The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Apr 2012
Ex vivo evaluation of the polymerization temperatures during cement augmentation of proximal femoral nail antirotation blades.
Previous studies have clearly demonstrated superior biomechanical behavior of augmented proximal femoral nail antirotation (PFNA) blades compared with nonaugmented ones with respect to implant cutout. Nevertheless, there is concern about thermal bone necrosis due to exothermic curing of polymethylmethacrylate (PMMA)-based bone cements. The objective of this study was to quantify the temperatures arising around perforated titanium PFNA blades when augmenting with PMMA. ⋯ The results of this study suggest that augmentation of titanium PFNA blades is not associated with a risk of thermal bone necrosis when using up to 6 mL of PMMA. However, larger amounts of cement lead to higher temperatures. PMMA application should therefore be kept low to minimally alter the biological system.
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J Trauma Acute Care Surg · Apr 2012
Prospective evaluation of selective nonoperative management of torso gunshot wounds: when is it safe to discharge?
Selective nonoperative management (NOM) has been increasingly used for torso gunshot wounds (GSWs). The optimal observation time required to exclude a hollow viscus injury is not clear. The purpose of this study was to determine the safe period of observation before discharge. ⋯ In the initial evaluation of patients sustaining a GSW to the torso, clinical examination is essential for identifying those who will require emergency operation. For those undergoing a trial of NOM, all failures occurred within 24 hours of hospital admission, setting a minimum required observation period before discharge.
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J Trauma Acute Care Surg · Apr 2012
Pain and satisfaction in hospitalized trauma patients: the importance of self-efficacy and psychological distress.
Unmanaged pain has been found to predict delayed return to work, psychologic distress, and chronic pain and disability in patients with traumatic injury. However, little is known about the pain experience during hospitalization. The primary objective of this study was to determine pain intensity, pain interference, and satisfaction with pain treatment in orthopedic trauma patients at hospital discharge. A secondary objective was to examine whether patient self-efficacy and psychologic distress were associated with pain and satisfaction. ⋯ Results suggest that orthopedic trauma patients have a significant pain burden but are satisfied with pain treatment during the hospital stay. Efforts are needed to improve pain assessment and management and findings imply that addressing self-efficacy and depressive symptoms may decrease pain and increase satisfaction at hospital discharge. Brief educational interventions that incorporate pain coping skills and self-management techniques may be a feasible approach to improving self-efficacy in the acute care setting. Additional recommendations include routine hospital screening for depression and increased communication between surgeons and mental health providers to identify patients at high risk for unmanaged pain and facilitate provision of early mental health services.
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J Trauma Acute Care Surg · Apr 2012
Nonsurgical management of delayed splenic rupture after blunt trauma.
Delayed splenic rupture (DSR) is a rare manifestation of blunt splenic trauma, and splenectomy remains the primary treatment for patients with DSR. The purpose of this study was to review our experience with nonsurgical management of DSR with the use of splenic artery embolization (SAE) as an adjunct treatment. ⋯ Nonsurgical management can safely be used in selected patients with DSR, especially for those with a good response to resuscitation. SAE is as effective for DSR as it is for acute splenic injury. Physicians should consider SAE as an option for the treatment of DSR.
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J Trauma Acute Care Surg · Apr 2012
Efficacy of beta-blockade after isolated blunt head injury: does race matter?
Several retrospective clinical studies and recent prospective animal models demonstrate improved outcomes with beta-blocker administration after isolated blunt head injury. However, no investigations to date have examined the influence of race on the potential therapeutic effectiveness of these medications. Our hypothesis was that mortality benefits associated with beta-blocker exposure after isolated blunt head injury varies based on ethnicity. ⋯ Our results indicate that beta-blockade after traumatic brain injury may not benefit all races equally. Further prospective research is necessary to assess this discrepancy in treatment benefit and explore other possible therapeutic interventions.