J Trauma
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We describe 14 patients with adrenal injuries from penetrating (ten) or blunt (four) trauma. The severity of their injuries was evidenced by the high incidence of hypovolemic shock (57%), mean Trauma Score (11), mean transfusion requirement (18 Units), number of associated injuries (4.9 per patient), complication rate (57%), and deaths (14%). Twelve patients required surgical exploration; adrenal repair, rather than removal, was possible in seven. Although adrenal insufficiency was suspected in three patients, it was not documented and no patient required corticosteroid replacement.
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All patients with a diagnosis of knee dislocation during a 7 1/2-year period (1984-1991) were reviewed retrospectively. There were 37 knee dislocations (KDs) in 35 patients. The mechanism of injury was predominantly motor vehicle or pedestrian crashes. ⋯ Arterial injuries were treated with interposition (five of six) or bypass graft (one of six) and fasciotomies (six of six). Amputation was required in one of six of the vascular injury group and none of 31 of the remainder of the patients with no vascular injury. We recommend the selective use of arteriography in patients with KDs based on a history or clinical findings of ischemia and do not recommend routine arteriography for all patients with KD.
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Review Case Reports
Unreduced dislocation of the elbow: case report and review of the literature.
A case report of an unreduced dislocation of the elbow requiring late open reduction is presented, and the literature is reviewed. Early reduction of elbow dislocation, by closed or open means, is of paramount importance if good functional results are to be obtained. Closed reduction of an elbow dislocation is unlikely to be successful if attempted later than 21 days after the injury. The results are acceptable if open reduction is undertaken within 3 months of the injury, but after 6 months the results are disappointing and arthroplasty is an alternative.
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Review Case Reports
Ipsilateral radial head dislocation with radial shaft fracture: case report.
An extremely rare injury, traumatic radial head dislocation with concomitant fracture of the radial shaft, is reported. The dislocated radial head could not be reduced by closed technique because of capsular interposition. Reduction of the radial shaft fracture was possible only after the dislocation of the radial head was reduced.
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Prospective and contemporaneous medical and economic cost studies of 144 victims of motor vehicle crashes admitted to a regional level I trauma center with multiple injuries (ISS > or = 16) revealed 122 non-ejected patients, of whom 102 required extrication (EXTRIC) from the vehicle for physical or medical reasons and 20 who did not (N group). There were no differences in age (EXTRIC, 34 +/- 17 years; N, 41 +/- 24 years), type of crash (Frontal: 57% EXTRIC, 60% N; Lateral: 32% EXTRIC, 35% N) restraint use (35% EXTRIC, 35% N), or mortality (29% EXTRIC, 30% N). However, the estimated maximum speed before the crash was higher in EXTRIC patients (50 +/- 16 mph vs. 46 +/- 18 mph N, p < 0.04), as was the change in velocity (delta V) on impact (EXTRIC 30 +/- 15 mph; N, 24 +/- 8 mph, p < 0.01). ⋯ In lateral MVCs, brain injuries were also more commonly associated with CIs of the side window frame or A pillar (72% CI vs. 25% no CI; p < 0.035); but as a whole in MVCs in which extrication was necessary, lower extremity injuries from instrument panel or toepan CIs appeared more frequent than those resulting from contacts only (p < 0.0001). In EXTRIC patients, 69% of those in shock had CI injuries, and 80% of the deaths in the EXTRIC group were associated with CI injury. These data suggest that measures designed to prevent CIs by strengthening car passenger compartment structures may reduce the incidence of severe brain and lower extremity injuries and may reduce the need for extrication after MVCs.