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Objective: To compare the pressure-reducing and pressure-redistributing characteristics of four operating room (OR) table mattresses using interface pressure measurements, in two positions adopted for surgical procedures. Method: Support surfaces were randomly assigned to 80 patients. These were: an overlay pad filled with fibres (the standard OR mattress), a custom-made viscoelastic polyurethane foam mattress, an inflatable mattress with air-filled cells and a fluid mattress. An XSENSOR full-body pressure-mapping pad was used to record interface pressures of 40 patients in the supine position and 40 patients in the lithotomy position. Measurements were analysed for peak pressure, peak pressure index, total contact surface area and the occurrence of a significant increase in interface pressure during the surgical procedure. Results: The highest interface pressures were measured on the standard mattress, in both the supine and lithotomy position. Overall, the fluid mattress showed the best pressure-reducing and pressure-redistributing capacities. Conclusion: As long as no reference values are available for interface pressures under which no pressure-related damage will occur, clinical testing of OR table surfaces is still necessary. Declaration of interest: The test mattresses were provided free of charge and the companies provided a contribution of €2000 each for the rental of the pressure-mapping system. None of the authors had a financial interest in or link with the companies.

On December 21st, 1992 the Martinair DC-10 charterflight MP-495, with on board 327 passengers and 13 crewmembers, crashed on landing in Faro, Portugal. Shortly after the crash the plane started to burn and exploded. Uninjured passengers and those with minor injuries were repatriated the following day. The majority of the patients who had been admitted to Portuguese hospitals followed on the 23rd. Of the patients repatriated on the 23rd, 13 were admitted to the Emergency Hospital at the University Hospital Utrecht. Two other patients were repatriated at later dates, of which one was appended to the group. The other patient (the 15th) was admitted directly to the surgical Intensive Care Unit. Within the Emergency Hospital they were placed in quarantaine, as foreseen by the Disaster Management Plan and the Methicillin resistant Staphylococcus aureus (MRSA) protocol. This report describes the admission and treatment of the patients. Of these patients, 13 were in stable condition. They had second and third degree burns of the extremities and of the face. Three patients required plastic surgical intervention. Two patients were shown to be contaminated with MRSA. The 14th patient required several days of ICU-treatment. The report also shows that disaster plans should be modular in structure, so that they can be used for admitting different sizes of groups of patients and that the quality of care supplied by different departments during the period of isolation in the special units is geared to the needs of patients.

This study evaluates the safety and results of surgery using TaraKlamp Circumcision DeviceRduring a group circumcision. A total of 64 circumcisions of Muslim boys were performed by Medical Assistants supervised by Medical Doctors in a hall in Kuala Lumpur, Malaysia. A new type disposable clamp was used, which was removed 4 days after the operation. No major complications occurred and the boys experienced in general mild pain postoperatively. Mostly good cosmetic results were obtained and 90% of the parents would recommend this new clamp to others. Group circumcisions with TaraKlamp Circumcision DeviceR(Kuala Lumpur, Malaysia) are safe, although proper patient selection and adequate training in using the device are mandatory.

BACKGROUND Bioresorbable implants for musculoskeletal injuries involving bone and ligaments in adults might have significant advantages compared to the conventionally used non-resorbable metal implants because they lead to a gradual transfer of the mechanical load from the implant to the healing bone and do not require a secondary removal operation. Tissue reactions may present a problem and bioresorbable screws are mechanically not as strong as their metal counterparts. OBJECTIVES To compare bioresorbable implants to non-resorbable implants with respect to functional outcome, wound infections, other complications and reoperation rate,in the fixation of bone fractures or re-attachment of soft tissue to bone. SEARCH STRATEGY We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (March 2004), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2004), MEDLINE (1966 to February 2004), EMBASE (1988 to February 2004), BL Inside (to February 2004), SIGLE (to February 2004), the metaRegister of Controlled Trials at http//:controlled-trials.com/, and reference lists of articles. SELECTION CRITERIA Randomised controlled trials (RCTs) and quasi-randomised trials, comparing bioresorbable osteosynthesis with metal osteosynthesis (including titanium and stainless steel implants) were included. DATA COLLECTION AND ANALYSIS Review authors independently assessed trial quality and extracted data. Data were pooled where relevant and possible. Sub-analyses for specific type of fractures and for specific type of tissue reactions were performed. Requests for more information were sent to trialists. MAIN RESULTS No significant difference between the bioresorbable and other implants could be demonstrated with respect to functional outcome, infections and other complications. Reoperation rates were lower in some of the groups of people treated with bioresorbable implants. AUTHORS' CONCLUSIONS In a selected group of compliant patients with simple fractures, the use of bioresorbable fixation devices might be advantageous.

The AO-plate was used for external fixation in 12 patients. The main indications were severe open fractures of the forearm and infected pseudarthroses at several locations. In 10 cases, the fixation provided enough stability to allow bone healing. The technique is simple, is convenient for the patient, and is always available without additional special equipment.

This case demonstrates once again the potential and serious complications of pelvic fractures, especially when associated urogenital injuries are missed. Missing the bladder rupture proved almost fatal to our patient. Second, it was confirmed that in very unstable pelvic fractures, external fixation alone does not provide enough stability. Local stability is the cornerstone in the treatment of (bone) infection, and in these cases, maximal stability is only obtainable with internal fixation. The advantages of metal implants in infected areas outweigh the disadvantages by far. For the bladder-rupture, we chose a two-stage approach. First, we performed a urinary diversion, to avoid surgical closure of the infiltrated bladder wall. All cavities, including the open bladder, were packed with omentum to fill the dead space with highly vital tissue to offer stout resistance to infection. Two years later, with the patient in excellent physical condition, urinary undiversion was carried out. Ultimately physical and social recovery was complete.