Eur J Trauma Emerg S
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Eur J Trauma Emerg S · Jun 2008
Tip-Apex Distance as a Predictor of Failure Following Cephalo-Medullary Fixation for Unstable Fractures of the Proximal Femur.
Current research has been unable to confirm that intramedullary fixation provides greater stability for unstable fracture configurations of the proximal femur than extra-medullary devices. We present a retrospective analysis of the outcome of proximal femoral fractures treated with the Proximal Femoral Nail (PFN, Synthes) with particular reference to implant position and adequacy of reduction. Between May 2002 and October 2004, 61 patients with low-energy unstable proximal femoral fractures underwent surgery at a mean 2.4 days. ⋯ A3 fractures. In patients with A3 fracture patterns, there is a significant relationship between increasing Tip-Apex distance (p = 0.023), varus mal-reduction (p = 0.038) and failure; 46% patients died within 12 months of surgery. The PFN is a satisfactory implant in the management of unstable proximal femoral fractures, however accurate reduction and implant position are essential to provide the best conditions for union and to prevent implant failure.
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Suicide bombing attacks have emerged as a lethal weapon in the hands of terrorist groups. Our aim was to review the medical experience acquired in Israel, Spain, the United Kingdom and the United States in managing terrorist attacks, and prepare medical systems for the difficult task of managing these events. EMS protocols are amended to deal with a large number of victims in an urban setting who must be rapidly evacuated to a medical center where resuscitative as well as definitive care is delivered. ⋯ Professional personnel and resources are recruited and re-directed away from routine tasks towards treating the victims. This is achieved by deferring non-urgent operations, procedures and imaging studies. Victims are frequently re-assessed and re-evaluated to control chaos, minimize missed injuries and ensure delivery of an adequate level of care.
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Eur J Trauma Emerg S · Jun 2008
Reconstructive Surgery after Compartment Syndrome of the Lower Leg and Foot.
Compartment syndrome at the lower extremity, if overlooked or treated inadequately in polytraumatized and multiply injured patients, regularly leads to progressive foot deformities and severe loss of function in the affected patients. The sequelae of compartment syndrome directly result from muscle contracture, necrosis and scarring and are further affected over time by gravity and posture (especially the sleeping position with the foot in equinus and inversion). While overlooked compartment syndrome of the lower leg leads to deformities of the whole foot, most frequently equinovarus, compartment syndrome of the foot results in painful toe deformities, mostly hammer or claw toes. ⋯ Progressive contractures are subject to tenotomy, extensive capsular release and excision of scarred tissue. Corrective fusions should be reserved for long-standing deformities with symptomatic arthritis. They are combined with soft-tissue procedures as indicated.
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Eur J Trauma Emerg S · Jun 2008
Percutaneous Dilational Tracheostomy in a Community Intensive Care Unit.
Percutaneous dilational tracheostomy (PDT) is increasingly being used to replace traditional surgical tracheostomy (ST) in the management of critically ill patients. There is considerable controversy regarding the safety of this procedure in the hands of non-surgeons, and most data so far have come from large tertiary care centres. We report our experience and safety data in the implementation of a PDT program for critically ill patients in a teaching community hospital in an attempt to demonstrate that this procedure can be performed safely outside of an academic ICU. ⋯ Percutaneous dilational tracheostomy appears to be at least as safe as traditional ST, and may have advantages with respect to timeliness and minimization of patient transport. The complication rate seen in our program is similar to that seen in other PDT series.
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Eur J Trauma Emerg S · Jun 2008
Secondary Abdominal Compartment Syndrome in a Patientwith Isolated Extraperitoneal Injuries.
The abdominal compartment syndrome (ACS) is defined as increased intra-abdominal pressure (IAP) associated with adverse physiologic consequences. The ACS ismost commonly diagnosed in patients sustaining abdominal or pelvic trauma, or suffering some other intraabdominal hemorrhagic catastrophe. Recently, several groups have reported cases in which patients sustaining extra-abdominal trauma developed ACS following acute resuscitation with crystalloids or blood. ⋯ SACS is a poorly understood and characterized syndrome where the increased intra-abdominal pressure occurs without abdominal injury. Timely diagnosis is difficult because of its low incidence and major trauma to other body regions. We report a fatal case of SACS, which progressed to necrotic and gangrenous large bowel.