RESUMEN
Treatment of slipped upper femoral epiphysis (SUFE) is directed at preventing progressive slippage, minimizing deformity and avoiding avascular necrosis and chondrolysis. Delay in treatment adversely affects long-term outcomes. In a retrospective study we assessed delays between symptom onset and evaluation of the patient in an orthopaedic department. 27 patients aged 10-16 years were grouped by source of referral (general practitioner or accident and emergency department), and hips were classified as stable or unstable according to ability to bear weight. The 27 children had 37 affected hips, 31 stable and 6 unstable. In the 20 patients referred by general practitioners, mean delay from symptom onset to orthopaedic evaluation was 119 days (range 2-504); in the 7 referred from accident and emergency departments it was 95 days (1-482). In the latter group the slips were more likely to be acute and unstable. 9 (45%) of the patients in the general-practitioner group had hip radiography before referral, all correctly diagnosed though not all the examinations included the recommended frog-lateral views. Long delays between onset and diagnosis of SUFE are most likely in patients with mild symptoms, able to bear weight on the hip. Any adolescent with undiagnosed hip or knee pain that has lasted more than a week should undergo radiological investigation of the hip, with frog-lateral as well as anteroposterior views.
Asunto(s)
Errores Diagnósticos/estadística & datos numéricos , Epífisis Desprendida/diagnóstico , Adolescente , Niño , Epífisis Desprendida/diagnóstico por imagen , Femenino , Fémur/diagnóstico por imagen , Humanos , Masculino , Radiografía , Derivación y Consulta , Estudios Retrospectivos , Factores de TiempoRESUMEN
All patients involved in motorcycle crashes admitted to various hospitals in the Yorkshire region of UK between January 1993 and December 1999 were retrospectively reviewed to identify the factors that are likely to predict a reduced survival. Of the 1239 patients requiring hospital admission, 74 died. The probability of reduced survival was estimated by a logistic regression model using independent variables such as head injury, thoracic trauma, abdominal injury, spinal injury and pelvic fracture and a compound variable of pelvic fracture combined with a long bone fracture. The odds ratio for head injury was 0.349, chest injury 0.39, abdominal injury 0.42, and the compound variable (pelvis plus a long bone fracture) 0.576. The mean injury severity score (ISS) in the fatal group was 35.96 compared to 12.2 in the group that survived (P<0.01). There was a significant difference in the Glasgow coma scale (GCS) between patients wearing a helmet and those that did not wear any protective headgear (P=0.0007). Head injury followed by chest and abdominal trauma were found to predict a reduced survival rate. Use of helmets should continue to be compulsory. Chest and abdominal injuries should be diagnosed and treated early to reduce mortality.
Asunto(s)
Accidentes de Tránsito/mortalidad , Motocicletas , Heridas y Lesiones/etiología , Traumatismos Abdominales/etiología , Traumatismos Abdominales/mortalidad , Adulto , Traumatismos Craneocerebrales/etiología , Traumatismos Craneocerebrales/mortalidad , Inglaterra/epidemiología , Femenino , Fracturas Óseas/etiología , Fracturas Óseas/mortalidad , Humanos , Puntaje de Gravedad del Traumatismo , Modelos Logísticos , Masculino , Oportunidad Relativa , Pronóstico , Estudios Retrospectivos , Traumatismos Vertebrales/etiología , Traumatismos Vertebrales/mortalidad , Tasa de Supervivencia , Traumatismos Torácicos/etiología , Traumatismos Torácicos/mortalidad , Heridas y Lesiones/mortalidadAsunto(s)
Anticoagulantes/efectos adversos , Hematoma/inducido químicamente , Hematoma/diagnóstico , Cadera , Dolor/inducido químicamente , Dolor/diagnóstico , Músculos Psoas , Warfarina/efectos adversos , Accidentes por Caídas , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Cadera/efectos adversos , Femenino , Hematoma/cirugía , Humanos , Relación Normalizada Internacional , Masculino , Persona de Mediana Edad , Dolor/cirugía , Factores de Riesgo , Factores de Tiempo , Tomografía Computarizada por Rayos X , Trombosis de la Vena/tratamiento farmacológicoRESUMEN
Ulnar collateral ligament rupture of the thumb is a relatively common injury that is often missed in the emergency department. This in combination with an interphalangeal joint dislocation of the ipsilateral thumb is rare and we report such a case. The importance of looking specifically for an associated ulnar collateral ligament laxity in any injury to the thumb is highlighted. The force producing a combination of ulnar collateral ligament rupture with ipsilateral simultaneous injury to the thumb is often severe enough to cause complete rupture of the ligament, necessitating open repair.