Injury
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Observational Study
Still no reliable consensus in management of blow-out fracture.
Management of blow-out fractures (BOF) is addressed by different specialties. The general agreement is that patients with the potential for late enophthalmus development require early surgical intervention. In this study we wanted to: (i) evaluate the differences in opinions between the specialties that manage BOF and also whether there was a difference between surgeons from different countries, (ii) evaluate if surgeons handle these cases based upon their own individual criteria,(1) (iii) evaluate the correlation between the management of patients with orbital floor fractures and any late sequelae detected upon eye examination. ⋯ There are considerable differences in opinions regarding the management of BOF due to a lack of a reliable consensus. The management of BOF appears to be based on both individual and local traditions. Guidelines based on a randomized prospective study in BOF are required.
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Proximal plate fixation is a crucial factor in osteosynthesis of periprosthetic femur fractures. Stability and strength of different fixation concepts for proximal plate fixation were compared. ⋯ Bicortical screw anchorage improves proximal plate fixation in periprosthetic fractures. The cerclage-screw combination is a valuable alternative especially in osteoporotic bone.
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Exsanguinating haemorrhage is a leading cause of death in severely injured trauma patients. Management includes achieving haemostasis, replacing lost intravascular volume with fluids and blood, and treating coagulopathy. The provision of fluids and blood products is contingent on obtaining adequate vascular access to the patient's venous system. We sought to examine the nature and timing of achieving adequate intravenous (IV) access in trauma patients requiring uncrossmatched blood in the trauma bay. ⋯ We found that most bleeding patients received a prehospital IV; however, we also found that obtaining prehospital IVs was associated with longer EMS on-scene times and longer prehospital times. Interestingly, we found that obtaining a prehospital IV was not associated with more rapid initiation of blood product transfusion. Obtaining optimal IV access and subsequent blood transfusion in severely injured patients continues to present a challenge.
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Comparative Study
Angular stable multiple screw fixation (Targon FN) versus standard SHS for the fixation of femoral neck fractures.
Head-preserving fracture care especially for the elderly may be complicated by acetabular screw penetration, cut out, delayed union or femoral head necrosis. The following comparative study analyses whether a new angular stable device may overcome these shortcomings. ⋯ The study revealed less subsidence of the head fragment, lower cut out rate and a lower rate of conversion to hemiarthroplasty after Targon FN fixation in comparison to a standard SHS fixation in a small number of patients with hip fractures. However, this was not accompanied by functional limitations in the SHS group.
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Winter sports have evolved from an upper class activity to a mass industry. Especially sledging regained popularity at the start of this century, with more and more winter sports resorts offering sledge runs. This study investigated the rates of sledging injuries over the last 13 years and analysed injury patterns specific for certain age groups, enabling us to make suggestions for preventive measures. ⋯ Mild head trauma was mainly found in very young sledgers, and injuries to the lower extremities were more frequent in adults. In accordance with the current literature, we suggest that sledging should be performed in designated, obstacle-free areas that are specially prepared, and that children should always be supervised by adults. The effect of routine use of helmets and other protective devices needs further evaluation, but it seems evident that these should be obligatory on official runs.