Injury
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The centralisation of care for trauma patients in trauma centres, alongside the creation of inclusive trauma networks, has proven to reduce mortality. In Europe, such structured trauma programs and trauma networks are in development. ⋯ The standardised mortality ratio declined over a period of 8 years, even though the SMR increased nonsignificantly in the lowest risk-adjusted mortality group. Future analysis of this subgroup could clarify whether this trend is due to an increase of limitation of care directives and if these deaths could have been prevented with improved trauma care. There might be opportunities to increase the survival of patients with severe TBI who have a non-TBI cause of death.
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Current literature offers scant insights into Schatzker IV tibial plateau fractures (TPFs) that affect the posterolateral (PL) column. This study seeks to elucidate the prevalence of meniscal and ligamentous injuries in the knee, as well as the clinical outcomes, in Schatzker IV TPF cases, both with and without PL column involvement. ⋯ This investigation reveals that Schatzker IV TPFs involving the PL column are highly associated with increased rates of LM and ACL injuries. Additionally, these fractures correlate with a greater likelihood of knee subluxation and meniscus entrapment, ultimately leading to poorer prognostic outcomes.
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Hip fractures have a high patient burden and mortality rate, particularly following revision surgery. Cement augmentation of cephalomedullary nails has been shown to lower the risk of cut-out, aiming to reduce the need and expense of revision surgeries. The aim of this study was to assess the economic impact of cement augmentation for the fixation of trochanteric hip fractures in fragile, elderly patients, across a range of European countries (UK, Spain, Italy, Germany, and France), from both a provider (hospital) and a payer perspective. ⋯ These models support the wider adoption of cement augmentation to reduce the healthcare system costs associated with length of stay and revision surgery. These results provide useful information to providers, payers, and policymakers to ultimately influence choice surrounding the 'gold-standard' treatment of an unstable trochanteric fracture following low energy trauma.
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Paediatric tibial shaft fractures are commonly treated nonoperatively and followed-up in the clinic setting. Loss of position has traditionally been managed with wedging of the cast or admission and manipulation in the operaing theatre. The authors present a technique to aid in the wedging of plasters for paediatric tibia and forearm fractures that reduces time requirement, hospital costs and emotional distress on the part of the patient and family.
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Retropubic hematomas are a common development in cases of pelvic ring trauma and post- operative repair of fractures to the anterior column of the pelvis. Early detection and diagnosis of such events using computed tomography angiography (CTA) are critical for successful intervention and patient recovery, especially when bleeding is a result of injury to the corona mortis (CM). The CM is the communication between the obturator vessels and the external iliac vessels typically via an accessory obturator vessel. This communication of vessels is identified as a major hindrance in anterior approaches to the pelvis. ⋯ The inconsistencies presented in angiogram studies compared to cadaver studies suggest that angiograms should be limited to a diagnostic and therapeutic role of identifying the CM or injury thereof in the retropubic region. However, measurements concerning safe zones should rather be extracted from cadaveric studies.