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 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
Conservative treatment of Garden stage I femoral neck fracture in elderly patients.
We reviewed 38 patients aged 65 years and older with fresh Garden stage I femoral neck fractures treated nonsurgically to determine factors that influence fracture union. The mean follow-up period was 20 (range 6-86) months. Twenty-three (61%) fractures united within 6 months after injury, while 15 (39%) failed to unite. ⋯ The incidence of union was considerably higher (p < 0.05) in patients who began ambulation 20 days or later after injury than in those who began within 19 days. There was no statistical difference in the amount of valgus or retroversion of the femoral head between patients whose fractures united and those whose fractures did not. Patients without severe dementia regained the ability to walk significantly more frequently than did patients with severe dementia (p < 0.05).
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Arch Orthop Trauma Surg · Feb 2002
Case ReportsMelorheostosis with occlusion of dorsalis pedis artery.
Melorheostosis is an unusual sclerotic dysplasia of bone. The case of a 51-year-old female patient with melorheostosis and occlusion of the dorsalis pedis artery is described. Although numerous vascular anomalies have been noted in patients with melorheostosis, occlusion of the dorsalis pedis artery has not been reported previously.
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Arch Orthop Trauma Surg · Feb 2002
Randomized Controlled Trial Comparative Study Clinical TrialResults of a prospective randomised study comparing a non-invasive surgical zipper versus intracutaneous sutures for wound closure.
A prospective randomised study was undertaken to investigate the advantages and disadvantages of a non-invasive surgical zipper (Medizip) vs intracutaneous sutures skin closure in orthopaedic surgery. The study group consisted of 120 consecutive patients, 45 men and 75 women with a mean age of 47 years. The Medizip was used in 20 surgical knee wounds, 20 hip wounds and 20 orthopaedic spine wounds. ⋯ Patients were positive in their assessment of the wound healing progress and results; they found the skin closure device agreeable to wear. The scar result was rated very good in 82% (n = 4 9) of the zipper group, and 85% (n = 5 1) in the intracutaneous group (p = 0 .67). Based on the results obtained, the non-invasive skin closure system Medizip represents a safe option in the spectrum of surgical wound treatment.