We remember the military medical practice of Croatian surgeon, Vatroslav Florschütz (1879-1967), known for his invention of the traction frame for repositioning bone fracture fragments of the upper and lower extremities. The method, known as the Balkan frame / beam or Balkan splint, was introduced and published in 1911 and used in war medicine thereafter. The memory of this invention adds to our orthopaedic heritage and sheds light on its creator working under the most demanding war circumstances. On the occasion of the 100th anniversary of the outbreak of World War I, reminiscence of Florschütz's war experience, his orthopaedic innovation and other innovations contributes to our understanding of human efforts to save lives and restore bodily function of the wounded during wars.
AIMS AND OBJECTIVES. The aim of this study was to describe characteristics in burn injuries in children (zero to six years old), consulting primary care and hospital-based care in Malmö, Sweden. Burn-injured children consulting the University Hospital or the 21 Health Centres, during year 1998 and year 2002, were included. BACKGROUND. Epidemiological studies of burns in children have mostly been hospital-based and the cases that never reached the hospital have been excluded. DESIGN. The study had a retroperspective design with data collected from medical records. METHODS. Chi-squared test was used to analyse differences in nominal data and cross tables were used to analyse the proportions between the characteristics of the injuries and sex, age and nationality. RESULTS. The burn-injured children were 148 and 80% of those were scalds, caused by hot liquid (71%) or hot food (29%). The greatest number was boys between one and two years old. Children to foreign born parents were more frequently affected and the extent of the injuries often larger. Almost all the accidents (96%) occurred in home environment, while a family member was next to the child. The Health Centres received more often children affected on hand/arm and by causes like hot food than the University Hospital. CONCLUSIONS. Our data demonstrate the importance of developing a programme for the prevention of paediatric scalds with education of family members to be aware of the danger. With present study the knowledge about the occurrence of injuries in scald accidents in children has become deeper. This knowledge may contribute to more individual adept child accident prevention programme, to use in the child health care.
Treatment of the patients with gunshot fractures of extremity long bones is one of the main problems of field surgery. The complex study of medical records obtained from 718 servicemen with gunshot fractures of extremity long bones who participated in counter-terrorist operation in the Republic of Chechnia (1994-1996) allowed to evaluate character and severity of the injuries, content of the treatment measures conducted at the stages of medical evacuation. The peculiarities of fighting trauma were the following: the high frequency of combined (22.5%) and multiple (25.9%) injuries, the high share of multi-fragmentation and splintered (76.4%), intra-articular fractures (17.3%), the primary defects of bones (7.1%) and soft tissues (4.8%), the injuries of main vessels (12.1%) and nerves (18.5%). Owing to the short periods of evacuation to the stage of specialized medical care (up to 18.2 +/- 5.3 h), high share of preserving variant of primary surgical treatment (82.3%); high quality of medical immobilization at the expense of wide introduction of functionally stable external osteosynthesis (51.2% of the casualties) it was possible to improve the treatment results.
At the burn centre in Donetsk, from 1979 to 1988, 236 sufferers with a III-IV degree frostbite of the extremities were treated. Operated on were 189 patients, who underwent necrectomy, amputation of the extremity and different types of skin plasty. Of these patients, 49.8% were recognized as invalids. After 1-10 years, all the patients after a III-IV degree frostbite of the extremities make complaints, require different types of treatment, 38.9%--the operative one. For timely and qualitative rehabilitation of this category of the sufferers, their prophylactic medical examination is necessary.
Despite the economic importance and hazardous nature of commercial logging in various regions, few medical studies have examined fatalities in this industry. Data derived from the files of the Ontario Chief Coroner's Office revealed 52 deaths, all men, from 1986 to 1991 in the province of Ontario. Forty-four cases were accidents (age range 20-73 years; average, 44 years), the majority involving experienced loggers. Personal error resulting in preventable unsafe work practices was a factor in most accidents (n = 35; 79.5%). Almost one half of injured workers were struck by either dead or cut trees. Although the majority of cases occurred in remote areas, delayed medical attention as a factor contributing to death was uncommon. Many of the injuries were nonsurvivable and most victims (n = 33; 75%) were dead at the scene. Most deaths were caused by either head and neck injuries (n = 20; 45.5%), multiple trauma (n = 10; 23%), chest trauma only (n = 6; 13.5%), or mechanical asphyxia (n = 5; 11%). Blood alcohol was negative in 24 accident victims tested. Eight deaths (age range 42-52 years; average, 49 years) were due to cardiac causes, mainly ischemic heart disease. Disease may have contributed to two accidents.
