J Trauma
-
Comparative Study
Combat musculoskeletal wounds in a US Army Brigade Combat Team during operation Iraqi Freedom.
A prospective, longitudinal analysis of musculoskeletal combat injuries sustained by a large combat-deployed maneuver unit has not previously been performed. ⋯ A large burden of complex orthopedic injuries has resulted from the combat experience in Operation Iraqi Freedom. This is because of increased enemy reliance on explosive devices, the use of individual and vehicular body armor, and improved survivability of combat-injured soldiers.
-
Comparative Study
Risk factors associated with early reintubation in trauma patients: a prospective observational study.
After mechanical ventilation, extubation failure is associated with poor outcomes and prolonged hospital and intensive care unit (ICU) stays. We hypothesize that specific and unique risk factors exist for failed extubation in trauma patients. The purpose of this study was to identify the risk factors in trauma patients. ⋯ Independent risk factors for trauma patients to fail extubation include spine fracture, initial intubation for airway, GCS at extubation, and delirium tremens. Trauma patients with these four risk factors should be observed for 24 hours after extubation, because the mean time to failure was 15 hours. In addition, increased complications, extended need for mechanical ventilation, and prolonged ICU and hospital stays should be expected for trauma patients who fail extubation.
-
Comparative Study
Can acute care surgeons perform emergency colorectal procedures with good outcomes?
Acute care surgeons (ACS) perform emergency colorectal procedures but may have lower case volumes when compared with their general surgical and colorectal colleagues, which may compromise outcomes. In the acute populations, the elderly may be at particular risk. ⋯ ACS caring for colorectal emergencies encounter critically ill patients with significant comorbidities, often from extended care facilities. If patient characteristics are considered when scrutinizing outcomes of emergency colorectal procedures, ACS perform as well as their colleagues who perform a higher volume of elective resections.
-
Comparative Study
Decompressive craniectomy in 14 children with severe head injury: clinical results with long-term follow-up and review of the literature.
Decompressive craniectomy (DC) is a controversial therapeutic measure used in patients with intractable intracranial hypertension after severe head injury. This study describes the morbidity and mortality of DC in 14 children with a mean follow-up of 3.2 years. We review published evidence from the past 10 years on the indications for DC in pediatric brain trauma. We also examine timing, surgical technique, and the results of this procedure. ⋯ DC reduces ICP in pediatric patients with traumatic brain injury. The mortality rate is low and long-term prognosis in survivors is good. Complications related to surgery are frequent. Wide craniectomy with duraplasty seems to be the most common technique. Defining the most appropriate indications and timing for DC in pediatric patients should be the objective of future prospective studies.
-
Comparative Study
Modified posterior closing wedge osteotomy for the treatment of posttraumatic thoracolumbar kyphosis.
Posttraumatic thoracolumbar deformities can occur in patients after conservative or inadequate surgical treatment. Anterior, posterior, or combined anterior and posterior procedures of Smith-Peterson osteotomy technique have been developed to correct thoracolumbar kyphosis to various degrees. Recently, many reports have addressed the specific problem of local posttraumatic thoracolumbar deformity; however, there is significant controversy over the ideal management. The objectives are to illustrate the technique of modified closing wedge osteotomy for the treatment of posttraumatic kyphosis and to report the radiographic results and clinical outcome of patients treated with the technique. ⋯ The modified wedge closing osteotomy achieves satisfactory kyphosis correction and good fusion with less blood loss and complications than other approaches, implying an alternative method in patients with posttraumatic kyphosis.