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Fracture management in emergency department

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https://www.readbyqxmd.com/read/28661986/comparison-of-pain-severity-and-management-in-burn-and-nonburn-trauma-patients
#1
Atulya Prasad, Naureen Osman, Henry C Thode, Adam J Singer
Burn injuries are generally considered to be among the most painful. However, there is little evidence to support this. It is also unknown if pain management in burn patients differs from patients with other sources of pain. We compared pain severity among patients presenting to emergency departments (EDs) across the United States with burn and nonburn injuries using data generated from the National Hospital Ambulatory Care Survey. Multivariate analyses was performed to determine the association between predictor variables and pain severity as well as pain management in the ED...
June 28, 2017: Journal of Burn Care & Research: Official Publication of the American Burn Association
https://www.readbyqxmd.com/read/28657260/utilising-magnetic-resonance-imaging-as-the-gold-standard-in-management-of-suspected-scaphoid-fractures-in-the-emergency-department-setting
#2
B Ramasubbu, E Mac Suibhne, A El-Gammal, N Sheehy, D Shields
Scaphoid fractures are the most common carpal bone fracture. Up to 40% of scaphoid fractures can be missed at initial presentation and investigation. Follow-up plain film radiograph has overall poor sensitivity and reliability. MRI has been shown to have an almost 100% sensitivity and specificity and so is the gold standard in scaphoid fracture diagnosis. Additionally, early specialist involvement is recommended. We proposed that following a designated pathway, there would be no significant increase in MRI requests...
February 10, 2017: Irish Medical Journal
https://www.readbyqxmd.com/read/28639869/economic-burden-of-inpatient-admission-of-ankle-fractures
#3
Justin D Stull, Suneel B Bhat, Justin M Kane, Steven M Raikin
BACKGROUND: Ankle fractures are among the most prevalent traumatic orthopaedic injuries. A large proportion of patients sustaining operative ankle fractures are admitted directly from the emergency department prior to operative management. In the authors' experience, however, many closed ankle injuries may be safely and effectively managed on an outpatient basis. The aim of this study was to characterize the economic impact of routine inpatient admission of ankle fractures. METHODS: A retrospective review of all outpatient ankle fracture surgery performed by a single foot and ankle fellowship-trained surgeon at a tertiary level academic center in 2012 was conducted to identify any patients requiring postoperative inpatient admission...
June 1, 2017: Foot & Ankle International
https://www.readbyqxmd.com/read/28625198/determining-the-clinical-significance-of-errors-in-pediatric-radiograph-interpretation-between-emergency-physicians-and-radiologists
#4
Jonathan Taves, Steve Skitch, Rahim Valani
OBJECTIVES: Emergency physicians (EPs) interpret plain radiographs for management and disposition of patients. Radiologists subsequently conduct their own interpretations, which may differ. The purposes of this study were to review the rate and nature of discrepancies between radiographs interpreted by EPs and those of radiologists in the pediatric emergency department, and to determine their clinical significance. METHODS: We conducted a retrospective review of discrepant radiology reports from a single-site pediatric emergency department from October 2012 to December 2014...
June 19, 2017: CJEM
https://www.readbyqxmd.com/read/28622117/periprosthetic-femoral-fractures-in-the-emergency-department-what-the-orthopedic-surgeon-wants-to-know
#5
Richard A Marshall, Michael J Weaver, Aaron Sodickson, Bharti Khurana
Femoral fracture in the setting of a hip arthroplasty is an increasingly common complication encountered in the emergency department (ED). Diagnosis and management of periprosthetic fractures are complicated, and orthopedic surgeons rely on imaging findings to guide the appropriate management approach to the injury. Delay in identification and appropriate definitive management of periprosthetic fractures is associated with high morbidity and mortality. At present, the Vancouver classification system for periprosthetic hip fractures is the most common classification system used by orthopedic surgeons...
July 2017: Radiographics: a Review Publication of the Radiological Society of North America, Inc
https://www.readbyqxmd.com/read/28616787/subtle-radiographic-signs-of-hamate-body-fracture-a-diagnosis-not-to-miss-in-the-emergency-department
#6
Nathan D Cecava, Mary F Finn, Liem T Mansfield
Hamate fractures are estimated to represent 1.7% of all carpal fractures and can occur at the hamulus (hook) or hamate body depending on mechanism of injury. Fractures of the hamate body can be exceedingly difficult to identify on standard wrist and hand radiographs in the emergency department. If the diagnosis is missed in the emergency department, orthopedic referral is often delayed. This can result in lasting functional disability for the patient, as these fractures have a propensity to destabilize the fourth and fifth carpometacarpal (CMC) joints...
June 14, 2017: Emergency Radiology
https://www.readbyqxmd.com/read/28611877/emergency-department-pain-management-following-implementation-of-a-geriatric-hip-fracture-program
#7
Scott D Casey, Dane E Stevenson, Bryn E Mumma, Christina Slee, Philip R Wolinsky, Calvin H Hirsch, Katren Tyler
INTRODUCTION: Over 300,000 patients in the United States sustain low-trauma fragility hip fractures annually. Multidisciplinary geriatric fracture programs (GFP) including early, multimodal pain management reduce morbidity and mortality. Our overall goal was to determine the effects of a GFP on the emergency department (ED) pain management of geriatric fragility hip fractures. METHODS: We performed a retrospective study including patients age ≥65 years with fragility hip fractures two years before and two years after the implementation of the GFP...
