J Trauma
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Comparative Study
Analysis of foot and ankle kinematics after operative reduction of high-grade intra-articular fractures of the calcaneus.
High-grade calcaneal fractures represent a complex injury, with limited data to support the advisability of open reduction. Restoration of foot and ankle kinematics during walking, which has been previously shown to be significantly limited after nonoperative treatment, has never been studied after the operation. This study was designed to address this lack of information to assess the advisability of the operation in this respect. ⋯ In high-grade calcaneal fractures, when recreation of gross calcaneal anatomy is obtained during the operation, walking ankle motion is recreated as well. However, subtalar motions, although recreated to a certain extent, still demonstrate limitations when compared with noninjured individuals. These results support the advisability of the operation in these complex injuries, but they demonstrate that subtalar motion is not completely normalized despite a favorable anatomic outcome.
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Review Meta Analysis
7.5% saline and 7.5% saline/6% dextran for hypovolemic shock.
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Multicenter Study Comparative Study
Blunt traumatic occult pneumothorax: is observation safe?--results of a prospective, AAST multicenter study.
An occult pneumothorax (OPTX) is found incidentally in 2% to 10% of all blunt trauma patients. Indications for intervention remain controversial. We sought to determine which factors predicted failed observation in blunt trauma patients. ⋯ Most blunt trauma patients with OPTX can be carefully monitored without tube thoracostomy; however, OPTX progression and respiratory distress are independently associated with observation failure.
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Comparative Study
Treatment of complex elbow injuries with a postoperative custom-made progressive stretching static elbow splint.
Complex elbow injuries consist of fractures of one or several of the bony stabilizers of the elbow, including the radial head, proximal ulna, coronoid process, collateral ligaments, and capsular complex. These injuries, if not properly treated, were reported to have a poor prognosis with recurrent instability, stiffness, posttraumatic arthrosis, and pain. This study was conducted to review clinical outcomes after fracture stabilization and ligament repair with a postoperative custom-made progressive stretching (CMPS) elbow splint in the treatment of complex elbow injuries. ⋯ The dilemma in managing complex elbow injuries is that extended immobilization leads to stiffness, but without proper reconstruction of the stabilizer, joint instability recurs. Our surgical protocol included removal of all loose bodies within the joint, stable fixation of fracture fragments if possible, and use of suture anchors to repair medial or lateral ulnar collateral ligaments. CMPS static elbow splints provided both postoperative protection and ROM movement. In our experience, if the stabilizers were reconstructed, hinged elbow external skeletal fixator is usually not necessary, and progressive stretching by CMPS splint can result in good ROM.