Trauma

Neglected fractures in young adults can be amongst the most difficult to treat in the spectrum of fractures of the femoral neck. Because of its complex anatomy and blood supply, timely fixation is paramount. When this does not occur, non-union and avascular necrosis are common complications. Here, we present a meta-analysis of three common options available to the surgeon treating such complications.

We identified 97 relevant papers by the keywords ‘femoral neck fractures’; ‘neglected’; ‘joint preserving’ and ‘young adults’; 23 met the inclusion criteria and reported on an overall population of 725 patients.

Osteotomy with internal fixation had a union rate of 91.33% (95% CI 84.91–92.87). Fractures fixed by internal fixation with pedicled muscle graft proceeded to union in 86.25% (95% CI 78.92%–88.54%) of cases and those managed with free fibular graft in 88% (95% CI 78.35%–90.84%), respectively. Internal fixation alone, in this study, used as an illustrative control group, was successful in 76.5% (95% CI 65.58%–83.81%) of cases.

These findings show superiority of osteotomy with internal fixation in the management of non-united femoral neck fractures, and more complex options with potentially higher morbidity confer no patient benefit.

Pretibial lacerations remain one of the commonest problems in plastic surgery. There is still no evidence of superiority of either a conservative or surgical approach for their management, nor any documentation regarding patients' performance following each approach.

We conducted a retrospective study of all patients treated for pretibial lacerations/haematomas in our unit, from May 2013 till April 2014 who were offered surgical or conservative management. Conservative management included washout of wound and application of non-adhesive dressings; the patients were discharged home on the same day and followed up in dressing clinic. The Eastern Cooperative Oncology Group score was used to assess patients' well-being during healing time.

There were 38 patients; 21 opted for conservative management and 17 for skin grafting, after consultation. Overall, 66% of conservatively managed wounds were completely healed and patients were discharged. Mean healing time was 66.28 (13–172) days and required 3.43 (1–8) visits to the unit. In the surgically managed group, 88% of the patients had their wounds completely healed with a mean healing time of 69.5 (14–147) days and 5.87 (2–11) visits to the unit required. Of the conservatively managed patients, 55.6% scored 0 on the Eastern Cooperative Oncology Group scale, denoting fine health, while only 7.6% of the surgically managed patients scored zero. In total, 77.8% of the conservatively managed patients reported they would not have a chosen a skin graft if given the choice again.

This study shows that satisfactory healing of pretibial lacerations may be achieved without surgical intervention in a high-risk group of patients, who reported good overall performance during healing time.

Blunt chest wall trauma is commonly recognised as a significant source of acute pain following injury but the longer term outcomes in this patient cohort are less well described. The aim of this pilot study was to investigate the incidence of chronic pain in patients with isolated blunt chest wall trauma, with or without rib fractures.

A short survey was completed over the phone, or as a postal survey. The emergency department medical records and hospital database were used to obtain the demographic data, including patient age, pre-existing conditions, trauma sustained, hospital and intensive care unit length of stay, mechanical ventilation days and mortality. Patients’ demographics were analysed using descriptive statistics and Mann–Whitney U and Fisher’s exact tests for comparison of variables.

A total of 100 patients were admitted to hospital with isolated blunt chest wall trauma in 2014, with 67 patients eligible for inclusion in the study; 40 patients responded to the survey (60% response rate). Chronic pain was reported in 14 (35%) patients with a median pain severity score of 6 out of 10 (IQR: 3–7). The only significant predictor of chronic pain was if the patient’s mechanism of injury was an assault.

The results of this pilot study have demonstrated that a high percentage of isolated blunt chest wall trauma patients suffer chronic pain at six months or more post-injury. Assault was the only predictor of chronic pain. Further prospective studies are required to evaluate the long-term outcomes following blunt chest wall trauma.

Trauma is a major burden on the healthcare system of Chicago with greater than 9000 major injuries annually. If fluctuations in trauma could be predicted by ecologic variables, more effective allocation of hospital and pre-hospital resources could be achieved.

The Illinois Trauma Registry was retrospectively analyzed to investigate several group-level factors potentially related to the incidence of major traumatic injury from 1999 through 2009. Univariate and multivariate linear regression analyses evaluated the effects of weekday, maximum daily temperature, rain, snow, and major holidays on daily trauma incidence.

A total of 107,546 trauma admissions occurred during the study period and were included in the analysis. Time of day (peak hours 22:00 to 02:00, odds ratio (OR) 2.66), weekday (OR 1.27 for Friday and Saturday), mean daily temperature, rain, snow, and four holidays were found to be associated with differential risks of trauma. Martin Luther King, Jr. day was protective, with OR 0.86; Independence Day, Halloween, and New Years Eve all experienced higher trauma burdens than monthly, weather-weighted averages.

Several ecologic variables were found to be associated with the incidence of traumatic injury in Chicago, accounting for 40.0% of the daily variance. These results will help inform staffing decisions.

Retained intraocular foreign body (IOFB) is a specific subgroup of open globe injury which is often preventable with appropriate use of eye protection. We describe the spectrum of injuries resulting in IOFB, outcomes and complications following vitrectomy surgery and context specific risk factors which may influence outcomes at our hospital.

Retrospective cohort study of 43 consecutive cases of IOFB that underwent vitrectomy surgery.

The median age was 34.6 years and 95.3% were male. The presenting visual acuities ranged from 6/6 (LogMAR 0.00) to Perception of Light (PL) with a median of Hand Motions (HM) (Interquartile Range (IQR) 6/24-HM). Hammering metal was the most common cause of injury (44.2%); 72% of injuries occurred while performing premeditated high-risk activities. The foreign body was metallic in 76.7% of cases and penetrated the cornea in 69.8% of cases. Lens injury occurred in 65.1%. The retina was impacted in 36 cases (83.7%), four of which impacted the macula. Macula impact was associated with poor visual outcome (p = 0.049, Fisher’s exact). Four cases (9.3%) had endophthalmitis. The median final visual acuity was 6/24 (IQR 6/9–6/60). Visual acuity improved in 63.4.0%. Ten cases (23.8%) were worse than 3/60. Better presenting vision was associated with better visual outcomes (p = 0.049, Fisher’s exact). The Ocular Trauma Score predicted outcomes well in better prognosis categories but underestimated final visual outcomes in the poor prognosis category. Central corneal scarring contributed to reduced visual outcomes.

The majority of IOFB injuries are preventable with appropriate use of eye protection. Visual outcomes are better than other causes of open globe injury. Resource constraints contribute to suboptimal final visual outcomes.