Eur J Trauma Emerg S
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Eur J Trauma Emerg S · Apr 2012
Severe pelvic fracture-related bleeding in pediatric patients: does it occur?
Pediatric pelvic fractures are rare and less likely to cause hemodynamic instability than similar injuries in adult patients. The associated injuries are common, and they have a major impact on mortality. The aim of the present study was to evaluate the risk of life-threatening hemorrhage associated with unstable pelvic fractures in children. ⋯ We conclude that life-threatening bleeding from pelvic or acetabular fractures in pediatric patients is rare (2.8%), and does not contribute to the overall mortality.
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Eur J Trauma Emerg S · Apr 2012
Indications for bullet removal: overview of the literature, and clinical practice guidelines for European trauma surgeons.
The incidence of gunshot wounds from civilian firearms is increasing. Despite this fact, guidelines on indications for bullet removal are scarce. In this analysis, we combine an overview of the available literature in these rare entities with our experiences in our own clinical practices. ⋯ In summary, there are only a few clear indications for bullet removal. These include bullets found in joints, CSF, or the globe of the eye. Fragments leading to impingement on a nerve or a nerve root, and bullets lying within the lumen of a vessel, resulting in a risk of ischemia or embolization, should be removed. Rare indications are lead poisoning caused by a fragment, and removal that is required for a medico-legal examination. In all other cases the indication should be critically reviewed.
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Volkmann's ischaemic contracture is a devastating condition with serious motor and sensory functional implications for the affected limb. This clinical review outlines acute compartment syndrome and Volkmann's ischaemic contracture, their presentation, evolution and current management. ⋯ Prevention is essential regarding Volkmann's ischaemic contracture. This can be achieved through careful observation of patients sustaining high-risk extremity injuries, notably, children with supracondylar fractures of the humerus, and immediate decompression if signs and symptoms of a compartment syndrome are present. Increased awareness amongst doctors of compartment syndrome is fundamental and will allow early recognition, clinical diagnosis and subsequent fasciotomy.
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The introduction of firearms in the fifteenth century led to the continuous development of bulletproof personal protection. Due to recent industrial progress and the emergence of a new generation of ballistic fibers in the 1960s, the ability of individual ballistic protections to stop projectiles greatly increased. ⋯ This review first summarizes current technical data for modern bulletproof vests, the materials used in them, and the stopping mechanisms they employ. Then it describes recent research into the specific ballistic injury patterns of soldiers wearing body armor, focusing on behind-armor blunt trauma.
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Eur J Trauma Emerg S · Apr 2012
What are the predictors of scapula fractures in high-impact blunt trauma patients and why do we miss them in the emergency department?
To find out the predictors of scapula fractures in high-impact blunt trauma patients and the predictors of missing them in the emergency department (ED). ⋯ After matching for ISS, the mortality of patients with scapula fracture was significantly higher than the control group. We observed that fractures in the glenoid and scapular neck occurred higher than in the body region. We found that the seniority of the ED doctor, consultation ratio for orthopedics in ED, and the existence of brain contusion were important parameters for missing scapula fractures in ED.