J Trauma
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High-energy tibial plateau fractures may present with an acute or impending compartment syndrome requiring emergent fasciotomy. There is little information regarding the optimal management of the fasciotomy wound with respect to the subsequent definitive internal fixation of the tibial plateau fracture. The purpose of this study was to compare the rate of infection complication after internal fixation of tibial plateau fractures in patients requiring fasciotomy for compartment syndrome with patients in whom a fasciotomy was not required. ⋯ Definitive internal fixation of tibial plateau fractures in the presence of open fasciotomy wounds does not seem to be associated with an increased infection risk.
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Comparative Study
A comparative analysis of serious injury and illness among homeless and housed low income residents of New York City.
Delivery of effective primary, secondary, and tertiary injury prevention in homeless populations is complex and could be greatly aided by an improved understanding of contributing factors. ⋯ Although homelessness presents unique, highly complex social and health issues that tend to overshadow the need for and the value of injury prevention, this study highlights potentially fruitful areas for primary, secondary, and tertiary prevention.
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Normal vital signs are typically associated with improved outcomes in trauma patients. Whether this association is true for geriatric patients is unclear. ⋯ Vital signs on presentation are less predictive of mortality in geriatric blunt trauma victims. Geriatric blunt trauma patients warrant increased vigilance despite normal vital signs on presentation. New trauma triage set points of HR >90 or SBP <110 mm Hg should be considered in the geriatric blunt trauma patients.
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Retrievable inferior vena cava filters (rIVCF) reduce the short-term risk of pulmonary embolism without the filter and inferior vena cava (IVC) thrombosis that have been reported with the use of permanent filters. Studies have shown that most rIVCFs are not removed, leaving patients at risk for thrombotic complications of rIVCF retention. We hypothesize that the application of a systematic follow-up for rIVCF will improve filter removal rates, providing patients short-term prophylaxis from pulmonary embolism whereas avoiding complications of permanent filter retention. ⋯ A dedicated system for following-up patients with rIVCFs markedly improves removal rates of retrievable filters.
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Fractures of the talar neck are relatively uncommon. The reported rates of avascular necrosis in Hawkins type II fractures vary from 34% to 50%. Various strategies have been adapted to prevent the occurrence of avascular necrosis. ⋯ The use of a vascularized cuboid pedicle bone graft and combined internal and external fixation can effectively prevent avascular necrosis of the talus in preliminary study. Further randomized control research is necessary to clarify the effectiveness of this technique.