Annals of the Royal College of Surgeons of England
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Strangulation of digits, the 'toe-tourniquet' syndrome needs prompt intervention as failure to recognise the condition can lead to ischaemia and loss of the appendage. It is a common condition though relatively under reported. Those who deal with children more frequently are aware of the condition but this is not the case for all medical practitioners and hence the diagnostic dilemma for accidental injury or child abuse arises. We report this case to increase physician awareness of the syndrome, to highlight the importance of early release of the tourniquet and to avoid misinterpretation of the condition as child abuse.
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A 22-year-old male was admitted to casualty with a penetrating injury to his left ventricle following a stabbing to his chest. Penetrating injuries to major organs that originate or pass through the relatively narrow mediastinal corridor may have catastrophic consequences with little in the way of external signs to indicate the severity of the injury. ⋯ Simple methods in trauma resuscitation, often being carried out in less than optimum conditions, are vital in order to save an injured patient's life. Decompression of the pericardial sac by intubation is described as a new and relatively simple method in the initial resuscitation of a patient with sharp cardiac injury, prior to definitive surgery.
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Ann R Coll Surg Engl · Jul 2006
Cost benefit with early operative fixation of unstable ankle fractures.
Ankle fractures are common and many require surgical intervention. It has been well documented that a delay in fracture fixation results in increased length of hospital stay and increased complication rate. Initial delay can also allow swelling or blistering to develop which may necessitate a further delay in operative fixation for up to 1 week. The aim of the current study was to review the length of hospital in-patient stay for operative ankle fractures over the previous 12-month period at our hospital and compare this to the length of hospital stay following the introduction of a fast-track system for the fixation of these fractures (all fractures fixed within 48 h). ⋯ This study shows that early operative intervention for ankle fractures reduces the length of hospital stay. Intensive physiotherapy and co-ordinated discharge planning are also essential ingredients for early discharge. Early operative fixation for unstable ankle fractures has substantial cost-saving implications with no increase in complication rate.