Injury
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Transcatheter angiographic emobilisation has been used as an effective control of haemorrhage associated with pelvic fracture. Although few complications of this procedure have been reported, gluteal muscle necrosis occurs occasionally. We assessed the type of pelvic fracture, concomitant injury, embolic site, embolic materials, and outcome in cases of gluteal muscle necrosis associated with angiographic embolisation for pelvic fracture-related haemorrhage, and investigated the factors associated with the development of gluteal muscle necrosis, one of the fatal complications of transcatheter angiographic embolisation. ⋯ Three patients died (mortality, 60%) of subsequent sepsis and disseminated intravascular coagulation. These cases showed that transcatheter angiographic embolisation with gelatin sponge and/or steel coil, while effectively controlling bleeding, may also result in gluteal muscle necrosis. Aggressive management including intraarterial antibiotic treatment may have a role, but our numbers are too small to confirm this.
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This is a retrospective study of ultrasound examination for patients with blunt scrotal trauma. Fifteen patients were examined over an 18-month period. The purpose of the study was to discover the ultrasonic features of blunt testicular trauma and to distinguish less severe from more severe injury with testicular rupture requiring surgery. ⋯ The ultrasound features of testicular trauma with rupture are irregularity of testicular outline and inhomogeneity of testicular texture. The value of ultrasound in diagnosing patients with testicular rupture and, therefore, requiring urgent surgery is discussed. In our limited study, irregularity of testicular outline was the distinguishing feature of rupture.
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firearm wounds of the chest are now common at our institution. The management algorithm for firearm wounds has not been evaluated for this mode of injury. ⋯ patients with firearm injuries reaching hospital suffered three times higher mortality and a longer ICU and hospital stay than those with stab injuries. However, early mortality was similar for both modes of injury and validates the continued application of the stab wound derived management algorithm to all modes of injury.
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Complication rates were compared in 140 smoking and 133 non-smoking patients with open tibial fractures. Both the groups were evenly matched demographically and in terms of primary fracture treatment. Flap failure complicated 7 (20%) patients in the smoking group and 4 (14%) in the non-smoking group. ⋯ Smoking is associated with an increased risk of complications in patients with open tibial fractures. There is an increased rate of flap failure, delayed union and non-union. We recommend patients with open tibial fractures should be advised to stop smoking to minimise these complications.
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Dr Ernst Baumann has been credited with describing an angle that can be measured from radiographs taken of children's elbows. This article presents three variations in the definition of this angle that we found in the orthopaedic literature. Variation I is the angle between the long axis of the humerus and a line through the physis of the lateral condyle of the distal humerus. ⋯ He did, however, believe that the reciprocal angle, variation II equalled the carrying angle of the elbow and this can be demonstrated by Fig. 1, which has been taken from an article that was published in 1929. The relationship between this angle and the carrying angle has since been proven to be more complex than Baumann believed. We recommend that a descriptive term such as the 'shaft-physeal' angle would cause less confusion and variation in the definition of this angle.