Injury
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The German society of trauma surgery published the "Treatment of Patients with Severe and Multiple injuries" guideline in 2011. This achieved the highest level of recommendation for guidelines published in Germany. This study investigated if there was an improvement in the survival rates of severed injured patients following the introduction of the guideline in clinical treatment. ⋯ The introduction and use of a guideline-based medical care regime for severely injured patients might reduce the rate of mortality.
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Many acute, deformed ankle injuries are manipulated in the Emergency Department (ED) before X-rays are taken to confirm the nature of the injury. This often occurs in the absence of neurovascular or skin compromise without consideration of other possible injuries such as talar, subtalar or calcaneal injuries. We believe that an inappropriate manipulation of an unknown injury pattern may place the patient at increased risk. ⋯ Re-manipulation was found to be significant (44% before X-ray vs. 18% after X-ray; chi-squared test: p=0.03; relative risk (RR)=2.72; 95% confidence interval (CI): 1.15-6.44). Delay to surgery and need for ORIF were not statistically different. We conclude that performing ankle injury X-rays before an attempt at manipulation, in the absence of neurovascular deficit or critical skin, may constitute best practice as it provides a better assessment of fracture configuration, guides initial reduction and significantly lowers the risk of re-manipulation and the potential risks associated with sedation without delaying surgery.
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Total knee arthroplasty is a common orthopaedic procedure in the UK; consequently, revision surgery and periprosthetic fractures are increasing in incidence. Strategies for management of these cases include non-operative strategies, internal plate fixation and revision of the distal femoral component. One under-reported practice is to perform distal femoral replacement in cases with poor distal femoral bone stock. ⋯ IV.
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Complex elbow instability (CEI) is one of the most troublesome pathologies that orthopaedic surgeons have to face. One of the key requirements regarding the CEI surgical treatment is an early rehabilitation programme to avoid the elbow stiffness caused by a long period of immobilisation. Although this is well known, no study has ever examined how, and to what extent, the functional range of motion (ROM) is recovered during the various stages of a prompt rehabilitation. Our aims were: (1) to prospectively analyse the pattern of ROM recovery in a series of patients with CEI who underwent early rehabilitation and (2) to identify the period of time during rehabilitation in which the greatest degree of motion recovery is obtained. ⋯ Following CEI surgical treatment, a rehabilitation programme needs to be started promptly and continued for at least 6 months because a significant improvement of ROM occurs prevalently in this period, which should be considered the critical time period to obtain a functional elbow in a majority of patients.
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The aim of this study was to check the feasibility and accuracy of measuring antetorsion during surgery using a mobile image intensifier (IF) with computed tomography (CT) function (ISO-C 3D; Siemens, Erlangen, Germany) in comparison to a conventional multi-slice CT scanner (LightSpeed QX/I CT; GE Healthcare, VA, USA). ⋯ Measuring femoral antetorsion using an intra-operative IF with CT function is a feasible and accurate method. This technique could be used when there is doubt about the antetorsion angle in the operated femur and it could help decrease the need for a separate revision surgery.