Injury
-
The change in knowledge resulting from formal training in trauma management on two different courses was examined. Seventy-four doctors and a control group were included in this prospective study over a 2-year period. They represented participants on two Advanced Trauma Life Support (ATLS) courses and four induction courses for junior doctors in Accident and Emergency (A&E) departments. ⋯ Standardization of approach is recommended. Assessment and audit of training in trauma management is feasible with limited resources. It may eventually be possible to measure individual clinician's proficiency against a standard scale.
-
With increasing violence in our society, the number of gunshot fractures is likely to increase. Fourteen femoral fractures caused by gunshot injuries were treated with statically locked intramedullary nailing within 8 h of injury. Three patients had concomitant femoral arterial injuries. ⋯ One fracture was graded as a poor outcome because of a non-union which was treated with an exchange nailing procedure and progressed to bony union. Our experience of immediate intramedullary nailing of gunshot femoral fractures has yielded results which approximate to those observed in treating closed femoral fractures. We would therefore recommend this as the treatment of choice in fractures of the femoral shaft caused by gunshots.