Response of the Australian Medical Services to restoration of mobile warfare on the Western Front in 1918 (part II).

On 4 July 1918, at the Battle of Hamel, the Australian Medical Services used a Field Ambulance Resuscitation Team for the first time, delivering life-saving blood transfusion and early definitive surgery to badly wounded soldiers very soon after their wounds had been inflicted. During the closing months of the war, many lives and limbs were saved by early resuscitation and effective surgery, an achievement that stands out in marked contrast to the situation in 1914, when inadequate resuscitation, outdated surgical methods and appalling delays in delivering treatment resulted in great numbers of unnecessary deaths.

Response of the Australian Medical Services to restoration of mobile warfare on the Western Front in 1918 (part I).

On 21 March 1918, after nearly 4 years of static warfare on the Western Front, German forces launched a massive offensive from the Hindenburg Line against a depleted British Fifth Army. Elite storm troops smashed through British forward and battle zone positions and advanced more than 17 miles in 2 days. By 5 April, the Germans were outside the town of Villers-Bretonneux, 40 miles from their starting position and 15 miles from the railway junction of Amiens. This paper examines the response of the Australian Medical Services to the restoration of mobile warfare and explains the measures that were put in place to deal with the evacuation of casualties.

Long-term outcome of MacIntosh reconstruction of chronic anterior cruciate ligament insufficiency using fascia lata.

The purpose of this study was to assess the long-term outcome of the MacIntosh lateral-substitution over-the-top anterior cruciate ligament (ACL) reconstruction in 82 patients (84 knees) at an average follow-up of 9.8 years. In this retrospective cohort study patients were evaluated with subjective questionnaires and by clinical and radiographic examination. Using the Lysholm score, 17 knees were rated excellent, 35 good, 19 fair, and 13 poor. The pivot shift test was negative in 74 patients. Altogether, 30 knee radiographs were evaluated. The mean Hospital for Special Surgery ACL radiographic score was 20.9. There was a non-significant association between the radiographic score and the Lysholm score and between a worsening radiographic score and increasing time from injury. The MacIntosh lateral-substitution over-the-top ACL reconstruction shows results comparable to those of previously reported long-term studies. Although endoscopically assisted intraarticular reconstructions with faster rehabilitation protocols have now become popular, this procedure may be considered in patients needing an intra- and extraarticular reconstruction in whom cosmesis is not an issue.

Fractures in children younger than age 1 year: importance of collaboration with child protection services.

The medical records of all children less than 1 year of age presenting to the Accident and Emergency Department over a 5-year period (1995-1999) with a fracture were retrospectively reviewed for possible abuse. Seventy-four children presented with fractures during the study period, with a mean age at presentation of 5 months (range 2 weeks to 1 year). Of these children, 46 had skull fractures and 28 had long bone fractures. Children were classified into one of seven categories: definite abuse, likely abuse, suspicious, likely accident, definite accident, neglect, or unknown cause. A three-tier system of grading for possible abuse was then used to analyze variance. The first tier consisted of the initial assessment by staff clinicians, the second retrospectively by an orthopaedic registrar, and the third retrospectively by a designated doctor in child protection (consultant pediatrician), all using the same information from the case notes. The use of the three-tier system of grading demonstrated a variance in the diagnosis of nonaccidental injury. The possibility of abuse was underestimated at the time of the original injury in over a quarter of cases (28.4%) when compared with the assessment by the consultant pediatrician. In 34 children (46%), there was no written documentation that nonaccidental injury was ever considered. While management depends on local guidelines and arrangements, the authors would advise that all children under 1 year of age with a fracture should be admitted to the hospital and referred to a pediatrician for child protection assessment.