The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Feb 2012
Nonisthmal femoral shaft nonunion as a risk factor for exchange nailing failure.
Although nail exchange with a larger diameter nail after additional reaming is typically considered the gold standard for failed femoral nailing, some reports question the role of exchange nailing. The purpose of this study was to evaluate the risk factors affecting the outcome of exchange nailing for femoral shaft nonunion after initial nailing. ⋯ Although exchange nailing is an excellent choice for aseptic isthmal femoral shaft nonunion occurring after the initial nailing, other treatment options such as augmentative plating should be considered for nonisthmal femoral shaft nonunions.
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Severe pelvic hemorrhage after low-energy trauma has been described in some reports of single cases only. However, it might not be as rare and unique as generally expected. The aim of this study was therefore to present a case series of 11 patients with severe pelvic hemorrhage after sustaining low-energy trauma and to discuss relevant considerations for the management of these patients. ⋯ Geriatric patients are prone to arterial hemorrhage after low-energy pelvic trauma. They should be admitted as an inpatient for observation with repeated control of the Hb level to diagnose hemorrhage at an early stage. Contrast-enhanced CT scans is the preferred imaging method for the assessment of pelvic hemorrhage, whereas arterial embolization is highly successful in terms of hemostasis.
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J Trauma Acute Care Surg · Feb 2012
L-arginine infusion during resuscitation for hemorrhagic shock: impact and mechanism.
Our previous work showed a survival advantage with L-arginine (L-Arg) pretreatment in a swine model of severe hemorrhagic shock. This study was designed to evaluating whether the benefit is sustained when L-Arg is given during resuscitation and whether the mechanism is mediated by enzymatic activation of nitric oxide (NO) synthesis. ⋯ L-Arg infusion during resuscitation offers a significant functional, metabolic, and survival benefit after severe hemorrhagic shock.The mechanism seems to be by activation of NO synthesis with its attendant benefits to local perfusion and inflammation after global reperfusion.
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Computed tomography (CT) scans have become imaging modalities of choice in trauma centers. The purposes of this study were to evaluate the trend of radiation exposure in acute trauma patients. Our hypothesis was that radiation dosage and charges would increase over time without change in patient acuity or outcome. ⋯ III, retrospective.
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The majority of type I coracoid fractures set out in Ogawa's classification constitute double disruption of the superior shoulder suspensory complex (SSSC) as proposed by Goss, frequently resulting in healing delay and adverse functional consequences.However, there are few reports alluding to strategies or concrete treatment methods of such injuries. The purpose of this report is to introduce our surgical strategy for treating the type I coracoid fracture with concurrent injuries and to describe our treatment method with their outcomes. ⋯ Although the majority of cases with type I coracoid fractures suffered double disruptions of SSSC, satisfactory results have been obtained with surgical treatment focusing on the assured reconstruction of a firm scapuloclavicular union.