June 2017: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28594518/pediatric-phalanx-fractures
#8
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 in the United States for fractures. 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...
February 15, 2017: Instructional Course Lectures
https://www.readbyqxmd.com/read/28590997/is-radiography-necessary-for-pediatric-emergency-department-clinicians-to-safely-manage-ankle-injuries
#9
Rohan Angus Ramasubbu
OBJECTIVES: Ankle radiography in the pediatric emergency department exposes a radiosensitive population to harmful ionizing radiation and is costly to health care systems. This study aimed to determine if ankle injuries in children could be managed safely and effectively without radiography. METHODS: This prospective study enrolled 94 patients with ankle injuries between July 14, 2015, and December 16, 2015. Participating clinicians filled out a tick-box questionnaire describing their predicted diagnosis and management...
June 6, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28586601/outcome-of-two-column-acetabular-fractures-treated-operatively-through-single-posterior-approach
#10
Muhammad Naeem Ur Razaq, Muhammad Ayaz Khan, Abbas Ali
BACKGROUND: Involvement of both columns in acetabular fractures is a common presentation; these fractures create a challenging situation for the surgeons in terms of understanding the dimensions of osseous injury and selection of surgical approach. The study was done with an objective to evaluate the efficacy of single posterior approach for acetabular fractures involving both columns directly reducing the posterior wall and column and indirectly reducing the anterior column. METHODS: An evaluation of 25 adult patients 18 male and 7 female presenting in the accident and emergency department of Khyber Teaching Hospital from December 2013 to June 2015 having acetabular fracture involving both the anterior and posterior column were included in this case series study...
October 2016: Journal of Ayub Medical College, Abbottabad: JAMC
https://www.readbyqxmd.com/read/28578470/which-immobilization-is-better-for-distal-radius-fracture-a-prospective-randomized-trial
#11
Carlo Gamba, Felipe Andrés Mingo Fernandez, Marta Cuenca Llavall, Xavier Lizano Diez, Fernando Santana Perez
INTRODUCTION: The aim of this study was to determine whether an above-elbow cast (AEC) is better than a below-elbow cast (BEC) at maintaining the initial reduction in the orthopaedic management of a distal radius fracture (DRF). METHODS: It is a prospective randomized study carried out in a single emergency trauma department. There were 72 patients older than 55 years of age (55-96) with a distal radius fracture treated orthopaedically. They were randomized into two groups: group B (AEC 32 patients) and group A (BEC 40 patients)...
June 3, 2017: International Orthopaedics
https://www.readbyqxmd.com/read/28571117/do-all-adult-orthopaedic-injuries-seen-in-emergency-departments-need-to-attend-fracture-clinic-a-queensland-multicentred-review
#12
Aidan Cleary, Robert Zeller, Chris Maguire, Shyan Goh, Nick Shortt
OBJECTIVE: Musculoskeletal injuries account for a significant proportion of ED presentations annually, with a large percentage being referred to the fracture clinic (FC). A literature review found that many referrals could be safely managed outside the traditional model of care. The present study aims to review all adult presentations to FCs at two Queensland metropolitan hospitals, finding low-risk injuries that can safely and appropriately be managed by their general practitioner (GP) or allied health professionals (AHPs), potentially affording significant savings to the health system...
June 1, 2017: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/28538455/operative-fixation-for-clavicle-fractures-socioeconomic-differences-persist-despite-overall-population-increases-in-utilization
#13
William W Schairer, Benedict U Nwachukwu, Russell F Warren, David M Dines, Lawrence V Gulotta
BACKGROUND: Clavicle fractures were traditionally treated conservatively, but recent evidence has shown improved outcomes with surgical management. The purpose of this study was to evaluate the recent trends in operative treatment of clavicle fractures, and to analyze for patient related factors that may affect treatment strategy. METHODS: The Healthcare Cost and Utilization Project (HCUP) California and Florida inpatient, outpatient, and the Emergency Department databases were used to identify all patients with clavicle fractures between 2005 and 2010...
June 2017: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/28523083/association-of-midfacial-fractures-with-ophthalmic-injury
#14
REVIEW
Constantinus Politis, Alexandra Kluyskens, Titiaan Dormaar
The aim of this study is to evaluate the incidence of ophthalmic complications following midfacial fractures and investigate its relation to surgical or nonsurgical treatment. This article is a retrospective study, describing the spectrum and incidence of ophthalmic injury in 106 patients presenting with midfacial fractures at the Department of Oral and Maxillofacial Surgery of the University Hospitals Leuven over a period of 16 months (January 2013 to April 2014). The mean age of the patients was 45.6 years with a gender distribution of 68 men and 38 women...
