J Trauma
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The therapeutic and prophylactic effects of nylon dressings coated with metallic silver in a direct current circuit have been examined in a rat model of fatal burn wound sepsis. Male Sprague-Dawley rats weighing 325 +/- 25 grams with 20% full-thickness scald injuries were used. Therapeutic effects were examined at 4 or 24 hours after surface inoculation with a lethal dose of Pseudomonas aeruginosa (Strain 59-1244). ⋯ The uncoated nylon had no barrier effect. Silver nylon was found protective but applied current was not required for significant (p less than 0.001) barrier effect. These results indicate silver nylon dressings may be a valuable antimicrobial burn wound covering device.
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Chylothorax following blunt chest trauma is rare; we found only 19 cases reported. We describe an unusual patient with chylothorax from closed chest injury. ⋯ Thoracostomy in the definitive therapeutic modality. Nonoperative or, when necessary, operative treatment of chylothorax after blunt trauma can lead to a successful outcome in 90% of cases.
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A case with a "side-swipe" injury in the left elbow while projected out an automobile window, resulting in avulsion of the distal one third of the humerus and proximal two thirds of the olecranon, is reported. The bony defect was reconstructed by an endoprosthesis to preserve elbow function.
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A new method of reduction of dislocated shoulders used by the Eskimos in Greenland is described. The method was tried as first attempt of reduction on 23 consecutive acute dislocations in the emergency room of a central Copenhagen hospital. ⋯ Three dislocations required general anesthesia and two attempts were unsuccessful, but dislocations were reduced using other methods. The advantage of using the Eskimo method is: 1) it is simple and can be used by nonmedical personnel; 2) nontraumatic; and 3) needs no facilities.
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Modern methods of open fracture management, skeletal fixation, and soft-tissue and bone reconstruction have dramatically improved the potential for limb salvage. The absence of adequate objective parameters on which to base the decision for salvage results in delayed amputations in many cases. The present study was undertaken to review the medical and economic impact of delayed versus primary amputations following severe open fractures of the tibia. ⋯ They averaged 22.3 days hospitalization, 1.6 surgical procedures to the involved lower extremity, and $28,964 hospital costs (range, $5,344-$81,282). The 29 patients with delayed amputations had an average of 53.4 days hospitalization, 6.9 surgical procedures, and $53,462 hospital costs (range, $14,574-$102,434). Six (20.7%) of the delayed amputation patients developed sepsis secondary to their involved lower extremity and died; no patient in the primary amputation group developed sepsis or died.(ABSTRACT TRUNCATED AT 250 WORDS)