Injury
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Direct or indirect trauma to the coccygeal bone can induce chronic coccygodynia. The aim of this study is a retrospective analysis of our patients surgically managed for traumatic coccygodynia and a critical review of the results obtained in comparison to the literature. ⋯ In patients with posttraumatic, conservative therapy-resistant coccygodynia, operative treatment with coccygectomy is a feasible management option. We recommend total or partial coccygectomy using a longitudinal incision in carefully selected and well-informed patients.
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In the management of Type IIIb injuries, Gustilo's classification has the disadvantages of a poor intra and inter-observer agreement rate, low specificity and sensitivity to salvage and inability to predict functional outcomes. We propose here a validated score which assesses the severity of injury to the covering structures, skeletal structures and functional tissues of the injured limb separately along with providing weightage to the presence of co-morbid factors. ⋯ According to the total score, injuries were treated by 'Fix and close' protocol; 'Fix, Bone Graft and Close' protocol, 'Fix and Flap' protocol or 'Stabilise, Watch, Assess and Reconstruct' protocol. The score was thus found to be useful clinically not only to assess salvage but also to provide guidelines in reconstruction.
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Concerning the tension-band principle of internal fixation, this study aims to establish whether any difference in interfragmentary gap exists after bone-reducing forceps are released, when a recommended suture-knot technique and a new technique are tested in vitro on a purpose built machine that features a model of a transverse fracture of the patella. In addition, a standard tension-band wiring technique has also been tested as one form of control. ⋯ This evaluation study has produced quantitative and comparable data of fracture gap as observed with the model of a transverse patella fracture, for both new and established surgical techniques. The contribution this study has made to the knowledge of the subject is that a testing device similar to the one in this study may be useful in the future for conducting preliminary studies of new or established tension-band techniques. The proposed tension-band suture method tested in this dissertation provided statistically significant quantitative data, which may after further work, support its use as an alternative method in the clinical setting.
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Intramedullary nailing is the treatment of choice for unstable or displaced tibial fractures. Titanium nails have been advocated for their improved biocompatibility and biomechanical properties but concerns are held about increased complications. We present results of 225 tibial fractures in 221 patients (90% follow-up) treated with the ACE titanium tibial nail (DePuy International Limited, Leeds, UK) inserted between 1995 and 2003 in one hospital department, which show no increased complications compared with the published literature. ⋯ Median union time was unaffected by open injury, reaming or age. Ninety (43.3%) patients required re-operation of which 23 (11%) had a second re-operation. In total 43 (20.7%) nails were removed, without any complication as previously reported for this nail.