J Trauma
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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
Results of a computed tomography protocol evaluating distal third tibial shaft fractures to assess noncontiguous malleolar fractures.
Intra-articular tibia fractures are reported to occur in 1% to 25% of tibia diaphyseal fractures. The objective of this study was to create a standard protocol to evaluate noncontiguous malleolar fractures associated with distal third tibial diaphyseal fractures using computed tomography (CT). ⋯ Plain radiographs are often insufficient for detecting posterior malleolus fractures in conjunction with ipsilateral distal third diaphyseal tibia fractures. Using a preoperative CT protocol for tibial shaft fractures can significantly improve the ability to diagnose associated intra-articular fractures that may not be evident on plain radiographs. Knowledge of these associated intra-articular fractures may prompt fracture stabilization and can prevent displacement during intramedullary nailing of tibia shaft fractures.
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Understanding the epidemiology of death after battlefield injury is vital to combat casualty care performance improvement. The current analysis was undertaken to develop a comprehensive perspective of deaths that occurred after casualties reached a medical treatment facility. ⋯ Hemorrhage is a major mechanism of death in PS combat injuries, underscoring the necessity for initiatives to mitigate bleeding, particularly in the prehospital environment.
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Comparative Study
Development and resuscitation of a sedated, mature male miniature swine severe hemorrhage model.
A sedated, mature male miniature swine hemorrhage model has been specifically developed to evaluate resuscitation products for the Defense Advanced Research Projects Agency Surviving Blood Loss program. ⋯ A sedated, sexually mature male miniature swine severe hemorrhage model has been successfully developed, resuscitated with Hextend and used to evaluate E2 as a small volume resuscitation product.
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With the aim of improving the understanding of iliosacral screw placement, two hypotheses were tested: (1) standard intraoperative inlet and outlet images are not based on orthogonal coordinates, and (2) therefore making starting point and aim changes by moving perpendicular to the c-arm beam will displace the guide wire on the other intraoperative radiographic view. ⋯ We commonly work in orthogonal systems. Within these systems, it is possible to make a uniplanar correction by moving perpendicular to one plane or radiographic view. The ideal views to image the safe zone for iliosacral screw placement do not create an orthogonal system. When this average angle arc is placed on a graphic model of the pelvis, it becomes clear that the plane of the radiographic beam of the ideal inlet view is collinear with the anterior aspect of the upper two sacral bodies. The outlet view is oblique to the upper sacral bodies. Surgeons must keep this in mind when using fluoroscopic views to insert iliosacral screws.