Injury
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One hundred consecutive referrals with pelvic and acetabular fractures treated over a three year period were reviewed with regard to their early management. Early management was subdivided into four areas: 1. initial assessment and treatment; 2. imaging; 3. referral; 4. management of associated injuries. ⋯ There were important failures in diagnosis and early treatment of these complex injuries. A set of simple guidelines is offered to help improve the situation.
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The internal fixation of pelvic ring fractures and dislocations has become more popular recently. Aggressive resuscitation of the injured patient includes pelvic stabilization and improves survival rates. ⋯ Recent radiographic techniques for pelvic imaging facilitate comprehensive preoperative planning and intraoperative decision-making for pelvic injuries. Improved outcomes are expected as treatment is individualized for each patient.
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Pelvic malunions or nonunions are the result of inappropriate treatment of rotationally or linearly unstable injuries of the pelvic ring. Long-term sequelae such as chronic pain in the posterior pelvic ring, gait abnormalities, leg length discrepancy, sitting discomfort, neurological problems or impingement on the visceral organs may be secondary to the disturbed integrity of the pelvic ring. The late correction of the deformity is technically much more demanding than the treatment of acute pelvic ring injuries. ⋯ Possible complications include nerve or vascular injuries, incomplete reduction of the deformity, failure to unite, incomplete pain relief, and infection. Prior to surgery, a careful clinical and radiological examination is mandatory to assess the relationship between the presenting anatomical deformity and the complaints of the patient. The final decision for surgery has to be made by the patient taking into account reasonable expectation and the potential complications associated with the corrective procedure.
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From 1 April 1991 to 31 March 1993 the Royal London Hospital Helicopter Emergency Medical Service (HEMS) attended 737 road traffic accidents, 90 (12 per cent) of which involved entrapments. Nine casualties (10 per cent) died, of which five died at the scene. Thirty-two patients with a median ISS 17 (range 1-59) were transported by helicopter to the Royal London Hospital. ⋯ Immediate and uncontrolled release of trapped victims is only indicated if there is immediate danger to life from the surroundings. We recommend a rigorous target of less than 30 min for the release of the casualty. To achieve this will require systematic extrication training for Fire Service crews and medical teams who are involved in immediate care.
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A series of 39 unstable fractures of the distal one-third of the clavicle is presented. As results after non-operative treatment of these fractures are poor, surgical therapy is indicated. ⋯ According to the classification of Neer and Jäger/Breitner, a clear therapeutic strategy for lateral clavicular fractures can be defined. Unstable clavicular fractures with associated acromioclavicular ligament disruption should however be considered as a separate subtype in the existing classifications.