She was diagnosed with a right proximal humerus fracture and admitted under joint orthopedic and medical care. 0000022245 00000 n Sign up here as a reviewer to help fast-track new submissions. 0000007500 00000 n Every effort has been made to ensure images are anonymous and all identifiable patient information is removed from the text. We discuss these issues in the context of an elderly nursing home resident who had multiple fractures missed following initial assessment for an unwitnessed fall. 0000035068 00000 n Exposure of the patient to assess for other injuries was interrupted, however, as she proceeded to have a tonic-clonic seizure in A&E. 0000002022 00000 n

0000008529 00000 n Recent studies have also suggested more liberal use of further imaging to overcome the problem of missed injuries. The following day she had bilateral hip hemiarthroplasties and K-wire stabilisation of the right shoulder. startxref 21st May 2020. 1 North Central Thames Foundation School, UCL Medical School, Royal Free Hospital, Room GF/664, Rowland Hill Street, London NW3 2PF, UK. Conclusion. Trauma patients with reduced cognitive function should undergo full ATLS assessment, and a prospective trial is required to see if age should be incorporated as a criteria for trauma team activation. Case Presentation. Review articles are excluded from this waiver policy. Pelvic radiographs clearly identified bilateral intracapsular neck of femur fractures, and the patient was taken to theatre the following day for bilateral hemiarthroplasties and manipulation and K-wire stabilisation of her right dislocated shoulder (Figure 3). This type of accident is traditionally considered a minor mechanism of injury and deemed not to necessitate transfer to a trauma centre. Academic Editor: Dimitrios S. Karataglis. 34 44 Fady Sedra, Arash Afsharpad, Benan Dala-Ali, Robert Lee, Lester Wilson; Royal National Orthopaedic Hospital, Stanmore HA7 4LP, UK BACKGROUND CONTEXT: Lateral approach to lumbar fusion has been gaining popularity in recent years. 0000036787 00000 n 0000005525 00000 n 0000035172 00000 n 0000008452 00000 n (3) More liberal use of advanced imaging, such as the full body CT, may help to overcome some of the difficulties associated with the geriatric trauma assessment and reduce rates of missed injuries [12]. terms and conditions of iWantGreatCare, please let us know by entering your email address and clicking the button below. Several days later, when cognition had improved, she was noted to be avoiding use of the left arm and was found to also have a left proximal humerus fracture which was managed conservatively. Published 06 Nov 2014. Her C-spine had not been immobilised as it was not deemed necessary following paramedic assessment. Accepted 19 Oct 2014. On arrival she was maintaining her own airway and speaking in full sentences, with a respiratory rate of 20, oxygen saturations of 98% on room air, and a clear chest on auscultation. 2 Trauma & Orthopaedics, Barnet Hospital, Wellhouse Lane, Barnet, Hertfordshire EN5 3DJ, UK. Our patient went on to have a turbulent admission, suffering several further seizures and requiring antibiotics for a chest infection. It is most likely that this was a missed injury that had not been picked up on admission, in part, due the fact that the initial AP chest radiograph did not show the left shoulder and also due to the difficulties of assessment. %PDF-1.7 %���� It also highlights that reliance on a limited, unwitnessed account to guide your assessment and management can be extremely detrimental to the patient and can result in missed injuries. However, this calls into question how we determine what a “trauma” case is. Anay Patel, Mark Yaffe, Brett McCoy, S. David Stulberg; Page: 139; Abstract; Free.

