Injury
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The presentation of traumatic wounds is commonplace in the accident & emergency department. Often, these wounds need referral to specialist care, e.g. trauma & orthopaedic, plastic or maxillofacial surgeons. Documentation and communication of the size of the wound can influence management, e.g. Gustilo & Anderson classification of open fractures. Several papers acknowledge the variability in measurement of chronic wounds, but there is no data regarding accuracy of traumatic wound assessment. The authors hypothesised that the estimation of wound size and subsequent communication or documentation was often inaccurate, with high inter-observer variability. A study was designed to assess this hypothesis. ⋯ The estimation of wound size is a common requirement of clinical practice, and inaccurate interpretation of size may influence surgical management. Assessment using estimation was inaccurate, with high inter-observer variability. Assessment of traumatic wounds that require surgical management should be accurately measured, possibly using photography and ruler measurement.
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Propofol infusion syndrome (PIS) is defined by arrhythmia, rhabdomyolysis, lactic acidosis, and unrecognized leads to death. We sought to determine the incidence of PIS in trauma patients and evaluate the efficacy of a prospective screening protocol in this patient population. ⋯ PIS is a morbid and lethal entity associated with sedation of critically injured patients. A simple screening procedure utilizing serum CPK (<5000 U/L) can essentially eliminate the development of PIS.
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Displaced distal tibia fractures require stable fixation while minimizing secondary damage to the soft tissues by the surgical approach and implants. Antegrade intramedullary nailing has become an alternative to plate osteosynthesis for the treatment of distal metaphyseal fractures over the past two decades. While retrograde intramedullary nailing is a standard procedure in other long bone fractures, only few attempts have been made on retrograde nailing of tibial fractures. ⋯ Rotational stability was superior for the RTN. Statistical analysis proved a significant difference (p<0.05) between the ETN and RTN for rotational stability. This study suggests that retrograde tibia nailing with the RTN is a promising new concept for the treatment of distal tibia fractures.
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The retrospective study was made to evaluate the fracture patterns at the proximal humeral shaft for which the long version of a standard proximal humeral nail (PHNLV) has been used. The indication has been decided by the individual surgeons. ⋯ There is clear evidence of specific characteristics which differentiate proximal third humeral shaft fractures from those of midshaft and distal third. They explain the specific problems of reduction and fixation. If disrespected they will lead to higher rates of therapeutic failure.
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To determine the outcomes and predictive factors of patients with open globe injury requiring pars plana vitrectomy (PPV). ⋯ Pupillary reaction is an important presenting ocular sign in estimating the post-vitrectomy poor visual outcome for open globe injury. Vision was restored and improved in more than half of the patients in this study; however, long-term sequelae should be monitored.