Male adolescent with cardiac rupture after blunt thoracic trauma.

Blunt cardiac injury, including a rupture of the atria or ventricle, is most commonly caused by motor vehicle collisions and falls from great heights. A rupture of a cardiac chamber is an extremely rare diagnosis with a high mortality rate. The best chance at survival can only be accomplished with timely intervention.

Complications in the Treatment of Delayed Union and Underlying Chronic Osteomyelitis After Right Crural Fracture Treated With Anterolateral Thigh Flap and Double-Barrelled Vascularized Fibula Graft.

Background: Segmental bone defects pose a major, unsolved clinical challenge and may be the result of high-energy trauma, infection, and tumour resection or revision surgery. Several options exist to reconstruct, including Ilizarov bone transport, Masquelet technique, cylindrical mesh technique, allografts, and vascularized bone autografts. We present a patient with a delayed union of the tibia with concomitant chronic osteomyelitis treated with anterolateral thigh (ALT) flap and double-barrelled vascularized fibula graft.

[Conservative treatment of scaphoid fractures].

Considering that pseudoarthrosis, or non-union, often occurs in patients with scaphoid fractures it is very important to start adequate treatment as soon as possible. On the basis of the literature, we advise immobilisation in a below-elbow cast, whereby the thumb is not immobilised and the wrist is in a slightly extended position. Despite the fact that non-dislocated fractures, at the very least, are usually consolidated within 4 weeks, we advise an immobilisation period of 6 weeks followed by clinical or radiological evaluation.

Correction to: Differences in Characteristics and Outcome of Patients with Penetrating Injuries in the USA and the Netherlands: A Multi-institutional Comparison.

In the original article Dennis Den Hartog's name was tagged incorrectly. It is correct as reflected here.

Patient-reported outcomes after a distal radius fracture in adults: a 3-4 years follow-up.

Background and purpose - There are few reports on the outcome of distal radius fractures after 1 year. Therefore we investigated the long-term patient-reported functional outcome and health-related quality of life after a distal radius fracture in adults. Patients and methods - We reviewed 823 patients, treated either nonoperatively or operatively in 2012.

Is there a need for standardized postoperative radiographs after operative treatment of wrist or ankle fractures?

Purpose: The purpose of this study was to evaluate the frequency of changes in treatment plan due to standardized postoperative radiographs. A secondary aim was to compare our results with a national benchmark.

Methods: This is a single-center retrospective case series of 167 consecutive patients, operated with open reduction and internal fixation (ORIF) for distal radius or ankle fractures in 2014.

Differences in Characteristics and Outcome of Patients with Penetrating Injuries in the USA and the Netherlands: A Multi-institutional Comparison.

Introduction: The incidence and nature of penetrating injuries differ between countries. The aim of this study was to analyze characteristics and clinical outcomes of patients with penetrating injuries treated at urban Level-1 trauma centers in the USA (USTC) and the Netherlands (NLTC).

Methods: In this retrospective cohort study, 1331 adult patients (470 from five NLTC and 861 from three USTC) with truncal penetrating injuries admitted between July 2011 and December 2014 were included.

Inter-observer agreement between 2-dimensional CT versus 3-dimensional I-Space model in the Diagnosis of Occult Scaphoid Fractures.

Background: The I-Space is a radiological imaging system in which Computed Tomography (CT)-scans can be evaluated as a three dimensional hologram. The aim of this study is to analyze the value of virtual reality (I-Space) in diagnosing acute occult scaphoid fractures.

Methods: A convenient cohort of 24 patients with a CT-scan from prior studies, without a scaphoid fracture on radiograph, yet high clinical suspicion of a fracture, were included in this study.

Clinical evaluation vs magnetic resonance imaging of the skier's thumb: A prospective cohort of 30 patients.

Introduction: A skiers thumb, or a partial or complete rupture of the ulnar collateral ligament (UCL) is a clinical diagnosis. Swelling, pain, natural left-right difference and inexperience of a young physician can cause difficulty to correctly diagnose this injury. However, our theory is that any physician, given the correct instructions, should be able to diagnose this injury solely on clinical findings, without the necessity of additional imaging.

Unscheduled return visits to a Dutch inner-city emergency department.

Background: Unscheduled return visits to the emergency department (ED) may reflect shortcomings in care. This study characterized ED return visits with respect to incidence, risk factors, reasons and post-ED disposition. We hypothesized that risk factors for unscheduled return and reasons for returning would differ from previous studies, due to differences in health care systems.

