Injury
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Surgical techniques and fixation strategies for the treatment of unstable posterior pelvic ring injuries continue to evolve. The safety of the posterior surgical approach in particular has been questioned due to historically high rates of wound related complications. ⋯ These concerns for infection and wound necrosis have led, in part, to increased interest in closed reduction and percutaneous fixation for treatment of these injuries but an open posterior approach remains the optimal strategy in some injury patterns. We describe herein a modified posterior approach to the pelvis designed to minimize wound related complications and present our clinical results demonstrating wound complication rates consistent with contemporary publications.
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Data concerning outcome after management of acetabular fractures by anterior approaches with focus on age and fractures associated with roof impaction, central dislocation and/or quadrilateral plate displacement are rare. ⋯ Nonanatomical reconstruction of the articular surfaces is at risk for failure of joint-preserving management of acetabular fractures through an isolated or combined modified Stoppa approach resulting in total joint replacement at mid-term. In the elderly, joint-preserving surgery is worth considering as promising clinical and radiographic results might be obtained at mid-term.
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Though augmentation plating (AP) with decortication and bone grafting (BG) reportedly has excellent outcomes for femoral shaft nonunions, there are no established indications of AP with decortication and BG. The purpose of this study was to evaluate the results of AP with decortication and autogenous BG for femoral shaft nonunions, focussing on the indications of AP with decortication and BG. ⋯ AP with decortication and autogenous BG is a good option for nonisthmal femoral shaft nonunions, such as supra-isthmal and infra-isthmal nonunions. In addition, this option is useful for selected cases of isthmal femoral shaft nonunions in which failure of exchange nailing is expected due to lack of a tight fit between the new larger nail and femoral cortices.
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Trauma is a major cause of death and disability worldwide, of which more than 90% occur in low- and middle-income countries. Given the magnitude of this inequality, there is a need to devise and use tools to assess the capacity of facility-based trauma care. ⋯ Additionally, organizational capabilities, such as trauma registries, trauma-specific training, and quality improvement programmes were lacking. The state of trauma care at district and provincial levels in Kenya demonstrates a strong case for national and global investment in clinical and systemic interventions.
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Drunk driving is an important risk factor for road traffic crashes, injuries and deaths. After June 2008, all drivers in Brazil were subject to a "Zero Tolerance Law" with a set breath alcohol concentration of 0.1 mg/L of air. However, a loophole in this law enabled drivers to refuse breath or blood alcohol testing as it may self-incriminate. The reported prevalence of drunk driving is therefore likely a gross underestimate in many cities. ⋯ Strong legislation and effective enforcement are necessary to reduce the prevalence of this dangerous behaviour. Correction techniques allow calculation of a truer prevalence of drunk driving, which can assist police and policymakers alike to redirect resources and align strategies.