Eur J Trauma Emerg S
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Eur J Trauma Emerg S · Apr 2009
Nonoperative Management of Blunt Splenic Trauma: Also Feasible and Safe in Centers with Low Trauma Incidence and in the Presence of Established Risk Factors.
Treatment of blunt splenic trauma has undergone dramatic changes over the last few decades. Nonoperative management (NOM) is now the preferred treatment of choice, when possible. The outcome of NOM has been evaluated. This study evaluates the results following the management of blunt splenic injury in adults in a Swedish university hospital with a low blunt abdominal trauma incidence. ⋯ Most patients in this study were managed conservatively with a low failure rate of NOM. NOM of blunt splenic trauma could thus be performed in a seemingly safe and effective manner, even in the presence of established risk factors. Routine follow-up with CT scan did not appear to add clinically relevant information affecting patient management.
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Proximal embolization of the splenic artery (PSAE) has recently been reported for traumatic splenic injury. The suggested mechanism of action entails a decrease in the splenic blood pressure without ischemia due to collateral blood supply. The main complications of selective embolization are continuous bleeding, splenic infarcts and splenic abscesses. The main complications of observation alone are continuous bleeding and formation of splenic pseudoaneurysms. Our aim was to assess the efficacy of PSAE in the cessation of bleeding without formation of pseudoaneurysms, and the outcome of the spleen after such intervention. ⋯ Proximal embolization of the splenic artery for severe splenic injury is highly successful in cessation of bleeding while preserving splenic architecture. There were minimal complications in this series demonstrated by clinical and Doppler examinations.
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Traumatic allogenic bone implantation is becoming increasingly common in the setting of road trauma and suicide bombings. We present a unique case where a large bony fragment from one individual became embedded in the arm of another person following a "head-on" collision involving two motorbikes. Several management issues are outlined.
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We studied 20 fractures of the neck of femur in 19 patients under the age of 16 years that were treated in the period from 1998 to 2004. There were nine boys and ten girls with an average age of 11 years. There was one case of Delbet type I (transepiphyseal separation). ⋯ Avascular necrosis occurred in nine cases (45%). Other complications included coxa vara in two, nonunion in two, postoperative infection in one, and refracture in one. The amount of displacement of the fracture and the quality of reduction and fixation influenced the occurrence of complications such as avascular necrosis and nonunion.
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Eur J Trauma Emerg S · Apr 2009
The Elastic Bridge Plating of the Forearm Fracture: A Prospective Study.
Rigid plate osteosynthesis with compression is still the treatment of choice for forearm fractures to gain anatomic reposition, provide proper rotation and avoid a bridging callus. Due to necessary operative dissection there is a serious risk for infection and malunion. Based on good clinical results with elastic bridge plating at femur, humerus and tibia, this technique was also started to be used for forearm fractures in our clinic in 1995. ⋯ One re-osteosynthesis, one secondary lag screw, and five cancellous bone grafts were necessary before final healing. About 79.1% of the patients had a perfect clinical outcome; 17.4% had additional severe injuries of the same arm. Bridge plating without interfragmentary compression is a reliable surgical procedure even for forearm fractures with low risk of infection and nonunion.