J Trauma
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Published reports about locked nailing for displaced comminuted proximal humeral fractures are few and the results contradictory. ⋯ Locked nailing can be an effective treatment for selected severely displaced three-part proximal humeral fractures. It is particularly useful for fractures with diaphyseal involvement. Familiarity with the fracture deformity and experience with the surgical techniques are critical for successful treatment results.
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Comparative Study
Do trauma centers improve functional outcomes: a national trauma databank analysis?
The development of a tiered trauma care system has lead to improved survival for the critically injured. The question as to whether the increased survival associated with the establishment of tiered levels of trauma care is paralleled by an improved functional outcome has not, however, been addressed. ⋯ These data indicate that the complex care delivered by advanced level trauma centers is associated with improved functional outcomes. Further investigations to identify the reasons for differences in these outcomes are necessary to improve care at lower tiered hospitals particularly for minimally injured patients.
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Preinjury warfarin anticoagulation has been shown to increase the mortality of traumatic intracranial hemorrhage. We have evaluated the impact on patient mortality of the rapid triage of patients at risk for warfarin associated traumatic intracranial hemorrhage. ⋯ We conclude from these data that a trauma center protocol for rapid identification of intracranial bleeding without a concomitant therapeutic protocol does not improve survival in head injured patients on preinjury warfarin.
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Recent concerns about the lifetime cancer risk associated computed tomography (CT) caused us to reevaluate the utility of this test in traumatized children. In addition, little is known regarding the utility of abdominal CT in children who have been emergently intubated. We sought to describe the injuries identified by abdominal CTs in intubated pediatric trauma patients and create a derivation set of predictors of intra-abdominal injury in this patient population. ⋯ In this series, a significant number of intubated pediatric trauma victims had intra-abdominal injuries identified by CT scan. The presence of abnormal abdominal examination findings and elevated LFTs appear to predict an abnormal CT scan.
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Nonoperative management (NOM) of blunt hepatic injury is the standard of care in the hemodynamically stable pediatric patient, but it is not without pitfalls. The purpose of this study is to assess the incidence and types of complications associated with NOM in terms of diagnosis, management, and outcomes. ⋯ Complications of NOM of pediatric blunt hepatic injury are rare, but may include biloma, hepatic artery pseudoaneurysm, and necrotic gallbladder. Complications occur only with Grade III or greater injuries and are accompanied by fever, right upper quadrant pain, feeding intolerance, and persistently elevated LFTs. The clinician must maintain a high index of suspicion for the development of complications and have a low threshold for obtaining a CT or US for diagnosis. Interventional radiology techniques, angiography, and ERCP are useful adjuncts to nonoperative management, but some patients may still require laparotomy for management of complications.