Injury
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While comorbidities and types of road users are known to influence survival in people hospitalised with injury, few studies have examined the association between comorbidities and survival in people injured in road traffic crashes. Further, few studies have examined outcomes across different types of road users with different types of pre-existing comorbidities. This study aims to examine differences in survival within 30 days of admission among different road user types with and without different pre-existing comorbidities. ⋯ This study highlights the need to prioritize enhanced management of trauma patients with comorbidities, given the increasing prevalence of chronic medical conditions globally, together with actions to prevent pedestrian crashes in strategies to reach Vision Zero.
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Children represent a significant portion of the patient population treated at combat support hospitals. There is significant data regarding post injury seizures in adults but with children it is lacking. We seek to describe the incidence of post-traumatic seizures within this population. ⋯ Within our dataset, we found an incidence of 1% of pediatric casualties experiencing a post-traumatic seizure. While this number appears infrequent, there is likely significant under detection of subclinical seizures.
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We herein report on a series of 21 patients with traumatic patellar osteomyelitis treated by single-stage surgery, and discuss the specific application of single-stage procedures for traumatic patellar osteomyelitis. ⋯ Single-stage wound treatment was successful in 20 of 21 patients. Treatments included radical debridement together with tissue flap for repair of soft tissue and extensor mechanism defects, and internal refixation of patellar fractures. 14 patients were treated with gastrocnemius flaps. One patient developed recurrent wound infection, which healed after reoperation. At a mean follow-up of 8 ± 2.63 years (range, 3.2-11.4 years), none had developed recurrence. Six patients had nearly full knee ROM (0°-105° to 0°-146°), whereas 11 patients had impaired knee mobility (ROM, 0°-90° to 0°-65°), 3 patients had knee joint stiffness with a ROM of 0°, and 1 patient had knee flexion contracture with a ROM of 78°-130° CONCLUSIONS: Single-stage surgical treatment consisting of various surgical techniques was an acceptable treatment for traumatic patellar osteomyelitis, allowing early exercise of the knee joint. The osteomyelitis did not recur, and most patients' knee ROM was restored to a certain extent, excluding patients with severe damage to the patellar articular surface and inactive functional exercise.
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Clostridium difficile is the most common cause of healthcare-associated infectious diarrhea and colitis, and carries the potential for high morbidity, particularly in frail patient populations. The purpose of this study was to utilize a large nationally representative database in order to report 1.) the incidence of CDC in patients with operative lower extremity fractures, 2.) risk factors for the development of CDC, 3.) the association of CDC with length of stay (LOS), readmission, and 30-day mortality rates. ⋯ The incidence of CDC in lower extremity orthopedic trauma patients was 0.71%. An occurrence of CDC was associated with approximately a 2.5 times increase in 30-day mortality, five times the readmission rate, and a longer hospital stay compared to patients without CDC. Mitigating the spread of c. diff through improved antibiotic stewardship and prompt treatment of CDC is paramount to decreasing the burden this infection imposes on orthopedic trauma patients and the healthcare system.
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Temporary spanning fixation aims to provide bony stability whilst allowing access and resuscitation of the traumatised soft-tissue envelope. Conventional monolateral fixators are prone to half-pin morbidity in feet, variation in construct stability and limited weight-bearing potential. This study compares traditional delta-frame monolateral external fixators to ankle spanning circular fixators. ⋯ IV, retrospective cohort study.