Injury
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In Denmark, guidelines from the Danish Orthopedic Society recommend that patients older than 65 years who sustain a Colles' fracture should be referred to assessment of underlying osteoporosis. An assessment of referral rates at our hospital during the period October 2010-September 2013 showed that none were referred. Due to this, an automatic out-patient referral system for assessment of underlying osteoporosis was established. With this system, patients are referred directly from the Emergency Department (ED). The purpose of this study was to assess how effective this new referral system was at improving referral rates for assessment of osteoporosis and to evaluate how many more cases of osteoporosis that was identified with this practice during the period October 2013-September 2014. ⋯ The results show that this type of automatic referral system can be an effective way of increasing the number of patients diagnosed with and treated for osteoporosis. It also shows that involvement of the ED in the screening for osteoporosis can be an effective way of increasing referral rates leading to higher rates of diagnosed osteoporosis. The early identification and initiating of treatment might result in a lower rate of secondary and potentially more severe osteoporotic fractures.
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Bone defects can be congenital or acquired resulting from trauma, infection, neoplasm and failed arthroplasty. The osseous reconstruction of these defects is challenging. Unfortunately, none of the current techniques for the repair of bone defects has proven to be fully satisfactory. ⋯ However, current techniques of BTE is laborious and have their own shortcomings. More recently, 2D and 3D bone printing has been introduced to overcome most of the limitations of bone grafts and BTE. So far, results are extremely promising, setting new frontiers in the management of bone defects.
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Comparative Study
High revision rate but good healing capacity of atypical femoral fractures. A comparison with common shaft fractures.
Healing of complete, atypical femoral fractures is thought to be impaired, but the evidence is weak and appears to be based on the delayed healing observed in patients with incomplete atypical fractures. Time until fracture healing is difficult to assess, therefore we compared the reoperation rates between women with complete atypical femoral fractures and common femoral shaft fractures. ⋯ Reoperation rates in patients with complete atypical femoral fractures are higher than in patients with common shaft fractures. The main reason for failure was peri-implant fragility fractures which might be prevented with the use of cephalomedullary nails at the index surgery. Fracture healing however, seems generally good. A watchful waiting approach is advocated in patients with fractures that appear to heal slowly.
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Meta Analysis
Meta-analysis of the effect of tertiary survey on missed injury rate in trauma patients.
Missed injuries are considered as an important issue in trauma patients and can lead to significant morbidity and even mortality. It has been shown that the standard primary and secondary surveys, recommended by the Advanced Trauma Life Support (ATLS) guidelines, are associated with missed injuries. It has been suggested that tertiary survey can minimise the number and effect of missed injuries. The present paper aimed to identify comparative evidence about the effect of tertiary survey on missed injury rate in trauma patients. ⋯ The best available evidence demonstrates a constant trend in favour of tertiary survey in terms of missed injury reduction, and supports its use in management of trauma patients. Further studies are required to clarify the most cost-effective and systematic way of addressing missed injuries in the first 24h. We recommend use of "missed injury detection rate" and "missed injury rate" as two different outcomes in future studies in order to address the issue of heterogeneity in definition of missed injury in the current literature.