Injury
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We report the results of a single centre prospective study of exchange nailing for aseptic non-union of a femoral fracture. Eighteen patients with 19 aseptic femoral non-unions had exchange nailing performed in our institution. We collected data on mechanism of injury, original fracture type, and indication for exchange nailing, further surgery and major complications. ⋯ Complications following exchange nailing occurred in 11 fractures (58%), in which further surgery was required (four repeat exchange nailings, two Ilizarov frame applications and five nail removals). The role of reamed exchange nailing in the treatment of femoral non-union needs to be re-evaluated. Although fracture healing is eventually achieved in most patients, a significant number of them required additional surgery to achieve union or to deal with complications arising from the exchange nailing.
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The spinal board is widely used as a means of extrication and efficient transport during the pre-hospital phase of trauma management. A number of concerns have been raised regarding its subsequent usage once the patient arrives in the emergency department. We undertook a telephone study of 100 A+E departments in the United Kingdom to ascertain current spinal board usage. Our study demonstrated great variability in practice across the UK and a marked lack of on-going audit or defined protocols governing spinal board usage following the pre-hospital phase of trauma management.