Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Feb 2002
Comparative StudyHumeral shaft fractures as predictors of intra-abdominal injury in motor vehicle collision victims.
To assess the utility of humeral shaft fractures as predictors of organ injuries and skeletal injuries in multiply injured patients involved in motor vehicle collisions (MVCs). A prospectively collected database of multiply injured motor vehicle occupants with an Injury Severity Score (ISS) greater than 12 admitted to a level I regional trauma centre during a 102-month period (January 1992 to June 2000) was reviewed to assess skeletal and organ injuries associated with a humeral shaft fracture. The effect of occupant location within the vehicle, the point of collision, and the use of a seat belt restraint was also examined to identify trends in injury patterns. ⋯ A lateral collision impact showed a trend towards increased splenic and hepatic injuries within the humeral shaft fracture group. The presence of a humeral shaft fracture in a multiply injured patient involved in a MVC is significantly associated with an increased incidence of both upper and lower extremity fractures and liver injury. Moreover, humeral shaft fractures may serve as a predictor of potential intra-abdominal pathology in multiply injured trauma patients involved in MVCs.
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Arch Orthop Trauma Surg · Feb 2002
Comparative StudyThe long-term effect of pelvic osteotomy on birth canal size.
The effect of pelvic osteotomy on birth canal size at skeletal maturity is unknown. This information would be useful to counsel women of reproductive age who have undergone pelvic osteotomy. It was the purpose of this study to answer that question. ⋯ The mid-pelvis dimensions were narrower in those who underwent osteotomy when older: 7.1 +/- 4.9 years (n = 24) and 11.9 +/- 7.9 years (n = 6) (p = 0.06) for those above and below the 9.5 cm mid-pelvis threshold, respectively. In conclusion, 6 of the 30 cases had a mid-pelvis which was below threshold at skeletal maturity. If the transverse mid-pelvis diameter at skeletal maturity is < 9.5 cm, then the likelihood of Cesarean section is increased, and this information should be given to the patient.
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Arch Orthop Trauma Surg · Feb 2002
Comparative StudyRequirements for NF-kappaB activation in hemorrhagic shock.
The activation of nuclear factor (NF)-kappaB contributes to the dysfunctional inflammatory response accompanying resuscitation from hemorrhagic shock (HS), in part through induction of pro-inflammatory cytokines including granulocyte colony-stimulating factor (G-CSF) and interleukin (IL)-6. In previous studies, we demonstrated that G-CSF and IL-6 up-regulation required both the ischemic and resuscitation phases of HS. In this study, we examined whether or not both phases of HS were required for NF-kappaB activation and the kinetics of its activation. ⋯ NF-kappaB activity did not increase in any of the unresuscitated groups compared with sham controls. In contrast, resuscitation as early as 1 h following HS resulted in increased NF-kappaB activity compared with both the unresuscitated shock group and sham controls; NF-kappaB activation persisted for 8 h. Thus, NF-kappaB activation requires both phases of HS, occurs rapidly following resuscitation, and persists throughout the early stages of dysfunctional inflammation following resuscitation.
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Arch Orthop Trauma Surg · Feb 2002
Comparative StudyOncologic and functional results after treatment of giant cell tumors of bone.
Surgical treatment of giant cell tumor of bone has always been a difficult problem because of its local aggressive behavior. Oncologic results and functional outcome are reported here in a retrospective study of 36 patients, treated by various surgical procedures. The average age at the time of diagnosis was 34 years, and the median follow-up period was 7 years. ⋯ Wide excision was associated with a poor functional outcome and marginal excision with a good functional outcome. For the treatment of giant cell tumor of bone, intralesional excision with local adjuvant therapy is recommended because of a good functional outcome. When applying cryosurgery as the local adjuvant, more vigorous freezing may be necessary to improve local tumor control.
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Arch Orthop Trauma Surg · Feb 2002
Comparative StudyAdjacent segment degeneration after lumbar spinal posterolateral fusion with instrumentation in elderly patients.
This retrospective study investigated adjacent segments radiologically and clinically after posterolateral fusion of the lumbar spine with instrumentation. Thirty-two patients over 60 years old with a postoperative follow-up of at least 4 years were included. These patients all met the criteria of a postoperative symptom-free period of over 2 years, evident fusion mass seen on plain radiographs, and no implant breakage or loosening. ⋯ However, no statistically significant difference (p = 0.7878) was found according to the Fisher exact test. Comparing the effect of different types of instruments, there still was no statistically significant difference (p = 0.1161) between the VSP plate and Isola rod groups in inducing degeneration of adjacent segments after posterolateral fusion of the lumbar spine. After measuring the mobility of degenerated adjacent segments, relative hypermobility was more likely responsible for the accelerated degeneration rather than the absolute increase of mobility.