J Trauma
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Head, face, and neck injuries (HFNIs) are an important source of combat mortality and morbidity. The objective of this study was to document the characteristics and causes of HFNIs during Operation Iraqi Freedom II. ⋯ The proportion of combat-related HFNIs is increasing and is primarily caused by IEDs. Improved protection for the vulnerable facial region is needed. Continued research on the changing nature of warfare and distribution of HFNIs is necessary to enhance the planning and delivery of combat casualty medical care.
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Comparative Study
Prevalence of pelvic fractures, associated injuries, and mortality: the United Kingdom perspective.
We wished to determine the characteristics of patients with pelvic ring fractures (PGs) in England and Wales, make comparisons to major trauma patients without pelvic injury (NPGs), and determine factors predicting mortality, including the impact of presence of pelvic reconstruction facilities in the receiving hospitals on outcome. ⋯ Age, early physiologic derangement, and presence of other injuries (head or trunk) were associated with reduced survival rates. When the expertise to deal with such a group of patients is not available, early transfer under safe conditions should be considered to improve survival rates.
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To identify significant demographic, clinical, and nonclinical factors among elderly persons influencing the discharge location after hospitalization resulting from a traumatic fall. ⋯ Gender, race, payment type, body region injured, Injury Severity Score, physiologically based Emergency Department Revised Trauma Score, and need for intensive care unit care were significant predictors of discharge location. Understanding and addressing the factors found in this study can improve the discharge planning process and posttreatment management.
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Worldwide, the base deficit is available as an objective indicator of acid base status. We used the base deficit as a measure of physiologic derangement in a Trauma and Injury Severity Score (TRISS)-like model as a predictor for outcome in trauma patients. ⋯ The performance of our proposed BISS model was superior to that of the TRISS model in the populations under investigation. Nevertheless, given the ease of assessment and the objective value of the base deficit, it may be considered as a good method to predict outcome and evaluate care of trauma patients. Whether this can be translated to trauma patients in general needs further investigation.
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Conventional intramedullary nails for trochanteric fractures have the disadvantages of intraoperative splintering resulting from large proximal section and postoperative femoral fracture caused by stress concentration at the nail tip. The present study reports the experience of using a specially designed double-screw nail with a smaller proximal section to avoid intraoperative splintering and a longer nail shank to avoid postoperative femoral fracture. ⋯ The double-screw nail can yield acceptable treatment results for both 31-A1 and 31-A2 and A3 trochanteric fractures and is particularly useful in patients with a small proximal femur. Type 31-A1 and 31-A2 and A3 trochanteric fractures should be separately analyzed in terms of treatment planning or prognostic study.