J Trauma
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Randomized Controlled Trial Clinical Trial
Colles' fractures treated by plaster and polyurethane braces: a controlled clinical study.
In a prospective randomized controlled trial polyurethane casts and traditional plaster-of-Paris braces were compared in 46 cases of Colles' fractures of the forearm. Secondary fracture dislocation, subjective inconveniences, and the need for secondary adjustment of the cast were recorded. ⋯ In comparison with plaster the synthetic bandage is lighter, water repellent, and hardens faster, and as far as circular bandages are concerned, they have zippers. It is concluded that polyurethane braces are a good supplement to plaster-of-Paris bandage in such fractures and recommended in selected cases.
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Pulmonary vein to artery missile embolus is extremely rare. Only one other case could be found in the world's literature and the present case appears to be the only reported survivor. ⋯ Extraction of the foreign body is secondary and becomes an absolute necessity only when it interferes with distal perfusion. Catheter embolectomy is contraindicated because of possible intimal damage, so that direct arteriotomy is preferred.
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A case of volar radio-carpal dislocation with complete anterior dislocation of the lunate is reported. The injury was caused, unusually, by forced hyperflexion. The mechanism by which this dislocation is produced and the possible order of events in this injury are discussed by reference to the radiological and operative findings. Successful treatment by closed reduction of the radiocarpal dislocations and open reduction of the lunate is reported, and the relevant literature is briefly reviewed.
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The diagnostic criteria of clinical fat embolism syndrome are most important. Petechial rush, positive chest X-ray films, low arterial oxygen content, and cerebral involvement are major features. ⋯ By early internal fixation of long-bone fractures in patients with multiple injuries it may be possible in most cases to prevent the development of the third grade, the severe clinical fat embolism syndrome. Thus specific treatment because of fat embolism was indicated in only three cases in this series of 211 patients with broken long bones and multiple injuries.
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External cardiac compression (ECC) was originally developed for patients with nontraumatic cardiac conditions, but it is now used for a wide variety of emergency conditions. As an integral part of cardiopulmonary resuscitation (CPR), ECC coupled with forced pulmonary ventilation may NOT be applicable to cases of cardiac arrest following penetrating and blunt thoracic and abdominal trauma. ⋯ In another 12 patients receiving forced ventilation and prehospital ECC, air embolism to the coronary arteries was the cause of death. CPR by paramedics, physicians, nurses, or lay persons does not appear to be of value in patients who have sustained cardiac arrest from truncal trauma.