Injury
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The classification of a Lisfranc injury has conventionally been based around Myerson's system. The aims of this study were to review whether a novel classification system based on sagittal displacement of the tarsometatarsal joint and breadth of injury as determined by a columnar theory was associated with functional outcomes and thus had a greater utility. ⋯ Column involvement and not sagittal displacement is the most significant factor in considering the severity Lisfranc injury and long term functional outcomes. This classification system has greater clinical utility than those currently proposed.
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Comparative Study
Comparing hospital outcomes between open and closed tibia fractures treated with intramedullary fixation.
Tibial shaft fractures comprise a large portion of operatively treated long bone fractures, and present with the highest rate of open injuries. Intramedullary fixation has become the standard of care for both open and closed injuries. The rates of short term complications and hospital length of stay for open and closed fractures treated with intramedullary fixation is not fully known. Previous series on tibia fractures were performed at high volume centers, and data were not generalizable, further they did not report on length of stay and the impact of preoperative variables on infections, complications and reoperation. We used a large surgical database to compare these outcomes while adjusting for preoperative risk factors. ⋯ When considering the complication rates for open and closed tibial shaft fractures treated with intramedullary fixation, there is no difference between 30-day complication rate, length of stay, or return to the operating room. Our reported postoperative infection rates were comparable to previous series, adding validity to our results. The heterogeneity of the hospitals included in ACS-NSQIP database allow our data to be generalizable. These methods may underrepresent the true occurrence of infection as operatively treated tibia infections may present late, requiring late revision. Despite limitations, the data reflect on the current burden of managing these once devastating injuries.
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To assess the surgical technique and report the outcomes following fixation of PCL bony avulsions through mini-invasive posterior knee approach as described by Burks and Schaffer. ⋯ The approach was fast and safe with excellent visualization. It allows surgeons to address other injuries in the same setting. It can be considered as a minimally-invasive open surgery without surgery-related morbidity. It is a reproducible technique that can be done at any trauma centre by surgeons with average experience. The subjective and objective results of the technique are excellent and comparable to the arthroscopic procedures that needs more specific centres with well-trained surgeons.
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Extremity injuries predominate in warfare, however their nature, and overall burden to the individual and the health service is yet to be characterised for the UK military in the recent conflicts of Iraq and Afghanistan. ⋯ Utilising a dedicated injury database, this study illustrates for the first time in the United Kingdom military population, that the extremities are involved in the vast majority of combat injuries and the large surgical workload required for their treatment.
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To predict spinal canal compromise, the assessment of plain radiography with magnetic resonance imaging (MRI) can aid the detection of vertebral body collapse and prevent the development of neurological deficits. ⋯ In patients with simple compression fractures, attention should be paid to the posterior vertebral body and both endplates as well as the T1-weighted MRI findings to allow early detection of spinal canal compromise, which can have devastating consequences.