Showing papers in "Injury-international Journal of The Care of The Injured in 1986"
406 citations
TL;DR: When you read more every page of this injury in america a continuing public health problem, what you will obtain is something great.
Abstract: Read more and get great! That's what the book enPDFd injury in america a continuing public health problem will give for every reader to read this book. This is an on-line book provided in this website. Even this book becomes a choice of someone to read, many in the world also loves it so much. As what we talk, when you read more every page of this injury in america a continuing public health problem, what you will obtain is something great.
258 citations
TL;DR: Milch's technique was found to be atraumatic and relatively painless and Kocher's technique should be used first, especially in those of heavy build.
Abstract: Two methods of reduction for anterior dislocation of the shoulder were compared in 111 patients. Milch's technique was found to be atraumatic and relatively painless. Greater success with Milch's technique was experienced in patients under 40 years of age in whom the dislocation had been present for less than 4 hours. Milch's technique should be tried initially in patients fulfilling these criteria. In other cases Kocher's technique should be used first, especially in those of heavy build.
106 citations
TL;DR: In a retrospective review of patients with multiple injuries matched for age and severity, 28.5 per cent of those whose fractures were treated conservatively died compared with 4.5% who were fixed, suggesting early stable fixation of fractures is recommended in patients withmultiple injuries.
Abstract: In a retrospective review of 71 patients with multiple injuries matched for age and severity, 28.5 per cent of those whose fractures were treated conservatively died compared with 4.5 per cent of those whose fractures were fixed. Early stable fixation of fractures is recommended in patients with multiple injuries.
69 citations
TL;DR: A prospective study of 73 patients with fractures of the metacarpal neck of the little finger finds that the corrected position of the fracture is not adequately maintained by a volar plaster slab, and Manipulation of these fractures is thus seldom indicated.
Abstract: A prospective study of 73 patients with fractures of the metacarpal neck of the little finger is reported. Fifty-seven (78 per cent) of the patients were followed up between 1 and 2 years after the injury. Forty-three (75 per cent) of these patients complained of symptoms, though only one patient considered himself disabled. The normal head/shaft angle at the fifth metacarpal neck measured in 12 control subjects as viewed on an oblique radiograph was 26 °. The importance of allowing for this normal angulation when assessing the angulation at the fracture is discussed. After manipulation, the corrected position of the fracture is not adequately maintained by a volar plaster slab. No definite relationship between the presence of symptoms and the residual angulation at the fracture site was demonstrated. Manipulation of these fractures is thus seldom indicated.
65 citations
TL;DR: A prospective, randomized trial of 104 consecutive patients with displaced fractures of the Femoral neck treated with either a sliding screw plate or four AO cancellous bone screws was performed to study the influence of the fixation device and the fixation procedure on the vascularity of the femoral head.
Abstract: A prospective, randomized trial of 104 consecutive patients with displaced fractures of the femoral neck treated with either a sliding screw plate or four AO cancellous bone screws was performed to study the influence of the fixation device and the fixation procedure on the vascularity of the femoral head. The vitality of the femoral head was determined by 99mTc-MDP scintigraphy performed 2-3 months after the operation. Eighty-seven patients (84 per cent) were available for assessment. The two treatment groups were comparable with regard to age, degree of primary displacement and quality of reduction. There were significantly more (P less than 0.01) avascular femoral heads or femoral heads with reduced vascularity in the sliding screw plate group (14/40, 35 per cent) than in the four AO cancellous bone screw group (5/47, 11 per cent).
61 citations
53 citations
TL;DR: If rotational alignment of the finger is maintained, fractures of the fifth metacarpal can be treated by immediate use with good functional and cosmetic results.
Abstract: Although fractures of the neck of the fifth metacarpal are common injuries, their management remains controversial In this study we present the results of early mobilization after these fractures in 101 patients We conclude that if rotational alignment of the finger is maintained, these fractures can be treated by immediate use with good functional and cosmetic results
49 citations
TL;DR: Dislocation following hemiarthroplasty was associated with advanced age and carried a formidable mortality and the elderly diabetic was identified as a particularly high-risk patient.
Abstract: Patients undergoing treatment for fractures of the upper end of the femur in a district general hospital over a 2-year period were analysed to identify preoperative illness, operative factors or postoperative complications associated with increased mortality. Both the mean age and mortality rate were higher than in many other reported series. The elderly diabetic was identified as a particularly high-risk patient. Dislocation following hemiarthroplasty was associated with advanced age and carried a formidable mortality.
