Injury
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Between 1991 and 1994, 21 patients with war missile injuries of the spine and spinal cord were treated; there were 17 men and four women, with a mean age 30.7 years; 52.4 per cent were civilians. The wounds were caused by shells (54.6 per cent) and bullets (45.4 per cent). The thoracic and lumbar spines were most commonly injured, and the injuries were frequently associated with lesions of other organs (47.6 per cent). ⋯ Penetrating injuries of the dura were recorded in 61.9 per cent, while the spinal cord was injured in 28.5 per cent of patients. The dural defect was reconstructed in these patients. There was a low incidence of postoperative complications (14.5 per cent) which emphasizes the importance of early surgery.
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There have been few published data describing the demand for and amount of Advanced Trauma Life Support (ATLS) training received by trainees in acute surgical specialties. We undertook a survey on aspects of ATLS training, questioning all senior house officers in accident and emergency (A & E) medicine, general surgery and orthopaedic surgery in the west of Scotland in January 1995. ⋯ There were few problems gaining study leave for the courses, but concern was expressed regarding the long waiting lists. ATLS training is therefore thought to be essential for surgical trainees, and the number of ATLS courses needs to be increased to cope with the demand.
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Fifty-five multiply injured patients with operatively treated unstable pelvic fractures were evaluated for patient-oriented outcome measures. Forty-six adult patients were eligible to complete the SF-36 medical outcome score and completed the SF-36 eight scale medical outcome score by postal questionnaire at a mean follow up to 2 years. The average Injury Severity Score of the eligible patients was 17.5. ⋯ Seventy-six per cent of patients responded to the surgery. There was a 14 per cent impairment in physical outcome score and a 5.5 per cent impairment in mental outcome score compared with the normal population. The physical and mental outcome of multiply injured patients with pelvic fractures can be measured objectively.