Eur J Trauma Emerg S
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Eur J Trauma Emerg S · Jun 2010
The Epidemiology of Traumatic Hemothorax in a Level I Trauma Center: Case for Early Video-assisted Thoracoscopic Surgery.
Hemothorax is a common sequela of chest trauma. Complications after chest trauma include retained hemothorax and empyema requiring multiple interventions. We studied the epidemiology of hemothorax and its complications at a level I trauma center. ⋯ More than 1 out of every 5 patients undergoing intervention for trauma-induced hemothorax develops a complication. The development of retained hemothorax is associated with empyema in 15.6% of cases and a 2-week median increase in length of stay. Future research into interventions such as Video-assisted thoracoscopic surgery (VATS) on the day of admission to completely evacuate hemothorax is warranted to reduce complication rates, length of stay and cost.
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Fractures and dislocations at the mid-tarsal (Chopart) joint are frequently overlooked or misinterpreted at first presentation. Inadequate joint reduction and stabilization almost invariably lead to painful malunions or nonunions, residual instability, and deformity. Because of the central position and the essential function of the mid-tarsal joint, malunions lead to a considerable impairment of global foot function and the rapid development of posttraumatic arthritis. ⋯ One patient underwent fusion of the talonavicular joint for avascular necrosis and collapse of the navicular. The mean American Orthopaedic Foot and Ankle Score (AOFAS) improved significantly from 38.8 preoperatively to 80.8 at follow-up. However, the majority of malunited mid-tarsal fracture-dislocations will require corrective fusion of the affected joint(s) with axial realignment because of manifest posttraumatic arthritis at the time of patient presentation.
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Eur J Trauma Emerg S · Jun 2010
Spinal Epidural Abscess Presenting with Paraplegia Following Delayed Presentation of Traumatic Esophageal Perforation without Spinal Fracture: Lessons to be Learnt.
We describe a case of esophageal perforation following blunt chest trauma with delayed presentation as paraplegia secondary to spinal epidural abscess formation. The case highlights the importance of the awareness of the possibility of esophageal injury in patients following road traffic collisions.
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Eur J Trauma Emerg S · Jun 2010
Case Report on the Demonstration of Minute Colonic Perforations Caused by Birdshot Injury.
Penetrating trauma of the colon is usually diagnosed intraoperatively and missed injuries cause considerable morbidity and mortality. Herein, we described an intraoperative diagnostic method for invisible openings on the colon due to a birdshot injury. A 30-yearold man was admitted to the hospital after sustaining gunshot pellet injuries to his abdomen, back, and extremities. ⋯ Five tiny (2-mm) openings on the retroperitoneal part of the descending colon were demonstrated with the help of the air bubbles. All of the openings were sutureligated and his postoperative course was uneventful. We believe that inflating the colon in cases of abdominal birdshot injuries may allow the demonstration of tiny perforations and provide immediate repairs of missed injuries.
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Symptomatic secondary osteoarthritis of the Lisfranc joints due to malunion following Lisfranc joint fracture dislocations or ligamentous lesions at the Lisfranc and innominate joint level generally lead to a painful functional loss and a substantial disturbance of the walking performance. Initially missed or inadequately addressed primary lesions still represent the major source of Lisfranc joint malunions. Neuro-osteoarthropathic disorders may also become manifest in the Lisfranc joint region and may be mistaken for truly posttraumatic consequences. ⋯ The concept of a corrective arthrodesis includes restoration of stable physiologic axes and length proportions of the foot columns. A standardized approach to analyze the clinical picture and corresponding pathomorphology and the transfer into a comprehensive surgical concept which respects the realignment of any component of deformity is a prerequisite for a good functional outcome and a high degree of patient satisfaction. A fusion limited to the medial three rays combined with a soft tissue release may be sufficient for a favorable outcome in the majority of cases and preserve the mobility of the two lateral rays.