Eur J Trauma Emerg S
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Eur J Trauma Emerg S · Feb 2007
Massive Rectal Hemorrhage from the Middle Hemorrhoidal Artery after Blunt Perineal Trauma Without Pelvic Fracture.
Severe pelvic hemorrhage after blunt trauma without bony fracture has been reported occasionally, and clinical presentation as a delayed massive rectal bleeding is very rare. ⋯ This report is unique not only for the unusual association of pelvic hemorrhage and rectal injury after blunt trauma without pelvic fracture but also because of the clinical presentation as a massive rectal bleeding. Undoubtedly, the delayed diagnosis and treatment, 12 h after the trauma, contributed to the fatal outcome.
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On October 8, 2005, a major earthquake measuring 7.6 on the Richter scale struck the Himalayan region of Kashmir. Around 90,000 people died in the mass disaster. The Bone and Joint Hospital in Kashmir found itself in a relatively unique situation of having to deal with the orthopedic morbidity generated by this quake. ⋯ Due to the unprecedented admission in terms of numbers the hospital utilized outreach methods to streamline admission by sending out specialists to the affected areas. Manpower was judiciously utilized to concentrate specialist advise where required. Besides documenting the pattern of trauma, this paper throws light on some unforeseen problems faced in dealing with a large number of patients far exceeding the normal capacity of the hospital.
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Eur J Trauma Emerg S · Feb 2007
Function Versus Position: A Randomized Controlled Trial of Interfocal Kirschner Wiring of Unstable Distal Radial Fractures.
A randomized, prospective study has been carried out to determine if immobilisation in dorsiflexion following K-wire fixation of unstable distal radial fractures improves functional outcome. ⋯ Immobilisation in dorsi-flexion following K-wiring for unstable distal radial fractures does not improve functional outcome. The overall functional results were excellent and we believe that Kwiring still as a place in the treatment of distal radial fractures in the previously defined population.
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Eur J Trauma Emerg S · Feb 2007
Reconstruction of Lower Extremity Fractures with Soft Tissue Defects.
Reconstruction of osseous and soft tissue defects after high-energy lower extremity trauma remains a challenge in trauma surgery. An initial planning of the reconstruction management is crucial in the therapeutic concept of these severe injuries. In Gustilo type II and IIIa fractures with minimal contamination a primary definite osseous stabilization by internal fixation along with primary soft tissue reconstruction is preferable. ⋯ Early secondary osseous reconstruction of larger osseous defects can be performed either by distraction lengthening technique or by a free vascularized bone graft. Early secondary soft tissue reconstruction necessitates a wide therapeutic repertoire in order to plan the optimal individual strategy. With a modern therapeutic strategy limb salvage with an adequate function after reconstruction of lower extremity fractures with soft tissue defects can be achieved in the majority of patients.
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Today, vacuum therapy can be regarded as established in routine clinical use. Many hundreds of reports on the subject of vacuum therapy have appeared in medical literature. This review intends to give an overview of the peer-reviewed literature published to date and its quality considering criteria of evidence-based medicine (EbM). ⋯ The clinical significance of this therapy is underlined by an obviously continuously marked extension of the range of indications in all surgical fields, and even in extreme ages of the patients. There is a considerable deficit of basic pathophysiological research and well-designed studies. This "deficiency," however, when judged against the quality of the general medical literature, does not point to the poor efficacy or low benefit of vacuum therapy but should rather be seen as a symptom of the clinical practitioner's problems in dealing with modern aspects of the theoretical background of EbM.