Injury
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This paper reports the results of treatment of 17 patients with fractures of the shaft of the humerus accompanied by paralysis of the radial nerve in a series of 111 patients with fractures of the shaft of the humerus. In early operative explorations in 14 cases the radial nerve appeared undamaged in 13 cases. ⋯ The high incidence of undamaged nerves at exploration suggests that a conservative approach by collar and cuff or Sarmiento bracing is justified in such cases of fractures of the shaft of the humerus. Paralysis of the radial nerve associated with fractures of the shaft of the humerus is, in our opinion, not an indication for early operative treatment.
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A prospective survey was conducted of all patients requiring admission to the Regional Burns Centre for South East Scotland at Bangour Hospital and the Royal Hospital for Sick Children in Edinburgh. All patients admitted between May 1983 and April 1984 were studied. ⋯ A total of 276 patients were studied, of whom 152 were transferred. Early management by referring hospitals was often far from ideal, with errors in initial care that should have been avoided.
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The fourteenth case of survival following traumatic hemipelvectomy is presented. Several features of these massive injuries are illustrated by this case report and provide an opportunity to suggest guidelines of surgical management, based on standard and new criteria.
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Because of the difficulty of assessing prognosis, a clinical and radiological review of 103 injuries of growth plates was performed. Thirteen patients showed retardation of growth and in 4 it was clinically obvious. In addition, external deformity occurred because of failure of remodelling in 1 case. ⋯ At the distal end of the tibia two groups of type IV injury were identified having respectively a 0 and 62.5 per cent incidence of retardation of growth. A new classification of distal injuries of the tibia is proposed, with superior predictive value for retardation of growth than that of Salter and Harris. This is valuable as a guide to prognosis and may facilitate treatment.
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Figures for the incidence of head injury are frequently cited but there has been no accurate estimate and the number of individuals left with persistent disability is not exactly known. This study identified all those admitted to hospital with a diagnosis of head injury, in a known population. In 1 year there were 160 survivors of head injury per 100,000 of population. Rates of disability of 0.38 per 100,000 in need of care and 0.75 per 100,000 unemployable and primarily in need of occupation, were found, excluding those over 65 years old.