J Trauma
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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.
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Comparative Study
Computed tomography alone for cervical spine clearance in the unreliable patient--are we there yet?
Injuries to the cervical spine (CS) occur in 2% to 6.6% of blunt trauma patients. Studies have suggested that computed tomography (CT) alone is sufficient for CS clearance in unreliable patients based on follow-up magnetic resonance (MR) imaging not altering management. We hypothesized that an admission cervical spine CT with no acute injury-using new CT technology-is not sufficient for CS clearance in an unreliable patient. ⋯ Newer generation CT continues to miss CS injuries in unreliable patients. MR changed the management in 7.9% of patients having had an admission CT with no acute injury. Thus, we recommend continued use of MR for CS clearance in the unreliable patient and ongoing evaluation as the quality of CT imaging continues to evolve.
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Severely bleeding trauma patients requiring massive transfusion (MT) often experience poor outcomes. Our purpose was to determine the potential role of near infrared spectrometry derived tissue hemoglobin oxygen saturation (StO2) monitoring in early prediction of MT, and in the identification of those MT patients who will have poor outcomes. ⋯ MT progresses rapidly to significant morbidity and mortality despite level I TC care. Patients who require MT can be predicted early, and persistent low StO2 identifies those MT patients destined to have poor outcome. The ultimate goal is to identify these high risk patients as early as possible to test new strategies to improve outcome. Further validation studies are needed to analyze appropriate allocation and study appropriate use of damage control interventions.
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To compare the stability of a novel, nonspanning external fixator with a standard volar locked plate for treatment of unstable distal radius fractures. ⋯ This study demonstrated no significant difference in the mechanical stiffness of the CPX nonspanning external fixator and volar locked plate in a cadaveric fracture model. Both constructs appear to be biomechanically equivalent in this experimental model; however, this is only one factor in the choice of fixation device for the management of unstable distal radius fractures.
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An epidemiologic profile of traumatic brain injury (TBI) in Australia and New Zealand was obtained following the publication of international evidence-based guidelines. ⋯ In Australia and New Zealand, mortality and favorable neurologic outcomes after TBI were similar to published data before the advent of evidence-based guidelines. A high incidence of prehospital secondary brain insults and an ageing population may have contributed to these outcomes. Strategies to improve outcomes from TBI should be directed at preventive public health strategies and interventions to minimize secondary brain injuries in the prehospital period.