A total of 83 patients who were admitted urgently to our hospital after major trauma, between August 2012 and March 2015, and fulfilled the criteria for surgical fixation of their multiple rib fractures. Patients who had concomitant nonsurvivable injuries or did not consent for surgery were excluded.Intervention: Open reduction and internal fixation (ORIF) of multiple rib fractures and flail chest segments versus traditional nonoperative management. Main Outcome Measurements:The primary outcome of interest was the total hospital length of stay (LOS). Secondary outcomes included the incidence of intensive care unit (ICU) admission and the incidence of respiratory complications such as hospital-acquired pneumonia, need for mechanical ventilation, and/ or tracheotomy. The mortality rate was also investigated.Results: A total of 83 patients were included, 47 of these in the ORIF group and 36 in the non-ORIF group. The mean hospital LOS for patients in the non-ORIF group was 30.41 days (SD 30.1). This was markedly reduced in the ORIF group to a mean of 14.53 days (SD 11.7), with the difference being statistically significant (P , 0.01). Twenty-eight patients (77.7%) in the nonoperatively managed group required admission to the ICU compared with a significantly lower 48.9% (23 patients) in the ORIF group (P , 0.01). The incidence of respiratory complications was lower in the ORIF group but this difference was not statistically significant. The mortality rate was 2.1% for the group that was treated surgically compared with 13.9% for the conservative group (P , 0.05).Conclusions: Surgical fixation of multiple displaced rib fractures reduced the total hospital LOS and the overall mortality in our major trauma patients and decreased the incidence of ICU admission.

Background: In June 2008, a maternity acupuncture service began operating within a Hutt Valley Hospital outpatient department, offering access to free acupuncture care for pregnancy and postnatal related conditions. This was the first and, to date, the only clinic of this type within a New Zealand hospital.Objective: To retrospectively describe and analyse routinely collected data from 2013 and 2014, on treatment delivered in this clinic. Specifically we report on the number of women treated, their presenting condition, referral patterns and patient centred outcomes for those women presenting with back or pelvic/hip pain.Methods: Data on the primary reason for seeking acupuncture and referral pathway were collected on a woman's initial visit. For those women presenting with back or pelvic/hip pain, a Measure Yourself Medical Outcome Profile (MYMOP) form was also completed, with a follow-up form completed on each subsequent visit until discharge.Findings: Two hundred and sixty-one women received treatment. The majority were referred through Lead Maternity Carer (LMC) midwives and were requesting acupuncture treatment for labour preparation, back or pelvic/hip pain. MYMOP reporting demonstrated a high level of patient satisfaction, with 80% of women reporting a change in their pain that was clinically significant.Conclusion: Data from this clinic illustrate a successful partnership between mainstream and complementary medicine, offering integrated healthcare to women in a public health system. Acupuncture offered a non-pharmaceutical treatment option and for those with back or pelvic/hip pain delivered high levels of patient satisfaction. It is hoped that this article will stimulate further interest in the under-researched area of maternity acupuncture.