Firearm injury is a potentially increasing public health problem worldwide. It is increasingly the subject of media and public attention. We aim to analyze the epidemiology, pattern and outcome as experienced. Data such as age, sex, race, scene and nature of injury, firearm used, alcohol and drug factors, anatomy involved, surgical requirements, transfusion details, ICU/HDU stay, complications, deaths, and outcome were collected from medical notes, WYMAS and Coroners office of all patients who presented with firearm injuries from January 1995 to December 2001. Seventy-eight cases presented to our institution. There were 19 fatalities at the scene of injury. 69 were male. 51 sustained injuries in public places, 20 at their homes and 7 in outdoor areas. Low velocity firearms were involved in 49 cases. 50 were crime related. Alcohol was identified in 34 patients and illicit drugs in 6 cases. 19 cases had bony injury with associated vascular injury in one case. Primary neurological injury was diagnosed in 5 cases. Lower extremities and upper limb injuries accounted for 59% and 26%. 3 had head and neck wounds. 4 patients had thoracic trauma and 5 had abdominal injury. 86% required surgical intervention. 11 patients had a total of 16 complications, the most common being secondary infection. 6% of patients died at the emergency department and 3 after. Chest injuries caused 5 deaths and head wounds caused 3 deaths illustrating criminal intention to cause fatal body harm.
We have reviewed the patients with vertical shear fractures of the Pelvis and report on our treatment protocol and long-term functional outcome. Methods: Between January 1993 and January 2002, out of 581 pelvic ring injuries treated in our unit, we identified 31 vertical shear fractures in 29 (4.9%) patients (4 female). Data such as age, sex, aetiology, associated injuries, ISS, resuscitation and transfusion requirements were recorded. ICU/HDU stay, surgical stabilization, urological injuries, systemic complications, neurological injury and mortality were recorded and analysed. Functional outcome was assessed using the following generic tools: EuroQol EQ-5D, SF36v2, SMFA, Majeed score and VAS.
The radiologic score of degenerative hip disease (Matta 1994) for the acetabular fracture group was: four excellent, eight good, 14 fair and three poor. Analysis of the functional outcome is shown in Table 1.
The aim of revision hip arthroplasty for infection is to eradicate infection and restore function. There is, in current literature, little evidence to suggest an optimal time interval between first (excision) and second (reconstruction) stage procedures in revision hip arthroplasty. Our aim was to assess the difference in outcome, in terms of patient pain, function and satisfaction, in relation to the time interval between surgeries. A prospective analysis was made of 22 consecutive patients who underwent two-stage revision total hip replacement between 1992 and 2001. There were 12 male and 10 female patients. The mean age at the time of revision surgery was 63.5 years (range 35–83 years). The indication for surgery was infection in all cases. Patients were subdivided into two groups according to the time interval between first and second stages : Group 1 – time interval 6 months or less; Group 2 – time interval greater than 1 year. Outcome was assessed at 1 year post-operatively using change in pain and function scores and patient satisfaction scores. Pre-operative pain and function scores were similar in the two Groups. Both Groups reported a similar improvement in pain at 1 year post-operatively. The patients in Group 1 also showed an improvement in function score, however, the patients in Group 2 showed no improvement in function. All patients felt the operation to be worthwhile as reflected in the patient satisfaction scores. The results suggest that good improvements in pain can be achieved after short and longer time intervals. A longer time interval may well be associated with a poorer outcome in terms of restoring function.