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Fracture management in emergency department

Ramesh Kumar, Frederic W B Deleyiannis, Corbett Wilkinson, Brent R O'Neill
OBJECTIVE The authors' goals in this study were to describe a series of dog attacks on children that required neurosurgical consultation and to better understand the pattern of injuries inflicted, the circumstances that place children at risk for attack, and the dog breeds involved. In addition, the authors review the surgical and medical management of these patients. METHODS The authors performed a retrospective review of all children requiring neurosurgical consultation for dog bite at a regional Level 1 pediatric trauma center over a 15-year period...
October 21, 2016: Journal of Neurosurgery. Pediatrics
Joshua M Abzug, Karan Dua, Andrea Sesko Bauer, Roger Cornwall, Theresa O Wyrick
Phalangeal fractures are the most common type of hand fracture that occurs in the pediatric population and account for the second highest number of emergency department visits for fractures in the United States. The incidence of phalangeal fractures is the highest in children aged 10 to 14 years, which coincides with the time that most children begin playing contact sports. Younger children are more likely to sustain a phalangeal fracture in the home setting as a result of crush and laceration injuries. Salter-Harris type II fractures of the proximal phalanx are the most common type of finger fracture...
November 2016: Journal of the American Academy of Orthopaedic Surgeons
Nader S Alkenani, Mariam A Alosfoor, Abdulaziz K Al-Araifi, Hala A Alnuaim
INTRODUCTION: This is a case report of extreme lengthening of the tibia of about 14.5cm using bone transport technique following road traffic accident trauma to the lower limbs. The management of the subsequent massive skeletal defects was challenging to orthopedic surgeons. Based on reported cases, the highest tibial lengthening was 22cm using bifocal transport, while the highest unifocal tibial lengthening reached 14.5cm. CASE PRESENTATION: A 20-year-old male driver was brought to the emergency department after a road traffic accident...
September 3, 2016: International Journal of Surgery Case Reports
P Manodh, D Prabhu Shankar, Devadoss Pradeep, Rajan Santhosh, Aparna Murugan
BACKGROUND: Maxillofacial fractures occur in a significant proportion worldwide and can occur as an isolated injury or in combination with other severe injuries including cranial, spinal, and upper and lower body injuries requiring prompt diagnosis with possible emergency interventions. The epidemiology of facial fractures varies with regard to injury type, severity, and cause and depends on the population studied. Hence, understanding of these factors can aid in establishing clinical and research priorities for effective treatment and prevention of these injuries...
September 23, 2016: Oral and Maxillofacial Surgery
P Legg, D Ramoutar, F Shivji, B Choudry, S Milner
INTRODUCTION Inappropriate referrals to the new patient fracture clinic unnecessarily consume hospital resources and many hospitals lack clear guidelines as to what should be referred. Many of these injuries can be definitively managed by the emergency department. Our aim was to construct and disseminate a clinical decision-making algorithm to reduce the frequency of inappropriate referrals to fracture clinics at our institution, to improve the management of patients with minor injuries and save the hospital and the patient the cost of unnecessary visits...
September 23, 2016: Annals of the Royal College of Surgeons of England
Tyler Snoap, Matthew Jaykel, Cayla Williams, Jason Roberts
BACKGROUND: Calcaneal fractures are commonly seen and treated in the emergency department. There are subsets of calcaneal fractures that pose a high risk to the adjacent soft tissue of the heel and can result in full-thickness tissue necrosis. OBJECTIVE: To identify which calcaneal fractures need to be managed within hours and triaged to the orthopedic team and which can be temporized in a neutral or plantarflexed ankle splint and seen in an outpatient setting. DISCUSSION: Tongue-type calcaneal fractures and tuberosity fractures must be triaged appropriately within the first few hours of presentation to prevent skin compromise...
September 19, 2016: Journal of Emergency Medicine
Anna Marie Chang, Amber Lin, Rongwei Fu, K John McConnell, Benjamin Sun
OBJECTIVE: The Institute of Medicine identified emergency department (ED) crowding as a critical threat to patient safety. We assess the association between changes in publicly reported ED length-of-stay (LOS) and changes in quality-of-care measures in a national cohort of hospitals. METHODS: Longitudinal analysis of 2012 and 2013 data from the American Hospital Association (AHA) Survey, Center for Medicare and Medicaid Services (CMS) Cost Reports, and CMS Hospital Compare...
