J Trauma
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Open distal humerus fractures are associated with soft tissue and bony injury. This study compares the results of a staged protocol using initial joint spanning external fixation and delayed definitive fixation to acute definitive fixation. ⋯ Open distal humerus fractures had poor outcomes relative to normative functional scores; however, this is possibly due to more severe soft tissue injuries that were felt better managed with staged management at the time of presentation.
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Patients with spinal cord injury (SCI) are at particular risk for deep vein thrombosis (DVT) during their hospital course. In most researches on the prevention of thromboembolic events after SCI, the cause of SCI was usually limited to traumatic origin, and pharmaco-prophylaxis was usually started immediately after SCI irrespective of the presence of DVT. For this reason, it is difficult to determine the exact incidence of DVT after SCI from all possible causes in the absence of anticoagulation treatment. We sought to determine the incidence of DVT and the effect of mechanical treatments without chemical prophylaxis. ⋯ The incidence of DVT in patients with SCI routinely given mechanical prophylaxis without anticoagulation was higher when compared with those reported in the setting of routine pharmaco-prophylaxis. Anticoagulation should not be excluded from initial DVT prophylaxis measures in the SCI patients unless there is any ongoing bleeding or severe coagulopathy. Further studies will be necessary to get a more precise data and to understand the clinical relevance of these results.
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Traumatic pneumomediastinum secondary to blunt chest injury in children is concerning for potential life-threatening tracheobronchial, esophageal, or vascular thoracic injuries. These patients often undergo extensive radiologic evaluation and invasive testing due to the unclear risk of traumatic pneumomediastinum. ⋯ Tracheobronchial, esophageal, or vascular thoracic injuries were uncommon in children with traumatic pneumomediastinum and occurred in the setting of additional thoracic and other organ system injuries. Pneumomediastinum without radiographic or clinical evidence of other thoracic injuries may not routinely require further diagnostic testing.
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Our objective is to evaluate the mortality and outcomes of hemodynamically unstable patients with pelvic fractures treated with a protocol that directs the patient to either early pelvic angiography or early retroperitoneal pelvic packing. ⋯ Early experience in our institution suggests that early pelvic packing with subsequent angiography if needed is as good as angiography with embolization in treating patients with hemodynamically unstable pelvic fractures.
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There is evidence that complement components regulate cytokine production in osteoblastic cells, induce cell migration in mesenchymal stem cells, and play a regulatory role in normal enchondral bone formation. We proved the hypothesis that complement might be involved in bone healing after fracture. ⋯ Our in vitro and in vivo results demonstrated the presence of C5aR in bone forming osteoblasts and bone resorbing osteoclasts. It is suggested that C5aR might play a regulatory role in fracture healing in intramembranous and in enchondral ossification, one possible function being the regulation of cell recruitment.