June 2017: Craniomaxillofacial Trauma & Reconstruction
https://www.readbyqxmd.com/read/28507966/ipsilateral-hip-and-knee-dislocation-with-open-tibial-fracture-a-case-report-of-a-limb-threatening-injury
#15
Ramesh Perumal, S R Sundararajan, J Vasudeva, S Rajasekaran
INTRODUCTION: Hip or knee dislocations are usually treated as a surgical emergency, but ipsilateral hip and knee dislocation should be considered a dual emergency that must be addressed immediately and reduced at the earliest. We present here the sequence of events and the final functional outcome of one such rare injury manages by us. CASE REPORT: A 22-year-old male was involved in a road traffic accident. He presented to the emergency department in 4 h injury time with painful deformities of the right hip and knee, along with Type I open wound right leg with abnormal mobility suggestive of fracture in the ipsilateral leg...
November 2016: Journal of Orthopaedic Case Reports
https://www.readbyqxmd.com/read/28494481/enhanced-hip-fracture-management-use-of-statistical-methods-and-dataset-to-evaluate-a-fractured-neck-of-femur-fast-track-pathway-pilot-study
#16
Nigel Gilchrist, Kristian Dalzell, Scott Pearson, Gary Hooper, Kit Hoeben, Jeremy Hickling, John McKie, Ma Yi, Sandra Chamberlain, Caroline McCullough, Marc Gutenstein
The increasing elderly population and subsequent rise in total hip fracture(s) in this group means more effective management strategies are necessary to improve efficiency. We have changed our patient care strategy from the emergency department (ED), acute orthopaedic wards, operating theatre, post-operation and rehabilitation, and called it Fracture Neck of Femur Fast Track Pathway. All clinical data and actions were captured, integrated and displayed on a weekly basis using 'signalfromnoise' (SFN) software...
May 12, 2017: New Zealand Medical Journal
https://www.readbyqxmd.com/read/28491210/-surgical-treatment-of-the-humeral-pallet-fractures-in-adults
#17
Redouane Hani, Mustapha Nekkaoui, Mohammed Kharmaz, Mohamed El Ouadghiri, Abdou Lahlou, Mly Omar Lamrani, Ahmed El Bardouni, Mustapha Mahfoud, Mohamed Saleh Berrada
The treatment of humeral pallet fractures is mainly based on reconstruction surgery with osteosynthesis. We collected the data of 40 patients with humeral pallet fracture from our archives in the Department of Orthopaedics and Traumatology at the Ibn Sina University Hospital, Rabat from january 2012 to december 2014. The aim of our study was to highlight the clinical, therapeutic and evolutionary features of these fractures as well as the challenges in managing these complex fractures and in evaluating the results...
2017: Pan African Medical Journal
https://www.readbyqxmd.com/read/28483544/clinical-decision-support-decreases-volume-of-imaging-for-low-back-pain-in-an%C3%A2-urban-emergency-department
#18
Adam Min, Vivian W Y Chan, Ruben Aristizabal, Ed R Peramaki, David B Agulnik, Nardia Strydom, Damon Ramsey, Bruce B Forster
PURPOSE: To determine whether point-of-care clinical decision support can effectively reduce inappropriate medical imaging of patients who present to the emergency department (ED) with low-back pain (LBP). MATERIALS AND METHODS: This was a prospective, single-center study of lumbar imaging referrals made by 43 emergency physicians at a major acute care center. Each physician saw at least 10 LBP cases in both pre- and post-intervention periods. A point-of-care checklist of accepted red flags for LBP was designed by a working group of physicians and embedded in the computerized order entry form for lumbar imaging...
May 2, 2017: Journal of the American College of Radiology: JACR
https://www.readbyqxmd.com/read/28466615/angiographic-embolization-in-pediatric-abdominal-trauma
#19
Yechiel Sweed, Jonathan Singer-Jordan, Sorin Papura, Norman Loberant, Alon Yulevich
BACKGROUND: Trauma is the leading cause of childhood morbidity and mortality. Abdominal bleeding is one of the common causes of mortality due to trauma. Angiography and embolization are well recognized as the primary treatments in certain cases of acute traumatic hemorrhage in adults; however, evidence is lacking in the pediatric population. OBJECTIVES: To assess the safety and efficacy of transcatheter arterial embolization (TAE) for blunt and penetrating abdominal and pelvic trauma in the pediatric age group...
November 2016: Israel Medical Association Journal: IMAJ
https://www.readbyqxmd.com/read/28465038/development-of-a-financially-viable-model-for-the-management-of-mandibular-fractures-as-day-cases-in-a-level-1-major-trauma-centre
#20
J Haq, J Olding, S Chegini, C Huppa, R Bentley, K Fan
There is a subgroup of patients with mandibular fractures who could safely and effectively be managed in an outpatient day-care unit. Suitability depends on medical, social, and operative factors, and identification of the correct criteria will govern management after that in the emergency department. Reduced use of beds would lead to less money being spent on emergency treatment, and increased capacity for elective surgery. The aims of this study were to identify a group of patients with mandibular fractures whose duration of operation and period of recovery would be suitable for treatment in the day-care unit, and to evaluate the potential financial benefits...
July 2017: British Journal of Oral & Maxillofacial Surgery
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