Psychiatric comorbidities in adult survivors of major trauma: findings from the Midland Trauma Registry.

INTRODUCTION Information for primary care providers about the outcomes of adult survivors of major medical trauma in the first year of recovery is not widely available. In particular, risks of impairment across multiple domains of functioning are poorly understood. AIM To determine the extent to which adults' experience impaired health-related quality of life (QoL), symptoms of post-traumatic stress disorder, depression, chronic pain and harmful alcohol use during the year following major trauma, and to identify factors associated with outcomes. METHODS Adults (aged ≥16 years) admitted to Waikato Hospital following major trauma sustained in Waikato District between 1 June 2010 and 1 July 2011 were sent a questionnaire in their first year of recovery. They were asked about their QoL, mental health, experiences of pain, post-traumatic stress disorder symptoms and use of alcohol. RESULTS Sixty-five questionnaires were completed (40% response rate). In the year following major trauma, trauma survivors met criteria for post-traumatic stress disorder (45%), harmful alcohol use (26%), moderate to severe chronic pain (23%) and depression (18%). Reports of poor health-related QoL were common, ranging from self-care difficulties (31%) to pain and discomfort (72%). Younger age, previous psychiatric illness, substance use, intensive care unit admission and length of hospitalisation were associated with symptoms. Thirty-seven adults (57%) reported symptoms in at least two domains. DISCUSSION A significant proportion of adults experience adverse psychosocial outcomes in the first year following major trauma. Screening and management of potentially comorbid psychosocial needs could improve care and outcomes for survivors.

[A woman with a painful ankle after a sprain]. / Een vrouw met een pijnlijke enkel na een verstuiking.

A 70-year-old woman presented with symptoms resembling an Achilles tendon rupture. Careful examination revealed a large avulsion fracture of the calcaneal tuberosity. Successful screw osteosynthesis of this tongue-type fracture was performed. Such careful examination is paramount to prevent one from missing this fracture.

Reconstruction plates for midshaft clavicular fractures: A retrospective cohort study.

BACKGROUND: For the fixation of displaced midshaft clavicular fractures different plates are available, each with its specific pros and cons. The ideal plating choice for this lesion remains subject to ongoing discussion. Reconstruction plates are cheap and easily bendable, but their strength and stability have been questioned. The aim of this study was to evaluate the failure rate of reconstruction plates in the fixation of clavicular fractures. MATERIALS AND METHODS: A multicenter, retrospective cohort study of all consecutive patients with a displaced, midshaft clavicular fracture (Robinson type 2a/2b) treated with a 3.5-mm reconstruction plate between 2006 and 2013 were evaluated. The primary outcome measure was reoperation rate due to implant failure. Secondary outcome measures were nonunion, symptomatic malunion and elective plate removal. RESULTS: One hundred and eleven patients were analyzed. During a median follow-up of 8 months, 14 patients (12.6%) had implant failure, of which 7 (6.3%) required a reoperation. Three nonunions (2.7%) and no symptomatic malunions occurred. Plate removal was indicated in 37.8% of patients because of implant irritation. DISCUSSION: The incidence of reoperation due to implant failure following clavicular plate fixation with a reconstruction plate is 6.3%. Although comparison with other plate types is difficult since rates in literature vary greatly, reoperation rates in other plates are reported around 2-3%, suggesting that reconstruction plates have a higher incidence of implant failure warranting reoperation. Therefore, especially in patients with known risk factors for complications (e.g. smoking, osteoporosis, comminuted fractures), a stronger plate than a reconstruction plate should be considered. LEVEL OF EVIDENCE: Level IV. Retrospective study.