J Trauma
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Two cases of the rare injury of avulsion of the triceps tendon are presented. The difficulties in clinical diagnosis and proper evaluation of the roentgenographic findings whenever present are discussed and the treatment is outlined.
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Two large series of civilian-incurred (212) and combat-incurred (228) tibial shaft fractures are compared. Closed tibial fractures were treated by closed manipulation and weight bearing ambulation in a long leg plaster cast. Open injuries following wound exploration and debridement were treated similarly with wound closure. ⋯ Allowing an open fracture to heal with exposed bone at the fracture site resulted in an average time to removal of external immobilization only two weeks greater than for the uncomplicated tibial fracture. Whether weight bearing ambulation was instituted immediately (24-48 hr) or early (3-4 wk) did not shorten the time to removal of external immobilization. The infection rate in 289 open tibial fractures (228 combat-incurred and 61 civilian-incurred) was 3.8%, and all infections occurred in the open penetrating injuries.
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Fiberoptic bronchoscopy proved to be a simple, safe, and accurate method of diagnosing acute inhalation injury. Both the anatomic level and the severity of large airway injury were easily identified. ⋯ The only clinical situation where bronchoscopy failed to identify an inhalation injury was in the immediate postburn period if the patient wasin hypovolemic shock. In this particular clinical circumstance the characteristic mucosal alterations may be absent; yet if bronchoscopy is performed after hypovolemic shock has been corrected, mucosal changes characteristic of inhalation injury will be seen.
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Nine burn patients with a mean burn size of 39% (range, 23-65%) and five normal individuals studied in an environmental chamber selected optimal comfort temperature by regulating a bedside temperature control unit. The normal individuals selected 27.8 degrees C plus or minus 0.6 (SE) as the comfort temperature and their mean skin temperature was 33.4 plus or minus 0.6 and core temperature 36.9 plus or minus 0.1 while in this environment. In contrast, the burn patients maintained a higher ambient comfort temperature (mean 30.4 plus or minus 0.7, p less than 0.05 when compared to controls) associated with an elevated core (38.4 plus or minus 0.3, p less than 0.01) and surface temperature (35.2 plus or minus 0.4, p less than 0.05). ⋯ The HGH response to known stimuli returned toward normal with time and recovery in the surviving patients. Alterations in comfort temperature, fasting blood glucose, and glucose-HGH interaction occur following thermal trauma. These changes taken together suggest that metabolic responses to injury may be the consequence of homeostatic readjustment within the hypothalamus.
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An unusual fracture-dislocation of the great toe is presented and discussed. A review of the literature is included and a possible mechanism discussed. The lack of information in the literature relative to this injury led us to report this case.