Injury
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According to the nationally imposed standard of care in the Netherlands, severely injured patients should be brought to a Level-1 trauma center for primary treatment. If not, they are considered to be undertriaged. This study aimed to determine the incidence of undertriage among severely injured geriatric patients and to evaluate the relation between hospital-undertriage and patient outcomes in elderly. ⋯ Undertriaged severely injured geriatric patients did not have a higher risk for poor outcomes. Level-2/3 hospitals seem to present a safe alternative for the treatment of these patients.
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Unstable ankle injuries often comprise multiple fracture lines; including a posterior malleolus fracture in up to 40% of cases. Surgical fixation of such injuries often requires multiple incisions. The configuration of the posterior malleolus fracture can also vary greatly, and the presence of this fracture is known to poorly affect patient outcomes. In this paper, the authors describe a modified posterolateral approach to the ankle which provides three windows for fixation of complex ankle fractures.
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Open lower limb fractures can carry significant morbidity and are typically managed with a well-defined care pathway. Thankfully such injuries are less frequent in paediatric populations. Management for children is the same as it is for adults. The aim of this study was to analyse paediatric patients undergoing treatment for open lower limb fractures at a UK major trauma centre over a ten-year period. ⋯ Paediatric patients should be treated as aggressively as adults with an open lower limb fracture. Scapular and scapular/parascapular flaps offer a more cosmetically and functionally appealing option. Prompt IV antibiotics, combined specialist orthopaedics and plastics experience help to reduce deep bone infections.
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Traumatic brain injury (TBI) presents significant challenges in prehospital care, particularly during on-scene triage, where accurate decision-making is crucial for improving patient outcomes. This study, part of a mixed-methods project, aims to explore these challenges and identify gaps in current on-scene triage practices. Additionally, it seeks to understand paramedics' perspectives on potential diagnostic tools such as brain biomarkers, near-infrared spectroscopy, and decision aids. ⋯ This study provides critical insights into the complexities of on-scene prehospital triage for patients with suspected TBI. Key recommendations include developing specific triage tools, exploring advanced technologies to support on-scene decision-making, enhancing paramedic training on TBI recognition, and addressing both barriers and facilitators to the implementation of new diagnostic technologies.
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Traumatic brain injury remains a significant concern in public health, affecting millions of individuals globally and leading to long-term cognitive and physical impairments. Historically, research in this field has primarily focused on male subjects, often neglecting to consider the substantial biomechanical and anatomical differences between genders and individuals of varying ages. The present study investigates sex-specific biomechanical responses to head impacts in real-world accidents, employing an advanced female finite element head model, with a particular focus on critical brain structures such as the corpus callosum and pituitary gland. ⋯ The smallest percentiles exhibited a higher risk of strain-related injury, while larger individuals demonstrated higher strain levels in key brain regions under similar impact conditions. Additionally, it was evaluated the efficacy of a safety helmet in a work-related scenario. These findings highlight the importance of subject-specific analyses in understanding TBIs and emphasise the need for continued refinement of FEHMs to improve the accuracy of injury prediction.