Eur J Trauma Emerg S
-
Eur J Trauma Emerg S · Jun 2007
The Finnish Forward Surgical Team Experience During EUFOR Operation RD Congo in 2006.
The army Forward Surgical Team (FST) is a mobile surgical asset designed to provide life- and limbsaving combat surgery in remote and austere terrains. Operation EUFOR RDC in Democratic Republic of the Congo (DRC) in 2006 was the first one planned and conducted solely by the European Union Forces (EUFOR). The first two European FSTs reported in the present article were established by the Finnish Defence Forces. ⋯ All trauma cases were of noncombat origin, and only one of them was severe. The European FST concept should be developed for future missions regarding the experiences gained during the reported deployment, the main goals being the mobility and the lightness of the unit. This kind of special trauma surgical asset, designed for remote theatres, will possibly be useful also in other emergency operations taking place in non-conventional circumstances; a concept of FST could easily be deployed in short notice to various accidental and natural disasters.
-
Following injuries to the pancreas and duodenum (PDI) patients often present in extremis and undergo immediate laparotomy for hemodynamic instability and peritoneal signs. Nonoperative management (NOM) may be offered in selected patients with lowgrade injuries. Precise mapping of the injury, most commonly by computed tomography, is a prerequisite for NOM because clinical symptomatology can be variable and misleading. ⋯ In these cases, the reported success rates vary from 74 to 95%. There are also a few severe pancreatic injuries that can be managed by stents with adequate reconstitution of the major pancreatic duct integrity and resolution of symptoms and without the need for operative management. Intensive monitoring and follow-up by clinical examination and repeat CT imaging is essential in these patients, as the risk of complications, and particularly a pseudocyst is high.
-
Eur J Trauma Emerg S · Jun 2007
Complications after Intramedullary Stabilization of Proximal Femur Fractures: a Retrospective Analysis of 178 Patients.
Secondary dislocation, non-union, re-fracture and implant failure are generally known complications after intramedullary fixation of proximal femur fractures with the PFN(®) (Synthes GmbH, Solothurn, Switzerland). The goal of our study was to assess the impact of patient- and treatment-specific risk factors on these complications. Complex fracture type and poor bone quality were defined as patient-specific risk factors. ⋯ Complication rate in these patients highly depended on treatment-specific risk factors. We conclude that the PFN is a secure implant for the stabilization of simple cases. Stabilization of complex proximal femoral fractures with the PFN, however, has a relevant complication rate and should therefore be considered a challenge.
-
Duodenal injuries are uncommon injuries but are associated with significant morbidity and mortality from a delayed diagnosis in the case of blunt trauma and associated major vascular injuries in penetrating trauma. A simplistic approach with primary repair or resection and anastomosis is ideal for the vast majority. Complex procedures such as pyloric exclusion with or without gastrojejunostomy may be indicated for delayed treatment or severe, high-grade combined pancreato-duodenal injuries. A high index of suspicion and a judicious treatment plan based on a careful consideration of all the available options are crucial for optimal outcome.
-
Eur J Trauma Emerg S · Jun 2007
Pressure Ulcers and Prolonged Hospital Stay in Hip Fracture Patients Affected by Time-to-Surgery.
Hip fractures are associated with high morbidity. Pressure ulcer formation after hip surgery is often related to delayed patient mobilization. The objectives of this study were to determine whether time-to-surgery affects development of pressure ulcers postoperatively and, thus, length of hospital stay. ⋯ Of the 722 patients enrolled, 488 patients (68%) received surgery at 12 h after admission. Approximately 30% (n = 214) developed pressure ulcers during admission, whilst 19% of patients operated within 12 h of admission developed pressure ulcers. Time-to-surgery was an independent predictor of both development of pressure ulcers (OR = 1.7, 95% confidence interval [CI] = 1.2-2.6; p = 0.008) and length of hospital stay (11.3 vs 13.3 days in the early and the late surgery group, respectively, p = 0.050). Furthermore, development of pressure ulcers was associated with prolonged postoperative hospital stay (19.5 vs 11.1 days for patients with and without pressure ulcers, respectively, p = 0.001) INTERPRETATION: : In hip fracture patients, time-to-surgery was an independent predictor of both postoperative pressure ulcer development and prolonged hospital stay. These data suggest that the implementation of an early surgery protocol following admission for hip fractures may reduce both the postoperative complications and overall hospital stay.