Injury
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To determine the association between mortality and the level of prehospital care in severely injured blunt trauma patients with or without severe head injury. ⋯ The level of prehospital care was associated with the risk of mortality. This was modified by whether the patient survived long enough to be admitted to the ICU.
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Trauma auditing is important for monitoring the process of trauma care and outcome prediction. This pilot study was conducted to evaluate quality improvement (QI) data following a mass casualty event and discuss its impact on the trauma care process and outcome. A pre-designed trauma quality improvement data set was used for all 103 injured patients admitted to Asir Central Hospital, Saudi Arabia, who were involved in a single motor vehicle crash. ⋯ Trauma management variations throughout all phases of care were associated with 10% and 9% incidence of preventable morbidity and mortality, respectively. Efforts including rigorous educational programs should be made to stress the initial assessment and resuscitation phase of care. Successful regionalized trauma care systems involving quality improvement programs report significant reduction in morbidity and mortality rates from trauma.
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During 13 months of data gathering, all injury-related information concerning trauma patients was gathered according to International Classification of Diseases, 10th revision (ICD-10). The severity of the injury was calculated according to Abbreviated Injury Scale (AIS-90) in six major university hospitals in Tehran. Twelve percent of 8000 hospitalised trauma patients were elderly (65 years or older) and 70% of them (675 patients) had suffered from fall-related injuries. ⋯ After adjustment for the gender, kind of fall and Injury Severity Score, it was shown that the elderly were more prone to death than their younger counterparts (odds ratio=5.8, 95% CI for odds ratio: 2.3-7.2), but there was no significant difference in mortality rate between elderly men and women. Further studies are needed to evaluate personal and environmental risk factors for falls in our population. Furthermore, significantly higher mortality rate in our elderly trauma victims necessitates prudent attention to elderly trauma care in our teaching hospitals.
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The basic principles of an internal fixation procedure using a conventional plate and screw system (compression method) are direct, anatomical reduction and stable internal fixation of the fracture. Wide exposure of the bone is usually necessary to gain access to and provide good visibility of the fracture zone to allow reduction and plate fixation to be performed. This procedure requires pre-contouring of the plate to match the anatomy of the bone. ⋯ An indirect closed reduction is necessary when using the LCP in the internal fixator method bridging the fracture zone. A combination of both plating techniques is possible and valuable, depending on the indication. It is important to command a knowledge of both techniques and their different features.
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Distal humerus fractures in adults are treated by open reduction and internal fixation, which produces good results in the majority of patients. However, in elderly patients or in cases with metaphyseal comminution, stable fracture fixation still remains problematic. Anatomical joint reconstruction and primary stable osteosynthesis are often particularly difficult to achieve in this group of patients since poor bone mineral quality is frequently encountered. ⋯ Investigations on whether the recently introduced Locking Compression Plates (LCPs) could enhance primary stability are rare. On the basis of clinical and biomechanical experiences, the authors consider LCPs a helpful tool for increasing primary stability in osteosynthesis of distal humerus fractures. LCPs might be of substantial advantage in patients with diminished bone mineral quality or in the presence of metaphyseal comminution.