J Trauma
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Randomized Controlled Trial Clinical Trial
Colles' fractures treated by plaster and polyurethane braces: a controlled clinical study.
In a prospective randomized controlled trial polyurethane casts and traditional plaster-of-Paris braces were compared in 46 cases of Colles' fractures of the forearm. Secondary fracture dislocation, subjective inconveniences, and the need for secondary adjustment of the cast were recorded. ⋯ In comparison with plaster the synthetic bandage is lighter, water repellent, and hardens faster, and as far as circular bandages are concerned, they have zippers. It is concluded that polyurethane braces are a good supplement to plaster-of-Paris bandage in such fractures and recommended in selected cases.
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A case of volar radio-carpal dislocation with complete anterior dislocation of the lunate is reported. The injury was caused, unusually, by forced hyperflexion. The mechanism by which this dislocation is produced and the possible order of events in this injury are discussed by reference to the radiological and operative findings. Successful treatment by closed reduction of the radiocarpal dislocations and open reduction of the lunate is reported, and the relevant literature is briefly reviewed.
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The diagnostic criteria of clinical fat embolism syndrome are most important. Petechial rush, positive chest X-ray films, low arterial oxygen content, and cerebral involvement are major features. ⋯ By early internal fixation of long-bone fractures in patients with multiple injuries it may be possible in most cases to prevent the development of the third grade, the severe clinical fat embolism syndrome. Thus specific treatment because of fat embolism was indicated in only three cases in this series of 211 patients with broken long bones and multiple injuries.
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The outcome of burn care is conventionally measured in terms of mortality. To extend our understanding beyond this level, and specifically to develop insight into the morbidity and other sequelae or burn injury, we have constructed a Burn-Specific Health Scale (BSHS). ⋯ Preliminary internal consistency and reliability testing of the scale has proved satisfactory. We present here the results of testing in 40 initial patients, with the following conclusions: 1) The psychosocial performance of patients with major burns lags behind their performance in other areas, and we need to explore alternate clinical strategies for their support; 2) The BSHS can be used to determine both individual and group performance and needs for intervention; 3) The postburn recovery is dynamic and undergoes marked changes for a prolonged period of time, at least 1 year post-hospitalization: this must be considered when such patients are being evaluated for various purposes, e.g., disability.