The applicability of the Visual Analogue Scale (VAS) has been questioned in the assessment of pain in the elderly. We compared VAS with three other pain scales, Verbal Rating Scale (VRS), Red Wedge Scale (RWS) and Box Scale (BS), in hip fracture patients.
VAS, VRS, RWS and BS were compared in 140 analysable patients undergoing surgery, 70 with hip fracture and 70 with other lower limb trauma. Pain scores were recorded once a day, repeated after 10 min, for 4 subsequent days starting pre-operatively. The primary endpoint was the rate of successful pain measurements in hip fracture patients and 90% was chosen as a sufficient level for an applicable pain scale.
Age was different between the groups (hip fracture 78 ± 11, other trauma 49 ± 11 years, P
The objective of this investigation was to determine the effect of wrist guard use on all upper-extremity injuries in snowboarders. This matched case-control study was conducted at 19 ski areas in Quebec, Canada. Cases were 1,066 injured snowboarders who reported upper-extremity injuries to the ski patrol during the 2001-2002 season. Controls were 970 snowboarders with non-upper-extremity injuries who were matched to cases on ski area and the nearest date, age, and sex, in that order. The response rate was 71.8% (73.5% for cases and 70.1% for controls). Cases were compared with controls with regard to wrist guard use. The prevalence of wrist guard use among snowboarders with hand, wrist, or forearm injuries was 1.6%; for those with elbow, upper arm, or shoulder injuries, it was 6.3%; and for controls, it was 3.9%. Thus, wrist guard use reduced the risk of hand, wrist, or forearm injury by 85% (adjusted odds ratio = 0.15, 95% confidence interval: 0.05, 0.45). However, the adjusted odds ratio for elbow, upper arm, or shoulder injury was 2.35 (95% confidence interval: 0.70, 7.81). These results provide evidence that use of wrist guards reduces the risk of hand, wrist, and forearm injuries but may increase the risk of elbow, upper arm, and shoulder injuries.
Over the past decade, the Firefighters' Burn Treatment Unit of the University of Alberta Hospital in Edmonton, Alberta, Canada, has treated 1399 inpatients suffering from thermal injury. Regional burn care is provided in a 10-bed intensive care unit with 18 plastic surgery reconstructive beds for a large referral region of central and northern Alberta, portions of the Northwest Territories, and neighboring provinces of British Columbia and Saskatchewan. Of the total burn inpatients during this period, 74 electrical injuries were treated (5.3% of all admissions): 71 were males (95.9%) and 3 females (4.1%). The mean age of all patients was 33.9 +/- 12.6 years (range 1-67). Compared to our general population of thermally injured patients, those with electrical injuries had smaller injuries [9.9 +/- 12.9% TBSA (range 1-65) versus 15.1 +/- 10.1], shorter length of hospitalization [18.6 +/- 7.3 days (range 1-80) versus 26.2 +/- 0.8], and substantially lower mortality once reaching the hospital (0% versus 4%). Electrical injuries were classified as flash in 30 cases, contact in 42 cases, and lightning in 2 cases; 74.3% of injuries occurred during work-related activities. A total of 118 operative procedures were performed during the acute admission (1.6 procedures per patient), including 19 amputations: 12 in the upper and 7 in the lower extremity. The mean time of amputation was 9.3 +/- 5.3 days after admission. In contact injuries of the upper extremity, 14 patients suffered amputations or neurologic injury that required reconstruction with free tissue transfers and nerve grafts. Long-term functional outcome of these patients using sensory testing, the Jebsen-Taylor hand function test, and wound coverage has revealed that these patients have substantial persistent sensory impairment of their upper extremities postinjury despite reconstruction, although many remain active and functional with acceptable wound coverage. Based on our analysis of electrical injury as it presents to one typical Canadian burn unit, our patients suffer limb loss on a delayed basis, which leads to substantial morbidity. Reconstruction of the upper extremity with microsurgical techniques after profound electrical injury has provided acceptable coverage, but in many instances is associated with poor or marginal sensory recovery limiting reemployment options for patients with upper extremity electrical burns. Further understanding of the cellular biology of delayed tissue loss after electric injury would offer the potential for reduction in amputation rate and improvement in functional outcome and overall morbidity.
A prospective study of 410 fractures seen in 398 children during 1 year was carried out. Fractures were more common on the left, and the upper extremities were more frequently injured than the lower extremities. The two commonest sites were the hand and the distal forearm. The radius was the bone most commonly fractured. Fifty-seven (13.9%) of the fractures involved epiphyses and 67 (16.3%) were torus fractures. Of the 398 patients 236 were males. There was a slightly increased incidence of fractures in the summer months and in older patients.