J Trauma
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Although gunshot injuries to the penis occur relatively infrequently in patients with penetrating trauma, they often present dilemmas of subsequent evaluation and management. We review our extensive experience with gunshot wounds to the penis at a high volume urban trauma center. ⋯ Evaluation and management of gunshot wounds to the penis may potentially be complex. Retrograde urethrogram should be performed in all cases except the most insignificant and superficial wounds. We describe our technique of penile exploration and artificial erection, noting excellent results in patients for whom follow-up is available. Additional studies are needed to prospectively evaluate techniques for management of gunshot urethral injuries.
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Deep vein thrombosis (DVT) has been identified as a marker of quality of care by various governmental and consumer groups. However, the lack of standardized DVT screening systems across trauma centers may introduce surveillance bias in the rates of DVT reported. We hypothesize that trauma centers with higher rates of duplex ultrasound detect more DVTs and subsequently report higher DVT rates to the National Trauma Data Bank. ⋯ More aggressive screening procedures may be associated with higher DVT rates. Trauma centers that screen more and report higher DVT rates may be falsely labeled as having decreased quality of care. Using DVT rate alone as an independent quality measure should be reevaluated because of the potential for surveillance bias.
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: The aim of this study was to develop a tool which can be used to do a collaborative and prospective survey on the epidemiologic characteristics, treatment and outcome of maxillofacial trauma in China and to ameliorate the existing score and treatment methods of maxillofacial trauma. ⋯ : The system has satisfactory stability, security, compatibility, and specialty. It can be used to collect standard cases of maxillofacial trauma and to do a collaborative research on the epidemiologic characteristics, treatment, and outcome of facial injuries. MISS is more accurate, objective, and credible than ISS and RFISS in reflecting the severity of maxillofacial trauma and evaluating the curative effect and prognosis.
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Comparative Study
Femoral shortening after surgical treatment of trochanteric fractures in nongeriatric patients.
Femoral shortening is a well-known clinical finding after surgical treatment of per- and intertrochanteric fractures. Particularly, in geriatric patients with poor bone quality and unstable fracture types, secondary compression of these fractures often leads to length inequality of the lower limbs. In younger patients with good bone quality and mobilization with delayed weight bearing, limb length shortening is expected to be a rare complication. The purpose of this study was to analyze incidence and degree of femoral shortening in patients younger than 60 years of age after fixation of different types of per- and intertrochanteric fractures. In addition, we compared the results of two different implants, which were used for operative treatment. ⋯ Femoral shortening after operative treatment of per- and intertrochanteric fractures was found to be a common clinical finding in nongeriatric patients. Nearly half of them showed a lower limb length inequality after fracture fixation. The degree of the shortening was rather low and depended mainly on the fracture type. Comparing the two different implants used for operative treatment, a cephalomedullary nail was more successful in preventing limb length discrepancy in unstable fracture types than dynamic hip screw.