49 citations
TL;DR: It has been found that correction of this septal involvement at the time of manipulation significantly improves the end-results and particular reference is directed to the involvement of the septum in grossly deviated noses.
Abstract: The management of nasal fractures has been found by several authors to be inadequate. The reason for this is obscure but may be poor understanding of the pathology of nasal fractures. There is no adequate comprehensive classification of nasal fractures. Various weights were dropped on cadavers' noses and the resultant fractured nasal pyramid was dissected out. The fracture lines are described and particular reference is directed to the involvement of the septum in grossly deviated noses. Confirmation of septal involvement is obtained using a CAT scanner. It has been found that correction of this septal involvement at the time of manipulation significantly improves the end-results (Murray and Maran, 1984).
49 citations
TL;DR: It is suggested that the elderly represent a group with special needs which might most effectively be met by an overnight observation ward served by neurosurgeons and specialists in geriatric medicine.
Abstract: The majority of patients admitted to hospital after head injury are young men and the characteristics of this group tend to dominate accounts of cranial injury. All patients of 65 years or more admitted to the Edinburgh Royal Infirmary neurotrauma unit over a 1-year period were studied and 146 suffering minor head injury were identified. In this group the sex incidence was equal and falls were responsible for two-thirds of the injuries. Alcohol was a contributory factor in over half of the male patients. The incidence of other noteworthy medical and social factors was high and the length of stay in hospital was twice that of younger persons. It is suggested that the elderly represent a group with special needs which might most effectively be met by an overnight observation ward served by neurosurgeons and specialists in geriatric medicine.
TL;DR: Drawbacks of traction-absorbing wiring in displaced fractures of the olecranon were observed in 29 out of 55 consecutive patients, and minor operative modifications in the TAW technique are suggested in order to avoid these drawbacks.
Abstract: Drawbacks of traction-absorbing wiring (TAW) in displaced fractures of the olecranon were observed in 29 out of 55 consecutive patients. Sliding of the K wires, with resulting skin troubles in 24 patients (10 patients with perforation of the skin), required premature removal of the implant. Minor operative modifications in the TAW technique are suggested in order to avoid these drawbacks.
TL;DR: Thirty consecutive supracondylar fractures of the humerus, treated by open reduction and internal fixation over a 4-year period from 1980 to 1984, are reviewed and it is felt that anatomical reduction with rigid fixation allowing immediate postoperative movement gives the least morbidity and best results.
Abstract: Thirty consecutive supracondylar fractures of the humerus, treated by open reduction and internal fixation over a 4-year period from 1980 to 1984, are reviewed. We feel that anatomical reduction with rigid fixation allowing immediate postoperative movement gives the least morbidity and best results.
[...]
TL;DR: It is demonstrated that a true mechanical block is not necessarily present and that the position of an unstable meniscal fragment is not consistently related to the fixed position of the knee under anaesthetic.
Abstract: Fifty patients presenting themselves with a locked knee were investigated prospectively by examination under anaesthesia and arthroscopy. Definite abnormality was found in 92 per cent. Torn menisci were present in 68 per cent and isolated ruptures of the cruciate ligament in 10 per cent. Loose bodies were found in 3 patients, degenerative changes alone in 2 patients and a pathological medial synovial shelf in 1 patient. No abnormality was demonstrated in 8 per cent. Sixteen per cent of the knees remained locked following the induction of anaesthesia. This study demonstrates that a true mechanical block is not necessarily present and that the position of an unstable meniscal fragment is not consistently related to the fixed position of the knee under anaesthetic. There were no clinical features that allowed the normal knees to be distinguished preoperatively from those with internal derangement. It is proposed that these patients should be managed by prompt examination under anaesthesia, arthroscopy and definitive surgery.
TL;DR: A prospective, randomized, double-blind trial to compare the results of physiotherapy for sprains of the lateral ligament of the ankle without the use of ultrasound with physiotherapy which included ultrasound shows no significant difference.
Abstract: Ultrasound is commonly used in association with other forms of treatment in the management of sprains of the lateral ligament of the ankle. Despite its widespread use there is little scientific evidence to support its role in the management of sprained ankles. We have conducted a prospective, randomized, double-blind trial to compare the results of physiotherapy for sprains of the lateral ligament of the ankle without the use of ultrasound with physiotherapy which included ultrasound. The results in the 154 patients who entered the trial demonstrate that there was no significant difference between the results achieved by the group treated with ultrasound and by those managed without.
