Injury
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Interhospital transfer of critically injured patients to a major trauma service reduces preventable death in major trauma. Yet some of those transferred die without intervention. These 'futile' interhospital trauma transfers (IHTs), and other potentially avoidable IHTs place enormous stress on families of trauma victims, can delay care, and incur great cost to public health resources. This study sought to characterise these IHTs using current state guidelines for interhospital transfer. ⋯ Futile IHTs were infrequent, however over half of all trauma patients transferred from other hospitals were discharged without tertiary-level intervention. Trauma services should consider developing systems such as telehealth to support regional general and orthopaedic surgeons to co-manage lower risk trauma, particularly minor head and minor spinal trauma patients. This could be an integral part of safely reducing potentially avoidable IHTs and their associated costs while maintaining a low rate of preventable mortality in trauma.
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Several studies have proven that ultrasound (US) can improve the efficiency of early diagnostics of anterior cruciate ligament (ACL) injuries. ACL US is mainly performed by sonologists or radiologists. We have very little data on how effective these tests are if they are performed by an orthopaedic surgeon. We also have no information on the applicability of ACL US in children and adolescents. In this retrospective study, we analysed the results of point of care ultrasound (POCUS), which were performed by orthopaedic surgeons on children with suspected ACL injury. ⋯ POCUS can indicate functional insufficiency caused by ACL injury in children and adolescents. The biggest advantage of the test is that it is quick and simple, non-invasive. Further prospective diagnostic tests and standardized examination protocols can confirm our favourable experiences.
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The rapid growth of urban instant delivery, facilitated by digital platforms and characterized by on-demand, short-term, task-based labor, has raised concerns about safety, particularly with the increasing frequency of instant delivery crashes (IDCs). This study addresses knowledge gaps in understanding injury patterns and risk factors associated with IDCs. Utilizing data extracted from judicial verdicts on IDC disputes in China, encompassing demographic, contextual, crash, and injury information, the research employs ordered logit regression to identify significant factors affecting injury patterns, the number of injuries per person (IPP), and injury severity. ⋯ Major injuries among victims emphasize potential long-term consequences and associated costs. The significance of gender, age, and risk behavior as determining factors highlights the need for targeted safety interventions. These findings offer crucial insights for stakeholders, guiding the formulation of precise safety measures and informed policy initiatives within the dynamic landscape of instant delivery safety.
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Fracture healing is a complex biological process that begins soon after a fracture has occurred. Whereas the role of vitamin D status on the maintenance of bone health is well established, the clinical effects of vitamin D deficiency in the healing of distal humeral fractures are less well explored. This study examines the role of vitamin D serum levels in distal humeral fractures (C2, C3) managed with open reduction and double plate fixation, by comparing its concentration in patients with or without radiographic signs of fracture healing and in control subjects. Our hypothesis is that 6 months from treatment vitamin D levels will be different between the groups of patients. ⋯ Vitamin D is primarily involved in the stages of hard callus formation and remodelling. It also has several functions that affect the early stages of fracture healing. Vitamin D influences the cellular process of bone healing, although the underlying mechanism is still partly unclear. It would be useful to determine the vitamin D status of fracture patients at admission and to start supplementation, with periodic checks, to foster the consolidation phase. Although vitamin D is clearly not the only factor influencing the consolidation of a surgically treated distal humerus fracture, its concentration can easily be determined and managed. Our data suggest that vitamin D levels should be determined at admission and that fracture patients with low concentrations should be started on vitamin D supplementation.
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The social and financial burdens of the operative environment remains to be a major problem in modern society. We analyse the impact of the introduction and application of a perioperative cloud system that cross-analyzes the pre-/intraoperative risks to minimize surgical time and maximize operation theater efficiency through improved planning. ⋯ A data filtering algorithm-assisted cloud system can be a reliable way to facilitate the planning of operating theater schedules. Patient stratification according to BMI and surgeon years of experience seems to affect intraoperative duration significantly, and the understanding of the risks and intraoperative steps has the potential to forecast surgeries with high precision.