J Trauma
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An emergency splenectomy was necessary 25 days after blunt injury of a patient whose initial peritoneal lavage was negative, whose visceral angiograms were negative, and whose abdomen remained asymptomatic during interval intensive observations. Delayed splenic rupture can occur rarely in the face of extensive diagnostic evaluation.
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Management of the pediatric patient sustaining a traumatic injury is influenced by patient size, surface area to body mass ratio, thermoregulation, and fluid requirements. A predetermined and systematic approach to the injured child guarantees recognition of life-threatening injuries and provides a method for rapid stabilization. The algorithm is divided into two distinct phases: life support and post-stabilization. The unique aspects of care of the injured child are highlighted to emphasize the significant differences in resuscitation and diagnosis from that of the adult patient.
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One hundred consecutive patients with 144 digital amputations performed at the University of Colorado Health Sciences Center between 1978 and 1980 were retrospectively reviewed. In this group, four patients demonstrated painful amputation stumps. Two of these were treated by surgical excision of neuromas and two patients, who had more vague complaints, were treated by desensitization which decreased the sensitivity of their stumps and allowed them to return to work. It is felt that this low incidence of painful neuromas and amputation stumps is due to the positive postoperative effort to send patients back to work as soon as possible, allowing them to perform their own therapy and thereby minimizing their disability and tendency to develop pain problems.
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Synthetic Adhesive Moisture vapor permeable (S. A. M.) dressings, Op-Site and Tegaderm, are compared to Fine Mesh Gauze (F. ⋯ M. dressings and scalp as a donor site allows for rapid reuse of a donor site. Pain is substantially decreased and rate of healing is increased when this combination is used. The scalp, because of its availability, accessibility, excellent color match for facial grafting, and rapid healing, is recommended as a donor site.
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Case Reports
The off-profile proximal radial epiphysis: another potential pitfall in the X-ray diagnosis of elbow trauma.
If the elbow is filmed in flexion in a pubertal age child, the proximal radial epiphyseal line may be projected through the articular surface of the radial head on standard or oblique AP views. This can theoretically mimic a fissure or chisel-type fracture. Fractures involving the articular surface of the radial head, however, are extremely rare in children and the true fissure fractures that occur in the adult are notably different in specific radiographic features.