Eur J Trauma Emerg S
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Eur J Trauma Emerg S · Apr 2009
Acute Traumatic Brain Injury: A Review of Recent Advances in Imaging and Management.
Acute traumatic brain injury (TBI) is a major cause of death and disability in young persons worldwide, producing a substantial economic burden on health services. New technology in computed tomography and magnetic resonance imaging is allowing the acquisition of more accurate and detailed information on cerebral pathology post-TBI. This has greatly improved prognostic ability in TBI and enables earlier identification of pathology, making it potentially amenable to therapeutic intervention. ⋯ Some traditional therapies for the treatment of acute TBI have been proven to be harmful and should be avoided. A number of management strategies have proved potentially beneficial post-TBI, but there is insufficient evidence to make definitive recommendations at present. Future therapies that are currently under investigation include decompressive craniectomy, progesterone therapy, and possibly therapeutic hypothermia.
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Eur J Trauma Emerg S · Apr 2009
Insufficient Evidence for Routine Use of Thromboprophylaxis in Ambulatory Patients with an Isolated Lower Leg Injury Requiring Immobilization: Results of a Meta-Analysis.
There are no generally accepted guidelines for the prevention of venous thromboembolism (VTE) in ambulatory patients requiring immobilization after an isolated lower leg injury. Our objective was to evaluate the effectiveness and safety of pharmacological interventions for preventing VTE in these patients. ⋯ There is insufficient evidence to warrant routine use of thromboprophylaxis in ambulatory patients with below-knee or lower leg immobilization after an isolated lower leg injury. The incidence of symptomatic VTE is too low to show a relevant clinical benefit from thromboprophylaxis.
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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.
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It is important to be alert to the possibility of pneumocephalus in patients with head injury. Pneumocephalus is a potentially lethal complication in patients with craniofacial fractures following severe head trauma. ⋯ A time sequence of cerebral CT scans shows how the pneumocephalus developed and finally resolved without surgical intervention. The etiology, diagnosis, treatment and possible complications of this injury are discussed briefly.
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Eur J Trauma Emerg S · Apr 2009
Comparison of Injury Pattern in Victims of Bear (Ursus thibetanus) and Leopard (Panthera pardus) Attacks. A Study from a Tertiary Care Center in Kashmir.
Patients injured in bear and leopard attacks present with different patterns of injuries and have different mortality rates. A common protocol may not be suitable for the management of injuries inflicted by these two large wild animals. ⋯ Wild animals usually attack in remote areas, where composite trauma centers do not exist, and the urgent referrals of these patients will have a significant impact on the final outcome. The management of these patients requires a team approach involving all of the subspecialties of traumatology.