Injury
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Displaced paediatric forearm fractures are most often treated by manipulation under anaesthetic, followed by the application of a circumferential Plaster of Paris (POP) splint. Some surgeons choose to split the cast in order to facilitate immediate "spreading" with minimal distress to the patient, should the distal limb become compromised. Usually however, this does not occur, and the cast is completed at a later visit to the plaster room. Time, money and inconvenience could be saved if this modification was not necessary, and the final plaster would be lighter. ⋯ Split POP splints which have not been spread, provide adequate stabilisation and protection of paediatric forearm fractures, and do not routinely require completion.
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Multiple trauma patients frequently suffer eye injuries, especially those patients with head traumas. We evaluated the accuracy of physical findings to determine the priorities of emergency ophthalmologic intervention in these patients. ⋯ Defining specific criteria of ophthalmologic examinations can clarify the necessity of emergency ophthalmologic examination and intervention.
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Challenges exist in how to deliver enhanced care to patients suffering severe injury in geographically remote areas within regionalised trauma networks at night. The physician led Enhanced Care Teams (ECTs) in the West Midlands region of England do not currently utilise helicopters to respond to incidents at night. This study describes this remote trauma workload at night within the regional network in terms of incident location; injury profile and patient care needs and discusses various solutions to the delivery of ECTs to such incidents, including the need for helicopter based platforms. ⋯ There is limited evidence to support the need for night HEMS operations in the West Midlands regional trauma network. The potential role of night HEMS in other regional trauma networks in England requires further evaluation with specific reference to the incidence of Major Trauma and efficiency of existing road based systems.
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Burst fractures of the low lumbar spine constitute approximately one percent of all lumbar fractures. There is still no consensus on the optimal treatment of low lumbar burst factures. We aimed to evaluate the functional and radiographic outcomes of conservative treatment in patients with low lumbar burst fracture. ⋯ Conservative treatment using a custom-moulded thoracolumbosacral orthosis with a thigh extension is a safe and effective method in patients with low lumbar spine burst fractures and can improve functional and radiographic outcomes.
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The aim of the present study was to present the long-term radiographic results with distraction osteogenesis in traumatic or congenital length discrepancies of long bones of the hand. ⋯ A distraction rate of 1mm/day proved to be a safe rate of lengthening in both metacarpals and phalanges.