Injury
-
Ongoing controversy exists over the indications and benefits of posterior malleolar fixation in ankle fractures. The aim of this pragmatic study was to evaluate the outcomes of posterior malleolar fracture fixation in ankle fractures in the setting of a major trauma centre. Our hypothesis is that posterior malleolus fixation leads to improved clinical outcomes. ⋯ This study demonstrates that in the practical setting of a major trauma unit, fixation of the posterior malleolar fracture leads to improved patient outcomes but with increased metalwork risks and reoperation rates.
-
Falling studies, i.e. assessing what happens when an individual falls, have been conducted in controlled environments but not in field studies for ethical reasons; this potentially limits the validity and applicability of previous studies. We performed field studies on existing YouTube © videos of skateboarders falling. The aims of these studies were to measure the wrist angle at impact on videos of real unprotected falls and to study the dynamics of the upper limbs when falling. ⋯ These studies confirm wrist extension at impact around 800 but the wrist(s) may hyper-extend risking toppling. Falls on both wrists minimise the risk of toppling. The "upper limb falling reflex" is defined; it is a rapid dynamic response leading to the fingers impacting the ground first on falling. Abnormalities with the upper limb falling reflex may indicate problems with development in young children and may increase the risk of injury in older people.
-
Low profile fragment specific plate fixation of lateral tibial plateau fractures - A technical note.
Precontoured plates used to stabilize lateral tibial plateau (LTP) fractures are limited in their ability to raft particular areas of the reconstructed articular surface. These implants also do not fit every individual's bony anatomy and can lead to soft tissue irritation. The purpose of this study was to evaluate fragment specific plate fixation of LTP fractures using generic small and mini fragment constructs. ⋯ Fragment specific fixation of LTP fractures using small and mini fragment plates creates a lower profile construct that reliably maintains fracture reduction to union.
-
This investigation aims to report on single and multiple unintentional nonfatal injuries among in-school adolescents in Liberia. ⋯ A high prevalence of unintentional single and multiple injuries was discovered and several factors were found that can be utilized in targeting programmes aimed at injury prevention among adolescents.
-
Cost-effectiveness is an essential tool for identifying high-value interventions in resource-limited settings. This study aims to evaluate the cost-effectiveness of the surgical management of fractures by surgical residents at Kamuzu Central Hospital (KCH). Currently, the 5-year surgical training program is supported by the Malawi Ministry of Health, and two universities in the United States and Norway. ⋯ The KCH surgical training program is highly cost-effective at reducing disability at an incremental cost of $215 per averted DALY. This CEA demonstrates that the current surgical training program is cost-effective in reducing morbidity among individuals with fractures.