[Terrible triad injuries]. / Terrible-Triad-Verletzungen.

The complex injury pattern of a posterior elbow dislocation with concomitant radial head and coronoid fractures is usually referred to as a terrible triad injury. Due to the concomitant compromise of several osteoligamentous structures of the elbow joint relevant for stability, these injuries pose a particularly major challenge to the treating trauma surgeons. For this reason, a careful preoperative analysis of all relevant injury components is mandatory in order to make an adequate treatment decision. In most cases, surgical treatment addressing all elements relevant for stability is necessary to achieve a stable and congruent elbow joint. Only this enables early functional follow-up treatment and minimizes the complication rate. Delayed or even insufficient treatment with persistent (sub)dislocation must be avoided at all costs, otherwise there is a high risk of serious posttraumatic functional disorders of the elbow with rapid progression of osteoarthritis.

Emergency Department Pain Management in Pediatric Patients With Fracture or Dislocation in a Bi-Ethnic Population.

STUDY OBJECTIVE: We determine whether ethnicity in a bi-ethnic population of northern Israel is associated with disparities in pediatric emergency department (ED) opioid analgesia in patients with fracture or dislocation. METHODS: A retrospective cohort study was conducted. All records of patients aged 3 to 15 years and receiving a diagnosis of a limb fracture or dislocation were extracted. Data on demographics, including ethnicity, nurse ethnicity, pain level, and pain medication, were collected. Medications were administered according to a nurse-driven pain protocol. RESULTS: During the nearly 4-year study period, 3,782 children with fractures visited the ED, 1,245 Arabs and 2,537 Jews. Of these, 315 Arabic patients and 543 Jewish patients had a pain score of 7 to 10. The proportion of Arabic and Jewish children who received opioid therapy was 312 of 315 (99.05%) and 538 of 543 (99.08%), respectively (difference 0.03%; 95% confidence interval -0.13% to 0.19%). Of the 315 Arabic children, 99 were approached by Arabic nurses (31.4%), and 98 of those received opioids (98.9%); 216 were approached by Jewish nurses (68.6%), and 214 of those received opioids (99%). Of the 543 Jewish children, 351 were approached by Jewish nurses (64.6%), and 348 of those received opioids (98.9%); 192 were approached by Arab nurses (35.4%), and 190 of those received opioids (98.9%). During the 2014 11-week Israeli-Palestinian armed conflict, 232 children with fractures visited the ED, 87 Arabs and 145 Jews, of whom 16 and 27 had pain scores of 7 to 10. The proportion of Arabic and Jewish children who received opioid medication was 16 of 16 (100%) and 26 of 27 (96%), respectively (difference 4%; 95% confidence interval -16% to 18%). CONCLUSION: Findings suggest that ethnic differences, including during periods of conflicts, have no effect on opioid analgesia in this ED.

Unusual wrist injuries in India.

We describe fives cases of an unusual type of injury to the wrist which has been seen in Sikhs, an ethnic population in India. It is caused by entrapment of the kara, an iron bangle, which is traditionally worn as one of five compulsory religious symbols. The injuries were an open transtriquetral palmar perilunar dislocation, a double palmar radiocarpal dislocation, and a compound, grossly displaced anterior Galeazzi fracture-dislocation. Two cases had unclassified injuries.