Radiographic Outcome of Unstable Distal Radial Fracture Treated by Closed Reduction and Pin in Plaster

Background There is controversy about the appropriate treatment for severely displaced and unstable comminuted fracture of distal radius (type C of AO or OTA classification). Recently, there has been an increase in the number of predilection for surgical management of this fracture. Aim To determine the radiographic outcome in type C fractures of the distal radius treated with closed reduction and pin in plaster. Materials and Methods Eighty consecutive patients 60 male and 20 female, average age 40 years (22–60 years), with type C fractures of the distal radius seen between February 2001 and July 2003 in Shahid Kamiab Hospital of Mashad University, were treated by closed reduction and pin in plaster, followed up by anteroposterior and lateral radiographs to evaluate radial height, inclination and volar tilt. Results There was significant improvement in the measurements of radial height, inclination and volar tilt after closed reduction and pin in plaster, and at the time the pins and plaster were removed. (P = 0.00). Conclusion Closed reduction and pin in plaster is an effective, simple and low cost method in type C fractures of distal radius with satisfactory outcome.

Risk for Repeat Emergency Department Visits for Violent Injuries in Youth Firearm Victims

Objective To identify significant risk factors associated with repeat emergency department (ED). Visits for violent injuries in youth firearm victims. Methods The study subjects of this retrospective cohort study were firearm victims aged 18 and younger presenting to a Pediatric Emergency Department/Trauma Center at Children's Hospital of Wisconsin between 1990 and 1995. The primary outcome was subsequent Emergency Department visits (REDV) at any emergency department in Milwaukee for a violent injury. Results A total of 495 subjects were eligible for the present study in the pediatric firearm victim's ED visit database. Eighty-five percent (n = 420) were males and 82% were African-Americans. Mean age was 15 years old (s.d = ±3.6). A majority of them had a single-parent family. Eighty-eight subjects (17.8%) had a prior history of ED visit due to violence. During the study time, 201 subjects had at least one REDV. In the multivariable model, a subject without a social worker consulting at the hospital were more likely to have REDV compared to subjects with a social worker consulting (O.R = 1.749; p-value = 0.047), controlling for guardian and disposition. Subjects disposed to detention center or police custody were more likely to have REDV compared to subjects disposed to home or a hospital (O.R = 5.351; p-value = 0.003). Conclusion Our analysis indicates that individuals with guardians, those who did not receive social worker intervention on their initial visit, and those discharged in police custody were associated with increased repeat ED visits due to a violent injury.

Interhospital Transfer of Acute Trauma Patients: How Long Does it Take and how is the Time Spent?

Background Trauma patients in rural areas are frequently transferred to regional trauma centers for expeditious evaluation and management of potentially life-threatening injuries. We sought to characterize how long the process takes, once it has begun, for acutely injured patients to be transferred from emergency departments (EDs) of referring hospitals to trauma centers and how the time is spent. Methods We conducted a retrospective multi-institutional case series study. We reviewed records of acutely injured trauma patients transferred from the EDs of 114 outlying hospitals to the EDs of three Level I or II regional trauma centers over a 12–24 month period. We calculated the duration of the transfer process and its component time intervals (reported as the mean ± standard deviation). Results Among 1099 patients transferred from 114 referring hospitals, the mean Injury Severity Score was 11.6. Mortality was 5.9%. Half of all transfers were by ground ambulance, 36% by helicopter, and 13% by airplane. The mean time from patient presentation at the ED of the referring hospital until transfer request was 126 ± 94 min, and the mean time from transfer acceptance until arrival at the trauma center was an additional 119 ± 60 min. The mean time from transfer acceptance to departure of the patient from the ED of the referring hospital was 68 ± 48 min. Transportation time accounted for 48 ± 29 min, or 40% of the total time between transfer acceptance and arrival at the accepting hospital. Conclusions Interhospital transfer of acutely injured trauma patients takes a substantial amount of time even after acceptance of the patient, and actual time spent in transportation accounts for only 40% of the time from transfer acceptance to arrival of the patient at the receiving hospital, on average. Efforts to speed transfers should focus on shortening the time from transfer acceptance to departure from the referring hospital.

Surgical Removal of a Knotted Intravascular Pulmonary Artery Catheter

A pulmonary artery (PA) catheter was placed in a 60-year-old patient with congestive heart failure, undergoing lumbar spinal surgery. In the prone position, no wedge pressure wave could be obtained, and multiple attempts at repositioning were unsuccessful. Fluoroscopy showed a catheter knot in the right internal jugular vein, which was removed surgically through the original venotomy site. The knot was thought to be caused by excessive manipulation at too great an insertion depth, with low cardiac output. We conclude it is important to follow the guidelines for PA catheter placement, using step-wise gentle manual attempts. If knotted, radiological interventions and surgical extrication must be considered.