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Epidemiology of pelvic and acetabular fractures across 12-mo at a level-1 trauma centre

World Journal of Orthopedics 2022年第8期13卷 744-752页

作者： rory cuthbert Samuel Walters David Ferguson Edward Karam Jonathan Ward Homa Arshad Paul Culpan Peter Bates Department of Trauma and Orthopaedic Surgery Royal London HospitalBarts HealthLondon E11BBUnited Kingdom

BACKGROUND Despite motor-vehicle safety advancements and increasingly rigorous workplace safety regulations,trauma/suicide remains the leading cause of death under the age of 45 in the United Kingdom.To promote centralisation of care and optimisation of major trauma outcomes,in 2012 the National Health Service introduced the Trauma Network System.To our knowledge,this is the first study to analyse the epidemiology of pelvic and acetabular trauma over a one-year period at a level-1 trauma centre in the United Kingdom,since nationwide introduction of the Trauma Network System.AIM To characterize the epidemiology of high-energy pelvic and acetabular fractures over a one-year period at a level-1 trauma centre,and explore both resources required to care for these patients and opportunities for future research and injury prevention initiatives.METHODS 227 consecutive patients at a level-1 trauma centre with pelvic and acetabular fractures were analysed between December 2017-December 2018.Paediatric patients(<18 years)and fragility fractures were excluded,leaving 175 patients for inclusion in the study.Statistical analysis was performed using Fisher’s exact test for categorical variables.RESULTS 72%of pelvic and acetabular fractures occurred in male patients at a median age of 45 years.15%were the result of a suicide attempt.48%of patients required pelvic or acetabular surgery,with 38%undergoing further surgery for additional orthopaedic injuries.43%of patients were admitted to intensive care.The median inpatient stay was 13 days,and the 30-day mortality was 5%.Pelvic ring trauma was more commonly associated with abdominal injury(P=0.01)and spine fractures(P<0.001)than acetabular fractures.Vertical shear pelvic ring fractures were associated with falls(P=0.03)while lateral compression fractures were associated with road traffic accidents(P=0.01).CONCLUSION High energy pelvic and acetabular fractures are associated with concomitant orthopaedic fractures(most commonly spine and lower limb),intensive care admission and pro

关键词： Pelvis Acetabulum Orthopedics Multiple trauma Trauma centers

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Evidence-based approach to providing informed consent for hip fracture surgery during the COVID-19 era

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World Journal of Orthopedics 2021年第6期12卷 386-394页

作者： rory cuthbert David Ferguson Babar Kayani Saeef Haque Aoun Ali Asif Parkar Peter Bates Krishna Vemulapalli Department of Trauma&Orthopaedic Surgery Queen's Hospital-RomfordLondon RM70AGUnited Kingdom Department of Trauma&Orthopaedic Surgery Royal London HospitalLondon E11FRUnited Kingdom

BACKGROUND Hip fractures are the most common reason for inpatient orthopaedic trauma admission.Urgent surgical intervention for hip fractures has remained a clinical priority throughout the coronavirus disease 2019(COVID-19)pandemic.Despite this,there is a paucity of clinical guidance addressing the informed consent process for hip fracture surgery in COVID-19 positive patients.This is of paramount medicolegal importance in a high-risk patient population.AIM To quantify the additional perioperative risks for COVID-19 positive patients undergoing hip fracture surgery and provide clinicians with an evidence-based framework to establish an informed consent process.METHODS Two hundred and fifty nine consecutive patients undergoing surgical intervention for hip fractures in four hospitals in the United Kingdom were recruited.51 patients were confirmed positive for COVID-19.Predefined outcomes were analyzed over a 30-d postoperative period.COVID-19 positive and COVID-19 negative patients were compared after adjustment for confounding factors.RESULTS COVID-19 positive patients had more intensive care admissions(27%vs 5%,P<0.001),longer inpatient stays(median 23 d vs 9 d,P<0.001)and a higher 30-d mortality(29%vs 10%,P=0.001)than COVID-19 negative patients.Postoperative complications were evident in 74.5%of COVID-19 positive patients.35.3%of COVID-19 positive patients suffered postoperative lower respiratory tract infections with 13.7%developing acute respiratory distress syndrome(ARDS)and 9.8%experiencing symptomatic thromboembolic events.CONCLUSION The COVID-19 pandemic has created uncertainty in the medical community worldwide and poses unique challenges in providing informed consent for surgery.COVID-19 positive patients undergoing hip fracture surgery should be consented for the additional risk of postoperative complications(including lower respiratory tract infection,ARDS,deep vein thrombosis and pulmonary embolism),increased requirement for intensive care admission,longer inpatient stay and higher risk of mortality

关键词： COVID-19 Hip fractures Mortality Morbidity Outcome assessment Informed consent

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Estimation of Genetic Parameters for Live Weight in South African Holstein Cattle

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Open Journal of Animal Sciences 2015年第3期5卷 242-248页

作者： Nokuthula Innocentia Ramatsoma cuthbert Baldwin Banga Khoboso Christina Lehloenya rory Gibson Department of Animal Sciences Tshwane University of Technology Pretoria South Africa Agricultural Research Council Animal Production Institute Irene South Africa Department of Animal and Wildlife Sciences University of Pretoria Pretoria South Africa

Cow live weight is of economic importance in dairy production;however, it is not included in the selection objective for South African dairy cattle. Variance components estimates are a prerequisite to incorporating a trait in the breeding objective. Variance components were estimated for live weight of lactating Holstein cows on two South African dairy herds. Live weight records on 9843 lactating cows, collected over a period of three years, were used. An analysis of variance was carried out to determine fixed effects to include in the model by the least squares method, using the Generalised Linear Models procedure of the Statistical Analysis System. Variance components were estimated by the Restricted Maximum Likelihood procedure using the ASREML programme. A high heritability estimate of 0.74 ± 0.19 is found, which suggests that there is scope for significant response to selection on live weight in the South African Holstein cattle population. A repeatability estimate of 0.86 was obtained. These results form the basis for incorporating live weight in the breeding objective for South African Holstein cattle. Further work, however, needs to be done to develop estimates based on a representative sample of the whole population, as the current study is based on data from only two herds.

关键词： Live Weight Breeding Objective Variance Components Heritability Dairy Cows

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