Eur J Trauma Emerg S
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Eur J Trauma Emerg S · Aug 2007
Early Placement of Optional Vena Cava Filter in High-Risk Patients with Traumatic Brain Injury.
Patients sustaining severe trauma are at high risk for the development of venous thromboembolic events (VTE). Pharmacologic VTE prophylaxis may be contraindicated early after trauma due to potential bleeding complications. The purpose of this study was to evaluate safety and feasibility of early prophylactic vena cava filter (VCF) placement and subsequent retrieval in multiple injured patients with traumatic brain injury (TBI). ⋯ Early VCF placement may be of benefit for multiple injured patients with TBI when pharmacologic VTE prophylaxis is contraindicated. VCF retrieval is safe and feasible. Filter placement- and retrieval-related morbidity is low.
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Treating proximal humeral fractures surgically has always been a challenge for the orthopaedic trauma surgeon. The challenge was and is due to numerous factors such as the specific anatomy of the proximal humerus, problems of an adequate approach and exposure of the fracture and different fracture fragments, possible iatrogenic injuries to the rotator cuff on approach and the detrimental effects of the former on the latter's gliding and contracting ability after surgery. Furthermore, the very different fracture patterns that can occur at the proximal humerus, the shear number of fragments which can be of extremely bad bone quality, the necessity for anatomic reduction of these fragments with an implant that will allow for a stable osteosynthesis and at the meantime will not impinge in the subacromial area and lastly, the intention of the physician-in-charge to commence with physical therapy as soon as possible post OP. ⋯ Most of the supposedly applicable surgical techniques and implants had major setbacks such as being limited to only very expert hands, necessitating a long-standing postoperative immobilisation, resulting in secondary loosening of implants, secondary loosening of reduction or impaired bone healing and, despite all efforts, finally led to poor function at the shoulder. With the advent of angular stable implants such as angular stable, anatomically contoured plates designed for proximal humeral fractures only and special angular stable nails for the same or similar indications the treatment options and the quality of treatment in this area was much improved. Our experience with angular stable nails of two different manufacturers in now more than 320 implantations reveals that indications for the surgical treatment of such fractures can be extended constantly, that the number of complications will simultaneously decline, the necessity for primary joint arthroplasty even in multiple fragment fractures is minimal and that long-term results are, comparing the published results in the literature with those of our institution, equal if not superior to other treatment options.
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Eur J Trauma Emerg S · Aug 2007
Fixation of Proximal Humeral Fractures with an Intramedullary Nail: Tipps and Tricks.
Antegrade interlocking nailing has been established as a valid option of treatment in proximal humeral fractures which follows the principles of minimum invasive surgery. The introduction of angular stability into intramedullary nailing has increased the stability of reconstruction even in osteoporotic fractures. ⋯ The creation of the correct nail entry point is crucial for anatomic reduction and stability of the reconstruction, as well. The knowledge on intraoperative reduction aids and additional tools of enhancing the stability of the reconstruction alleviates a mechanically sound application of antegrade intramedullary nailing in most highly unstable proximal humeral fractures.
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Eur J Trauma Emerg S · Aug 2007
Postoperative Management after Pneumonectomy for Blunt Thoracic Trauma.
Pneumonectomy for blunt thoracic injury carries a high mortality rate. We present a case of severe bilateral blunt thoracic injury in which left pneumonectomy was done. The immediate postoperative measures were directed to maintain right heart performance by minimizing hypoxia, avoiding fluid overload and limiting pulmonary hypertension. We believe that this approach contributed to the favorable outcome of this patient.
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Eur J Trauma Emerg S · Aug 2007
Acute Anterior Thigh Compartment Syndrome Revisited: A Case Report and Review of Literature.
We present a rare case of acute anterior compartment syndrome of the thigh in a rugby player with no history of trauma during the game. Decompressive fasciotomy with subsequent closure of the wound resulted in good outcome. Acute compartment syndrome of the thigh should be suspected following vigorous exercise and fasciotomy is to be performed on urgent basis.