Injury
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The purpose of this study is to examine the epidemiology of firework-related injuries among an emergency department (ED) nationally representative population of the United States for the years 2000-2010, including whether the type of firework causing the injury is differential by patient demographics and whether the severity of injury is associated with the firework type. ⋯ Understanding the specific types of fireworks may lead to better preventative methods and regulations. Moreover, preventative methods should be taken to reduce the rate of firework-related injuries among U.S. youths [1], and possibly more regulations and enforcement of laws geared towards prohibiting novice use of fireworks.
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Case Reports
Salvage of infected intramedullary knee arthrodesis with vascularized free fibula and staged fixation.
Intramedullary knee arthrodesis is indicated when an infected total knee arthroplasty revision is failed. There is a high risk of infection after this procedure and the only option of treatment considered in these cases is AK amputation. We present an alternative to AK amputation in intramedullary arthrodesis infected cases that has been successful in all patients we have treated. ⋯ All patients were able to walk independently with one crutch. In conclusion, although our series is short to export results, our protocol treatment is a good alternative to AK amputation. The treatment entails at least three major surgical procedures through a protracted period of time, but the avoidance of an AK amputation seems worth the risk in a fully informed and compliant patient.
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Cancer patients are at an increased risk of dying following an injury, of which among the elderly is predominately caused by falling. In addition, patients with certain types of cancer are more prone to bone injury. However, studies are needed that examine the role of cancer site and metastasis on the relationship between cancer and death following traumatic injury. ⋯ Cancer patients with and without spread over the age of 50 years are more likely to die in-hospital after a fall than elderly patients without cancer. However, this relationship may exist only for patients with specific cancer types.
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Observational Study
Tertiary survey in trauma patients: avoiding neglected injuries.
Medical personnel in trauma centres in several countries have realised that undiagnosed injuries are common and are now focussing their attention on reducing the incidence of these injuries. Tertiary survey is a simple and easy approach to address the issue of undiagnosed injuries in trauma patients. Tertiary survey consists of reevaluating patients 24 hours after admission by means of an anamnesis protocol, physical examination, review of complementary tests and request for new tests when necessary. ⋯ The application of the protocol for tertiary survey proved to be easy, inexpensive and beneficial to patients (particularly polytraumatised patients) because it enabled identification of important injuries that were not detected on admission in a large group of patients.
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The aim of this study was to assess the union rates in a series of patients with failed femoral shaft aseptic non-union who were treated with percutaneous concentrated autologous bone marrow grafting. Bone marrow harvesting and cell injection were performed under general anaesthesia in a single surgical procedure. Radiographic union was diagnosed in fractures with a score ≥ 10 according to the radiographic union scale in tibial fractures (RUST) and confirmed by clinical examination. ⋯ However, a relationship between the number of osteoprogenitors injected and the rate of union was noted, 20.2 ± 8.6 × 10(8) versus 9.8 ± 4.3 × 10(8), p<0.005, between the patients with and without union, respectively. The efficacy of percutaneous autologous concentrated bone marrow grafting seems to be related to the number of osteoprogenitors available in the aspirates. Optimisation of the aspiration technique and concentration process is of paramount importance to increase the incidence of a successful outcome.