United they fall, divided they stand

The historical context of unification or separation of the academic bodies of the various branches of the profession in Great Britain and Ireland is examined.     

Bone allografts: What they can offer and what they cannot

Bone allografts can be used in any kind of surgery involving bone from minor defects to major bone loss after tumour resection. This review describes the various types of bone grafts and the current knowledge on bone allografts, from procurement and preparation to implantation. The surgical conditions for optimising the incorporation of bone are outlined, and surgeon expectations from a bone allograft discussed.     

The older they are the harder they fall: Injury patterns and outcomes by age after ground level falls

BackgroundTrauma centers are seeing an increasing number of geriatric patients that are more susceptible to injuries even from relatively minor insults such as a ground level fall (GLF). As life expectancy increases, people are living in the geriatric age bracket for decades and often use anticoagulation agents for various comorbidities. We hypothesize that this patient population is not homogenous and we investigated the injury patterns and outcomes after GLF as a function of age and anticoagulation use. We also sought to identify injury patterns and patient characteristics of GLF patients.MethodsA retrospective review of a Level I trauma center’s database identified all adult (age > 18) trauma patients admitted after GLFs between 1/2003 and 12/2013. Demographics, injury patterns, antiplatelet use, anticoagulation use (including warfarin, enoxaparin, and rivaroxaban) and outcomes were abstracted.ResultsThe cohort included 5088 patients. 3990 patients were >60 years and 38.2% were male. With each decade, although the mean ISS did not considerably change (range 7.0–8.6), mortality increased (0.9% at <60 years vs. 5.5% at >90 years), and the likelihood of home discharge decreased dramatically (73.7% at <60 years vs. 18.2% at >90 years). Abdominal solid organ injuries were rare (0.8%). Age was associated with an increased incidence of cervical spine (p = 0.002), rib (p = 0.009) and pelvic fractures (p < 0.001). Only aspirin use was significantly associated with intracranial bleed (p = 0.001). Aspirin (p = 0.049) or warfarin (p < 0.001) use was associated with increased overall mortality.ConclusionGLF patients are not homogenous as certain injury patterns change with increasing age. Aspirin use was associated with an increased incidence of intracranial bleeds, whereas other antiplatelet or anticoagulation agents were not. GLF is also associated with significant morbidity and mortality that increases dramatically with age. Both aspirin and warfarin are independently associated with increased mortality. These patient differences have implications for their evaluation and management.Level of evidenceEpidemiological/prognostic study level IV.