Injury
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P values were frequently misused and misinterpreted, the fragility index (FI) has been utilized to evaluate the robustness of randomized controlled trials (RCTs) as a complement to p-values. This study aimed to assess the statistical robustness of RCTs for femoral neck fractures through the utilization of the FI. ⋯ The RCTs pertaining to femoral neck fractures were not as statistically robust as previously thought and should be interpreted with caution. We recommend that the orthopaedic RCT report FI as a supplement for the P values to help readers draw reliable conclusions based on the fragility of the outcomes.
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China has the highest number of road injury deaths in the world. The aim of this study was to determine the long-term incidence and mortality trends of road injuries in China between 1990 and 2019 and to make projections up to 2030. ⋯ The incidence of road injuries in China has increased overall, while the overall mortality rate has decreased over the past 30 years, and this trend is expected to continue in the future. Effective effort is needed to improve road safety, especially for elderly individuals and female cyclists. In addition, pedestrian road safety also needs to be improved.
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Electronic fracture databases were queried for 'tibial plateau fracture' and 'Ilizarov frame' between July 2009 and 2019. Inclusion criteria; age >60 years; CT identified multiple column (Schatzker V or VI) injuries; Ilizarov fixation; adequate follow-up data. Patient demographics, fixation technique, time to frame removal, residual radiological tibial deformity, joint incongruity, significant peri‑operative complications and progression to salvage TKA were reported. ⋯ 35 patients >60 years were treated with Ilizarov frame techniques for multiple column injuries. 84 % were female. Average age was 68 (62-81) with a follow-up of 6.6 years (2.3-11.3). 33 of the 35 patients investigated for osteoporosis had evidence of decreased bone mass (94 %). 94 % were Schatzker VI injuries. 22 cases required cross knee extension with a frame duration 155 days (range 103-317). Those without had a frame duration 128 days (range 93-212). 20 cases had a combined internal/external fixation technique and 9 cases required allograft or bone substitute. There was one case of non-union requiring salvage to constrained TKA. Three cases (9 %) of metalwork removal, two for prominent metalwork and one for deep infection. There were no VTE events and there was 0 % mortality in the two post-operative years. Oxford knee scores and SF-12 scores demonstrate that minimal residual deformities in the coronal and sagittal planes following frame removal are tolerated well within this age group. This study demonstrates Ilizarov techniques are highly successful at permitting early weight bearing and achieving union with associated low morbidity rates in an older population.
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This paper provides an overview of a single centre's experience with rectal injury over a decade. It hopes to use this data to provide context to our current approach to managing these injuries in the civilian setting. ⋯ Rectal trauma is still associated with a high rate of rectal/urogenital and infection related morbidity. Although pre-sacral drainage and distal stump washout have been largely abandoned in civilian practice, faecal diversion currently remains the cornerstone of the management of rectal trauma in our environment. Although there was a low rate of intra-abdominal septic complications in patients who had undergone diversion, this needs to be balanced against the low rate of stoma reversal.
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The new EU Medical Device Regulation (MDR) was introduced in 2017 to increase the safety and quality of medical devices in the European Union. Theoretically, several hundred thousand medical devices must be approved under the new MDR guidelines, although the majority of these products have been and will be in daily use in countless operations on the European market for decades. The expected expenditure of time and money until the MDR is fully implemented is associated with high costs, patient disadvantages but also manufacturer problems. The following briefly summarizes the current situation in many European countries and presents the consequences for patients and hospitals and in this context also emphasizes the interdependence between hospitals, patients and manufacturers.