Eur J Trauma Emerg S
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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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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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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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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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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.