J Trauma
-
Comparative Study
Effectiveness of state trauma systems in reducing injury-related mortality: a national evaluation.
Regional trauma systems were proposed 2 decades ago to reduce injury mortality rates. Because of the difficulties in evaluating their effectiveness and the methodologic limitations of previously published studies, the relative benefits of establishing an organized system of trauma care remains controversial. ⋯ These data demonstrate that a state trauma system is associated with a reduction in the risk of death caused by injury. The effect is most evident on analysis of MVC deaths.
-
The technique of percutaneous catheterization of the subclavian vein by the infraclavicular approach is dependent on the location of the subclavian vein in relation to the clavicle. The purpose of this study was to analyze the anatomic relationship between these two structures and how it is influenced by changes in shoulder positioning. ⋯ Infraclavicular subclavian venipuncture should be performed with shoulders in a neutral position and also in slight retraction. An appreciation of the anatomic relationship between the clavicle and the subclavian vein is the key to successful execution of this technique.
-
The liver plays a critical regulatory role in the acute inflammatory response to injury, although the mechanisms of this regulation are not well understood. transforming growth factor-beta1 (TGF-beta1) is induced after burn injury and may contribute to an inhibitory or fatal effect on hepatocytes. We investigated the association over time between plasma concentration of TGF-beta1, expression of TGF-beta1 m-RNA in liver tissue, and histologic analysis of liver apoptosis after burn injury. ⋯ The levels of induced TGF-beta1 and TGF-beta1 m-RNA after L burn injury are higher and peak earlier than after M burn injury. Elevated TGF-beta1 may be associated with cell death in hepatocytes. The TGF-beta1 rise may be associated with hepatocyte injury and systemic response to massive burn.
-
The best estimates of nonfatal gunshot wounds in the United States come from hospital emergency room data and may miss, among other things, wounded individuals who do not seek medical treatment. Criminals may be those least likely to rely on professional care for their wounds. This study provides evidence of whether medical care is solicited by criminals after gunshot wounds. In addition, the circumstances of the injury events are described. ⋯ Among these "criminals," the vast majority reported that they obtained professional care for their gunshot wounds. Such evidence suggests that individuals previously thought unlikely to enter the medical care system after a firearm injury usually do so. Statistics on medically treated nonfatal gunshot wounds probably do not substantially underestimate the actual number of nonfatal shootings.
-
Case Reports Randomized Controlled Trial Comparative Study Clinical Trial
New technique for treatment of unstable distal femur fractures by locked double-plating: case report and biomechanical evaluation.
A comminuted, intra-articular distal femur fracture was surgically treated by the authors with a locked, double-plating technique because fixation stability could not be initially achieved by using a standard double-plating technique. The purpose of this study was to determine biomechanically whether a locked double-plate construct would enhance fixation stability compared with a nonlocked double-plate construct. ⋯ The technique described is particularly applicable for severely comminuted fractures of the distal femur and fractures in osteopenic bone with poor screw purchase. It offers a simple alternative for enhancing fixation stability, which avoids the potential complications of methylmethacrylate-enhanced screw fixation.