International orthopaedics
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Hip fractures are a common and increasing problem. Outcome varies considerably between hospitals. The reasons for this variability are complex. ⋯ In the space of 5 years, only modest improvements have been made in the care of patients with hip fracture. Audit tools should look at pre-existing comorbidity and functional outcome as well as the process of care, mortality and length of hospital stay. Future guidelines should be evidence-based, concentrate on outcome measures, and account for variations in demography.
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Randomized Controlled Trial Clinical Trial
Local anaesthetic injection with and without corticosteroids for subacromial impingement syndrome.
Fifty patients with impingement syndrome refractory to long-term conservative treatment were randomized to three treatment groups. All patients received an injection of 10 ml 0.5% bupivacaine, in group 1 without corticosteroid, in group 2 with crystalline corticosteroid and in group 3 with lipoid corticosteroid. Treatment in group 1 had to be stopped because of inefficacy. In groups 2 and 3 favorable results were achieved in 19 out of 40 patients.
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Between 1992 and 1995, 50 patients with 51 acetabular fractures underwent internal fixation using 3.5 mm cortical screws. There were 21 simple and 30 associated fracture types, as described by Letournel. Most of the patients had sustained multiple injuries with an average injury severity score (ISS) of 20 points. ⋯ At 2 year follow-up, 38 out of 44 of the patients had excellent or good clinical and radiological results. In acetabular fractures with sufficiently large fragments, screw fixation with 3.5 mm cortical screws proved satisfactory. In very comminuted fractures or where there is poor patient compliance an additional buttress plate should be used.