Injury
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For AO/OTA 31-A2 fractures (A2 fractures) treated with dynamic hip screw (DHS), postoperative lateral wall fracture (PLWF) is thought to be a major cause of femoral medialisation and reoperation. Though trochanter stabilising plate (TSP) had been reported to have a good effect in preventing femoral medialization, its effects and indication in A2 fractures remain controversial. We hypothesized that TSP may improve treatment outcomes in patients with high risk of postoperative lateral femoral wall fractures. The purpose of this study was to investigate (1) the main risk factors predictive of PLWF in A2 fractures and, (2) whether TSP can improve treatment outcomes in patients with high risk of PLWF. ⋯ Lateral wall thickness is the main risk factor for PLWF in A2 fractures treated with DHS. Use of TSP in A2 fractures with critical thin lateral wall thickness <2.24 cm can significantly decrease the lag screw sliding distances, PLWF rate and reoperation rate.
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We present a case of a patient with thyroid storm exhibiting symptoms similar to those of traumatic injury. This patient presented multiple traumatic wounds on his limbs and face, loss of consciousness, and tachycardia. Diagnosis was initially confounded by the similarity between the symptoms of traumatic hypovolemic shock and trauma-induced thyroid storm. This case report discusses the factors leading to the diagnostic delay and highlights the dangerous manifestations of thyroid storm.
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Observational Study
Basal haemoglobin levels as prognostic factor for early death in elderly patients with a hip fracture - A twenty year observation study.
Hip fractures are a significant cause of mortality and morbidity in the elderly. This study investigated the relationship between initial haemoglobin (Hb) levels and a prognostic parameter for outcome in those patients. ⋯ Those findings in our study population with 3595 patients over a period of twenty years have proven that initial Hb levels are a useful and cost effective parameter to predict mortality in elderly patients with a hip fracture. This prognostic factor may help to increase the outcome of elderly patients with a hip fracture.
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Percutaneous fixation of pelvic and acetabular fractures are technically demanding procedures, and high rates of screw misplacement and potential neurovascular complications have been reported. One hundred and sixty two screws from a prospectively collected database were analysed to evaluate the accuracy of a fluoroscopically assisted computer navigated technique to insert a cannulated screw to treat pelvic and acetabular fractures. Actual screw position and trajectory with the intraoperative surgical plan stored in the navigation computer. ⋯ Post operative CT analysis of patients showed 10 screws perforated cortical bone. Our results show that the use of computer navigation can aid in the accurate placement of percutaneous screws along a predefined plan. It is still possible to incorrectly place a screw and great care needs to be taken with the surgical plan and also to understand the complex anatomy of the bony pelvis.
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Difficult removal of locking plates including less invasive stabilisation systems (LISSs) and locking compression plates (LCPs) sometimes occur. However, investigations of the mechanisms and correlated factors of complicated removal remain scant. This study aims to identify correlated factors for the difficult removal of locking plates and to propose suggestions for decision making regarding implant removal and the prevention of complicated removal. ⋯ Complications occur with LCP/LISS removal, and it should not be a routine procedure. If removal is indicated, performing surgery as soon as radiographs show fracture healing is recommended. Different considerations should apply when making decisions and removing implants from patients with different fracture sites.