The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · May 2012
Comparative StudyFolded free vascularized fibular grafts for the treatment of subtrochanteric fractures complicated with segmental bone defects.
Subtrochanteric fractures of the femur complicated with segmental bone defects are uncommon injuries and challenging to manage. We evaluated the effect of reconstructing extensive bone defect in the subtrochanteric area (mean, 6.9 cm) with folded free vascularized fibular graft (FVFG). ⋯ V, therapeutic study.
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J Trauma Acute Care Surg · May 2012
Comparative StudyPrimary open reduction and internal fixation with headless compression screws in the treatment of Chinese patients with acute Lisfranc joint injuries.
Although primary open anatomic reduction and stable internal fixation has become a standard treatment principle of Lisfranc joint injuries, there are still some debates existed among surgeons as to the most appropriate treatment of this injury. The aim of this cohort study was to analyze the early (mean, 3.2 years) clinical and radiographic outcomes of one surgeon's experience associated with a standardized protocol of open reduction and internal fixation using headless compression screws (HCS) in a consecutive series of Chinese patients with Lisfranc joint injuries. ⋯ Our results have shown that fixation of an unstable tarsometatarsal joint with AO 3.0 mm HCS can provide the firm stability, the precise reduction of the joint, and satisfactory short-term clinical and radiographic outcomes without any screw breakage, although posttraumatic osteoarthritis in the midfoot is still a significant challenge for orthopedic surgeons.
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J Trauma Acute Care Surg · May 2012
Comparative StudyRecombinant human soluble thrombomodulin improves mortality and respiratory dysfunction in patients with severe sepsis.
Respiratory dysfunction associated with severe sepsis is a serious condition leading to poor prognosis. Activation of coagulation is a consequence of and contributor to ongoing lung injury in severe sepsis. The purpose of this study was to examine the efficacy of recombinant human soluble thrombomodulin (rhTM), a novel anticoagulant agent, for treating patients with sepsis-induced disseminated intravascular coagulation (DIC) in terms of mortality and respiratory dysfunction. ⋯ III, therapeutic study.
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J Trauma Acute Care Surg · May 2012
Comparative StudyThe effect of care bundle development on surgical site infection after hemiarthroplasty: an 8-year review.
Proximal femoral fracture is the most common reason for emergency orthopedic admission in the United Kingdom with an annual cost of £ 1.7 billion to the National Health Service. Surgical site infection (SSI) after proximal femoral fracture increases patient morbidity and mortality. Methicillin-resistant Staphylococcus aureus (MRSA) poses a particular risk in this patient cohort as a large proportion of these patients are residents of long-term care facilities and are therefore transient or chronic carriers of MRSA. We recorded the effect of three stages of care bundle development on the infection and specifically the MRSA rate after hemiarthroplasty over an 8-year period. ⋯ IV, therapeutic study.
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J Trauma Acute Care Surg · May 2012
Comparative StudySystemic inflammation worsens outcomes in emergency surgical patients.
Acute care surgeons are uniquely aware of the importance of systemic inflammatory response and its influence on postoperative outcomes; concepts like damage control have evolved from this experience. For surgeons whose practice is mostly elective, the significance of such systemic inflammation may be underappreciated. This study sought to determine the influence of preoperative systemic inflammation on postoperative outcome in patients requiring emergent colon surgery. ⋯ II, prognostic study.