Bekkenbanden voor acute stabilisatie van instabiele bekkenfracturen

Bekkenbanden zijn ontwikkeld voor de acute behandeling van instabiele bekkenringfracturen in de prehospitale fase. Deze behandeling is gericht op het beperken van het inwendig bloedverlies door het verkleinen van het bij bekkenfracturen toegenomen bekkenvolume en het stabiliseren van de fractuurdelen. Het effect van commercieel verkrijgbare bekkenbanden op de reductie van de symphysis pubisdiastase en de hemodynamische stabiliteit is aangetoond. Het langdurig gebruik van bekkenbanden wordt ontraden wegens toegenomen risico op het ontwikkelen van decubitus. Met name langdurige immobilisatie met een bekkenband op een traumaplank dient voorkomen te worden. In dit artikel wordt een aantal verschillende bekkenbanden besproken en wordt een casus gepresenteerd.Pelvic circumferential compression devices have been developed for initial treatment of unstable pelvic ring fractures in the prehospital situation. The treatment is aimed at achieving tamponade by reducing the increased pelvic volume and reducing the bleeding from fracture surfaces. The effect of commercially available pelvic circumferential compression devices on the reduction of symphysis pubis diastasis and the resuscitation has been proved. Prolonged use of these devices is complicated by the risk of development of pressure sores. Therefore prolonged immobilization on a spine board should be avoided. A number of different pelvic binders will be discussed in this article, which also presents a case

Burden of hydrocoele assessed from medical and surgical records in a lymphatic filariasis endemic country, Samoa

Background: Samoa is a Pacific Island country that has long been known to have a high burden of lymphatic filariasis. Little has been documented about the burden of disability due to the chronic complications of the disease. We examined the rates of hydrocoele amongst the Samoan male population to better understand the situation. Methods: Information on numbers of suspected hydrocoele cases in men aged 18 years and older from 2006 to 2013 was sought using ICD-10 codes and/or keywords from three sources: the hospital patient information system plus the surgical clinic and operating theater records in Tupua Tamasese Meaole and Malietoa Tanumafili II hospitals in Samoa. Chart review of suspected hydrocoele cases was used to confirm the diagnosis of hydrocoele amongst suspected cases. The following data items were extracted from patient records where available: date of diagnosis, age, village, hydrocoele characteristics (duration, size, and volume), history and cause of injuries, whether lymphatic filariasis was a differential diagnosis, whether ultrasound scan was used to verify diagnosis, and details of any surgery performed. Population data were obtained from the Samoa Bureau of Statistics. Results: There were 535 suspected cases identified from the 3 sources between 2006 and 2013, of which 328 were diagnosed as hydrocoele; charts for 56 suspected cases (10.5%) could not be located. The mean age of men with hydrocoele was 49.2 years. The proportion of men aged ≥ 18 years diagnosed with hydrocoele over the study period was 0.62% (328/52,944). North West Upolu had the highest proportion amongst the four regions of Samoa (p < 0.001). The proportion of men presenting with hydrocoele increased with age (p < 0.001). 14.3% of patients had an injury that could have contributed to the hydrocoele. Only 4.0% of all patient records had lymphatic filariasis recorded as a differential diagnosis. 60.7% of all patients with hydrocoele had some form of surgery, with no difference between regions (p = 0.276). The majority of surgeries were hydrocoelectomies, where the tunica vaginalis is everted. The mean age of patients that had surgery was 48.2 years. It was difficult to estimate hydrocoele size and duration due to non-standardized way of reporting. Conclusions: This study used multiple sources to document the number of hydrocoele cases that presented annually to medical facilities in Samoa. This represents a minimum estimate of the burden since some cases may have not presented for treatment. The numbers presenting have fluctuated over the years (2006 to 2013), and improvements in the reporting system are needed. The health system needs to consider ways to address a large number of patients that still require surgery, as well as conducting follow-up of those that did receive surgery. Additionally, clinicians should consider lymphatic filariasis as a differential diagnosis for hydrocoeles

Implementation of a standardized protocol to manage elderly patients with low energy pelvic fractures: can service improvement be expected?

