Injury
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of dynamic hip screw and gamma nail: a prospective, randomized, controlled trial.
We report a prospective, randomized, controlled trial, comparing the results of treatment with a dynamic hip screw (DHS) and a gamma nail in 95 consecutive patients with peri-trochanteric fractures of the femur. The DHS was used in 48 patients, the gamma nail in 47. Clinical and radiological outcomes were similar, but the gamma nail was associated with a higher incidence of complications, in particular fracture of the femur below the implant in eight cases. This is consistent with previous reports, and we do not recommend the gamma nail for the treatment of peri-trochanteric femoral fractures.
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Four patients have presented secondarily to this unit in recent years with rhabdomyolysis following prolonged compartment syndromes consequent upon drug overdoses or severe injury. Multiple complications arose due to the severe nature of the compartment syndrome itself and also its late and sometimes incomplete initial treatment. ⋯ Our experience with these cases demonstrates the importance of repeat examination under anaesthetic of the affected limbs following fasciotomy, even if apparently healthy granulation tissue is forming, and the value of persistent oedema and elevated creatine phosphokinase levels as markers of continued pathology. Observation of these factors may enable amputations and prolonged nerve palsies to be avoided in future patients.
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Comparative Study
Diagnostic value of ultrasonography and conventional radiography for the assessment of sternal fractures.
This study compares the sonographic and conventional radiographic examination of sternal fractures. Forty-five patients with a suspected sternal fracture were examined radiographically and sonographically. Sixteen had a sternal fracture which could be identified sonographically. ⋯ Ultrasonic investigation of the sternum is a useful way to demonstrate fractures that provides a similar sensitivity to conventional radiography. In contrast sonography is not suited for portraying the grade of displacement. In case of doubt after radiological examination the ultrasonic examination serves as a valuable tool but conventional plain radiography remains the standard means of documenting a sternal fracture.
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Thirty-seven consecutive patients with severe snowboard-related injuries (defined by referral to a Level I trauma centre) were reviewed. The type and mechanism of each injury were examined and found to be similar to those reported for skiers. Mild closed head injuries were common (54 per cent). ⋯ The incidence of snowboarding injuries sufficiently severe to require tertiary referral was estimated at 0.03 injuries/1000 snowboarder days. Similar to reports of minor snowboarding injury, these data indicate that injury patterns in more serious snowboarding accidents are quite different from those of serious downhill skiing accidents. Injured snowboarders suffer splenic injuries more often and chest and spinal injuries less often than do skiers, and should be evaluated for blunt injuries with these statistical differences in mind.