Injury
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The aim of this study was to evaluate the clinical and radiological results of adult forearm fractures treated with interlocking intramedullary nailing. ⋯ Intramedullary interlocking nailing with a compression screw is an alternative method of fixation for treating adult forearm fractures and provides good clinical outcomes with reliable union rates.
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Aim To review the indications, complications and outcomes of extracorporeal membrane oxygenation (ECMO) in major trauma patients. Methods Single centre, retrospective, cohort study. Results Over a ten year period, from 13,420 major trauma patients, 11 were identified from our institutional trauma registry as having received ECMO. ⋯ Overall survival to discharge was 45%, and was higher with VV ECMO (64%), than other configurations (25%). Conclusion ECMO was rarely used in major trauma, the most common indication being severe hypoxaemic respiratory failure secondary to lung injury. In this severely injured cohort, overall survival was poor but better in VV compared to VA and better if initiated early (<72 hours), compared to late.
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Meta Analysis
Operative versus non-operative management of blunt pancreatic trauma in children: Systematic review and meta-analysis.
Blunt abdominal trauma is the major cause of abdominal injury in children. No clear guidelines exist for the initial management of blunt pancreatic trauma in children. The aim of this study was to perform a systematic review and meta-analysis of initially non-operative versus initially operative treatment in children with blunt pancreatic injury. ⋯ Most patients with pancreatic trauma can initially be treated non-operatively, while early surgical treatment may benefit patients with lesions of the main pancreatic duct. ERCP offers both highly accurate diagnosis and potential treatment of ductal injuries.
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Typically, a healthcare intervention is evaluated by comparing data before and after its implementation using statistical tests. Comparing group means can miss underlying trends and lead to erroneous conclusions. Segmented linear regression can be used to reveal secular trends but is susceptible to outliers. We described a novel method using segmented robust regression techniques to evaluate the effect of introducing a dedicated hip fracture unit (HFU). ⋯ Robust regression is a useful adjunct to ordinary segmented linear regression techniques in modelling retrospective time-series and dealing with outliers. The changes observed in hip fracture patient outcomes over a 6-year period was likely multifactorial.
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Application of supraacetabular Schanz screws is usually performed under image intensifier guidance. The aim of this study was to perform it without imaging, with the hypothesis that, respecting anatomical landmarks, pre- and intraoperative fluoroscopy can be avoided. ⋯ According to the described anatomical data, we defined a 2-2-2-20-20 concept, starting with a 2 cm skin incision 2 cm distal and 2 cm medial to the ASIS with a drill angulation of 20° inferior and 20° lateral orientation. Using this technique, all Schanz screws could be sufficiently inserted without intraprocedural x-ray imaging.