Injury
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Proximal humeral fractures with a spiral line of fracture extending from the humeral head to the diaphyseal region are increasing. Treatment for these fractures is comparable to that for shaft fractures. The purpose of this study was to evaluate the use of a new "Long" humeral nail for this type of lesion and identify the best distal locking. ⋯ IV.
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Cortical impingement is a common complication after cephalomedullary nailing, but the evidence about its consequences is very limited. The aim of this study was to assess the clinical implications of cortical impingement on patients treated with cephalomedullary nails. ⋯ Cortical impingement of the anterior cortex of the femur was not associated with the presence of pain, so that other causes should be assessed to explain the pain after 6 months of being treated with a cephalomedullary nail. Femoral fractures, and delayed union or nonunion of the fracture may occur theoretically in patients with cortical impingement.
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Fractures of the medial third of the clavicle comprise less than 3% of all clavicle fractures. The natural history and optimal management of these rare injuries are unknown. The aim of our study is to describe the demographics, management and outcomes of patients with medial clavicle fractures treated at a Level 1 Trauma Centre. ⋯ Sixty eight patients with medial clavicle fractures were identified over a 5year period, with excellent functional results seen following conservative management.
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The gold standard for fractures of the acetabulum is to perform an open reduction and internal fixation in order to achieve anatomical reduction. In a well-defined subset of patients, percutaneous techniques may be employed but achieving reduction by closed means can be challenging especially for fractures with large degrees of displacement. ⋯ The young obese patient refused all forms of blood products transfusion and presented with a displaced transverse posterior wall fracture. While we do not recommend routine use of such technique and recognize its numerous limitations, we present it as an alternative strategy in a small subset of patients.
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Hip fractures are common in the elderly and have a high risk of early mortality. Identification of patients at high risk of early mortality could contribute to enhanced quality of care. A simple scoring system is essential for preoperative identification of patients at high risk of early mortality in clinical practice. Of risk models published, The Nottingham Hip Fracture Score (NHFS) shows the most promising results so far. However, there is still room for improvement. ⋯ The AHFS can identify frail elderly at high risk of early mortality following hip fracture surgery accurately. With the AHFS, the patient can be classified into the low, medium or high risk group, which contributes to enhanced quality of care in clinical practice.