Injury
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Comparative Study
Analysis of radiation exposure to the orthopaedic trauma patient during their inpatient hospitalisation.
There has been considerable concern regarding radiation exposure to both the patient and treating surgeon and the possible risk of resulting malignancy. We sought to analyse the total effective dose of radiation that a cohort of orthopaedic trauma patients are exposed to during their inpatient hospitalisation and determine risk factors for greater exposure levels. ⋯ The average orthopaedic patient receives a total effective radiation dose of more than 30 mSv, much greater than is considered acceptable as a recommended permissible annual dose by the International Commission on Radiological Protection (20 mSv). These findings indicate that the average trauma patient (in particular those with polytrauma or fractures involving the spine, pelvis, chest wall, or long bones) is exposed to high levels of radiation during their inpatient hospitalisation. The treating physicians of such patients should take into consideration the large amounts of radiation their patients receive just during their initial hospitalisation, and be prudent with the ordering of imaging studies involving radiation exposure.
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Comparative Study
Fracture pattern and fixation type related to loss of reduction in bicondylar tibial plateau fractures.
Bicondylar tibial plateau fractures can be treated with locked plating applied from the lateral side with or without additional application of a medial plate (dual plating). Recent studies demonstrate that these injuries can be sub-grouped based upon their morphology by computed tomography (CT). The purpose of this study is to evaluate the relationship between fracture pattern, method of fixation and loss of reduction in bicondylar tibial plateau fractures. ⋯ Level III (retrospective comparative study).
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Multicenter Study
A national survey of acute hospitals in England on their current practice in the use of femoral nerve blocks when splinting femoral fractures.
Missed compartment syndrome can have devastating long-term impact on a patient's function. Femoral fracture has been reported in 52-58% of acute thigh compartment syndromes in the existing literature. Time to diagnosis of compartment syndrome is cited as a key determinant of outcome. Use of femoral nerve blocks in splinting of femoral fractures may mask signs of early compartment syndrome. We present the attitudes of emergency department and orthopaedic staff in NHS trusts in England with regard to this issue. ⋯ Femoral nerve block is an under-utilised, effective mode of analgesia following femoral fractures. There is a low risk of associated compartment syndrome, but clinicians should be especially vigilant in high-energy injuries. We recommend that all acute trusts receiving trauma should have a protocol for the use of femoral nerve blocks agreed by the emergency and orthopaedic departments.
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Comparative Study
Patterns of triangular fibrocartilage complex (TFCC) injury associated with severely dorsally displaced extra-articular distal radius fractures.
The aim of the study was to examine triangular fibrocartilage (TFCC) injury patterns associated with unstable, extra-articular dorsally displaced distal radius fractures. ⋯ Severe displacement of an extra-articular radius fracture suggests an ulnar-sided ligament injury to the TFCC. The observed lesions concur with findings in a previous cadaver study. The lesions follow a distinct pattern affecting both radioulnar as well as ulnocarpal stabilisers.
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This study from the Swedish Hip Arthroplasty Register (SHAR) compares cemented (Thompson(®), Exeter Trauma Stem (ETS)(®)) and uncemented (Austin-Moore(®)) monoblock hemiarthroplasties (n=1116 and 616, respectively) with modular ones (n=18,659). Austin-Moore(®) prostheses lead to more re-operations (6.7%) compared to modular implants (3.5%) and Thompson(®)/ETS(®) (2.4%). A Cox regression analysis, adjusting for other risk factors, shows twice the risk of re-operation for Austin-Moore(®) implants (CI 1.5-2.8), in particular, due to periprosthetic fracture (5.4; CI 3.2-9.1) and dislocation (1.9; CI 1.3-3.0). ⋯ Due to the increased risk of re-operations, it should not be used in modern orthopaedic care. Cemented Thompson(®) or ETS(®) implants could still be suitable for the oldest, low-activity patients. To finally decide if there is a place for them, patient-reported outcome must be analysed as well.