Trauma in the elderly patient.

Major Trauma Centres and Emergency Departments are treating an increasing number of elderly trauma patients in the UK. Elderly patients, defined as those over the age of 65 years, are more susceptible to injury from lesser mechanisms of trauma than younger adults. The number of elderly trauma cases is rising yearly, accounting for >25% of all major trauma nationally. The elderly have different physiological reserves and a different response to trauma due to premorbid frailty, co-existing conditions and prescribed medication. These factors need to be appreciated in trauma triaging, radiological assessment and clinical management. A lower threshold for trauma-call activation is recommended, including a lower threshold for advanced imaging. We will review general principles of trauma in the elderly, outline injury patterns in this age group and illustrate the radiological features per anatomical site, from head to pelvis and the extremities. We advocate using contrast-enhanced computed tomography as the primary diagnostic imaging modality as concern about intravenous contrast agent-induced nephropathy is relatively minor. Prompt investigation and diagnosis leads to timely appropriate treatment, therefore the radiologist can discerningly improve morbidity and mortality in this vulnerable group.

Clinical applications of mesenchymal stem cells in the treatment of fracture non-union and bone defects.

Bone defects resulting from trauma or resorption, whether physiological or pathological, remain a major challenge in the management of patients. The limits of bone regeneration still result in many people never recovering fully their function and quality of life; with all the social, financial and psychological implications. The aim of this review is to present the current level of possible applications of stem cells and tissue engineering in bone repair. From animal models to human trials, the knowledge surrounding the use of mesenchymal stem cells in manipulating bone healing, where normal physiological procedures have failed, are presented in chronological order. The possibilities in clinical applications of mesenchymal stem cells are evident and exciting. The efficacy, including long-term, of such treatment options still requires further knowledge and appropriately conducted clinical trials, with adequate patient numbers. Once these techniques are properly mastered and perfected, the benefits to regenerative medicine will be immense.