Lactate: a predictive marker after shock related injury ▸

This prospective observational study compared the ability of plasma lactate with the lactate/pyruvate ratio at the time of hospital presentation to predict shock related outcome after injury. The study also examined the effect of ethanol on the obtained results. Plasma lactate alone was found to be a better predictor than the lactate/pyruvate ratio of post-injury shock related outcome. In addition, lactate/pyruvate ratio interpretation was confounded by increased plasma ethanol.

This study is important in that it seems to be the first to demonstrate the confounding effect of ethanol on the interpretation of lactate/pyruvate ratio. It is the largest to date to support plasma lactate as being superior to the lactate/pyruvate ratio as a predictor of outcome in injured patients. Development of near-patient testing of parameters such as lactate may have a future role in assessing haemodynamic status and guide clinical intervention as well as being a useful outcome audit tool.

Boxer's fractures: a new angle? ▸

Fracture of the fifth metacarpal neck is a common hand injury presenting to emergency departments. The starting point of this study was that in the absence of rotational deformity or functional deficit caused by pseudoclawing, the decision to treat “boxer's” fractures surgically or conservatively is usually based on the degree of angulation at the fracture site. It was hypothesised that the reliability of measurement of fracture angulation is poor. Three fellowship trained orthopaedic hand surgeons evaluated the anteroposterior, oblique, and lateral radiographs of 32 consecutive patients on two separate occasions and formulated management plans.

The reliability of the measurement of fracture angulation between the three different observers was only “slight” and even the reproducibility of measurements of a single observer was only “fair”. Based on assessment of the radiographs, there was significant variability in the recommended treatment plans.

This study …