Journal of orthopaedic trauma
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Road traffic crash-related death, injury, and chronic disability continue to be a major worldwide burden to drivers, pedestrians, and users of mass transit, especially in low- and middle-income countries (LMIC). Projections predict worsening of this burden, and while motorization of LMIC increases exponentially, a corresponding improvement in prehospital and acute in-hospital trauma care has not been seen. The WHO now has 2 programs that address different elements of this challenge, namely, the Violence and Injury Prevention department (prevention) and the Emergency and Essential Surgical Care project (treatment). Activities of Violence and Injury Prevention have included developing guidelines for prehospital and essential trauma care, whereas activities of the Emergency and Essential Surgical Care have included developing the Integrated Management of Emergency and Essential Surgical Care toolkit and a textbook, "Surgical Care at the District Hospital." Organized surgical institutions in high-income countries-trauma associations, university departments, surgical nongovernmental organizations, etc.-can benefit from the infrastructure and tools the WHO has developed to better address the deficits in surgical services to improve the equitable distribution of surgical care services and resources to LMIC.
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The measurement of functional outcomes in pelvic fracture patients remains difficult for authors. The authors aimed to test the construct validity, respondent burden, floor and ceiling effects, and patient perception of 3 previously published pelvic outcome questionnaires. ⋯ Three previously published pelvic outcome instruments were found to have strong construct validity based on correlation with the Physical Component Score of the SF-36 and both indices of the SMFA. Subjects identified mental and emotional outcomes as important consequences of their injury; however, none of the pelvic questionnaires measure these domains, as they all correlate poorly with the Mental Component Score of the SF-36. Ceiling effects limit the utility of the all 3 current instruments, and their reliability and responsiveness over time remain unknown. No currently available outcome instrument seems to captures all of the important consequences of these injuries.
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To establish the nature and extent of femur sagittal bowing by determining outer and inner anterior cortex geometries and sizes using analytical 3-dimensional computed tomography modeling and relate the resultant femoral curvature with the curvatures of available intramedullary nails. ⋯ The study confirms that the radius of curvature of most intramedullary nails exceeds the sagittal radius of curvature of most adult femurs (both AROC and MROC). An intramedullary nail selected based on the anterior curvature would impinge on the anterior cortices at the proximal and distal anterior aspects of the femur in specimens with AROC > MROC. Conversely, in specimens with AROC < MROC, an intramedullary nail selected based on the anterior curvature would impinge on the proximal and distal posterior cortices. That cortical thickness varied significantly in accordance with gender and age is also relevant to surgical planning. MROC, in addition to the AROC alone, should be one of several design parameters used to match specific intramedullary nail design to an individual patient.
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The aims of this study were to evaluate the morphologic discrepancies between the short straight proximal femoral nail antirotation-Asian version (PFNA-II) and the anterior bow of the femur in Chinese patients and to propose a further design modification. ⋯ There is a mismatch between the current short straight PFNA-II and the anterior bow of the femur in the Chinese population. In light of the documented complications and technical problems related to this mismatch, further modifications with an anterior bow are proposed.