J Trauma
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Review Case Reports Comparative Study
Coagulopathic patients with traumatic intracranial bleeding: defining the role of recombinant factor VIIa.
The combination of coagulopathy and intracranial bleeding (ICB) is a well-recognized cause of morbidity and mortality in the neurosurgical patient because of the risk of hematoma expansion. Although recombinant factor VIIa (rFVIIa) has been shown to be useful in intracerebral hemorrhage, its use in other forms of ICB such as subdural hematomas (SDHs) has rarely been described. ⋯ rFVIIa is an inducer of hemostasis, which successfully controlled potentially devastating bleeding in all of 15 coagulopathic neurosurgical patients with ICB. The use of rFVIIa lowered the INR into the operable range in all patients, allowing surgery, and in some cases, obviated the need for surgery. Randomized, placebo-controlled clinical trials are needed to further assess the efficacy and cost-effectiveness of this approach in this setting.
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In patients with unstable pelvic ring fractures, the factors related to poor outcome are still controversial. The purpose of our study was to evaluate the long-term functional outcome of patients with unstable pelvic ring fractures and correlate it with various other factors. ⋯ The long-term functional outcome after unstable pelvic ring fracture was not associated with Injury Severity Score, fracture location or fracture type. We discovered a close correlation between neurologic injury and functional outcome.
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Major limb amputations are among the most debilitating wounds sustained by those who survive a combat injury and these injuries leave a lasting impression with the public. This article will review the history of major limb amputation in military trauma surgery. ⋯ Major limb amputation remains a fearsome outcome of limb injury. However, during the last 500 years, military trauma surgeons have solved the problems of bleeding, infection, and neurovascular repair after major limb injury such that amputation rates even during times of active military conflict are at historic lows.
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Multicenter Study
Knee dislocations with vascular injury: outcomes in the Lower Extremity Assessment Project (LEAP) Study.
The purpose of this study is to report the clinical and functional results of a cohort of patients with knee dislocations associated with vascular injury. ⋯ Patients who sustain a limb-threatening knee dislocation have a moderate to high level of disability 2 years after injury. Nearly one in five patients who present to a Level I trauma center with a dysvascular limb associated with a knee dislocation will require amputation. Prolonged warm ischemia time was associated with a high rate of amputation. Patients who sustain vascular injuries associated with a knee dislocation need immediate transport to a trauma hospital, rapid assessment and diagnosis at presentation, and revascularization. Patients with these injuries can be effectively treated without angiography before surgery.