J Trauma
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A three-part clavicle fracture not previously described is presented. Treatment of distal clavicle fractures is reviewed, and operative treatment for this type of fracture is recommended. ⋯ The acromioclavicular joint is not entered, and the wire is bent 90 degrees at its distal tip and removed once the fracture has united. In the case reported full use was possible in 6 months.
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Blunt trauma to the chest may produce a spectrum of cardiac lesions extending from asymptomatic myocardial contusion to rapidly fatal cardiac rupture. A case is discussed in which a patient with signs of cardiac tamponade after blunt trauma was found to have a rupture of the atrium. During repair of the cardiac injury, an unusual tear of the right superior pulmonary vein was also discovered. Both injuries were successfully repaired and the patient recovered.
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Currently available diagnostic techniques for myocardial contusion following blunt chest trauma were evaluated. We investigated 30 patients prospectively over a period of 1 year for the presence of myocardial contusion. Among the 30 patients, eight were found to have myocardial contusion on the basis of abnormal electrocardiograms, elevated creatine phosphokinase MB fraction (CPK-MB), and positive myocardial scan. ⋯ CPK-MB fraction was elevated in four of eight patients (50%). Definitive electrocardiographic changes were seen in only two of eight patients (25%). It appears that myocardial scan using technetium pyrophosphate and CPK-MB fraction determinations are the most reliable aids in diagnosis of myocardial contusion following blunt chest trauma.
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The Esophageal Obturator Airway (EOA) has been considered an effective ventilatory technique for cardiopulmonary resuscitation; however, few studies of its field effectiveness have been performed. We evaluated the EOA in 158 cases of prehospital cardiac arrest resuscitated by EMT II personnel utilizing the EOA for airway maintenance. The time of insertion from arrival of the unit and the number of unsuccessful attempts were recorded. ⋯ There was marked improvement in all parameters following ET intubation. The EOA presents technical problems which make it inferior to ET tubes in resuscitation of individuals in the field with cardiac arrest. Close monitoring of its use should be undertaken in areas where it is the primary method for airway maintenance.
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From 1977 to 1980 fixation with an external fixateur was performed in 33 injuries of the upper extremity: ten fractures of the hand, 22 Colles' fractures, and one osteotomy for Madelung's deformity. Application was primary in 19 patients and after another type of fixation (cast or Kirschner wire) had failed to hold reduction in 14 patients. All ten hand fractures healed in 4 to 12 weeks, and the distal radius fractures united in 6 to 10 weeks. The external fixateur for unstable fractures of the hand and wrist with bone or soft-tissue loss provides rigid skeletal stabilization, accessibility for wound care, and early joint mobilization.