Intra-articular Hematoma Block Compared to Procedural Sedation for Closed Reduction of Ankle Fractures.

Background: Initial treatment for a displaced ankle fracture is closed reduction and splinting. This is typically performed in conjunction with either an intra-articular hematoma block (IAHB) or procedural sedation (PS) to assist with pain control. The purpose of this study was to compare the safety of IAHB to PS and evaluate the efficiency and efficacy for each method.

Surgical Coaching from Head-Mounted Video in the Training of Fluoroscopically Guided Articular Fracture Surgery.

Background: The evolving surgical skills education paradigm in orthopaedics has generated a strong demand for validated educational tools and methodologies. This study aimed to confirm that a one-on-one faculty coaching review of the head-mounted video recording of a resident's surgical performance on a validated articular fracture simulation trainer would substantially improve subsequent performance.

Methods: Fifteen first-year or second-year orthopaedic surgery residents reduced and fixed a standardized intra-articular tibial plafond fracture model under fluoroscopic guidance.

Outcomes after operative management of symptomatic rib nonunion.

Objective: To report the outcomes of rib reconstruction after painful nonunion.

Design: Retrospective case series.

Setting: Level I trauma center.

Injuries to the ankle syndesmosis.

➤ Despite being common, syndesmotic injuries are challenging to diagnose and treat.➤ Anatomic reduction of the ankle syndesmosis is critical for good clinical outcomes.➤ Intraoperative three-dimensional radiography and direct syndesmotic visualization can improve rates of anatomic reduction.

The effect of early operative stabilization on late displacement of zone I and II sacral fractures.

Introduction: This study was designed to evaluate the effect on displacement of early operative stabilization on unstable fractures when compared to stable fractures of the sacrum.

Methods: Patient consisted of those sustaining traumatic pelvic fractures that also included sacral fractures of Denis type I and type II classification, who were over 18 at the time of the study. Patients were managed emergently, as judged appropriate at the time and then subsequently divided into two cohorts, comprising those who were either treated operatively or non-operatively.

Bleeding disorders in orthopedic surgery.

With increasing recognition of the complications related to coagulopathies, it is of paramount importance for all orthopedic surgeons to possess a basic knowledge of common bleeding disorders. The evaluation of the coagulopathic patient requires a careful history, physical examination, and laboratory evaluation. Bleeding disorders commonly include quantitative and qualitative platelet and coagulation factor disorders and coagulation inhibitors.

Equivalence considerations for orally inhaled products for local action-ISAM/IPAC-RS European Workshop report.

The purpose of this article is to document the discussions at the 2010 European Workshop on Equivalence Determinations for Orally Inhaled Drugs for Local Action, cohosted by the International Society for Aerosols in Medicine (ISAM) and the International Pharmaceutical Consortium on Regulation and Science (IPAC-RS). The article summarizes current regulatory approaches in Europe, the United States, and Canada, and presents points of consensus as well as ongoing debate in the four major areas: in vitro testing, pharmacokinetic and pharmacodynamic studies, and device similarity. Specific issues in need of further research and discussion are also identified.

Low complication rate associated with raising mature flap for tibial nonunion reconstruction.

Background: Tibia fractures may require soft tissue coverage with transposed tissue and can develop nonunions. Tibial defects can be approached with a posterolateral approach or by elevating the previously transposed tissue. No literature has previously reported the efficacy or safety of the latter approach.

Operative treatment of chest wall injuries: indications, technique, and outcomes.

Most injuries to the chest wall with residual deformity do not result in long-term respiratory dysfunction unless they are associated with pulmonary contusion. Indications for operative fixation include flail chest, reduction of pain and disability, a chest wall deformity or defect, symptomatic nonunion, thoracotomy for other indications, and open fractures. Operative indications for chest wall injuries are rare.

Medical clearance risk rating as a predictor of perioperative complications after total hip arthroplasty.

