Injury
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The liver is one of the most injured organs in both blunt and penetrating trauma. The aim of this study was to identify whether the AAST liver injury grade is predictive of need for intervention, risk of complications and mortality in our patient population, and whether this differs between blunt and penetrating-trauma mechanisms. ⋯ AAST grade in isolation is not a good predictor of the need for operation in hepatic trauma. Increasing AAST grade was not found to correlate with increased risk of mortality for both blunt and penetrating hepatic trauma. In both blunt and penetrating trauma, increasing AAST grade is significantly associated with increased bile leak. The need for ERCP and endoscopic sphincterotomy to manage bile leak in our setting is low. Similarly, the rate of rebleeding and of angioembolization was low.
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Observational Study
Disparity in guideline adherence for prehospital care according to patient age in emergency medical service transport for moderate to severe trauma.
The aim of this study was to investigate the association between patient age and guideline adherence for prehospital care in emergency medical services (EMS) for moderate to severe trauma. ⋯ We found disparities in guideline adherence for prehospital care according to patient age at the time of EMS assessment of moderate to severe trauma. Considering this disparity, the prehospital trauma triage and management for older patients needs to be improved and educated to EMS providers.
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Comparative Study
Prevalence of atypical femoral fractures, a clinical update: A comparative retrospective study 7 years later.
Atypical femoral fractures (AFFs) are a rare type of subtrochanteric or diaphyseal fracture frequently associated with the use of bisphosphonates (BPs). They are a clinical entity often overlooked, for which a correct clinical-instrumental classification is essential for a successful treatment. Nowadays, there is no accurate data on their real incidence. The aim of this work is to evaluate the period prevalence of AFFs and their risk factors, and to compare actual results with a previous study conducted at the same Institution seven years previously. ⋯ The efficacy of BPs for the prevention of osteoporotic fractures is widely demonstrated. However, particularly prolonged use of these drugs may increase the risk of developing AFFs in some patients. The incidence of AFFs is higher than that reported in the literature, if evaluated only for the subtrochanteric and diaphyseal sites (essential diagnostic criterion in the definition of AFFs). In our study, the incidence of AFFs doubled after seven years. The present data also confirm the frequent association between the use of BPs and the onset of AFFs.
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Comparative Study
Dual mobility cup in hip fracture: Indications and clinical results compared with bipolar hip arthroplasty.
The choice between hemiarthroplasty (HA) and total hip arthroplasty (THA) for displaced femoral neck fractures remains debated. There is increasing use in dual mobility cup total hip arthroplasty (DMC-THA) to prevent dislocations in these high-risk patients. Aim of this study is to retrospectively analyze patients treated in a single Center for femoral neck fracture comparing HA and DMC-THA in terms of: functional outcome, rate of complications and mortality. ⋯ DMC-THA offer better functional results than HA in elderly patients with femur neck fractures. The mean surgical time was longer in DMC-THA but this did not influence blood loss, time of discharge or one-year mortality. In our series dislocation never occurred in both groups.
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Global surgery research efforts have been criticized for failure to transition from problem identification to intervention implementation. We developed a context-appropriate trauma quality improvement (TQI) bundle to ameliorate care gaps at a regional referral hospital in Cameroon. We determined associations between bundle implementation and improvement in trauma resuscitation practices. ⋯ The implementation of a context-appropriate TQI bundle was associated with significant improvements in previously identified trauma care deficits at a single regional hospital. Data-derived interventions targeting frontline capacity at the local level can bridge the gap between identifying care limitations and improvement in resource-limited settings.