Injury
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Multicenter Study
Long-term results of unstable pelvic ring fractures in children.
Seventeen patients less than 12 years old sustained unstable pelvic ring fractures and were treated non-operatively. They were followed for 2 to 25 years. ⋯ Five patients complained about chronic back pain, two were functionally impaired by severe pelvic asymmetry. Healing of an unstable pelvic fracture in malposition with asymmetry causes poor results and must be prevented.
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This study analyses the relationship between the level of experience of both surgeon and radiographer and the radiation dose administered in theatre, during fixation of extracapsular proximal femoral fractures. From the 63 dynamic hip screw procedures performed, 10 were done by Senior House Officers (SHOs), 10 by Consultants and 43 by Registrars, whereas Basic Radiographers were involved in all cases. Fractures were classified as two part, three part or four part. ⋯ The highest radiation dose and screening times were recorded when an SHO was the operating surgeon and the lowest when a registrar was the surgeon. The two part and three part fractures performed by registrars were subdivided according to the experience of the radiographer. In both cases a statistically significant difference was found between the dose of radiation administered in theatre and the years of experience of the radiographers (p < 0.05).
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The Glasgow Coma Score (GCS) is an important factor in the management and prognosis of a patient with neurosurgical pathology. We have found that there is often a disparity between the quoted and actual GCS of patients referred to this unit. ⋯ Forty-two (51%) out of a total of 82 patients had a correct GCS on referral. The proportion of patients referred with a correct GCS did not vary with either the grade or speciality of the referring doctor.
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One hundred and eighty one patients with chest injuries (145 with blunt injuries and 36 with penetrating injuries) were managed using a standardized protocol at the JIPMER Hospital between 1990 and 1995. The insertion of an intercostal tube drain, provision of analgesia and oxygen was sufficient in 80 per cent of patients. ⋯ Most patients with chest injuries do not require an operation and can be treated adequately at District General Hospitals. Those with penetrating injuries are more likely to need surgery than those with blunt injuries.
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During 41 procedures of intramedullary nailing of femoral and tibial fractures, the primary surgeon and the first assistant wore ring dosimeters on their dominant index fingers. While the average fluoroscopy time per procedure was 4.6 min, the average dose of radiation to the dominant hand of the primary surgeon was 1.27 mSv and 1.19 mSv to the first assistant. The dose limit for the extremities is 500 mSv per year, as recommended by the International Commission on Radiological Protection. ⋯ The average registered ionizing dosage without a thyroid shield was approximately 70 times higher than with thyroid lead protection. In a previous study we found average fluoroscopy times during intramedullary nailing of the tibia and femur of 4.6 min per procedure. Extrapolation of this value leads to the result, that even when 1000 intramedullary nailings were carried out without wearing lead protection, only 13 per cent of the dose limit recommended by the International Commission on Radiological Protection for the thyroid of 300 mSv per year would be reached; by wearing the lead protection only 0.2 per cent of the recommended dose would be reached.