Purpose: The incidence of low energy pelvic fractures (FPFs) in the elderly is increasing. Comorbidities, decreased bone-quality, problematic fracture fixation and poor compliance represent some of their specific difficulties. In the absence of uniform management, a standard operating procedure (SOP) was introduced to our unit, aiming to improve the quality of services provided to these patients. Methods: A cohort study was contacted to test the impact of (1) using a specific clinical algorithm and (2) using different antiosteoporotic drugs. Multivariate regression analysis was used to determine prognostic factors. Study endpoints were the time-to-healing, length-of-stay, return to pre-injury mobility, union status, mortality and complications. Results: A total of 132 elderly patients (≥65 years) admitted during the period 2012–2014 with FPFs were enrolled. High-energy fractures, acetabular fractures, associated trauma affecting mobility, pathological pelvic lesions and operated FPFs were used as exclusion criteria. The majority of included patients were females (108/132; 81.8%), and the mean age was 85.8 years (range 67–108). Use of antiosteoporotics was associated with a shorter time of healing (p = 0.036). Patients treated according to the algorithm showed a significant protection against malunion (p < 0.001). Also, adherence to the algorithm allowed more patients to return to their pre-injury mobility status (p = 0.039). Conclusions: The use of antiosteoporotic medication in elderly patients with fragility pelvic fractures was associated with faster healing, whilst the adherence to a structured clinical pathway led to less malunions and non-unions and return to pre-injury mobility state

To retain or remove the syndesmotic screw: a review of literature

Introduction: Syndesmotic positioning screws are frequently placed in unstable ankle fractures. Many facets of adequate placement techniques have been the subject of various studies. Whether or not the syndesmosis screw should be removed prior to weight-bearing is still debated. In this study, the recent literature is reviewed concerning the need for removal of the syndesmotic screw. Materials and methods: A comprehensive literature search was conducted in the electronic databases of the Cochrane Library, Pubmed Medline and EMbase from January 2000 to October 2010. Results: A total of seven studies were identified in the literature. Most studies found no difference in outcome between retained or removed screws. Patients with screws that were broken, or showed loosening, had similar or improved outcome compared to patients with removed screws. Removal of the syndesmotic screws, when deemed necessary, is usually not performed before 8-12 weeks. Conclusion: There is paucity in randomized controlled trials on the absolute need for removal of the syndesmotic screw. However, current literature suggests that it might be reserved for intact screws that cause hardware irritation or reduced range of motion after 4-6 months

Selective solar absorber coating research at the CSIR (South Africa)

Abstract: A sol-gel technique has been established at a laboratory scale for low cost production of high efficient selective solar absorbers comprising a composite material of nano-structured carbon in a nickel oxide matrix. In order for these materials to be applied in real world scenarios it is necessary to extensively scale up the fabrication process to allow large area coatings. This can be done by adapting this sol-gel technique to large area deposition. In this project, we are undertaking research and development activities for three-years to make a &apos;Lab to Large scale&apos; transition in order to eventually integrate into existing solar collectors for low cost domestic water heating in a rural area for social good. A spray coating technique has been used to deposit these C/NiO coatings on aluminum substrates. Preliminary optical results have shown absorptance of up to 90 %. The preparation and characterization as well as the process towards developing a large-area solar selective coating for low cost domestic heating will be discussed

Mechanical construction and installation of the ATLAS tile calorimeter

This paper summarises the mechanical construction andinstallation of the Tile Calorimeter for the ATLASexperiment at the Large Hadron Collider in CERN, Switzerland. The TileCalorimeter is a sampling calorimeter using scintillator as the sensitivedetector and steel as the absorber and covers the central region of the ATLASexperiment up to pseudorapidities ±1.7. The mechanical construction ofthe Tile Calorimeter occurred over a periodof about 10 years beginning in 1995 with the completionof the Technical Design Report and ending in 2006 with the installationof the final module in the ATLAS cavern. Duringthis period approximately 2600 metric tons of steel were transformedinto a laminated structure to form the absorber of the sampling calorimeter.Following instrumentation and testing, which is described elsewhere, themodules were installed in the ATLAS cavern with a remarkable accuracy fora structure of this size and weight.Peer Reviewe