J Trauma
-
133Xenon lung scanning post-thermal injury was used to detect inhalation injury in 86 patients admitted to the United States Army Institute of Surgical Research during 1974. Inhalation injury was indicated by the 37 (43%) positive scans. Based on all available clinicopathologic evidence, 11 (13%) of the scans were erroneous with seven (8%) falsely positive and four (5%) falsely negative. ⋯ Inhalation injury, as expected, had an adverse effect on survival rates. The group of patients whose expected mortality lay between 40 and 59% were most notably affected. One hundred per cent (five of five) of those with inhalation injury died; only one of eight without inhalation injury died.
-
Most serious lower-limb injuries with severe bone and soft tissue damage heal when treated wisely by techniques available today. Unfortunately, a small percentage of patients face prolonged physical and economic disability as a result of extensive damage to bone and soft tissue, nonunion of fractures with infection, nerve and blood-vessel injury, and complications of surgical treatment. ⋯ When a lower-limb prosthesis can provide stability support, and mobility painlessly, and overcome the morbidity and disability of an infected ununited fracture, amputation may be the treatment of choice. In the present review of our experiences in the past 17 years with patients having severly injured and diseased lower limbs where little chance existed for rehabilitation to acceptable levels of function by various methods of treatment, open amputation through infected bone followed by secondary closure was chosen to salvage the unfortunate patient with littlw chance of achieving acceptable function after infected ununited fractures of the lower limbs.
-
Bullet emboli from peripheral wounds occur with sufficient frequency that they must be considered in every case of missile injury not accompanied by an exit wound. A case is presented which demonstrated a venous migration of such a bullet from the axillary vein into the femoral vein through the heart, presumably by gravity.