Your email address is required to prevent abuse of the service through ensuring you are a real person. Special thanks are due to Tony Virdee for assistance in the initial conception of this report. 0000037609 00000 n He answered all our questions patiently and honestly. However, many of these patients can sustain severe multisystem injuries, even if initially appearing stable [2, 3]. The inability of these populations to communicate pain and discomfort is a major barrier to adequate assessment and diagnosis, and, therefore, this alone should mandate a full trauma assessment to avoid missing injuries, which account for a significant healthcare burden [10]. carried out the largest series of trauma patients with ground level falls to date, incorporating 57,302 patients and noting a significant incidence of severely injured elderly patients compared with the nonelderly (11.5% versus 9%, ), as well as a mortality rate of 4.4% compared with 1.6%, respectively (). The decision was taken that the best option for this patient would be for a fast procedure with reduced anesthetic time, and, therefore, an uncemented Austin Moore prosthesis was used with additional cable stabilisation. He was so good with our 5month old daughter (the patient) and made us feel that she would be safe in his care. During that time we had no verbal communication from her that she may been in pain. 0000004824 00000 n She continued to be seen by both medical and orthopedic teams on the ward postoperatively, and, although remaining stable, she still appeared drowsy and unresponsive relative to her normal state, making further history and examination an ongoing struggle. We should be actively searching for evidence and cause of pain and may benefit from utilisation of additional behavioural pain assessment tools [11]. xref A contributing factor that makes the accurate assessment of the older patient difficult is the lack of available history that often accompanies them. Your email address will not be used for marketing purposes, further information can be viewed in 0000035639 00000 n Spaniolas et al. 0000001176 00000 n

They were unable to provide any information about her fall, simply saying she had been found on the floor of her bedroom by a nurse. The most recent data recommends a cutoff of 70 years at which to consider a patient with trauma to be elderly and, therefore, at an increased risk of mortality for a given injury severity score [5].

0000014966 00000 n 2020-05-21 Person. Simon Parker was the main author of the paper. This was certainly true of our case, where the trauma was unwitnessed; the patient had a history of dementia, and shortly into the assessment was left with a GCS of 13/15 following a seizure. 0000003363 00000 n Intraoperatively, the anesthetist raised concerns over the patient’s oxygen saturation and blood pressure, and it was noted that both neck of femur fractures were associated with lesser trochanter extension. Her abbreviated mental test score at this time was 0/10 with no baseline level of cognition with which to compare. 0000038271 00000 n 0 They offer unique physiological and structural differences that leave them at an increased risk of mortality; however, those that survive the initial burden will often go on to achieve a functional outcome. Introduction.

We will be providing unlimited waivers of publication charges for accepted research articles as well as case reports and case series related to COVID-19. Variation in Contact Areas in the Proximal Femur Depending on Implant Design. trailer A 79-year-old nursing home resident was brought to the emergency department following an unwitnessed fall. %%EOF 0000000016 00000 n This lasted 2-3 minutes and self-terminated but left her with a GCS of 13/15 (E3, V4, M6) in the postictal period, making further history and examination difficult. Examination of the other extremities was unremarkable. She was also fully alert but disorientated, with a Glasgow Coma Score of 14 and pupils that were equal and reactive to light. However, those that survive the initial burden of the trauma will often achieve some level of functional outcome [7]. 0000006401 00000 n Surprisingly, however, despite the greater average injury severity and worse mortality rates, elderly patients were less likely to be admitted to the trauma service or to receive urgent or emergency surgical interventions [1].

They deserve to be triaged, evaluated, and treated with this consideration in mind. AP radiographs of the left shoulder showing a proximal humeral fracture (a, b). Postoperative radiographs demonstrating (a) bilateral hemiarthoplasties and (b) K-wire stabilisation of the right shoulder. 0000001673 00000 n Following the postictal period she was further assessed but no other injuries were identified. Age is not currently treated as an independent factor in the calculation of injury severity, and, therefore, where a hospital or ambulance service utilises scores such as the injury severity score (ISS) or Abbreviated Injury Scale (AIS) as its determinant of trauma activation, the recognised issue of increased mortality rates in the elderly population goes unaccounted for, with patients being transferred to the nearest hospital rather than a trauma centre. Her past medical history included Parkinson’s disease, dementia, hypertension, and asthma, and over the last 3 days they described an increasing level of confusion and poor communication relative to her normal state, but little else of note. If you believe this review is inappropriate and breaks the Her heart rate was 97 beats per minute and blood pressure was 163/98 mmHg. © 2008-2020 iWGC Ltd. <<44DE30B87BB452469D3C35F3452D2097>]/Prev 95325>>

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