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Steroids for acute spinal cord injury

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Methylprednisolone has been shown to enhance sustained neurologic recovery in a phase III randomised trial; findings replicated in a second trial. Therapy must be started within 8 hours of injury using an initial bolus of 30 mg/kg by IV for 15 …

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Antifibrinolytic drugs for acute traumatic injury

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Tranexamic acid safely reduces mortality in bleeding trauma patients without increasing the risk of adverse events.  Tranexamic acid should be given as early as possible and within three hours of injury, as treatment later than this is unlikely to be effective.
Uncontrolled …

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Colloids versus crystalloids for fluid resuscitation in critically ill patients

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There is no evidence that resuscitation with colloids reduces the risk of death, compared to resuscitation with crystalloids, in patients with trauma, burns or following surgery. Furthermore, the use of hydroxyethyl starch might increase mortality. As colloids are not associated with …

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Internal fixation implants for intracapsular hip fractures in adults

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There were no major differences in patient survival or complications related to the operation, using different implants for internal fixation of intracapsular hip fractures, from the available evidence within randomised trials.
Numerous different implants with screws, pins and side plates have been used …

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Extramedullary fixation implants and external fixators for extracapsular hip fractures in adults

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Sliding Hip Screws (SHS) appear to be preferable for fixation of hip fractures in adults, given the markedly increased fixation failure rate of fixed nail plates.
Extramedullary fixation of hip fractures involves the application of a plate and screws to the lateral …

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Dynamic compression plating versus locked intramedullary nailing for humeral shaft fractures in adults

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Intramedullary nailing is associated with an increased risk of shoulder impingement, with a related increase in restriction of shoulder movement and need for removal of metalwork. There is not enough evidence to determine if there were any other important differences, including in …

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Perioperative fluid volume optimization following proximal femoral fracture

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Limited low quality and weak evidence from randomised controlled trials to support the use of advanced haemodynamic monitoring compared to protocol using standard measures such as CVP for perioperative fluid volume optimisation for patients with proximal femoral fracture exists.   Research findings …

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Condylocephalic nails versus extramedullary implants for extracapsular hip fractures

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The use of condylocephalic nails (in particular Ender nails), for trochanteric fracture is no longer appropriate. Any advantages in intra-operative outcomes of condylocephalic nails are outweighed by the increase in fracture healing complications, reoperation rate, residual pain and limb deformity when compared …

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Early mobilisation for elbow fractures in adults

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There is a lack of evidence to inform on the timing of mobilisation, and specifically on the use of early mobilisation, after non-surgical or surgical treatment for adults with elbow fractures.
Falling on the outstretched arm can result in an elbow fracture. Loss …

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Surgical interventions for treating distal humeral fractures in adults

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There is insufficient evidence to determine whether surgery is, and which surgical interventions are, the most appropriate for the management of different types of distal humerus fractures.
Distal humeral fractures in adults are relatively uncommon injuries that require surgical intervention in most cases. …

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