Injury
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Displaced intracapsular fractures of the neck of femur are routinely treated in the elderly with either cemented or uncemented hemiarthroplasty. Recent evidence suggests a superior outcome with the use of cement, but uncemented prostheses are still employed for those with multiple co-morbidities or particular frailty. In Scotland, the Scottish Intercollegiate Guidelines Network (SIGN) recommendations are used to identify which patients should receive a cemented prosthesis. ⋯ It is concluded that, in conjunction with the treating senior anaesthetist, cemented implants should be considered in all patients, especially those who are deemed to be frail and with multiple co-morbidities. A periprosthetic fracture rate of 14% at a mean of 2 years after uncemented hemiarthroplasty represents a potentially unacceptable risk for such a frail population. In particular, we feel that the AMP should not be used for treating displaced intracapsular neck-of-femur fractures.
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Comparative Study
Functional outcomes following syndesmotic fixation: A comparison of screws retained in situ versus routine removal - Is it really necessary?
Syndesmotic disruption can occur in up to 20% of ankle fractures and is more common in Weber Type C injuries. Syndesmotic repair aims to restore ankle stability. Routine removal of syndesmosis screws is advocated to avoid implant breakage and adverse functional outcome such as pain and stiffness, but conflicting evidence exists to support this. The aim of the current study is to determine whether functional outcome differs in patients who had syndesmosis screws routinely removed, compared to those who did not, and whether a cost benefit exists if removal of screws is not routinely necessary. ⋯ Our study has shown that retained-screw fixation does not significantly impair functional capacity, with additional cost-effectiveness. We therefore advocate that syndesmosis screws be left in situ and should only be removed in case of symptomatic implants beyond 6 months postoperatively.
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Seatbelt use is a major determinant of a driver's safety on the road. In Turkey and other middle-income countries, seatbelt use is lower than in high-income countries and contributes to the higher burden of road traffic injuries. Assessing factors behind drivers' motivations to wear seatbelts can help determine appropriate interventions for specific subpopulations. ⋯ Drivers with passengers had higher odds of selecting Reason 3, especially younger drivers who are more likely to succumb to peer pressure. Older drivers had higher odds of selecting Reason 3. Peer groups and peer education campaigns may have an impact. Education interventions combined with extrinsic campaigns can be aimed at younger drivers to increase and maintain adherence in the population.
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Sacroiliac (SI) screw fixation for unstable pelvic fractures stands out as the only minimally invasive method among all other ORIF procedures. A strictly transverse screw trajectory is needed for central or bilateral fracture patterns up to a complete iliosacroiliac fixation. However, secure screw insertion is aggravated by a narrow sacroiliac bone stock. ⋯ Hence, in dysplastic pelvises, sacroiliac screw insertion should be recommended into the 2nd sacral segment. Our IT workflow for the automatic computation of 3-D corridors may assist in surgical pre-operative planning. Furthermore, the workflow could be implemented in computer-assisted surgery applications involving pelvic trauma.
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Comparative Study
Emergency stabilization of the pelvic ring: Clinical comparison between three different techniques.
Emergency devices for pelvic ring stabilization include circumferential sheets, pelvic binders, and c-clamps. Our knowledge of the outcome of these techniques is currently based on limited information. ⋯ Level III.