Eur J Trauma Emerg S
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Eur J Trauma Emerg S · Aug 2007
A Retrospective Study of Five Clinical Criteria and One Age Criterion for Selective Prehospital Spinal Immobilization.
Full spinal immobilization of blunt trauma victims is a widely accepted prehospital measure, applied in order to prevent (further) damage to the spinal cord. However, looking at the marginal evidence that exists for the effectiveness of spinal immobilization, and the growing evidence for the negative effects following immobilization, a more selective protocol might be able to reduce possible morbidity and mortality as good as the present prehospital immobilization protocol. In a retrospective study, the sensitivity of a selective prehospital immobilization protocol that adds an age criterion to five clinical spine clearance criteria is examined. ⋯ In this retrospective study, a selective protocol based on clinical criteria instead of trauma mechanism showed 99.2% sensitivity for spinal fractures with or without spinal cord damage. Based on this study and the current controversy surrounding spinal immobilization, a prospective study should be considered to evaluate the five clinical criteria and one age criterion in the prehospital setting.
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Eur J Trauma Emerg S · Aug 2007
Perioperative Application of a Serum Protein Solution (Biseko(®)) After Proximal Femur Fracture of Elder Patients.
Fractures of the proximal femur are frequently seen in elderly people and will increase due to the demographic development of most industrialized countries. Early operation of dislocated fractures with either osteosynthesis or hemiprothesis has become a standard treatment for this type of injury. The high co-morbidity often leads to secondary complications like infections still resulting in a perioperative mortality rate of 11%. ⋯ Concerning IL-6, IL-8, IL-10 and serum leukocytes no significant differences were observed. The result shows a beneficial influence of the serum protein solution Biseko(®) concerning the number of perioperative complications. The design of this study and the small number of patients does not yet allow any conclusion concerning the effectiveness of this treatment.
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The surgical treatment of proximal humeral fractures constitutes a great challenge. Not all fracture types can be successfully reconstructed. Indications for a primary joint replacement arise from critical fracture patterns and defined ischemia-predicting criteria in the elderly. ⋯ Multicenter studies observed an averaged Constant Murlay Score of 56 to 73.5 points. 79% of the patients had no or only mild pain in the follow up, ROM was acceptable (41.9% Anteversion >90°, 34.7% Abduction >90°). Generally, subjective evaluations are much better than objective results. The incidence of complications after primary humeral head replacement is still relatively high, whereas the 10-year-survival-rate of shoulder hemiarthroplasties was found to be 100%, currently.
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Eur J Trauma Emerg S · Aug 2007
Stent Grafts for Acute Traumatic Injury of the Thoracic Aorta: A Single-Centre Experience.
The presented study reveals the single centre experiences with the minimally invasive endovascular repair for acute traumatic thoracic aortic lesions in the care of multitrauma patients. ⋯ The endovascular approach to acute traumatic thoracic aortic lesions is feasible, safe, and effective in multitrauma patients. The low endovascular therapy-related morbidity and mortality in the postoperative period is encouraging. The results seem to be favorable to those published of open emergency repair.
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Traumatic facial diplegia is an uncommon pathology, and is usually associated with bitemporal bone fractures. Traumatic Horner syndrome is mostly associated with carotid artery dissection. ⋯ The patient had developed his neurological deficits 9 days following trauma. We discuss the mechanisms of the facial palsy and Horner syndrome and the importance of their diagnosis.