Eur J Trauma Emerg S
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Eur J Trauma Emerg S · Aug 2012
A comparative study between gamma nail and percutaneous compression plating for the treatment of intertrochanteric hip fractures.
Nowadays, the literature shows better results in the treatment of intertrochanteric (AO/OTA 31.A1-A2) hip fractures with dynamic hip screw (DHS) compared with gamma nail (GN). Besides, percutaneous compression plate (PCCP) gives results which are better or similar to those obtained with DHS. But only two reports compare the results between PCCP and GN. The aim of this trial is to compare the outcome of treatment of these fractures with either a PCCP or a GN. ⋯ PCCP has lower overall economical cost and blood transfusional requirements for a similar or better outcome in terms of procedure-related complications.
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Eur J Trauma Emerg S · Aug 2012
Iliac vessel injuries: difficult injuries and difficult management problems.
Injury to the iliac vessels poses a serious and frustrating treatment dilemma for all trauma surgeons. Generally, patients present in profound shock secondary to severe hemorrhage from either iliac arterial, venous, or combined injuries. Despite improvements in our emergency medical services (EMS), rapid transport, standard training of trauma surgeons, and improved technology, the morbidity and mortality from iliac vessel injuries remain high, ranging from 25 to 40 %. ⋯ Injuries to the iliac vessel remain a daunting task, even after great advances in anatomic injury grading and damage control as well as advances in surgical techniques and critical care. Despite all the advances in treatment and appropriate management strategies, the morbidity and mortality from iliac vessel injuries remain high, demonstrating the complex challenge their treatment presents to even the modern-day trauma surgeon.
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Femoral vessel injuries are amongst the most common vascular injuries admited in busy trauma centers. The evolution of violence and the increase in penetrating trauma from the urban battlefields of city streets has raised the incidence of femoral vessel injuries, which account for approximately 70% of all peripheral vascular injuries. ⋯ Similarly, they incur low mortality but are associated with significantly high morbidity. Prompt diagnosis and treatment are the keys to successful outcomes with the main goals of managing ischemia time, restoring limb perfusion, accomplishing limb salvage and instituting rehabilitation as soon as possible.
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Eur J Trauma Emerg S · Aug 2012
Popliteal vessel injuries: complex anatomy, difficult problems and surgical challenges.
The incidence of popliteal vessel injuries is low, even in busy urban trauma centers. As a result of this fact, few trauma centers and trauma surgeons have developed extensive experience in the management of these injuries. ⋯ Successful outcomes for limb salvage and survival result from early recognition and rapid surgical intervention by a multidisciplinary approach with a great participation of different surgical specialties. From the historical perspective, anatomy, incidence and associated injuries, to the clinical presentation, diagnosis, management, and morbidity and mortality, the aim of this article is to review the various aspects of these complex injuries.
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Vascular injuries in branch vessels of the popliteal artery, such as the tibioperoneal trunk, and shank vessels, such as anterior, posterior tibial, and peroneal vessels, occur in both blunt and penetrating trauma. Their management has evolved significantly in the past few decades. While their incidence is variable, limb loss and morbidity remain significant. ⋯ Shank vessel injuries still comprise a significant proportion of combat and civilian vascular injuries, and modern advances have led to a dramatic decrease in amputation rates.