J Trauma
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Our goal was to evaluate the utility of the pelvic ring stability examination for detection of mechanically unstable pelvic fractures in blunt trauma patients. ⋯ The presence of either pelvic deformity or unstable pelvic ring on physical examination has poor sensitivity for detection of mechanically unstable pelvic fractures in blunt trauma patients. Our study suggests that blunt trauma patients with Glasgow Coma Scale >13 and without pelvic pain or tenderness are unlikely to suffer an unstable pelvic fracture. A prospective study is needed to determine whether a set of clinical criteria can safely detect or exclude the presence of an unstable pelvic fracture.
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Comparative Study
Comparative study of different intraoperative 3-D image intensifiers in orthopedic trauma care.
Recently, isocentric C-arm fluoroscopy (Iso-C 3D) has been introduced as a precise imaging modality for intraoperative evaluation and management of fractures and osteosyntheses. The Siemens Iso-C 3D collects multiple fluoroscopic images during a 190-degree arc of rotation around the anatomic region of interest and reconstructs them into sagittal, axial, and coronal planes. Like the Iso-C 3D, the new Ziehm Vario 3D imaging system reconstructs images in multiple planes, but only requires a 136-degree arc of rotation. The purpose of this study was to compare the image quality and range of applicability of these two imaging systems. ⋯ Although the Iso-C 3D imaging system was superior in delineating the joint surfaces, the image quality, and the overall clinical applicability, the study revealed that both devices provided 3D images with sufficient quality to the surgeon to assess clinically relevant questions, including the quality of fracture reduction and implant positioning. On the other hand, the Ziehm Vario 3D is capable of doing scans of the shoulder area, which could not be taken with the Siemens Iso-C 3D because of the isocentric design.
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Rib and sternal fracture repair are controversial. The opinion of surgeons regarding those patients who would benefit from repair is unknown. ⋯ A majority of surveyed surgeons reported that rib and sternal fracture repair is indicated in selected patients; however, a much smaller proportion indicated that they had performed the procedures. The published literature on surgical repair is sparse and unfamiliar to most surgeons. Barriers to surgical repair of rib and sternal fracture include a lack of expertise among TRS, lack of research of optimal techniques, and a dearth of randomized trials.
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The association of methamphetamine exposure and outcomes after trauma is not known. ⋯ Patients exposed to Methamphetamines do not have increased mortality or complications or lengths of ICU and hospital stay. However, they are more likely to require admission to the ICU.
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This study examined the clinical and radiologic results of cervical spine injuries associated with a unilateral lateral mass-facet fracture (ULMFF) in an attempt to clarify the fracture pattern and treatment strategies using single-level anterior fusion. ⋯ This retrospective review of ULMFF showed that nonsurgical treatment is usually unsuccessful, and early single-level anterior arthrodesis has a favorable outcome. However, exclusive two-level stabilization or pedicle screw fixation needs to be considered in the separation type.