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Fracture management in emergency department

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https://www.readbyqxmd.com/read/28926505/do-all-clavicle-fractures-in-children-need-to-be-managed-by-orthopedic-surgeons
#1
John Adamich, Andrew Howard, Mark Camp
OBJECTIVES: Although many uncomplicated pediatric fractures do not require routine long-term follow-up with an orthopedic surgeon, practitioners with limited experience dealing with pediatric fractures will often defer to a strategy of frequent clinical and radiographic follow-up. Development of an evidence-based clinical care pathway can help unnecessary radiation exposure to this patient population and reduce costs to patient families and the health care system. METHODS: A retrospective analysis including patients who presented to the Hospital for Sick Children (SickKids) for management of clavicle fractures was performed...
September 18, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28913762/the-role-of-computed-tomography-ct-in-predicting-diplopia-in-orbital-blowout-fractures-bofs
#2
Michaela Cellina, Chiara Floridi, Marta Panzeri, Oliva Giancarlo
PURPOSE: The management of orbital blowout fractures (BOFs) is controversial: the evaluation of diplopia is the most important criterion for planning whether to undertake surgery. Our aim was to determine CT findings that may suggest the presence of diplopia when patients with BOFs cannot be adequately examined to plan an orbital repair. METHOD AND MATERIALS: We retrospectively evaluated CT of all patients presented to our Emergency Department for blunt craniofacial trauma (N = 3334) from January 2014 to March 2016, selecting patients with CT-demonstrated BOFs...
September 14, 2017: Emergency Radiology
https://www.readbyqxmd.com/read/28894783/intravenous-lidocaine-versus-morphine-sulfate-in-pain-management-for-extremity-fractures-a-clinical-trial
#3
Arash Forouzan, Hassan Barzegari, Hassan Motamed, Ali Khavanin, Hamideh Shiri
INTRODUCTION: Considering the existing contradictions regarding effectiveness of intravenous (IV) lidocaine, especially in emergency department (ED), the present study was designed to compare the analgesic effect of IV lidocaine and morphine sulfate in pain management for extremity bone fractures. METHOD: In this triple blind clinical trial, 15 to 65 year-old patients with extremity fractures and in need of pain management were randomly allocated to either IV lidocaine or morphine sulfate group and were compared regarding severity of pain 5, 10, 15, 20, 25, and 30 minutes after infusion via intention to treat analysis...
2017: Emergency (Tehran, Iran)
https://www.readbyqxmd.com/read/28870847/bundle-of-care-for-blunt-chest-trauma-patients-improves-analgesia-but-increases-rates-of-intensive-care-unit-admission-a-retrospective-case-control-study
#4
Cédric Carrie, Laurent Stecken, Elsa Cayrol, Vincent Cottenceau, Laurent Petit, Philippe Revel, Matthieu Biais, François Sztark
INTRODUCTION: This single-centre retrospective case-control study aimed to assess the effectiveness of a multidisciplinary clinical pathway for blunt chest trauma patients admitted in emergency department (ED). PATIENTS AND METHODS: All consecutive blunt chest trauma patients with more than 3 rib fractures and no indication of mechanical ventilation were compared to a retrospective cohort over two 24-month periods, before and after the introduction of the bundle of care...
September 1, 2017: Anaesthesia, Critical Care & Pain Medicine
https://www.readbyqxmd.com/read/28825959/pediatric-orthopedic-injuries-evidence-based-management-in-the-emergency-department
#5
Jamie Lien
Upper and lower extremity injuries are common in children, with an overall risk of fracture estimated at just under 1 in 5 children. Pediatric bone anatomy and physiology produce age specific injury patterns and conditions that are unique to children, which can make accurate diagnosis difficult for emergency clinicians. This issue reviews the etiology and pathophysiology of child-specific fractures, as well as common injuries of the upper and lower extremities. Evidence-based recommendations for management of pediatric fractures, including appropriate diagnostic studies and treatment, are also discussed...
September 2017: Pediatric Emergency Medicine Practice
https://www.readbyqxmd.com/read/28797555/to-log-roll-or-not-to-log-roll-that-is-the-question-a-review-of-the-use-of-the-log-roll-for-patients-with-pelvic-fractures
#6
REVIEW
Inês Filipa da Cunha Rodrigues
Pelvic fractures are one of the most serious injuries in polytrauma - massive haemorrhage is a major complication and the leading cause of death. The assessment and early management of these injuries in the Emergency Department (ED) focuses on the recognition of haemodynamic instability and should follow Advanced Trauma Life Support (ATLS) guidelines. The log-roll technique, although an accepted practice in trauma care, has been reported to be inadvisable when a pelvic fracture is suspected. This paper, which includes a case study, briefly explains the pathophysiology and initial management of pelvic fractures...