TL;DR: The metabolic environment of synovial fluid and subchondral bone was considerably changed at the 3-week stage of experimental osteoarthritis and this was probably secondary to regional venous congestion.
Abstract: The purpose of the present study was to evaluate the environmental changes in synovial fluid and subchondral bone during synovitis in rabbits in which the knee joint on one side was subjected to a procedure causing instability; a traumatic synovitis rapidly developed. Three weeks following the procedure, partial pressure of oxygen (Po2), partial pressure of carbon dioxide (Pco2) and hydrogen ion concentration (pH) were measured in vivo in the juxta-articular bone and in the synovial fluid of both the normal and the affected sides. Mass spectrometry was used for simultaneous registration of Po2 and Pco2, while a monocrystalline antimony pH electrode was used for simultaneous measurement of pH in vivo. Hypoxia, hypercapnia and relative acidity were found in synovial fluid and subchondral bone of knees with synovitis. The metabolic environment of synovial fluid and subchondral bone was considerably changed at the 3-week stage of experimental osteoarthritis and this was probably secondary to regional venous congestion.
TL;DR: It may be that the reason for the failure of head restraints to afford the expected protection is their inappropriate design and lack of adequate adjustability.
Abstract: During a 5-month period a study was made of motor vehicle occupants presenting at an Accident and Emergency department following an accident. Records were made of the incidence of neck injuries in relation to the presence of head restraints and the use of seat belts. There was a slight reduction in injuries when a head restraint was fitted but this difference did not achieve statistical significance. The incidence of neck injury was not increased if a seat belt was worn. It may be that the reason for the failure of head restraints to afford the expected protection is their inappropriate design and lack of adequate adjustability.
TL;DR: In almost all cases injury was due to failure of supervision and it was not recognized initially that the trampoline is an extremely dangerous piece of equipment that can project people up to 9 m (30 ft) in the air.
Abstract: Between 1963 and 1978 16 patients were seen as a result of trampolining accidents; 15 had spinal injuries in the lower cervical region, resulting in severe paralysis. Their ages ranged from 10 to 43; 13 were male and the mean age was 21. There were six schoolboys. The factors causing the injuries were analysed. In almost all cases injury was due to failure of supervision and it was not recognized initially that the trampoline is an extremely dangerous piece of equipment that can project people up to 9 m (30 ft) in the air. The accidents occurred as a result of people landing on their heads. The recommendations to make this sport safer are discussed.
TL;DR: It is suggested that if the severity of head injuries sustained by injured PCs could be reduced (e.g. by wearing helmets) survival rates would improve as most fatalities do not involve other major injuries.
Abstract: Five hundred and thirty-eight motorcyclist (MCs) and 523 pedal cyclist (PCs) victims of road traffic accidents were studied. Nineteen out of 21 of the PCs who died suffered major head injuries (AIS greater than or equal to 4) whereas 21 out of 87 MCs suffered no head injury at all. PCs who died more commonly sustained a head injury, and on average sustained more severe head injuries than dying MCs. Surviving PCs suffered head injuries more commonly than surviving MCs. MCs who died having sustained a head injury usually suffered other, often multiple, injuries of equal or greater severity whereas dying PCs commonly suffered no other injury of comparable severity to their head injury. It is suggested that if the severity of head injuries sustained by injured PCs could be reduced (e.g. by wearing helmets) survival rates would improve as most fatalities do not involve other major injuries. Helmets might also reduce the incidence and severity of head injuries in PCs who survive their accident.
TL;DR: A retrospective survey over a 66-month period of children admitted with head injury who subsequently developed meningitis within the same period yielded six cases, giving an incidence of 0.38 per cent; two of the six died, and four survived with no sequelae.
Abstract: A retrospective survey over a 66-month period of children admitted with head injury who subsequently developed meningitis within the same period yielded six cases (five boys, one girl), giving an incidence of 0.38 per cent. Two of the six died, and four survived with no sequelae. Four cases occurred within the first week. One patient, who had received prophylactic antibiotics, developed Escherichia coli meningitis after 14 days and one had meningitis 2 years after the head injury. The most common organism was pneumococcus (four cases). Three patients had periorbital haematomas and none had cerebrospinal fluid leakage. Increasing drowsiness and fever were the most consistent features. Radiography of the skull was of little use in demonstrating fracture of the base of the skull. Two of the four surviving patients had craniotomy with successful dural repair.
