Eur J Trauma Emerg S
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The tibia is an exposed bone with vulnerable soft tissue coverage and is therefore predisposed to local soft tissue problems and delayed bone healing. The objective in distal tibial fracture treatment is to achieve stable fixation patterns with a minimum of soft-tissue affection. ⋯ Anticipating the pitfalls, intramedullary nailing meets the requirements of the method of choice in distal tibial fracture fixation. In conclusion, intramedullary nailing of distal tibial fractures is a reliable method of fixation, possessing the advantages of closed reduction and symmetric fracture stabilization of an area with a delicate soft tissue situation, but prospective randomized trials are needed to compare modern intramedullary fracture fixation with modern plate fixation in distal tibial fractures.
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Eur J Trauma Emerg S · Dec 2009
Treatment of Distal Lower Leg Fractures: Results with Fixed-Angle Plate Osteosynthesis.
Twenty-five patients with closed distal tibial fractures were treated with a fixed-angle (locked) plate osteosynthesis. The study period was from 1.1.06 to 31.12.07. According to AO classification, there were three A1, eight A2, nine A3, one B2, two C1, and two C3 fractures. ⋯ No loss of reduction occurred. Fixed-angle plate osteosynthesis is a good alternative to intramedullary nailing when treating closed distal lower leg fractures. It is a demanding surgical method with good clinical and functional results.
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Relaparotomy is sometimes required for complications that develop after abdominal surgery, but it is associated with high mortality. We aimed to investigate the independent risk factors related to mortality in patients that undergo relaparotomies. ⋯ Advanced age and APACHE II score ≥ 20 were found to be independent risk factors affecting relaparotomy-related mortality.
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Eur J Trauma Emerg S · Dec 2009
Management of Thyroid Gland Hemorrhage After Blunt Trauma: A Case Report and Review of the Literature.
Thyroid hemorrhage is a rare injury in patients suffering from blunt trauma to the neck. The case of a 60-year-oldwoman is describedwho developed increasing swelling in the neck with a mild inspiratory stridor after a fall from her bed. The fall had resulted in hemorrhage within a previously existing goiter. Further analysis by means of a CT scan revealed severe tracheal compression and active bleeding, which prompted immediate operative intervention. The patient recovered without complications. The decision-making process in this case is outlined, and other reports describing patients with thyroid hemorrhage after blunt cervical trauma are reviewed. ⋯ Although blunt thyroid injury is an uncommon condition, failure to consider the diagnosis or failure to anticipate complications of thyroid hemorrhage may result in progressive bleeding and airway compromise. Decision making is based on the patient's vital signs and, if possible, the findings on a contrastenhanced CT scan of the neck.
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Eur J Trauma Emerg S · Dec 2009
A Single-Lumen Central Venous Catheter for Continuous and Direct Intra-abdominal Pressure Measurement.
Abdominal compartment syndrome (ACS) is associated with high morbidity and mortality rates. Therefore, the need for a good diagnostic tool to predict intra-abdominal hypertension (IAH) and progression to ACS is paramount. Bladder pressure (BP) has been used for several years for intra-abdominal pressure (IAP) measurement but has the disadvantage that it is not a continuous measurement. In this study, a single-lumen central venous catheter (CVC) is placed through the abdominal wall into the abdominal cavity to continuously and directly monitor the intraabdominal pressure (CDIAP). The aim of this study was to evaluate the use of CDIAP to measure BP as a representative of the true IAP. ⋯ Continuous direct intra-abdominal pressure measurement proved that the BP measurement approach of Kron is representative of the IAP. CDIAP measurement is accurate and makes it easier for the nursing staff to be informed of the IAP.