J Trauma
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Comparative Study
Risk of mortality: the relationship with associated injuries and fracture treatment methods in patients with unilateral or bilateral femoral shaft fractures.
The aim of the study was to determine the relative contributions to mortality of a unilateral or a bilateral femoral fracture in patients with or without injuries to other body regions. ⋯ The increase in mortality with BFs is more closely associated with the presence of associated injuries and poor physiologic parameters than with the presence of the BF alone. The presence of BFs should alert the clinician to the very high likelihood (80%) of significant associated injuries in other body systems and their life-threatening potential. Damage control fixation options should be considered in the subgroup with a very high New Injury Severity Score.
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Comparative Study
Motion in the unstable cervical spine during hospital bed transfers.
Hospital bed transfers, moves to examination room, X-ray, hospital bed, and/or surgery, have the potential of causing harm to a patient with an unstable cervical spine. This study evaluated motion generated in an unstable segment of the cervical spine during hospital bed transfers. A secondary goal purpose was to assess reduction in cervical motion using three collars and a no collar condition. ⋯ Bed transfers made with a lateral transfer device seem to be as safe as those made by the lift and slide manual transfer. None of the collars tested were significantly better at preventing cervical spine motion during a transfer, but each allowed less movement than no collar.
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Arterialized venous flaps can be useful for hand/digit reconstruction, providing very thin skin coverage. However, their popularity has been limited by concerns over poor peripheral perfusion and severe congestion, which may be to be due to unrestricted arteriovenous shunting and pressurization of the efferent vein. To mitigate these problems, we design our flaps to restrict shunting. This report describes our clinical experience with these techniques. ⋯ Restriction of arteriovenous shunting enhances peripheral perfusion and decreases congestion of venous flaps, thereby improving reliability and utility for hand/digit reconstruction.
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Comparative Study
Smoking in trauma patients: the effects on the incidence of sepsis, respiratory failure, organ failure, and mortality.
There is a high percentage of smokers among trauma patients. Cigarette smoking has been associated with the development of acute lung injury and the adult respiratory distress syndrome in critically ill patients. It is also known that nicotine exerts immunosuppressive and anti-inflammatory effects with chronic use. Trauma patients who are smokers usually go through acute nicotine withdrawal after the traumatic event and during their stay in ICU. How the smoking status and acute nicotine withdrawal affect outcomes after trauma is unknown. This question was addressed in this study by analyzing the incidence of sepsis, septic shock and multiple organ dysfunction syndrome, and other outcomes in smoking and nonsmoking trauma patients. ⋯ The smoking status plays a minimal role in the outcome of healthy trauma patients. This suggests that the acute nicotine withdrawal that usually occurs in critically ill patients has no clinically significant implications after injury.
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Intra-articular malunion of the distal radius may be complicated with radiocarpal and radioulnar joint subluxation, which may result in joint stiffness and loss of function. Conventional corrective osteotomy emphasizes on the restoration of the articular step-off. However, little information is available concerning the restoration of a concentric functioning joint through osteotomy. ⋯ Repositioning osteotomy consistently restores joint alignment and achieves functional improvement either in cases of nascent simple malunion or complex intra-articular malunion.