Injury
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Early mortality following hip fracture surgery remains a significant issue with a much studied, multifactorial aetiology. This study designed to test the variables affecting 30 day mortality in a socially deprived cohort against national models, and secondarily aimed to uncover and quantify new risk factors. ⋯ This study has confirmed the NHFD casemix adjusted model is a fair barometer for units treating a socially deprived cohort. It also has shown a clear differentiation between risk conveyed by delay to theatre for clinical reasons and suggests delay for non-clinical reasons, although clearly not desired, may not have a significant effect on death rate. Finally, it both amplifies and prompts further investigation into the potential benefit of early mobilisation.
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There is a paucity of research addressing the morbidity and mortality associated with polytrauma in elderly patients. This study aimed to compare the outcomes of elderly trauma patients with an isolated lower extremity fracture, to patients lower extremity fractures and associated musculoskeletal injuries. ⋯ Patients who sustained MLE and ULE fractures, had increased mortality, complications and in hospital care requirements as compared to patients with isolated lower extremity injuries. These outcomes are comparable between ULE and MLE fracture patients over the age of 80 however patients 65-80 with ULE fractures had increased mortality as compared patients 65-80 with MLE fractures. Understanding the unique considerations and requirements of elderly trauma patients is vital to providing successful outcomes.
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Randomized Controlled Trial
Regional anaesthesia on the finger: Traditional dorsal digital nerve block versus subcutaneous volar nerve block, a randomized controlled trial.
To identify the most comfortable digital nerve block by comparing painfulness and efficiency of two commonly used digital nerve blocks: the volar subcutaneous nerve block and the traditional dorsal nerve block. ⋯ In patients requiring digital anaesthesia in the Emergency Department, the anaesthetic technique affects both the discomfort of the injection and extent of anaesthesia. The traditional dorsal digital nerve block is preferred for dorsal injuries. The subcutaneous volar nerve block is preferred for volar injuries.
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Closed intramedullary (IM) nailing among various modalities is one of the commonest sought out procedure in current practice for management of femoral-diaphyseal fractures (FDF) following trauma. However, it has some limitations like prolonged procedural duration, high radiation exposure and a steep learning curve. Therefore, with limited resources in odd hours and at a high patient turnover center where closed reduction can be a challenge, we adopted a modified mini-open technique which can overcome the limitations of closed reduction technique. ⋯ In conclusion, mini-open technique is a safer alternative in patients with FDF at high-volume centers and in odd-hours when the available resources are limited.