Injury
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Multicenter Study Clinical Trial
Injury of knee ligament associated with ipsilateral femoral shaft fractures and with ipsilateral femoral and tibial shaft fractures.
A series of 110 patients with 114 fractures of the femur were reviewed an average of 3.9 years after injury. Demonstrable knee ligament laxity was present in 31 (27 per cent) of these patients, while 13 (11 per cent) complained of instability. Thirty-three patients with 34 ipsilateral femoral and tibial shaft fractures were examined an average of 3.7 years after injury. ⋯ Most of the patients with instability had a rupture of the anterior cruciate ligament with or without damage to other ligaments. We conclude that knee ligament injury is more common with ipsilateral fracture of the femur and tibia than with just a single ipsilateral femoral fracture. We advocate careful assessment of the knee in all cases of fracture of the femur.
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We reviewed 32 patients with open pelvic fractures treated over a 5-year period. Eleven patients had isolated fractures of the ilium and in 21 patients pelvic ring disruption was associated with a perineal laceration. Three patients died from massive haemorrhage soon after admission and one patient from severe sepsis. Early pelvic stabilization and meticulous attention to the soft tissue injury proved invaluable in the management of open unstable pelvic fractures.
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All trauma admissions to the Royal Victoria Hospital, Belfast, in 1987 were entered in a computerized trauma register. Analysis of these patients by severity showed that only 3.8 per cent had ISS scores of 16 and over. Of these, 42 per cent arrived at hospital between midnight and 0900. ⋯ The specialties involved in the treatment of these patients are analysed. It is argued that we cannot instantly leap from the present arrangements to fully developed trauma centres. The most efficient and cost-effective way of initiating better systems would be to appoint sufficient accident and emergency consultants to a number of pilot scheme hospitals so that there would always be a senior doctor present, day or night, in the accident and emergency department to carry out the initial resuscitation and to mobilize the correct trauma team for the severely injured patients.