Eur J Trauma Emerg S
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Eur J Trauma Emerg S · Jun 2008
Tip-Apex Distance as a Predictor of Failure Following Cephalo-Medullary Fixation for Unstable Fractures of the Proximal Femur.
Current research has been unable to confirm that intramedullary fixation provides greater stability for unstable fracture configurations of the proximal femur than extra-medullary devices. We present a retrospective analysis of the outcome of proximal femoral fractures treated with the Proximal Femoral Nail (PFN, Synthes) with particular reference to implant position and adequacy of reduction. Between May 2002 and October 2004, 61 patients with low-energy unstable proximal femoral fractures underwent surgery at a mean 2.4 days. ⋯ A3 fractures. In patients with A3 fracture patterns, there is a significant relationship between increasing Tip-Apex distance (p = 0.023), varus mal-reduction (p = 0.038) and failure; 46% patients died within 12 months of surgery. The PFN is a satisfactory implant in the management of unstable proximal femoral fractures, however accurate reduction and implant position are essential to provide the best conditions for union and to prevent implant failure.
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Eur J Trauma Emerg S · Jun 2008
Isolated Gallbladder Injury after Blunt Abdominal Trauma: a Case Report and Review.
We describe a case of isolated gallbladder contusion after deceleration trauma. On admission, no evident signs of intra-abdominal injury were present. However, after 24 h observation an explorative laparotomy was performed because of persistent abdominal complaints. ⋯ Contusion of the gallbladder allows conservative treatment, but in case of a rupture, surgery will be necessary. Accompanying bile duct injuries can be treated by endoscopic stenting. If active arterial bleeding is present, selective embolization can be performed.
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Suicide bombing attacks have emerged as a lethal weapon in the hands of terrorist groups. Our aim was to review the medical experience acquired in Israel, Spain, the United Kingdom and the United States in managing terrorist attacks, and prepare medical systems for the difficult task of managing these events. EMS protocols are amended to deal with a large number of victims in an urban setting who must be rapidly evacuated to a medical center where resuscitative as well as definitive care is delivered. ⋯ Professional personnel and resources are recruited and re-directed away from routine tasks towards treating the victims. This is achieved by deferring non-urgent operations, procedures and imaging studies. Victims are frequently re-assessed and re-evaluated to control chaos, minimize missed injuries and ensure delivery of an adequate level of care.
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Eur J Trauma Emerg S · Jun 2008
Reconstructive Surgery after Compartment Syndrome of the Lower Leg and Foot.
Compartment syndrome at the lower extremity, if overlooked or treated inadequately in polytraumatized and multiply injured patients, regularly leads to progressive foot deformities and severe loss of function in the affected patients. The sequelae of compartment syndrome directly result from muscle contracture, necrosis and scarring and are further affected over time by gravity and posture (especially the sleeping position with the foot in equinus and inversion). While overlooked compartment syndrome of the lower leg leads to deformities of the whole foot, most frequently equinovarus, compartment syndrome of the foot results in painful toe deformities, mostly hammer or claw toes. ⋯ Progressive contractures are subject to tenotomy, extensive capsular release and excision of scarred tissue. Corrective fusions should be reserved for long-standing deformities with symptomatic arthritis. They are combined with soft-tissue procedures as indicated.
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Eur J Trauma Emerg S · Jun 2008
Percutaneous Dilational Tracheostomy in a Community Intensive Care Unit.
Percutaneous dilational tracheostomy (PDT) is increasingly being used to replace traditional surgical tracheostomy (ST) in the management of critically ill patients. There is considerable controversy regarding the safety of this procedure in the hands of non-surgeons, and most data so far have come from large tertiary care centres. We report our experience and safety data in the implementation of a PDT program for critically ill patients in a teaching community hospital in an attempt to demonstrate that this procedure can be performed safely outside of an academic ICU. ⋯ Percutaneous dilational tracheostomy appears to be at least as safe as traditional ST, and may have advantages with respect to timeliness and minimization of patient transport. The complication rate seen in our program is similar to that seen in other PDT series.