Early mobilisation versus plaster immobilisation of simple elbow dislocations: Results of the FuncSiE multicentre randomised clinical trial

Background/aim To compare outcome of early mobilisation and plaster immobilisation in patients with a simple elbow dislocation. We hypothesised that early mobilisation would result in earlier functional recovery. Methods From August 2009 to September 2012, 100 adult patients with a simple elbow dislocation were enrolled in this multicentre randomised controlled trial. Patients were randomised to early mobilisation (n=48) or 3 weeks plaster immobilisation (n=52). Primary outcome measure was the Quick Disabilities of the Arm, Shoulder, and Hand (Quick-DASH) score. Secondary outcomes were the Oxford Elbow Score, Mayo Elbow Performance Index, pain, range of motion, complications and activity resumption. Patients were followed for 1 year. Results Quick-DASH scores at 1 year were 4.0 (95% CI 0.9 to 7.1) points in the early mobilisation group versus 4.2 (95% CI 1.2 to 7.2) in the plaster immobilisation group. At 6 weeks, early mobilised patients reported less disability (Quick-DASH 12 (95% CI 9 to 15) points vs 19 (95% CI 16 to 22); p<0.05) and had a larger arc of flexion and extension (121° (95% CI 115° to 127°) vs 102° (95% CI 96° to 108°); p<0.05). Patients returned to work sooner after early mobilisation (10 vs 18 days; p=0.020). Complications occurred in 12 patients; this was unrelated to treatment. No recurrent dislocations occurred. Conclusions Early active mobilisation is a safe and effective treatment for simple elbow dislocations. Patients recovered faster and returned to work earlier without increasing the complication rate. No evidence was found supporting treatment benefit at 1 year

Functional treatment versus plaster for simple elbow dislocations (FuncSiE): a randomized trial

Background. Elbow dislocations can be classified as simple or complex. Simple dislocations are characterized by the absence of fractures, while complex dislocations are associated with fractures. After reduction of a simple dislocation, treatment options include immobilization in a static plaster for different periods of time or so-called functional treatment. Functional treatment is characterized by early active motion within the limits of pain with or without the use of a sling or hinged brace. Theoretically, functional treatment should prevent stiffness without introducing increased joint instability. The primary aim of this randomized controlled trial is to compare early functional treatment versus plaster immobilization following simple dislocations of the elbow. Methods/Design. The design of the study will be a multicenter randomized controlled trial of 100 patients who have sustained a simple elbow dislocation. After reduction of the dislocation, patients are randomized between a pressure bandage for 5-7 days and early functional treatment or a plaster in 90 degrees flexion, neutral position for pro-supination for a period of three weeks. In the functional group, treatment is started with early active motion within the limits of pain. Function, pain, and radiographic recovery will be evaluated at regular intervals over the subsequent 12 months. The primary outcome measure is the Quick Disabilities of the Arm, Shoulder, and Hand score. The secondary outcome measures are the Mayo Elbow Performance Index, Oxford elbow score, pain level at both sides, range of motion of the elbow joint at both sides, rate of secondary interventions and complication rates in both groups (secondary dislocation, instability, relaxation), health-related quality of life (Short-Form 36 and EuroQol-5D), radiographic appearance of the elbow joint (degenerative changes and heterotopic ossifications), costs, and cost-effectiveness. Discussion. The successful completion of this trial will provide evidence on the effectiveness of a functional treatment for the management of simple elbow dislocations. Trial Registration. The trial is registered at the Netherlands Trial Register (NTR2025)

Management and outcome of burn injuries during pregnancy: A systematic review and presentation of a comprehensive guideline

Pregnant women are a vulnerable subgroup of burn patients, due to altered physiological state and possible adverse effect on the fetus. The aim of this study was to develop a guideline for a tailored treatment of pregnant patients with burns to optimally treat both mother and fetus. This study consists of two parts: the first part contains a systematic review that presents a comprehensive overview of the literature on the management and outcome of pregnant women who sustain severe burn injuries and based on the results of this review, a guideline on the general, obstetric and burn management was developed and presented in the second part. A total of 35 studies including 1395 patients were included. Although the clinical outcomes seemed to be similar to non-pregnant patients, one study showed that mortality might be higher in the pregnant population. Predictive factors for maternal and fetal mortality were a total burned surface area of over 40% and inhalation injury. Early surgery may lead to a higher chance of survival of mother and fetus. A comprehensive guideline on the general management of pregnant patients with burns, obstetric management and specific burn management is provided. We encourage international burn organizations and guideline committees to use and evaluate the presented guideline

Ruptuur van de tibialis-anteriorpees: Een case report en overzicht van de literatuur

Subcutaneous rupture of the tendon of tibilais anterior is a very rare injury. Because relatively few patients have been recorded there is a lack of awareness of the condition and late diagnosis is common. In this case report a patient with a subcutaneous rupture is described and relevant literature is reviewed, concerning the clinical features, diagnostic entities and choice for conservative or surgical treatment

