J Trauma
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Twenty-five civilians with combined neurovascular and musculo-skeletal trauma to 27 extremities were studied retrospectively. The mechanism of injury was crushing in 16, avulstion in six, and penetrating in three. Autogenous saphenous vein was used to restore arterial circulation in the majority. ⋯ Three immediate amputations were the result of irreversible neurovascular and soft-tissue trauma. Sepsis played a role in three late amputations; delayed primary treatment,, irreversible neurologic injuries and extensive soft-tissue damage contributed. A carefully individualized multidisciplinary approach resulted in salvage of 20 of 27 severely injured extremities.
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A 2-year survey of burn victims in a 15-county region was conducted to help define the need for a burn unit. There were 1,165 patients hospitalized for burn care; 58 patients were transferred; 32 to more sophisticated facilities, 15 out of state. The mean hospitalization rate was 33/100,000; 95/100,000 for persons under 2 year old. ⋯ House fires were responsible for 90 deaths. Despite incomplete records and the lack of firm criteria for burn severity, regional burn data describe the health care system, as it relates to burns, and identify high risk groups. The range inseverity of thermal injuries is great; the quality of care provided is difficult to assess.
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In a retrospective study of 82 subtrochanteric fractures of the femur in the St. Paul-Ramsey Hospital, there were 32 treated by traction, 50 by open reduction and internal fixation. In adults 50% of those treated by traction had undesirable results using strict criteria for varus, shortening, and rotational deformity: 21% of those treated by operation had undesirable results due to varus, rotational deformity, medial migration of the distal fragment, and nonunion. ⋯ If reduction is not achievable, bone grafting and extra protection are required. If reduction can be predicted as not achievable, good results can be obtained with traction although the healing period is longer. In the presence of a residual gap in the medial surface of the femur in the region of the lesser trochanter, poor results are frequent.