J Trauma
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The Leapfrog Group initiative has led to an increasing public demand for dedicated intensivists providing critical care services. The Acute Care Surgery training initiative promotes an expansion of trauma/surgical care and operative domain, redirecting some of our focus from critical care. Will we be able to train and enforce enough intensivists to care for critically ill surgical patients? ⋯ EPs training in a Surgical Critical Care Fellowship can acquire critical care knowledge equivalent to that of surgeons. EPs trained in a Surgical Critical Care paradigm can potentially expand the intensive care unit workforce for Surgical Critical Care patients.
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Comparative Study
The proximal femur nail antirotation: an identifiable improvement in the treatment of unstable pertrochanteric fractures?
The optimal surgical treatment of patients with an unstable extracapsular proximal femoral fracture is yet to be found. From the biomechanical point of view, the use of an intramedullary device in combination with a dynamic femoral head/neck stabilization implant seems an optimal technique. One of these intramedullary devices, the Proximal Femoral Nail (PFN), has several drawbacks in practice. The Proximal Femur Nail Antirotation (PFNA) has been designed to address these. We hypothesized that the placement of one femoral head/neck fixation device in the PFNA would improve positioning of the implant in the femoral head compared with the PFN and reduce the number of reoperations in both short and long term. ⋯ This study shows that osteosynthesis with the PFNA does not improve the position of the implant in the femoral head compared with the PFN. However, the risk of a secondary complication and the necessity of a late reoperation are significantly higher in patients treated with a PFN compared with patients treated with a PFNA.
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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.
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Acute pain after injury affects the comfort and function of the wounded soldier and the physiology of multiple body systems. In the civilian population, pain alters the function of the autonomic nervous system, causing increased heart rate and blood pressure. However, there are no data regarding the impact of combat-related pain on physiologic responses. This study is a retrospective analysis that examined the relationship of pain and physiologic parameters in injured soldiers. ⋯ In contrast to data from civilian patients, early pain scores were not related to heart rate or blood pressure. A pain score of 10 corresponded to an increased respiratory rate. Despite little relationship between pain and injury severity in the civilian population, the increasing ISS was proportional to the pain scale in wounded soldiers.
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Comparative Study
Modified technique of percutaneous posterior columnar screw insertion and neutralization plate for complex acetabular fractures.
To overcome the complexity of acetabular fractures, several techniques, such as extensive surgical exposure, transtrochanteric osteotomy, and columnar screw fixation, were reported. However, all these techniques have their disadvantages and limitations. We report the surgical results of a modified technique with posterior columnar screw insertion and neutralization plate in a single Kocher-Langenbeck approach for complex acetabular fractures. ⋯ This study provided a modified surgical technique of percutaneous insertion of posterior columnar screw that appeared to be safe and reliably hold the column in place for healing.