Eur J Trauma Emerg S
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Eur J Trauma Emerg S · Dec 2012
Clinical outcomes following invasive versus noninvasive preoperative stabilization of closed diaphyseal femur fractures.
The use of invasive traction (INV-T) to stabilize femur fractures prior to fixation (open reduction and internal fixation, ORIF) remains controversial. Some centers have utilized noninvasive traction (NINV-T) or splinting preoperatively. It is possible that INV-T decreases hemorrhage. However, the use of INV-T in pediatric patients and for femoral neck fractures in adults is associated with worsened outcomes. We hypothesized that there is no difference in the need for transfusion between those who receive INV-T and NINV-T. ⋯ INV-T is not associated with improved outcomes in adult patients with closed mid-shaft femoral fractures who are operated upon within 48 h of arrival.
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Eur J Trauma Emerg S · Dec 2012
Invasive and surgical procedures in pre-hospital care: what is the need?
On occasion, advanced invasive procedures in pre-hospital care can be life saving. This study aimed to identify the contemporary use of these procedures on a regional doctor-led air ambulance unit, and to define the need, skill set and training requirements for a regional pre-hospital team in the UK. ⋯ A steady increase in the number of procedures was observed over time. Less invasive methods of airway and breathing support were frequently inadequate, though definitive surgical airway or chest decompression was effective each time it was performed. Thoracotomy was performed infrequently. There are implications for the training of pre-hospital doctors who work in the majority of the UK.
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To evaluate the outcome of the management of iatrogenic arterial injuries following knee arthroplasty using a primary endovascular approach. ⋯ An endovascular approach may be considered for the management of these injuries, although it is likely to involve long-term surveillance and may not be appropriate for all cases. Surgeons performing TKA should be aware of the potential risk factors for arterial injury and maintain a high index of suspicion for these infrequent injuries during the post-operative period.
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Acute elbow instability usually develops after injuries involving the bony or ligamentous stabilizers of the joint. It occurs frequently after dislocation and/or fracture-dislocation, but isolated valgus or varus overloading can also lead to ligament ruptures with subsequent instability. Chronic instability can result from incompletely healed acute injuries or from recurring microtrauma, for example after repetitive strain from participating in certain sports. ⋯ Stable conditions of the joint are essential for early functional post-traumatic or postoperative treatment of the elbow, as permanent mobility deficits may result otherwise. The following article gives an overview of the current understanding of these injuries and concepts in treatment.