Injury
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A total of 86 adult patients who underwent routine surgery to remove metal internal fixation devices were studied prospectively. At the time of surgery, 46 patients were symptomatic, but only 27 requested surgery; 59 were admitted for routine surgery on medical advice. There was no correlation between symptoms, the length of time the implant had been in situ or the location of the implant. ⋯ No wound infections occurred. Potential difficulties in the removal of implants and possible risks of retained implants are discussed, relating to refracture, osteopenia, metal toxicity and neoplasia. In conclusion, it may be appropriate to leave asymptomatic implants in situ, except for femoral and tibial diaphyseal plates.
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The principles of Advanced Trauma Life Support (ATLS) were adopted by a Royal Navy surgical team deployed to northern Iraq. Over a 6-week period, 18 casualties of both military and civil trauma required active resuscitation, 10 being under the age of 16 years. Triage of multiple casualties was necessary on three occasions. ⋯ Non-medical staff were trained most effectively to assess vital signs, although sophisticated monitors became available. These problems are discussed and compared with previous experience. Recommendations are made to improve future outcome.
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All victims of major blunt trauma have been said to be at risk of cervical spinal injury. In a prospective study of 410 such patients at our institution, we identified 13 patients (6.12 per cent) with unstable cervical spines. Loss or defect of consciousness following injury (regardless of duration), neurological deficit consistent with cervical cord or nerve root injury and neck tenderness were significantly predictive of an unstable cervical spine. Immediate radiographic investigation of the cervical spine is mandatory in such patients, but may not be required in patients without these signs.