Fracture prevalence during an unusual period of snow and ice in the Netherlands.

Background: The objective of the current study was to assess the effect of an unusual 10-day snow and ice period on the prevalence of fractures in an emergency department (ED) in the Netherlands. Furthermore, patients with fractures during the snow and ice period were compared to those in the control period with respect to gender, age, location of accident, length of stay, disposition, and anatomical site of the injury.

Methods: Fracture prevalence during a 10-day study period with snow and ice (January 14, 2013 until January 23, 2013) was compared to a similar 10-day control period without snow or ice (January 16, 2012 until January 25, 2012).

[Skier's thumb].

Skier's thumb is a partial or complete rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. It is an injury that rather frequently occurs in certain sports. When diagnosed incorrectly, delay in treatment can ultimately lead to chronic instability and pain.

Walkouts from the emergency department: characteristics, reasons and medical care needs.

Objectives: The aim of this study was to assess the walkout rate and to identify influencing patient and visit characteristics on walkout. Furthermore, we assessed the reasons for leaving and medical care needs after leaving.

Methods: In a 4-month population-based cohort study, the characteristics and influencing factors of walkout from two emergency departments in the Netherlands were studied.

[An occult fracture of the capitate bone].

Background: Evaluating patients with wrist injuries is diagnostically challenging. Physical examination alone is not sufficient for establishing a diagnosis and fractures of the wrist region are not always visible on x-rays.

Case Description: In this article, we present a case of a patient who had sustained trauma to the wrist and was taken care of at the emergency department.

Rupture of the ulnar collateral ligament of the thumb - a review.

Skier's thumb is a partial or complete rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. It is an often-encountered injury and can lead to chronic pain and instability when diagnosed incorrectly. Knowledge of the anatomy and accurate physical examination are essential in the evaluation of a patient with skier's thumb.

Is there a need for a clinical decision rule in blunt wrist trauma?

Background: Blunt wrist trauma is a very common injury in emergency medicine. However, in contrast to other extremity trauma, there is no clinical decision rule for radiography in patients with blunt wrist trauma.

Objective: The purpose of this study is to describe current practice and to assess the need and feasibility for a clinical decision rule for radiography in patients with blunt wrist trauma.

Interobserver variability among radiologists for diagnosis of scaphoid fractures by computed tomography.

Purpose: To determine the interobserver variability among radiologists for computed tomography (CT) diagnosis of scaphoid fractures.

Methods: Four specialized musculoskeletal radiologists evaluated the CT scans of 150 consecutive patients who were clinically suspected of having sustained a scaphoid fracture but whose scaphoid-specific radiographs were normal. The radiologists were asked to determine the presence or absence of a scaphoid fracture and to localize the fracture.

Current methods of diagnosis and treatment of scaphoid fractures.

Fractures of the scaphoid bone mainly occur in young adults and constitute 2-7% of all fractures. The specific blood supply in combination with the demanding functional requirements can easily lead to disturbed fracture healing. Displaced scaphoid fractures are seen on radiographs.

Early computed tomography compared with bone scintigraphy in suspected scaphoid fractures.

Purpose: This study examined whether multidetector computed tomography (CT) is superior to bone scintigraphy for diagnosis of an occult scaphoid fracture.

Methods And Materials: In a study period of 22 months, 100 consecutive patients with a clinically suspected scaphoid fracture and no fracture on scaphoid radiographs, were evaluated with CT within 24 hours after injury and bone scintigraphy between 3 and 5 days after injury. The reference standard for a true (radiographic occult) scaphoid fracture was either (1) diagnosis of fracture on both CT and bone scintigraphy or (2) in case of discrepancy, clinical and/or radiographic evidence of a fracture during follow-up.

[A woman with a painful shoulder and cold hand].

A 65-year-old woman presented with a left-sided humeral fracture and a cold hand, caused by a dissection of her axillar artery. She was treated conservatively and perfusion recovered spontaneously.

Non-operative treatment of non-displaced scaphoid fractures may be preferred.

Aim: To evaluate the outcome of non-displaced scaphoid fractures treated with 6 weeks of cast immobilisation, and to establish whether the benefits of non-operative treatment might outweigh those of early operation.

Methods: A retrospective study analysed 89 consecutive cases of scaphoid fracture treated at our institution between 2004 and 2007. Diagnosis and treatment methods and complication rates were evaluated.