J Trauma
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The tibial segmental fractures usually follow high-energy trauma and are often associated with many complications. We designed a two-stage protocol for these complex injuries. The aim of this study was to assess the outcome of tibial segmental fractures treated according to this protocol. ⋯ Use of the two-stage procedure for treatment of segmental tibial fractures is recommended. Surgeons can achieve good reduction with stable temporary fixation, soft-tissue reconstruction, ease of subsequent definitive fixation, and high union rates. Our patients obtained excellent knee and ankle joint motion, good functional outcomes, and a comfortable clinical course.
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Artificial dural substitutes are increasingly being used in decompressive craniectomy to prevent peridural fibrosis and facilitate cranioplasty for patients with head injury. The safety of the dural substitute should be systemically evaluated. We focus on Neuro-Patch (B. Braun, Boulogne, France), a nonabsorbable substitute and commonly used by neurosurgeons. ⋯ The use of Neuro-Patch does not increase the incidence of neurosurgical site infection and hydrodynamic complications, including subdural hygroma and cerebrospinal fluid leakage, after decompressive craniectomy or cranioplasty for severe traumatic brain injury. However, extra-axial hematoma at the site of craniectomy is more often encountered in patients with Neuro-Patch and forms a compressive lesion on the adjacent brain.
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To evaluate whether older injured motor vehicular crash (MVC) occupants' access to trauma centers (TC) reflects the lower threshold suggested in triaging recommendations. ⋯ In contrast to the American College of Surgeons triaging recommendations, injured MVC occupants older than 60 years are less likely to be transported to a TC than their younger counterparts. Further studies should establish whether the lower access to TC experienced by the older population is a function of geographical factors, emergency medical services unconscious bias, or other factors.
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Female gender may protect against infectious complications after injury. This protection may be due to a beneficial effect of estrogen (E2) as the salutary effects are age and estrus cycle related. However, outcome may be worse in females developing infectious complications or organ failure after injury. To assess the role of E2 in postshock organ failure, we studied the effect of E2 on parameters of lung injury in an in vitro cell culture model. ⋯ Exposure of HT-29 cells to either H/R or E2 had a deleterious effect on HMVEC monolayers. In addition, there seemed to be a synergistic effect of H/R and E2 on pulmonary endothelial injury. This study supports the findings noted in recent clinical studies suggesting E2 decreases infectious complications but may be associated with poorer outcomes if complications occur.
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To examine the association of scene mobility status (SMS) and injury severity and mortality among motor vehicular crash (MVC) victims. ⋯ MVC occupants who "self-exited" or "exited with assistance" experienced a very low injury severity and mortality. Further efforts are needed to decrease the overtriaging of these patients.