Injury
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In our accident service department all trauma radiographs are reported acutely and those misinterpreted by the casualty officers are presented at the daily clinicoradiological conference. We have reviewed this practice over a 6-month period. From over 25,000 patients attending the accident service, 16,246 radiographs were requested and reported. ⋯ However, the incidence of misinterpretation was highest in examination of the fingers, especially in children. We believe that these low figures are principally the result of involving both orthopaedic surgeons and radiologists at the formal daily conference. We regard our system of audit as beneficial to patients' care and anticipate reduced litigation which may offset the increased cost of audit.
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A series of 123 patients who attended a district general hospital in Belfast over a 14-year period from 1975, sustained 126 plastic bullet injuries, resulting in one death and several serious injuries. This report shows the significant association of serious injury and/or death from plastic bullets in which the impact is above diaphragmatic level.
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Review Case Reports
Venous bullet embolism: a case report and review of the literature.
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Extrahepatic biliary tract and gallbladder injuries are rare, but many occur after both blunt and penetrating abdominal trauma. During a 5-year period, 24 patients requiring laparotomy for abdominal trauma were found to have an extrahepatic biliary tract injury, representing 13 per cent of all patients admitted with hepatic trauma during the same period. The majority of patients had injury to the gallbladder; only one case of common bile duct injury was identified. ⋯ Isolated gallbladder injury occurred in only 8 per cent of patients. The overall mortality associated with gallbladder trauma was 16 per cent. This uncommon injury usually results from severe trauma and is associated with a high incidence of other major visceral injuries.
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An effective method for reducing anterior dislocation of the glenohumeral joint which does not require either sedation or traction is described. The patient performs the manoeuvre. ⋯ Easy reduction was achieved in 72 per cent, with no complications and patients spent less than half as long in the accident and emergency department as when it is not successful. We recommend this simple technique as a first method of reduction in patients presenting to accident and emergency departments.