Injury
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The aim of this study was to investigate the use of opioids among hip fracture patients, and the potential relation between perioperative prescription of opioids, mortality and chronic opioid use. The purpose of this study was to investigate the use of opioids among hip fracture patients postoperatively and 90- and 180 days after discharge. The study also analysed predictors of early death at 30-, 90 and 365 days after discharge. ⋯ The results of our study indicate no general reason to refrain from prescribing opioids to hip fracture patients based on a fear of potential abuse or increased mortality.
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Treatment of a transverse acetabular fracture type is possible from an anterior approach, a posterior approach or both. Different fixation methods have been described but whether one is superior to the other is still under debate. The aim of the current study was to test the different fixation alternatives of stabilization of transverse acetabular fractures under two basic physiological loading conditions: standing and sitting utilizing a finite element model. ⋯ Posterior column plating combined with an anterior column screw has quite comparable results to a both column plating in transverse fractures, suggesting that two column fixations might be unnecessary. This method is also very superior to anterior column plating combined with a posterior column screw in that type of fractures.
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We present two cases of occult internal iliac arterial injury identified during operative reduction of a widely displaced posterior column posterior wall acetabular fracture. This complication was not recognised until reduction of the column fracture. ⋯ We also present management options when this complication occurs. We believe any surgeon treating acetabular fractures should be aware of this serious and potentially fatal complication.
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Hyponatraemia is common in hospitalised patients. In recent years the relationship between hyponatraemia and bone metabolism, falls and fractures has become more established. This study evaluates the prevalence of hyponatraemia (plasma sodium<135mmol/l) in 3897 patients undergoing operative treatment for hip fracture and the relationship between hyponatraemia and mortality in these patients. ⋯ Hyponatraemia is common in elderly patients with hip fractures both at initial presentation and during admission. In this vulnerable patient group, hyponatraemia may delay time to definitive surgery and is a potentially reversible cause of increased post-operative mortality. Every effort should be made to identify and correct hyponatraemia in hip fracture patients.
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The architecture of joints has potentially the greatest influence on the nature of intra-articular fractures. We analysed a large number of intra-articular fractures with two aims: (1) to determine if the pattern of injuries observed supports our conjecture that the local skeletal architecture is an important factor and (2) to investigate whether associated dislocations further affect the fracture pattern. ⋯ These results very strongly support the study hypotheses: the skeletal architecture of joints clearly plays a highly significant role in determining the nature of intra-articular fractures. Intra-articular fractures involving the convexity are much more likely to be associated with a concurrent joint dislocation.