The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Feb 2012
Comparative StudyA biomechanical comparison of static versus dynamic lag screw modes for cephalomedullary nails used to fix unstable peritrochanteric fractures.
The gamma nail has an option to statically lock its lag screw (static mode) or to allow its lag screw to move within the nail to compress the intertrochanteric fracture (dynamic mode). The purpose of this study was to compare the biomechanical stiffness of static and dynamic lag screw modes for a cephalomedullary nail used to fix an unstable peritrochanteric fracture. ⋯ There is a 60 N/mm (12.4%) reduction in axial stiffness when the lag screw is in dynamic mode. Given the statistically significant reduction in axial and lateral stiffness with use of the dynamic mode, static lag screw mode should be further explored clinically for treatment of unstable peritrochanteric fractures.
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Traumatic hematomas in the posterior fossa are rare, especially traumatic posterior fossa subdural hematomas (SDHs), which account for <1% of head injured patients. The aim of this study was to investigate the features of traumatic posterior fossa SDHs. ⋯ IV.
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J Trauma Acute Care Surg · Feb 2012
Impact of stress on resident performance in simulated trauma scenarios.
Training and practice in medicine are inherently stressful. The effects of stress on performance in clinical situations are poorly understood. The purpose of this study was to examine the stress responses and clinical performance of residents during low and high stress (HS) simulated trauma resuscitations. ⋯ In trainees, some aspects of performance and immediate recall appear to be impaired in complex clinical scenarios in which they exhibit elevated subjective and physiologic stress responses. The findings of this study highlight a potential threat to patient safety and demand further investigation. Future studies should strive to further elucidate the effects of stress on specific components of performance and investigate ways to reduce its negative impact.
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J Trauma Acute Care Surg · Feb 2012
Osteosynthesis of symptomatic nonunions of type II fractures of the distal clavicle using modified locking T-plate and bone grafting.
Type II distal clavicle fractures are generally unstable and hence prone to nonunion because of their specific biomechanical configuration. Nonunion of type II distal clavicle fractures sometimes poses a difficult problem causing pain and functional impairment of the shoulder girdle and upper limb. Therefore, operative treatment should be performed for symptomatic nonunions. However, there is very little information in the literature on nonunions of type II distal clavicle fractures to date. ⋯ Osteosynthesis using modified oblique locking T-plate and autogenous iliac bone graft results in good to excellent outcomes with the functional improvement for symptomatic nonunions of type II fractures of the distal clavicle. Our method may be primarily considered an useful alternative for symptomatic nonunions of type II distal clavicle fractures, and bone grafting should be considered in all cases.
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J Trauma Acute Care Surg · Feb 2012
Does size matter? A prospective analysis of 28-32 versus 36-40 French chest tube size in trauma.
The optimal chest tube size for the drainage of traumatic hemothoraces and pneumothoraces is unknown. The purpose of this study was to compare the efficacy of small versus large chest tubes for use in thoracic trauma. Our hypothesis was that (1) there would be no difference in clinically relevant outcomes including retained hemothoraces, the need for additional tube insertion, and invasive procedures and (2) there would be an increase in pain with the insertion of large versus small tubes. ⋯ : II.