The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Jun 2012
Comparative StudyScrew- versus plate-fixation strength of acetabular anterior column fractures: a biomechanical study.
The standard for operative treatment of acetabular fractures is open reduction and plate fixation. Recently, screw fixation-only methods through less invasive approaches are reported, but biomechanical data are missing. Questions posed in this study are (1) is the static fixation strength of different screw types equivalent to the standard plate fixation for anterior column fractures of the acetabulum? and (2) does the placement of an additional screw in the infra-acetabular corridor increase the fixation strength independent of the used implant? ⋯ Therapeutic study, level IV.
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J Trauma Acute Care Surg · Jun 2012
Surgical treatment of complex regional pain syndrome type II with regional subcutaneous venous sympathectomy.
The effectiveness of a new surgical technique for the treatment of severe chronic pain stages was evaluated. For the last 140 years, the treatment of complex regional pain syndrome type II (CRPS II) has been an unsolved problem. Therapeutic approaches have included conventional pain medication, physical therapy, sympathetic blocks, transcutaneous or spinal cord stimulation, injections or infusion therapies, and sympathectomy. When used alone or in combination, these therapies often yield unfavorable results. The majority of physicians who treat patients with CRPS are convinced that a surgical treatment of the affected extremity only exacerbates the symptoms, especially its hallmark excruciating pain. ⋯ Therapeutic study, level III.
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J Trauma Acute Care Surg · Jun 2012
Comparative StudyManagement of blunt and penetrating biliary tract trauma.
Penetrating or blunt injury to the biliary tree remains a rare complication of trauma occurring in 0.1% of trauma admissions. Because of the different presentations, sites of biliary tract injury, and associated organ injury, there are many possible management pathways to be considered. ⋯ Therapeutic study, level V.
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J Trauma Acute Care Surg · Jun 2012
Evaluating the use and utility of noninvasive angiography in diagnosing traumatic blunt cerebrovascular injury.
Digital subtraction angiography (DSA) is the gold standard for radiographic diagnosis of blunt cerebrovascular injury (BCVI), but use of computed tomography angiography (CTA) and magnetic resonance angiography (MRA) has increased dramatically in BCVI screening. This study explores the utility, effectiveness, and cost of noninvasive CTA and MRA screening for BCVI. ⋯ Diagnostic study, level III; economic analysis, level IV.
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J Trauma Acute Care Surg · Jun 2012
Steady-state and time-dependent thermodynamic modeling of the effect of intravenous infusion of warm and cold fluids.
Hypothermia results in vital sign lability, coagulopathy, wound infections, and other sequelae. Normothermia can be restored by several modalities, including passive blanket heating, warm forced-air devices, and active fluid warming (AFW). In AFW, intravenously administered fluids are heated to 40 to 45 °C to minimize net thermal losses and to raise body temperature. Clinical studies have demonstrated the efficacy of AFW as part of a strategy encompassing several methods, but the isolated contribution of AFW to warming has not been theoretically examined in detail. ⋯ Our calculations reveal that AFW has a larger measurable beneficial effect for patients with more severe hypothermia, but true rewarming of the patient with AFW alone would require prohibitively large fluid volumes (more than 10 L of 40 °C fluid) or dangerously hot fluid (20 mL/kg of 80 °C fluid for a 1 °C increase). The major beneficial effect of AFW is the prevention of further net heat loss.