Eur J Trauma Emerg S
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Eur J Trauma Emerg S · Aug 2008
Midfacial Fractures: A Scoring Method and Validation on 117 Patients.
The midfacial region (MR) is located in the middle-third of the face, composed of several bones and surrounded by complex anatomical structures so that MR fractures (MRFs) often involve other parts of the face. A staging system for classifying MRFs is of paramount importance in order to exchange information among trauma centers. Le Fort described three lines of fractures but still there is no scoring method to stage MRFs. ⋯ In conclusion, the proposed classification is a simple and precise method of staging MRFs. It can summarize MRFs and be used in daily practice. It is our understanding, however, that a multi-centers study should be performed before the effectiveness of the proposed classification can be clearly stated.
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Eur J Trauma Emerg S · Aug 2008
The use of Hypertonic Saline in the Treatment of Post-Traumatic Cerebral Edema: A Review.
Effective methods for treating cerebral edema have recently become a matter of both extensive research and significant debate within the neurosurgery and trauma surgery communities. The pathophysiologic progression and outcome of different forms of cerebral edema associated with traumatic brain injury have yet to be fully elucidated. There are heterogeneous factors influencing the onset and progress of post-traumatic cerebral edema, including the magnitude and type of head injury, age, co-morbid conditions of the patient, the critical window for therapeutic intervention and the presence of secondary insults including hypoxia, hypotension, hypo/hyperthermia, degree of raised intracranial pressure (ICP), and disruption of blood brain barrier (BBB) integrity. ⋯ More recently, fluid resuscitation strategies using hyperosmolar agents such as pentastarch and hypertonic saline (HS) have achieved some success. HS treatment is of particular interest due to its apparent advantageous action over other types of hyper-osmotic solutions in both clinical and laboratory studies. In this review, we provide a summary of recent literature concerning the pathogenesis and mechanisms involved in the various types of cerebral edema, and the possible mechanisms of action of HS for the treatment cerebral edema.
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Eur J Trauma Emerg S · Aug 2008
Severe Fracture of the Tibial Pilon: Results with a Multidirectional Self-locking Osteosynthesis Plate Utilizing a Two-stage Procedure.
The objective of this study is to determine the treatment result of severe fractures of the tibial pilon using a two-stage treatment plan with a singular implant type. The setting is a level 1 trauma centre, the design a consecutive series of patients with a retrospective data evaluation. Due to anatomical circumstances, soft-tissue treatment is extremely important for fractures of the tibial plafond. ⋯ There was no secondary loss of reduction or need for arthrodesis. The mean AOFAS score was 73.4 (52-97). A two-stage treatment plan in fractures of the distal lower limb with external fixation followed by locked-plate osteosynthesis reduces local complications with a good functional result.
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Postinjury abdominal compartment syndrome (ACS) has evolved during the 1980s together with the introduction of damage control surgery (DCS) principles. DCS made it possible to salvage severely injured trauma patients who previously would have exsanguinated due to uncontrollable coagulopathic bleeding. These patients had severe hemorrhagic shock; their abdomens were tightly packed and had ongoing massive resuscitation. ⋯ Open abdomen is one of the important preventive strategies but it is not free from morbidity and mortality. With aggressive open abdomen management in postinjury ACS these complications can be minimized. More importantly, timely hemorrhage control and hemostatic resuscitation are the likely solutions for more efficient prevention of the postinjury ACS.
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Injuries to the pancreaticoduodenal complex present a significant challenge both in diagnosis and management. The retroperitoneal location of the pancreas means that it is not a common site of injury, but this also contributes to the difficulty in diagnosis, as the organ is concealed, and investigation often results in delay with its attendant increase in morbidity. ⋯ In many cases the surgical management is relatively simple, but occasionally complex and technical surgical solutions are necessary and the position of the pancreas makes its access and all procedures on it challenging. To compound this, pancreatic trauma is associated with a high incidence of injury to adjoining organs and major vascular structures, which adds to the high morbidity and mortality, and complications occur in 30-60% of patients [1, 2].