September 19, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Susan Nedza, Donald E Fry, Susan DesHarnais, Eric Spencer, Patrick Yep
OBJECTIVES: The Center for Medicare and Medicaid Services (CMS) is actively testing bundled payments models. This study sought to identify relevant details for 90-day post-discharge Emergency Department (ED) visits of Medicare beneficiaries following total joint replacement (TJR) surgery meeting eligibility for a CMS bundled payment program. METHODS: The CMS research identifiable file for the State of Texas for 2011-2012 was used to identify patients who underwent TJR...
September 9, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Matthew A Sullivan, Charles J Cogan, Joshua M Adkinson
Pediatric hand injuries are extremely common. Although many hand injuries are adequately managed in the emergency department, some may need evaluation and treatment by a pediatric hand surgeon to ensure a good functional outcome. This article discusses the diagnosis and management of the most common pediatric hand maladies: fingertip injuries/amputation, tendon injuries, and phalangeal and metacarpal fractures. The plastic surgery nurse should be familiar with hand injuries that require intervention to facilitate efficient management and optimal postoperative care...
July 2016: Plastic Surgical Nursing
Michael D Singleton
BACKGROUND: Although numerous observational studies have demonstrated a protective effect of motorcycle helmets against head injury, the degree of protection against specific head injury types remains unclear. Experimental biomechanics studies involving cadavers, animals and computer models have established that head injuries have varying etiologies. This retrospective cross-sectional study compared helmet protection against skull fracture, cerebral contusion, intracranial hemorrhage and cerebral concussion in a consecutive series of motorcycle operators involved in recent traffic crashes in Kentucky...
September 2, 2016: Traffic Injury Prevention
Nicholas D Fletcher, Bryan J Sirmon, Ashton S Mansour, William E Carpenter, Laura A Ward
PURPOSE: Outcomes are excellent following surgical management of displaced supracondylar humerus fractures. Short delays until surgical fixation have been shown to be equivalent to immediate fixation with regards to complications. We hypothesized that insurance coverage may impact access to care and the patient's ability to return to the operating room for outpatient surgery. METHODS: A retrospective review of supracondylar humerus fractures treated at a large urban pediatric hospital from 2008 to 2012 was performed...
October 2016: Journal of Children's Orthopaedics
Erica Kristen Ludi, Saurabh Rohatgi, Matthew E Zygmont, Faisal Khosa, Tarek N Hanna
OBJECTIVE: The objective of the present study is to examine the concordance of facial fracture classifications in patients with trauma who underwent surgery and to assess the epidemiologic findings associated with facial trauma. MATERIALS AND METHODS: Patients with trauma who underwent facial CT examination and inpatient operative intervention during a 1-year period were retrospectively analyzed. Patient demographic characteristics, the mechanism of injury, the radiology report, the surgical diagnosis, and clinical indications were reviewed...
November 2016: AJR. American Journal of Roentgenology
Ido Stahl, Daniel Dreyfuss, Dror Ofir, Lior Merom, Michael Raichel, Nir Hous, Doron Norman, Elias Haddad
BACKGROUND CONTEXT: Timely interpretation of computed tomography (CT) scans is of paramount importance in diagnosing and managing spinal column fractures, which can be devastating. Out-of-hospital, on-call spine surgeons are often asked to evaluate CT scans of patients who have sustained trauma to the thoracolumbar spine to make diagnosis and to determine the appropriate course of urgent treatment. Capturing radiographic scans and video clips from computer screens and sending them as instant messages have become common means of communication between physicians, aiding in triaging and transfer decision-making in orthopedic and neurosurgical emergencies...
August 16, 2016: Spine Journal: Official Journal of the North American Spine Society
B H Miranda, Z P Spilsbury, A Rosala-Hallas, S Cerovac
BACKGROUND: Hand injuries are common, contributing up to 30% of accident and emergency (A&E) attendances. The aim of this study was to prospectively analyse the pathological demographics of hand injuries in a level 1 trauma centre with a Hand Trauma Unit and direct A&E links, and compare clinical and intra-operative findings. The null hypothesis was that there would be no differences between clinical and intra-operative findings (100% diagnostic concordance). METHODS: Data were prospectively collected for referrals during 2012...