Employment Relations in Indonesia’s Retail Sector: Institutions, Power Relations and Outcomes

This thesis examines employment relations in Indonesia’s retail sector. Drawing on the disciplines of Political Economy, Economic Geography and Industrial Relations, it investigates the relationship between global retail and home and host country institutions in order to identify the factors responsible for the converging and diverging patterns in employment outcomes. The thesis develops an actor-centred institutionalist approach, which extends the utility of embeddedness theory by taking into account the impact of contestation between trade unions and corporate actors in multiple institutional arenas on firm-level industrial relations and employment outcomes. Using in-depth comparative case study methods, this approach is applied to a European retailer, an Asian transnational retailer and a prominent domestic retailer in the food industry. The thesis demonstrates that country-of-origin effect has little influence on firm-level employment relations in the Indonesian retail sector. Rather, similarities in the organization of work, skill formation and baseline remuneration in the three retailers are a consequence of product market pressure and regulatory and institutional constraints, while differences in job security and the distribution of wages and benefits stem from organized labour’s differential capacity to challenge the prerogative of management in each firm. As these findings suggest, while embeddedness theory provides useful insights into the behaviour and strategy of transnational retailers, its utility is greatly enhanced when it is combined with an actor-centred institutionalist approach that acknowledges the power relations between industrial relations actors in different institutional domains and the potential impact of contestation across those domains on firm-level employment outcomes

Three-dimensional imaging is a novel and reliable technique to measure total body surface area

Objective: The aim of this study was to explore the diverse clinimetric aspects of three-dimensional imaging measurements of TBSA in clinical practice compared with the methods currently used in clinical practice (i.e., the rule of nines and palm method) to measure TBSA in clinical practice. Method: To assess reliability, two independent researchers measured the TBSAs of 48 burn patients using Artec MHT™ Scanner and software. Subsequently, a resident and burn specialist estimated the TBSA of the same wounds using the rule of nines and palm method. Results: Three-dimensional imaging showed excellent inter-observer reliability, with an intra-class correlation coefficient (ICC) of 0.99, standard error of measurement (SEM) of 0.054, and limits of agreement (LoA) of ±0.15 × the mean TBSA (between the measurements of two researchers). The inter-observer reliability of the methods used in current clinical practice was less reliable, with an ICC of 0.91, SEM of 0.300 and LoA of ±0.78 × the mean TBSA. The inter-observer reliability was least reliable between three-dimensional imaging and the residents compared with the burn specialists for the estimated TBSA, with an ICC of 0.68, SEM of 0.69 and LoA of ±1.49 × the mean TBSA. Conclusion: The inter-observer reliability of three-dimensional imaging was superior compared with the rule of nines and palm method

Low antithrombin III levels in neonates with idiopathic respiratory distress syndrome: poor prognosis

Automated microanalytic chromogenic coagulation assays allow serial monitoring of critically ill newborn infants. In this study 84 premature infants [26 healthy prematures and 58 neonates with idiopathic respiratory distress syndrome (IRDS)] were studied daily during the first week of life, to investigate the possible significance of hemostatic abnormalities in IRDS. In neonates with IRDS, coagulation factors II and X, antithrombin III (AT-III), plasminogen, and alpha 2-antiplasmin were significantly lower than control values. Recovery of the initially low AT-III levels was delayed relative to the other coagulation parameters measured. An AT-III less than or equal to 0.15 U/ml was present within the first 6 h of life in eight patients who developed IRDS, seven of whom died within 48 h. Autopsy of these neonates showed widespread fibrin deposition and hemorrhage in vital organs consistent with intravascular coagulation. These findings indicate that very low levels of AT-III are associated with disseminated intravascular coagulation in neonates with IRDS and suggest that a deficiency of AT-III is predictive of a poor outcom

A systematic review on surgical and nonsurgical debridement techniques of burn wounds

Objective: To provide a complete overview of all burn debridement techniques studied in recent literature and to find the best evidence with regard to efficiency and safety. Method: A systematic review was performed. Searches were conducted in electronic databases such as PubMed, Embase, Cochrane, CINAHL, Web of Science, and Academic Search Premier. All studies published from 1990 onwards, on the efficiency and/or safety of burn debridement techniques in patients with thermal burn injuries of any age, were included. Primary outcomes were time to complete wound healing and time to complete debridement. Randomized trials were critically appraised. Results: Twenty-seven studies, including four randomized clinical trials, were included. Time to wound healing in the conventional tangential excision (seven studies), hydrosurgery (eight studies), enzymatic debridement (eleven studies), and shock waves group (one study) ranged from 13–30, 11–13, 19–33, and 16 days, respectively. Time to complete debridement ranged from 5–10, 4–23, and 1–9 days, respectively. Furthermore, secondary outcomes (including grafting, mortality, and scar quality) were compared between the debridement categories. Conclusion: Convincing evidence in favor of any of these techniques is currently lacking. Future studies regarding (new) debridement techniques need to use standardized and validated outcome measurement tools to allow improved standardization and comparisons across studies