Injury
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The complication rate after locking plate fixation of proximal humerus fractures is high. In addition to low bone mineral density, a lack of medial support has been identified as one of the most important factors accounting for mechanical instability. As a result of the high failure rate, different strategies have been developed to enhance the mechanical stability of locking plate fixation of proximal humerus fractures. The aim of the present article is to give an overview of the current biomechanical and clinical studies that focus on how to increase the stability of locking plate fixation of proximal humerus fractures. ⋯ Further clinical studies with a higher number of patients and a higher level of evidence are required to develop a standardised treatment algorithm with regard to cement augmentation and bone grafting. Although these measures are likely to have a stabilising effect on locking plate fixation, its general use cannot be fully recommended yet.
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Functional status can be affected for considerable time after injury. Individual's functional status trajectories, or pathways, following injury may provide insights into achieving, or not achieving, optimal functional status. This study aims to (1) investigate functional status trajectories of injured individuals over two years by multiple dimensions and, (2) determine whether there are differences in functional status trajectories between those hospitalised and non-hospitalised. ⋯ Cross-sectional group-level prevalence does not adequately depict the underlying pathways experienced by individual participants. Our analyses indicate the importance of following up all study participants in longitudinal studies, including those reporting to have attained 'recovery' and of not under-estimating the impact of non-hospitalised injuries.
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To evaluate the efficacy and safety of single-stage posterior debridement, compact bone grafting and posterior single-segment fixation for the treatment of mono-segmental lumbar tuberculosis. ⋯ Single-stage posterior debridement, compact bone grafting and posterior single-segment fixation is an effective method for the treatment of mono-segmental lumbar tuberculosis.
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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.