Injury
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Observational Study
Tree-based algorithm for prehospital triage of polytrauma patients.
There is a need for better allocation of medical resources in polytrauma, by optimizing both the over and undertriage rates. The goal of this study is to provide a new working definition for polytrauma based on the prediction of the need for specialized trauma care. ⋯ Our tree-based decision algorithm is a user-friendly and reliable alternative to the preexisting scores, which offers good performance to predict the need for specialized trauma care.
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Comparative Study
Optimizing compression: Comparing eccentric plate holes and external tensioning devices.
Elimination of interfragmentary motion in fracture fixation using plates to impart compression and promote primary bone healing through absolute stability has been well described as a reliable and successful method to treat simple transverse and short oblique fracture morphologies. Our hypothesis is that dynamic compression plating augmented by external compression techniques would produce and maintain a significantly greater amount of compression than using the plate alone. ⋯ Plate compression is a reliable method for inducing compression across transverse and short oblique fractures. Augmenting plate compression technique with external compression techniques (Verbrugge clamp or ATD) allows for a significantly greater compressive load to be achieved. Compression lost after removal of the external compression device indicates that the maximal compression attainable across a fracture may not be reliably maintained with standard dynamic compression plating techniques.
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Observational Study
Early surgery within 2 days for hip fracture is not reliable as healthcare quality indicator.
To analyze prospectively the influence of the timing of surgery on morbidity and mortality, and to assess whether the early surgery within 2 days admission may be a reliably healthcare quality indicator. ⋯ Delaying surgery up to 4 days was not associated with higher morbidity or mortality rates. We recommend concentrating more on preoperative optimizing the condition of patient with sufficient medical treatment rather than being bound by a universal timing of surgery.
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The treatment of isolated lateral malleolar fractures with deltoid ligament rupture remains controversial. We prospectively analysed 35 patients with isolated lateral malleolar fractures during 2006-2013. Radiography and magnetic resonance imaging (MRI) were performed to assess the degree of reduction, ligament damage, and stability. ⋯ Postoperative medial clear space measurements were not significantly different between groups. MRI was shown to be a useful tool in the preoperative identification of isolated lateral malleolus fractures prone to valgus instability. In the case of high-grade unstable fractures of the lateral malleolus, repair of the anterior deltoid ligament is adequate for restoring medial stability.
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Extreme sports (ESs) are increasingly popular, and accidents due to ESs sometimes require helicopter emergency medical services (HEMSs). Little is known about their epidemiology, severity, specific injuries and required rescue operations. ⋯ High-risk ESs led to high-energy accidents, characterized by a large proportion of severe injuries and axial traumas (spine, thorax, pelvis and proximal femur). We identified a considerable percentage of thoracolumbar vertebral fractures, mainly in the T12-L2 junction. HEMSs dedicated to high-risk ESs implied longer and more complex interventions.