Injury
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By a prospective database analysis of patients with an injury to the chest admitted to the University Medical Center Utrecht between 2000 and 2004 were studied. All patients with a blood gas analyses were included. Absolute BD was used for analyses. Clinical outcome parameters were recorded. ⋯ Admission BD is a predictive factor in thoracic trauma patients for mortality and chest related complications. Furthermore it is a predictive factor for ICU admission, required ventilation and hospital stay. The use of BD in thoracic trauma patients can potentially identify patients who require additional monitoring or early aggressive therapy.
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Randomized Controlled Trial Comparative Study
A randomised clinical trial comparing minimally invasive surgery to conventional approach for endoprosthesis in elderly patients with hip fractures.
In recent years, the concept of minimally invasive surgery has invaded the orthopaedic field and literature on the subject is spawning. Mini-incision surgery for total hip arthroplasty has been studied without a clear consensus on the efficacy, safety and advantage of that technique. To our knowledge, the efficacy and safety of mini-incisions in hip fracture surgery has not been studied in a randomised fashion. ⋯ Based on the results of the present study, we cannot recommend the use of a minimally invasive approach over a standard approach in the implantation of a cemented endoprosthesis.
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Comparative Study
The comparison of two classifications for trochanteric femur fractures: the AO/ASIF classification and the Jensen classification.
This study compares the reproducibility of two classifications for trochanteric femur fractures: the Jensen classification and the AO/ASIF classification. Furthermore we evaluated the agreement on fracture stability, choice of osteosynthesis, fracture reduction and the accuracy of implant positioning. In order to calculate the inter-, and intra-observer variability 10 observers classified 50 trochanteric fractures. ⋯ The postoperative agreement on choice of implant, fracture reduction and position of the implant was kappa0.17, kappa0.29 and kappa0.22, respectively. Both classifications showed poor reproducibility. This study suggests that the definition of stability of trochanteric fractures remains controversial, which possibly complicates the choice of osteosynthesis.
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The utilisation and consequences of standardised operative procedures may importantly differ between different healthcare systems. This is the first investigation comparing the treatment and outcome of femoral shaft fractures stabilised with an identical implant between trauma centres in 2 continents (Europe, EU and South Africa, SA). ⋯ Our investigation demonstrates the importance of several major differences between 2 different regions of the world in the treatment of femoral shaft fractures, despite involving only high level trauma centres and using an identical implant. The intercontinental comparison of results from clinical studies should be interpreted very carefully considering the heterogeneity of populations and clinical settings.