TL;DR: The range of injuries sustained at an ice-rink and presented to an Accident Service department is described and Beginners appear to be more prone to injury than experienced skaters.
Abstract: The range of injuries sustained at an ice-rink and presented to an Accident Service department is described. A total of 203 patients with 222 injuries presented themselves during a 2-month period. There were 103 noteworthy injuries, including 61 fractures, 2 dislocations and 2 severed tendons, but the commonest injuries were wounds, sprains and bruises. Beginners appear to be more prone to injury than experienced skaters. In addition to using well-fitting skate-boots to protect the ankle, some injuries could be avoided by wearing elbow and knee pads, and a thick pair of gloves. The number of injuries compared with the total number of skaters was small but produced a noteworthy increase in the workload of the Accident Service.
TL;DR: The most frequent lesion found was rupture of the anterior cruciate ligament, and in two cases an arthrotomy would have been done on the wrong side of the knee if the operation had not been preceded by arthroscopy.
Abstract: Seventy-six children under 16 years of age (mean age 14.5) underwent diagnostic arthroscopy of the knee. Seventeen were examined under local anaesthesia as outpatients. The referring doctors suspected a meniscal lesion in 25 cases, but in only 6 of these was the diagnosis confirmed. The surgeon's diagnosis was verified in 9 out of 31 cases; unsuspected lesions of both menisci in one knee make a total of 10 patients with meniscal lesions (10 knees, 11 menisci). The most frequent lesion found was rupture of the anterior cruciate ligament (12). Because of the arthroscopy, three minor meniscal lesions could be observed without treatment, and no menisci were totally removed. In two cases an arthrotomy would have been done on the wrong side of the knee if the operation had not been preceded by arthroscopy. Fifteen arthroscopic operations were done but only three for meniscal lesions.
TL;DR: A series of 71 patients with subcapital fractures of the femur treated by internal fixation with three AO cancellous screws is reviewed, finding early weight bearing did not affect the incidence of non-union, avascular necrosis or regression of the screw.
Abstract: A series of 71 patients with subcapital fractures of the femur treated by internal fixation with three AO cancellous screws is reviewed Sixty-five patients survived and were followed up for 26–73 months from injury (mean 47 months) The incidence of non-union was 47 per cent The incidence of avascular necrosis was 333 per cent in displaced fractures and 77 per cent in undisplaced fractures Early weight bearing did not affect the incidence of non-union, avascular necrosis or regression of the screw We recommend internal fixation of subcapital fractures of the femur by this method
TL;DR: In patients with severe head injury admitted to a neurosurgical unit, coma is more likely to be due to the injury than to the blood alcohol level, and alcohol does not adversely affect outcome in such patients.
Abstract: Many head-injured patients have been drinking alcohol, and it has been suggested that the effect of a raised blood alcohol may be to potentiate brain damage after head injury. To investigate this, a study was carried out on 38 consecutive, recently head-injured patients admitted to the Glasgow Neurosurgical Unit. Conscious level, blood alcohol and serum creatine kinase BB (CKBB) were measured on admission (the latter by radioimmunoassay). Conscious level related strongly to outcome (chi 2 = 11.678, P less than 0.001), and serum CKBB (chi 2 = 8.333, P less than 0.01) but not to blood alcohol level. In patients with severe head injury admitted to a neurosurgical unit, coma is more likely to be due to the injury than to the blood alcohol level, and alcohol does not adversely affect outcome in such patients.
TL;DR: The incidence of acetabular erosion by Monk (hard top) hip prostheses for subcapital fractures as compared with that by Austin Moore prostheses is presented.
Abstract: Primary prosthetic replacement has become the method of treatment for acute subcapital fractures of the femur and is now widely accepted as a treatment for elderly patients. This paper presents the incidence of acetabular erosion by Monk (hard top) hip prostheses for subcapital fractures as compared with that by Austin Moore prostheses.
TL;DR: A very rare case of type II Monteggia lesion with an associated fracture-separation of the distal radial epiphysis is reported and the mechanism of injury is discussed.
Abstract: A very rare case of type II Monteggia lesion with an associated fracture-separation of the distal radial ephiphysis is reported and the mechanism of injury is discussed.