J Trauma
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Dysautonomia after severe traumatic brain injury (TBI) is a clinical syndrome affecting a subgroup of survivors and is characterized by episodes of autonomic dysregulation and muscle overactivity. The purpose of this study was to determine the incidence of dysautonomia after severe TBI in an intensive care unit setting and analyze the risk factors for developing dysautonomia. ⋯ Dysautonomia frequently occurs in patients with severe TBI. A younger age and DAI could be risk factors for facilitating the development of dysautonomia.
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Lumbopelvic distraction stabilization with (triangular osteosynthesis) or without additional iliosacral screw allows anatomic reduction of the posterior pelvic ring after severely displaced sacral fractures, correction or resection osteotomies of malunions, respectively, septic sacroiliitis and permits early weight bearing. However, this technique is complicated by wound necrosis or infection in up to 20% to 30%. We describe our experience with a less invasive technique. ⋯ The presented technique respects the lumbar anatomy and provides the access required for lumbopelvic stabilization, while having the potential to decrease or even prevent postoperative wound disorders if combined with a polyaxial low-profile system. The low number of cases presented may, however, limit the relevance of the conclusions in cases of severe Morell-Lavallé lesions with skin disorders.
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Comparative Study
A comparative biomechanical analysis of fixation devices for unstable femoral neck fractures: the Intertan versus cannulated screws or a dynamic hip screw.
First introduced in 2005, the "Intertan" (IT), an intramedullary nail with two cephalocervical screws, has become an increasingly popular option for treating intertrochanteric fractures. The purpose of this study was to identify the utility of this device for stabilization of unstable femoral neck fractures compared with cannulated screws (CS) and a dynamic hip screw (DHS). ⋯ Our results suggest that (1) none of the tested devices restore a comparable mechanical strength in the fractured specimens compared with the intact femurs, and (2) the "IT" possesses some biomechanical benefits for internal fixation of unstable femoral neck fractures compared with DHS and CS. Because the IT constructs failed with an inferior femoral neck fracture, complicating the mandatory anchorage of a prosthetic stem in a revision operation, more biomechanical experiments using the IT in the presence of a posterior comminution defect are required, along with clinical outcome studies.
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Missed fractures, the most common diagnostic error in emergency departments, are usually the result of a misread radiograph or the failure to obtain a radiograph. However, a poorly positioned or poorly taken radiograph may also result in diagnostic errors. We sought to analyze the frequency of missed or misdiagnosed finger fractures that could be attributed to inadequate radiographs. ⋯ Diagnostic errors attributed to inadequate radiographs are rare. Proper radiographic evaluation of finger trauma requires at least true anteroposterior and lateral views. An oblique view can complement the lateral view but not replace it. Poor quality radiographs or inadequate views should never be accepted or used as a basis for treatment.
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Complications of excessive crystalloid after critical injury have increased interest in vasopressor support. However, it is hypothesized that vasopressor use in patients who are under-resuscitated is associated with death. We performed this study to determine whether volume status is associated with increased mortality in the critically injured exposed to early vasopressors. ⋯ Vasopressor exposure early after critical injury is independently associated with death and mortality is increased regardless of fluid status. Although it is not advisable to withhold support with impending cardiovascular collapse, use of any vasopressor during ongoing resuscitation should be approached with extreme caution regardless of volume status.