Injury
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This paper reports a study of 266 patients who were admitted to an Accident Service after being involved in road traffic accidents during the four-month period from February to May in 1976. There were 216 front-seat occupants, of whom 21 per cent were wearing seat belts: 156 patients were treated as outpatients and 105 patients were admitted to the wards. ⋯ There was an 11 per cent increase in the use of seat belts compared with a similar study carried out in 1971 and random roadside surveys also showed a 10 per cent increase. The implications of these findings are discussed.
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This paper reports a study of ipsilateral fractures of the femoral and tibial shafts in 21 patients treated according to a detailed plan including shock treatment, prophylaxis against fat embolism, soft-tissue and fracture treatment. Death due to hypovalaemic shock was eliminated and the incidence of fat emboliism (9-5%) reduced in comparison with an earlier series. ⋯ Results have improved compared with earlier series. All fractures healed within 15 months, and functional end results have been excellent in the majority of the surviving patients (89%).
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Comparative Study
A conservative approach to penetrating injuries of the chest. Experience with 131 successive cases.
One hundred and thirty-one cases of penetrating injuries of the chest were reviewed prospectively. A policy of conservative management is advocated, based on the intercostal drainage of moderate or large collections of fluid and/or air. The site of the intercostal drain is not an important factor in the management.
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Five patients with blast injuries to the lungs after bomb explosions are reported. In each patient radiological changes were apparent on the initial chest film taken within 4 hours of the explosions. Arterial hypoxaemia was also present. ⋯ Two patients died, one owing to bilateral pneumothorax which occurred during anaesthesia, and the other owing to overwhelming infection. Hypoxaemia persisted for 4 months in one of the survivors. Lung function tests which were performed on the same patient 10 monhts after the blast injuries, however, were normal.
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Twenty-nine patients with non-union of the humeral shaft, who were treated in 3 major Vancouver hospitals, were studied. Reasons for non-union, effectiveness of various treatment methods, and complications are discussed. ⋯ Compression plating with cancellous bone grafting gave the best rate of healing. However, both early and late operative treatment gave a relatively high complication rate.