hospital. The study shows that initial treatment at a FAP had no significant influence on the prognosis of the injured. Presumably the best ways to improve the prognosis of the victims of war are to train local people in first aid, to support locally existing medical facilities and to establish an evacuation system in order to support these first aiders and medical facilities.
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Thirty boys, aged 2-12 years, presented with penile zip entrapment to one Paediatric Accident and Emergency Department over a 7 year period. The rate of presentation was one zip entrapment per 4068 new patient attendances. In contrast to previous reports, injuries occurred most commonly whilst the zip was being done up and whilst underpants were being worn. ⋯ Contrary to previous suggestions, most children (26 out of 30) were easily managed in the Accident and Emergency Department without general anaesthetic. No patient required circumcision or suffered any sequelae. An algorithm for treatment based upon the experience of this study is presented.
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At our institution, the small AO external fixator has been utilized on the wrist and hand on over 200 patients since 1979. Disregarding fractures of the distal radius, the main indications were fracture dislocations of the wrist, Kienböck's disease, combined injuries with bone defects of the wrist and metacarpals, and basilar fractures of the thumb metacarpal. In this paper, five well-established applications will be described with respect to treatment concept, indication, technique, and personal results. Furthermore, recommendations and reservations are listed to help in the prevention of the most frequent complications.