May 10, 2017: International Journal of Orthopaedic and Trauma Nursing
https://www.readbyqxmd.com/read/28795066/otolaryngological-presentations-in-times-of-terror-profile-from-a-tertiary-health-center-in-north-central-nigeria
#7
Adeyi A Adoga, Daniel D Kokong, Kenneth N Ozoilo
OBJECTIVES: To report the incidence, socio-demographic characteristics, otorhinolaryngological presentations and outcomes of management of patients at the Jos University Teaching Hospital following terror attacks. METHODS: A prospective descriptive hospital based study of consecutive patients presenting with ear, nose and throat injuries as a result of bomb blasts and ethno-religious crises within a six-year period and managed at the Jos University Teaching Hospital were studied for age, gender, ear, nose and throat presentations, injury mechanism, interventions and outcome of interventions...
July 2017: Bulletin of Emergency and Trauma
https://www.readbyqxmd.com/read/28770512/immediate-intensive-mobilization-compared-with-immediate-conventional-mobilization-for-the-impacted-osteoporotic-conservatively-treated-proximal-humeral-fracture-a-randomized-controlled-trial
#8
S Carbone, C Razzano, P Albino, R Mezzoprete
PURPOSE: To select in a 2-year survey of proximal humerus fractures accessing the emergency department, a population of osteoporotic stable impacted fractures and to randomize them into two groups, one with an immediate intensive mobilization program and the other with an immediate conventional mobilization program. METHODS: In emergency department, patients with clinical signs of shoulder girdle fracture were submitted to standard X-ray examination and CT scan...
August 2, 2017: Musculoskeletal Surgery
https://www.readbyqxmd.com/read/28745851/maxillofacial-trauma-managing-potentially-dangerous-and-disfiguring-complex-injuries-digest
#9
Devjani Das, Lea Salazar, Milana Zaurova
Patients with maxillofacial trauma require a careful evaluation due to the anatomical proximity of the maxillofacial region to the head and neck. Facial injuries can range from soft-tissue lacerations and nondisplaced nasal fractures to severe, complex fractures, eye injuries, and possible brain injury. Though the Advanced Trauma Life Support (ATLS) guidelines provide a framework for the management of trauma patients, they do not provide a detailed reference for many subtle or complex facial injuries. This issue adds a more comprehensive and systematic approach to the secondary survey of the maxillofacial area and emergency department management of injuries to the face...
April 22, 2017: Emergency Medicine Practice
https://www.readbyqxmd.com/read/28743319/nationwide-survey-on-current-management-strategies-of-toddler-s-fractures
#10
Jade Seguin, Daniel Brody, Patricia Li
BACKGROUND: Tibial fractures are common in children less than 3 years old. The traditional management involves immobilization in an above knee cast for both confirmed (positive x-ray) and presumed (normal x-ray) toddler's fractures. This carries health care implications and causes unnecessary burden for patients and their families. There is a paucity of literature describing the ideal immobilization strategy for this injury. OBJECTIVES: To determine: 1) the variation between Canadian emergency departments in management of toddler's fractures; 2) the variation in management between confirmed and presumed toddler's fractures; 3) the association between demographic variables and immobilization strategies...
July 26, 2017: CJEM
https://www.readbyqxmd.com/read/28741327/-prescription-pattern-in-the-management-of-type-i-open-forearm-fractures-in-pediatric-patients
#11
J A López-Tello, B J Torres-Fernández, N G Escalona-Reynoso
BACKGROUND: Pediatric open fractures account for more tan 10% of hospital admissions in a Pediatric Trauma Clinical Department. It is important to identify the predominant surgical management prescription pattern in pediatric patients presenting with Type I open forearm fractures at a referral center in an emerging economy. MATERIAL AND METHODS: Observational, cross-sectional, analytical, secondary-source (logs) sampling study of consecutive cases. The cases included subjects under 17 years of age presenting with Type I open forearm fractures at a Pediatric Trauma Clinical Department from January 1st, 2009 to December 31st, 2013...
January 2017: Acta Ortopédica Mexicana
https://www.readbyqxmd.com/read/28661986/comparison-of-pain-severity-and-management-in-burn-and-nonburn-trauma-patients
#12
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
#13
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
#14
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
#15
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
#16
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
#17
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
#18
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
#19
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
#20
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
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