Injury
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Tibial plateau fractures (TPFs) are an independent, non-modifiable risk factor for surgical site infections (SSIs). Current antero-lateral approaches to the knee dissect through the anterior tibial angiosome (ATA), which may contribute to a higher rate of SSIs. The aim of this study was to develop an angiosome-sparing antero-lateral approach to allow reduction and fixation of lateral TPFs and to investigate its feasibility in a consecutive cohort. ⋯ The angiosome-sparing approach developed was able to be used in a prospective cohort and the clinical results to date are encouraging. Future clinical studies need to investigate the potential benefits of this surgical approach when compared with the previously described antero-lateral approaches.
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Selective non-operative management (SNOM) of penetrating abdominal wounds has become increasingly common in the past two or three decades and is now accepted as routine management for stab wounds. Gunshot wounds are more frequently managed with mandatory laparotomy but recently SNOM has been successfully applied. This review systematically appraises the evidence behind SNOM for civilian abdominal gunshot wounds. ⋯ SNOM can be safely applied to some civilian patients with abdominal gunshot wounds and reduces the rates of negative or non-therapeutic laparotomy. Patients who require delayed laparotomy have similar rates of morbidity and mortality and similar length of stay to those patients who undergo immediate laparotomy.
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Randomized Controlled Trial
Fractures of the posterior wall of the acetabulum: Treatment using internal fixation of two parallel reconstruction plates.
Our aim was to evaluate the efficacy of the treatment method using internal fixation of parallel reconstruction plates for the posterior wall of the acetabulum fractures. ⋯ the internal fixation of two parallel reconstruction plates facilitated rigid fixation and avoided fracture fragment injury, was an effective and reliable alternative method to treat fractures of the posterior wall of the acetabulum.
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Review Historical Article
Intra-abdominal injury from extra-peritoneal ballistic trauma.
Over the last century sporadic reports have described intra-abdominal injury without penetration of the abdominal cavity but the underlying mechanism of energy transfer appears variable. This article reviews the 19 documented cases of this phenomenon and discusses the mechanism of energy transfer in both primary blast injury and ballistic injury that may be responsible.
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Ankle fractures are among the most common injuries of the lower extremity encountered by orthopaedic surgeons. With increasing population age and osteoporosis, the prevalence of these fractures is expected to increase. The aim of this study was to evaluate complications and the need for revision surgery after the surgical treatment of ankle fractures in patients over 60 years of age. We report the outcomes of 186 consecutive patients who underwent operative treatment for rotational ankle fractures in our institution from 2007 to 2010. ⋯ Our data show that surgical treatment of ankle fractures in the elderly is associated with a high rate of complications. The factors predicting a high rate of complications include smoking, age, diabetes, local factors and a higher modified Charlson score. It is important to bear the factors in mind whilst deciding whether surgical treatment should be used in the treatment of such fractures in the elderly and explains these to patients at the time of obtaining consent. Further large-scale studies are needed to validate the predictive value of the suggested modified Charlson score.