Injury
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Multicenter Study
Radiological outcomes of distal radius extra-articular fragility fractures treated with extra-focal kirschner wires.
The classical colles fracture (extra-articular, dorsally angulated distal radius fracture) in patients with osteoporotic bone is becoming increasingly more frequent. There still appears to be no clear consensus on the most appropriate surgical management of these injuries. The purpose of this study is to appraise the use of percutaneous extra-focal pinning, in the management of the classical colles fracture. ⋯ In female patients over 60 years of age, the best predictor of radial length, when k-wire fixation is to be used, is the radial length prior to fracture reduction. Thus if there is radial shortening visible in the initial radiographs as measured in terms of ulnar variance, one should consider a method of fixation other than inter-fragmentary k-wires.
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Multicenter Study
Functional outcome of shoulder hemiarthroplasty for fractures: A multicentre analysis.
In this multicentre study, data on 102 shoulder hemiarthroplasties for the treatment of fractures were analysed retrospectively with regard to tuberosity healing and functional outcome. ⋯ In this study, we found that anatomical tuberosity healing around the prosthesis improved functional outcome and range of motion.
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The utilisation and consequences of standardised operative procedures may importantly differ between different healthcare systems. This is the first investigation comparing the treatment and outcome of femoral shaft fractures stabilised with an identical implant between trauma centres in 2 continents (Europe, EU and South Africa, SA). ⋯ Our investigation demonstrates the importance of several major differences between 2 different regions of the world in the treatment of femoral shaft fractures, despite involving only high level trauma centres and using an identical implant. The intercontinental comparison of results from clinical studies should be interpreted very carefully considering the heterogeneity of populations and clinical settings.
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To comprehensively examine the inter-hospital transfer of major trauma patients-including the reason for transfer, duration, escorts, interventions and unexpected events. ⋯ Considerable variability in request for transfer and transfer times, transfer escorts and mortality risk exist. The single greatest issue identified that most severely injured group were escorted by the most junior doctors (HMOs) and had the highest mortality. This crucial issue must be addressed by the State Trauma System and by any redesigned retrieval service in Victoria. A detailed review of activation and responsiveness criteria and the nature of the transfer escort is indicated. The establishment of Adult Retrieval Victoria may address many of the concerns raised by this study.
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Multicenter Study
Knife inflicted penetrating injuries of the maxillofacial region: a descriptive, record-based study.
Penetrating knife injuries of the face are more common in South Africa than the rest of the world. These injuries can be life-threatening, especially where the major blood vessels of the face are involved. The approach to treatment should be multidisciplinary, beginning with the trauma unit to provide airway maintenance and haemodynamic stabilisation. An interventional radiologist may be consulted for angiography. The aim of the present study was to retrospectively analyse all cases of knife-inflicted penetrating injuries to the maxillofacial region with the knife in situ and subsequently develop a management protocol to be used by maxillofacial surgery registrars when presented with such cases. ⋯ Patients with knife injuries to the face with no definite signs of vascular injury can thus be safely and accurately managed on the basis of physical examination and plain-film radiography. An angiogram is mandatory if the patient presents with excessive bleeding, an expanding haematoma or if the knife blade is in the region of any large vessels.