J Trauma
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The use of permanent inferior vena cava filters (IVCFs) offers protection against pulmonary embolism (PE) but increases the long-term risk of deep vein thrombosis (DVT) and does not affect long-term mortality. The use of retrievable IVCFs in trauma patients offers the dual advantage of protection against PE during the risk period and the option of filter removal thus avoiding complications of DVT. Despite the safety of removal, it is likely that many of these retrievable filters are not removed. ⋯ The use of retrievable IVCFs, when necessary, produced predictable protection against PE and DVT complications. Despite the opportunity for removal, most patients, in fact, did not have their filters removed, even when posthospital care could be tracked. The practices of the surgeon, the transfer to extended-care facilities, near or far, and the reluctance to remove long-standing IVCFs contributed to the high-retention rate.
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The purpose of this study was to evaluate risk factors for nonunion after femoral nailing of femoral shaft fractures. A case-control study with two to one matching was conducted. Forty-five patients with 46 femoral nonunions (cases) and 92 patients with healed femoral shaft fractures (controls) were identified from our orthopedic trauma registry. ⋯ The characteristics that were significantly different between the two groups were open fracture, delay to weight bearing, and tobacco use. Fracture classification, gender, direction of nail insertion (antegrade vs. retrograde), and Injury Severity Score were not predictive of nonunion. We conclude that open fracture, tobacco use, and delayed weight bearing are risk factors for femoral nonunion after intramedullary nailing for diaphyseal femur fractures.
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Epidural emphysema is a rare condition, and when occurs in isolation it is usually benign and resolves spontaneously after the underlying cause has been treated. Epidural emphysema is usually accompanied by pneumothorax, subcutaneous emphysema, or pneumomediastinum. ⋯ Although nonsurgical pneumoperitoneum can arise in different ways, generally pneumomediastinum or pneumothorax is observed in cases with an intrathoracic source. We report two cases of combined traumatic epidural emphysema and nonsurgical pneumoperitoneum in patients with pneumothorax, pneumomediastinum, and extensive subcutaneous emphysema after blunt trauma.
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Hunting-related accidents occur worldwide during the hunting season. The "true incidence" of hunting-related accidents in Denmark is not illuminated in that no compulsory systematic registration procedure is available. The possible impact of alcohol consumption on the risk of being involved in a hunting accident is not yet known; however, the subject frequently is debated throughout the world. ⋯ The incidence of hunting-related accidents in Denmark seems considerably higher than reported. Compulsory and systematic registration of all hunting-related accidents involving firearms should be introduced in Denmark. Legislation rules regarding alcohol intake during hunting should be considered by the authorities.