J Trauma
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As utilization of computed tomography (CT) scans in the evaluation of trauma patients increases, pneumothoraces (PTXs) seen on CT but not on chest X-ray (CXR), known as occult PTXs (OPTXs), are becoming more prevalent. The incidence of PTXs simply missed on CXR among OPTXs is unclear. A previous retrospective review of CXRs at our institution generally confirmed the occult versus missed designation, but lower fidelity images may have biased this determination. Thus, we repeated this evaluation using the high-quality images and improved the methodology. ⋯ We estimate that 80% of PTXs considered occult in the trauma room were truly occult. The most common missed sign was subcutaneous emphysema. PTXs are poorly assessed by CXR, and accurate diagnosis should focus on other imaging modalities.
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To introduce a minimally invasive procedure and investigate its clinical significance in the treatment of displaced intra-articular calcaneal fractures. This minimally invasive procedure consists of percutaneous leverage, manual compression, and fixation with anatomic plates and compression bolts through small lateral incisions. ⋯ This minimal invasive procedure featured percutaneous leverage, manual compression, and the application of the anatomic plates and compression bolts through lateral approach is proved to be an effective treatment for displaced intra-articular calcaneal fracture, offering the combination of fewer soft tissue complications and good reduction. With < 3-mm displacement of the posterior facet after reduction, the restoration of the calcaneal width and height can be very important to achieve satisfactory radiologic and functional outcomes.
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Intraabdominal vascular injury (IAVI) as a result of penetrating and blunt trauma carries a high mortality rate. This study was performed to compare current mortality rates with a previously reported historic control. ⋯ Although over 20 years have passed, no significant changes have occurred in the mortality associated with IAVI. Patients presenting in shock with IAVI continue to have a high mortality rate.
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We aimed to determine the effect of femur fractures on mortality, pulmonary complications, and adult respiratory distress syndrome (ARDS). In addition, we aimed to compare the effect of femur fractures with other major musculoskeletal injuries and to determine the effect of timing to surgery on these complications. ⋯ Femur fractures are a major musculoskeletal injury and increase the risk of mortality and pulmonary complications as much as any other musculoskeletal injuries. There is a unique relationship between ARDS and femur fractures, and this must be considered carefully in treatment planning for these patients.
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Although previous studies have identified an association between the transfusion of relatively older red blood cells (RBCs) (storage ≥ 14 days) and adverse outcomes, they are difficult to interpret because the majority of patients received a combination of old and fresh RBC units. To overcome this limitation, we compared in-hospital mortality among patients who received exclusively old versus fresh RBC units during the first 24 hours of hospitalization. ⋯ In trauma patients undergoing transfusion of 3 or more RBC units within 24 hour of hospital arrival, receipt of relatively older blood was associated with a significantly increased mortality risk. Reservation of relatively fresh RBC units for the acutely injured may be advisable.