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
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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Eur J Trauma Emerg S · Apr 2009
The Effects of Hook Plates on the Subacromial Space. A Clinical and MRI Study.
The disruption of the acromioclavicular joint is a relatively common injury of the shoulder girdle, often occurring in young athletes. The therapy of third degree injuries (Tossy III or Rockwood III-VI) is still controversial, and several operative techniques are practiced. In a retrospective study, 28 (= 72%) of the total number of 39 cases with a Tossy III disruption operated in our hospital between January 1998 until December 2002 with a hook plate according to Dreithaler were followed up. ⋯ Age related degenerative changes were seen in 46%, however, the accentuation of the operated side was only 14%. In MRI there was no case of a complete rotator cuff tear. Corresponding to the sonographic examination increased numbers of exostoses, heterotopic ossifications, and arthrosis of the AC-joint were observed.
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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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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.