Injury
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Meta Analysis
Routine pelvic X-rays in asymptomatic hemodynamically stable blunt trauma patients: A meta-analysis.
There is no consensus on how pelvic X-rays should be ordered selectively in blunt trauma patients which may save time, reduce radiation exposure and costs. The aim of this systematic review and meta-analysis was to assess the need for routine pelvic X-rays in awake, respiratory and hemodynamically (HD) stable blunt trauma patients without signs of pelvic fracture. Criteria to identify patients who could safely forgo pelvic X-ray were evaluated. ⋯ In awake, hemodynamically and respiratory stable blunt trauma patients, PE could identify those patients who could safely forgo pelvic X-ray. Selective ordering of pelvic X-ray may lead to a decrease in patient work-up time, lower radiation exposure, and reduce costs. A decision making flow chart is proposed..
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Mass casualty incidents impose a large burden on the emergency medical systems, hospitals and community infrastructures. The pre-hospital and hospital capacities are usually bear the burden of casualties large numbers. One of the challenging issues in mass casualty incidents is the distribution of casualties among the suitable health care facilities. ⋯ This review was registered in international prospective register of systematic reviews (PROSPERO) with registration number CRD42016049115.
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Multicenter Study
Periprosthetic acetabular fractures: A New classification proposal.
Acetabulum periprosthetic fractures are rare, but are increasing, due to increase in high-energy trauma and a decrease in mortality index. Reconstruction of an acetabular fracture, in the presence of hip arthroplasty can be very complex and represents a real challenge for orthopedic surgeon. Aim of this multicentric study is to classify periprosthetic acetabulum fractures and to propose a treatment algorithm. ⋯ Fracture classification systems must facilitate communication between surgeons and encourage documentation and research. However, they should also have prognostic value, so from them should come directly a treatment algorithm. In our experience, most important factors as prognostic and therapeutic predictors were: implant stability and timing of fracture: intraoperative or postoperative. In postoperative fractures CT is mandatory to evaluate cup mobilization and fracture patterns. Our classification proposal is simple and easy to remember for daily use. From it is derived a simple treatment plan.
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Periprosthetic fractures are increasing. The treatment is mostly surgical, but it has a high complication rate. Re-fracture and non-union with implant failure are the more frequent complications. Those complications are difficult to treat and can lead to severe disability. The purpose of this study is to determine the clinical results of periprosthetic femoral re-fracture treatment. ⋯ Re-fractures and non-union with implant failure are common after periprosthetic fracture treatment. Infection and malunion are the main complications of their treatment. Residual limping with the necessity of aids even after fracture healing is often present. The choice of a correct surgical strategy is essential to minimize the risk of new complications and ensure the highest possibility to heal. The most important factor is to achieve a good stability, a reasonable vital environment and don't leave new areas of lower resistance uncovered. Poor functional outcome has to be expected especially in refracture after a revision surgery.
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To determine whether there is a correlation between the length of forearm to the distal interphalangeal joint (DIPJ) of the little finger and length of antegrade intramedullary (IM) femoral nails in adults. ⋯ Length of the forearm from the tip of the olecranon to the DIP joint of the little finger represents the ideal length of IM nail for the femur. It can be readily performed with the use of a tape measure and can serve as a useful adjunct to determining ideal length in cases where the contralateral femur cannot be used.