J Trauma
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This study concerns the results of treatment of 39 patients with 40 tibial fractures which had progressed to nonunion and which subsequently were treated by autogenous bone grafting and cast immobilization. Thirty-one fractures were initially open and nine of these became infected nonunions. ⋯ The difficulty with correcting and maintaining correction of the initial deformity and long periods of joint immobilization contributed to these results. Each patient with a nonunion of the tibia should be assessed so that a recommendation as to the need for immobilization, its type, and the necessity for bone grafting or not can be made.
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Randomized Controlled Trial Clinical Trial
A prospective study of prophylactic penicillin in acutely burned hospitalized patients.
The use of prophylactic low-dose penicillin acutely burned, hospitalized patients remains controversial. Fifty-one adult patients with burns of 1% to 91% total body surface area were prospectively studied to determine the efficacy of prophylactic penicillin in the prevention of wound cellulitis and burn wound sepsis, and to examine the influence of prophylactic penicillin on the emergence of antibiotic resistant microorganisms. ⋯ No patient in either group developed gentamicin-resistant Gram-negative organisms, although the gastrointestinal tracts of two patients in the penicillin group showed new colonization by yeast. We conclude that the routine administration of prophylactic penicillin neither protects against cellulitis and burn wound sepsis, nor promotes selection of antibiotic-resistant bacteria in hospitalized patients with acute thermal injury.
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This study reports on the effects of early cooling on the morphology of partial-thickness burns. After 10% body surface dorsal scald burns at 75 degrees C for 10 seconds, guinea pigs were treated by ice-water immersion at 10 minutes postburn of only the burned surface for 30 minutes. Skin samples from treated and untreated burn wounds were examined at 2, 8, 24, and 96 hours postburn by light and electron microscopy. ⋯ There was also less damage to the dermal microvasculature and less edema fluid compared to untreated burn wounds. At 96 hours, the cooled burn wounds demonstrated minimal dermal hemorrhage and polymorphonuclear leukocytic infiltration, compared to the untreated wounds. These results indicate that on a cellular level, cooling has beneficial effects on the experimental burn wound.