October 2016: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
Christopher S Mulligan, Susan Adams, Julie Brown
Indoor trampoline parks are increasing as a source of injuries among children. We conducted a prospective cohort study, with semi-structured interview and medical record review, of children aged <17 years presenting to a paediatric emergency department following an injury at an indoor trampoline park. In a 6-month period in 2014, 40 such children (55% female) presented to the department. Common mechanisms were individual jumpers falling while attempting a somersault or trick, landing awkwardly on an obstacle such as a ball or protective padding, and multiple users on a single trampoline...
August 15, 2016: Injury Prevention: Journal of the International Society for Child and Adolescent Injury Prevention
Iulian Daniel Vîlcioiu, Dragoş George Zamfirescu, Ioan Cristescu, Andrei Ursache, Şerban Arghir Popescu, Cosmin Antoniu Creangă, Ioan Lascăr
Giant cell tumor of bone (GCTB) represents one of the commonest bone tumors encountered by an orthopedic surgeon. The giant-cell tumor is generally classified as benign but the fast growing rhythm and the aggressive soft-tissue invasion may in some cases demonstrate a malign potential of the tumor. We present the case of an aggressive giant cell tumor in a young patient that was first diagnosed in our emergency department with a fracture of the distal femur after a low energy trauma. With further examinations, we discovered that the tumor was invading the both femoral condyles and was vascularized by three major arterial pedicles...
2016: Romanian Journal of Morphology and Embryology, Revue Roumaine de Morphologie et Embryologie
Joshua Nyaribari Ondari, Moses Muia Masika, Richard Bwana Ombachi, John Ernest Ating'a
OBJECTIVE: To determine the difference in infection rate between 24h versus five days of prophylactic antibiotic use in management of Gustilo II open tibia fractures. DESIGN: Unblinded randomized control trial. SETTING: Accident and Emergency, orthopedic wards and outpatient clinics at Kenyatta National Hospital (KNH). PATIENTS: The study involved patients aged 18-80 years admitted through accident and emergency department with Gustilo II traumatic open tibia fractures...
October 2016: Injury
Mark A Pittman, Lalena M Yarris, Michelle D Lall, Jessica L Smith, Charlotte P Wills, Jacob W Ufberg, Cullen B Hegarty, Jeffrey N Love
OBJECTIVES: Fractures comprise 3% of all Emergency Department (ED) visits. Although Emergency Physicians are often responsible for managing most of the initial care of these patients, many report a lack of proficiency and comfort with these skills. The primary objective was to assess how prepared recent Emergency Medicine (EM) residency graduates felt managing closed fractures. Secondary objectives identified whether residency training or independent practice contributed most to the current level of comfort with these procedures, and which fractures were most commonly reduced without orthopedic consultation...
August 1, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Marc D Benayoun, Jason W Allen, Brendan P Lovasik, Matthew L Uriell, Robert M Spandorfer, Chad A Holder
BACKGROUND: Computed tomography (CT) of the cervical spine (C-spine) is routinely ordered for low-risk mechanisms of injury, including ground-level fall. Two commonly used clinical decision rules (CDRs) to guide C-spine imaging in trauma are the National Emergency X-Radiography Utilization Study (NEXUS) and the Canadian Cervical Spine Rule for Radiography (CCR). METHODS: Retrospective cross-sectional study of 3,753 consecutive adult patients presenting to an urban Level I emergency department who received C-spine CT scans were obtained over a 6-month period...
August 2016: Journal of Trauma and Acute Care Surgery
I P Pengas, A Assiotis, W Khan, T Spalding
Extensor mechanism rupture is a serious event requiring prompt diagnosis and treatment. Patella fractures are reportedly six times more frequent than soft tissue injuries such as quadriceps or patella tendon ruptures. Classically quadriceps and patella tendon ruptures are seen more in males, with those over 40 predominantly suffering from quadriceps tendon ruptures, often associated with an underlying condition, whereas patella tendon ruptures are mostly associated with sport injuries and are commonly seen in the under 40s...
June 27, 2016: Injury
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