Hip arthroplasty has become the standard treatment of end-stage osteoarthritis. However, postoperative complications are the risks associated with joint arthroplasty, which most significantly impact patient results and the total cost of care. Currently, no predictive system has been developed for categorizing levels of risk for the development of postoperative complications in patients undergoing total hip arthroplasty.

Can we predict successful completion of the common foundation programme at interview?

Aim: To gain an understanding of patterns of retention and attrition for student nurses on the diploma of higher education (DipHE)/bachelor of science (B.Sc.) (adult) on completion of the common foundation programme (CFP=year 1 of the programme).

Stress radiographs in orthopaedic surgery.

Stress radiographs are useful in determining the amount of ligamentous laxity present following trauma. The results may be helpful in determining diagnosis, surgical indications, and the type and timing of rehabilitation. Some techniques for obtaining stress radiographs involve specific patient positioning or manually applied force; others require use of a particular testing device.

Can an interview score sheet assist with student selection onto the bachelor of science/diploma of higher education (adult) nursing programme? Findings from a pilot study.

Aim: To develop an interview score sheet (ISS) to assist with the selection of student nurses on the Bachelor of Science (B.Sc.)/Diploma of Higher Education (DipHE) (Adult).

Quality of life, survivorship, and psychosocial adjustment of young women with breast cancer after breast-conserving surgery and radiation therapy.

Purpose/objectives: To examine changes in quality of life (QOL), psychosocial adjustment, and survivorship issues over time of women younger than 45 years who underwent breast-conserving surgery and radiation therapy (RT) for breast cancer.

Design: Repeated measures, longitudinal design.

Methods: Data were collected at four time points: start of RT, midpoint of RT, end of RT, and six months after RT.

Lichtenstein inguinal hernia repair in a primary healthcare setting.

Background: Given the generally accepted poor outcome of inguinal hernia repair when using nylon darn, and the recent interest in low-tension mesh repair, an attempt was made to demonstrate the feasibility, outcome and patient perception of providing Lichtenstein inguinal hernia repair, using local anaesthesia, wholly within the primary healthcare sector.

Methods: A prospective study reviewed clinical outcome and patient perception in 100 adults referred with inguinal hernia only. No selection was made regarding age, sex, American Society of Anesthesiologists status or previous repairs.

Balancing the curriculum: promoting aesthetic knowledge in nursing.

The view of nursing as both art and science is widely held within the profession; however, this belief is not reflected in nurse education where the artistic aspects of nursing practice continue to be overshadowed by the emphasis on the scientific, the technical and the objective. It is suggested that nursing knowledge can be considered within four fundamental types or patterns of knowledge: empirical, aesthetic, personal and moral, each interrelated and interlinked, with aesthetic knowledge argued to encompass the art of nursing. Nursing's dual identity as an art and science arguably requires a balance within the curriculum, therefore the promotion and acquisition of aesthetic knowledge seems a desirable aim.

Mental health problems on Operation Resolute (Bosnia).

Mental health problems have been studied in a total of 2201 consultations with British troops in a primary health care practice on Operation Resolute (Bosnia) from 1 January to 31 March 1996. About one in 40 (2.5%) of the consultations were for mental health problems; Post Traumatic Stress Disorder (PTSD), depressive disorder, and grief reaction were the most common disorders, followed by acute adjustment reaction and panic disorder.

Management of foreskin problems.

One hundred consecutive cases of boys with foreskin problems referred to local paediatric surgeons in the Edinburgh area were studied. Fifty five underwent circumcision and the remainder were managed more conservatively with or without the use of local or general anaesthetic. Although sometimes avoiding general anaesthetic, the more conservative methods involved more frequent visits to the clinic, a larger number of complications, and a longer follow up period.

Repair of coronal and subcoronal hypospadias: an 8-year retrospective study.

Twenty-three patients undergoing treatment for coronal and subcoronal hypospadias over an 8-year period were reviewed. A ventral skin tube inlay graft was used in all cases, and a comparison made between Nesbitt's button hole technique and three other procedures used for ventral skin cover. The button hole procedure was associated with fewer fistulae and provided acceptable cosmesis.