J Trauma
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Comparative Study
Facial nerve decompression surgery in patients with temporal bone trauma: analysis of 66 cases.
In the treatment of facial nerve paralysis after temporal bone trauma, it is important to appropriately determine whether nerve decompression surgery is indicated. The aim of this study was to examine the efficacy of facial nerve decompression surgery according to fracture location and the ideal time for surgery after trauma by analyzing the therapeutic outcome of traumatic facial nerve paralysis. ⋯ The results of this study demonstrated that the ideal time for decompression surgery for facial nerve paralysis after temporal bone fracture was the first 2 weeks after trauma in patients with severe, immediate-onset paralysis. Our study also showed that surgery should be performed within 2 months at the latest. These findings provide useful information for patients and help to determine the priority of treatment when concomitant disease exists.
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Comparative Study
Neurological, functional, and biomechanical characteristics after high-velocity behind armor blunt trauma of the spine.
Behind armor blunt trauma (BABT) describes a nonpenetrating injury to the organs of an individual wearing body armor. The aim of this study was to investigate the neurologic and functional changes that occur in the central nervous system after high-velocity BABT of the spine as well as its biomechanical characteristics. ⋯ The results from our animal model indicate that high-velocity BABT of the spine generates high pressure and acceleration in the spine, induces varying degrees of paralysis of hind limbs, and disturbs cerebral function. The neuronal degeneration caused by the pressure wave may be one of the important pathologic events involved in the development of trauma-related complications.
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Comparative Study
Elevated admission systolic blood pressure after blunt trauma predicts delayed pneumonia and mortality.
Although avoiding hypotension is a primary focus after trauma, elevated systolic blood pressure (SBP) is frequently disregarded. The purpose of this study was to determine the association between elevated admission SBP and delayed outcomes after trauma. ⋯ In blunt trauma patients with or without TBI, elevated admission SBP was associated with worse delayed outcomes. Prospective research is necessary to determine whether algorithms that manage elevated blood pressure after trauma, especially after TBI, affect mortality or pneumonia.
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Comparative Study
Utility of repeat head computed tomography in patients with an abnormal neurologic examination after minimal head injury.
Previous studies proposed that repeat head computed tomography (RHCT) is of no value in patients with a minimal head injury (MHI) and normal neurologic examination (NE). The goal of our study was to investigate the value of RHCT in patients with MHI with an abnormal NE. ⋯ Of all patients with MHI with an abnormal NE at the time of RHCT, 63% had a PA-NE. Although a RHCT is beneficial to patients with an acutely deteriorating or U-NE, it appears to be of little value in patients with a PA-NE. Compared with RHCT, serial NE may be a stronger predictor for the need for intervention in patients with MHI.
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Traumatic sternal fractures occur in approximately 3% to 8% of all blunt trauma patients. Most of these fractures are treated conservatively, but a small number require operative intervention. Only a few studies have reported operative fixation of sternal fractures, and no investigation to our knowledge has systematically reviewed the literature on this intervention. ⋯ Although the outcomes were generally positive, only one-half of the articles documented patient follow-up. In future studies, focus needs to be placed on long-term results and specific indications for surgery. The first step toward a standardized sternal fracture operative trial must be a prospective study of incidence and nonoperative long-term outcomes. It is likely that as the interest and demand for plate fixation increases, the demand for orthopedic involvement with sternal fractures will also increase.