Injury
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Bone fractures fail to heal and form nonunions in roughly 5% of cases, with little expectation of spontaneous healing thereafter. We present a systematic review and meta-analysis of published papers that describe nonunions treated with low-intensity pulsed ultrasound (LIPUS). ⋯ LIPUS treatment can be an alternative to surgery for established nonunions. Given that no spontaneous healing of established nonunions is expected, and that it is challenging to test the efficacy of LIPUS for nonunion by randomized clinical trial, findings are compelling. LIPUS may be most useful in patients for whom surgery is high risk, including elderly patients at risk of delirium, or patients with dementia, extreme hypertension, extensive soft-tissue trauma, mechanical ventilation, metabolic acidosis, multiple organ failure, or coma. With an overall average success rate for LIPUS >80% this is comparable to the success of surgical treatment of non-infected nonunions.
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Review Multicenter Study
Injury factors associated with discharge status from emergency room at two major trauma hospitals in The Gambia, Africa.
Injuries are the leading cause of disability across all ages and gender. In this study, we identified predictors of discharge status and disability at discharge among patients who seek emergency room treatment. ⋯ Epidemiology of injuries in The Gambia is similar to other low-income countries. However, the magnitude of cases and issues uncovered highlights the need for a formal registry.
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The changing demographics of Achilles tendon rupture (ATR) patients have not fully been investigated. However, there has been a general suspicion that this injury is occurring in an increasingly older population, in terms of mean age. The aim of this study was to objectively show an increase in age in Achilles tendon rupture patients over time. ⋯ Level III; Retrospective cohort study.
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Review
Population incidence of pedestrian traffic injury in high-income countries: A systematic review.
Road traffic injuries are the fifth leading cause of years of life lost, with pedestrians comprising 39% of all road deaths. International recognition of this public health issue has led to a reduction in road traffic deaths in many high-income countries. However data on non-motorised road users such as pedestrians is incomplete. Additionally, non-fatal injuries are poorly documented. The aim of this study was to identify the incidence of pedestrian traffic injury reported from high-income countries. ⋯ This review concluded a high burden of pedestrian trauma in HICs with individual reports reporting from rates of 20 to 203 per 100,000 population. Recommended interventions directed at reducing the burden of pedestrian trauma were not universally present in the reported high-income countries. Implementation of such safety strategies and demonstration of improvement in pedestrian trauma rates and outcomes present directions for further research.
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Randomized Controlled Trial Multicenter Study Comparative Study
Posterior versus lateral approach for hemiarthroplasty after femoral neck fracture: Early complications in a prospective cohort of 583 patients.
To compare early complications after the posterior and the direct lateral (transgluteal) approach, when using hemiarthroplasty in the treatment of displaced femoral neck fractures in the elderly. ⋯ There was an 8-fold increased risk for prosthetic dislocations after the posterior approach compared to lateral approach. There was a high risk for recurrent prosthetic dislocations and a subsequent risk for further surgeries and a poor end result. The potential advantages of the posterior approach have not been demonstrated after femoral neck fractures and we advise against its continued use.