CT scan-evaluated outcome of pulsed electromagnetic fields in the treatment of acute scaphoid fractures: a randomised, multicentre, double-blind, placebo-controlled trial

We hypothesised that the use of pulsed electromagnetic field (PEMF) bone growth stimulation in acute scaphoid fractures would significantly shorten the time to union and reduce the number of nonunions in a randomised, double-blind, placebo-controlled multicentre trial. A total of 102 patients (78 male, 24 female; mean age 35 years (18 to 77)) from five different medical centres with a unilateral undisplaced acute scaphoid fracture were randomly allocated to PEMF (n = 51) or placebo (n = 51) and assessed with regard to functional and radiological outcomes (multiplanar reconstructed CT scans) at 6, 9, 12, 24 and 52 weeks. The overall time to clinical and radiological healing did not differ significantly between the active PEMF group and the placebo group. We concluded that the addition of PEMF bone growth stimulation to the conservative treatment of acute scaphoid fractures does not accelerate bone healing.

Temporary abdominal closure

The increasing recognition of abdominal compartment syndrome's adverse effect on patient outcome has been coupled with our expanding knowledge of techniques of temporary abdominal closure. Temporary abdominal closure can be used prophylactically to prevent abdominal compartment syndrome developing and more commonly in the treatment of patients with progressing or advanced abdominal compartment syndrome. The preferred technique involves a negative suction dressing protecting the fascial and skin edges, collecting intraperitoneal fluid and reducing contamination. Attempts of early closure will facilitate recovery.

Management of open abdomen

Non-closure of abdominal fascia and the resultant open abdomen after laparotomy has become a major advance in the management of critically ill or injured patients. The benefits of open abdomen are many and include the prevention of intra-abdominal hypertension and the consequent abdominal compartment syndrome. Appropriately and exquisitely managed, it can provide all the benefits and prevent highly morbid complications of leaving the abdomen open. This review will provide some insights into such management.

The clinical and radiological outcome of pulsed electromagnetic field treatment for acute scaphoid fractures

The use of pulsed electromagnetic fields (PEMF) to stimulate bone growth has been recommended as an alternative to the surgical treatment of ununited scaphoid fractures, but has never been examined in acute fractures. We hypothesised that the use of PEMF in acute scaphoid fractures would accelerate the time to union by 30% in a randomised, double-blind, placebo-controlled, multicentre trial. A total of 53 patients in three different medical centres with a unilateral undisplaced acute scaphoid fracture were randomly assigned to receive either treatment with PEMF (n = 24) or a placebo (n = 29). The clinical and radiological outcomes were assessed at four, six, nine, 12, 24 and 52 weeks.

A log-rank analysis showed that neither time to clinical and radiological union nor the functional outcome differed significantly between the groups. The clinical assessment of union indicated that at six weeks tenderness in the anatomic snuffbox (p = 0.03) as well as tenderness on longitudinal compression of the scaphoid (p = 0.008) differed significantly in favour of the placebo group.

We conclude that stimulation of bone growth by PEMF has no additional value in the conservative treatment of acute scaphoid fractures.

Management of open abdomen

Non-closure of abdominal fascia and the resultant open abdomen after laparotomy has become a major advance in the management of critically ill or injured patients. The benefits of open abdomen are many and include the prevention of intra-abdominal hypertension and the consequent abdominal compartment syndrome. Appropriately and exquisitely managed, it can provide all the benefits and prevent highly morbid complications of leaving the abdomen open. This review will provide some insights into such management.

Temporary abdominal closure

The increasing recognition of abdominal compartment syndrome's adverse effect on patient outcome has been coupled with our expanding knowledge of techniques of temporary abdominal closure. Temporary abdominal closure can be used prophylactically to prevent abdominal compartment syndrome developing and more commonly in the treatment of patients with progressing or advanced abdominal compartment syndrome. The preferred technique involves a negative suction dressing protecting the fascial and skin edges, collecting intraperitoneal fluid and reducing contamination. Attempts of early closure will facilitate recovery.

Trauma during pregnancy

Injury to the pregnant woman evokes a certain amount of anxiety because of its infrequent occurrence and the complex implications. By definition, it constitutes a multitrauma and, throughout the resuscitation and assessment of the woman, it is important to remember that there are two patients. Of particular importance is that one of these patients must be resuscitated aggressively to save the other and, very occasionally, the baby has to be delivered to save the mother. Early transfer to an urban environment should be considered. The aim of the present paper is to provide an overview of the current management and issues in relation to trauma in pregnancy.

A complicated forearm greenstick fracture: case report

Closed reduction of a greenstick fracture of the forearm in a child of 9 years was complicated by interposition of the deep flexor tendon of the third, fourth, and fifth fingers in the fracture gap. Undelayed release of the tendon resulted in a complete functional recovery.