J Trauma
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Comparative Study
Risk of mortality: the relationship with associated injuries and fracture treatment methods in patients with unilateral or bilateral femoral shaft fractures.
The aim of the study was to determine the relative contributions to mortality of a unilateral or a bilateral femoral fracture in patients with or without injuries to other body regions. ⋯ The increase in mortality with BFs is more closely associated with the presence of associated injuries and poor physiologic parameters than with the presence of the BF alone. The presence of BFs should alert the clinician to the very high likelihood (80%) of significant associated injuries in other body systems and their life-threatening potential. Damage control fixation options should be considered in the subgroup with a very high New Injury Severity Score.
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To investigate the association between a number of hospital level composite index methodologies developed from trauma indicators with inhospital mortality. ⋯ Trauma composite indices demonstrate construct validity when used as measures of hospital level process and represent potentially useful methods of analyzing and reporting quality indicators.
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Comparative Study
The combination of an online organ and tissue registry with a public education campaign can increase the number of organs available for transplantation.
A persistent shortage of organs and inexhaustible waiting lists continue to result in many people dying while awaiting transplantation. On July 1, 2006, the California Department of Motor Vehicles joined forces with California's Online Organ and Tissue Registry and launched a campaign to increase donation rates. This campaign included intense public and media education. The efficacy of such a campaign on donor demographics has not been studied. ⋯ Public and media education significantly improved organ donor demographics. Although this study compares only 2 years before with 2 years after the donation campaign, the results are extremely favorable. Therefore, a public donation campaign and an organ donor registry are effective promotions that could help increase the number of organs available for transplantation.
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Arterialized venous flaps can be useful for hand/digit reconstruction, providing very thin skin coverage. However, their popularity has been limited by concerns over poor peripheral perfusion and severe congestion, which may be to be due to unrestricted arteriovenous shunting and pressurization of the efferent vein. To mitigate these problems, we design our flaps to restrict shunting. This report describes our clinical experience with these techniques. ⋯ Restriction of arteriovenous shunting enhances peripheral perfusion and decreases congestion of venous flaps, thereby improving reliability and utility for hand/digit reconstruction.
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Comparative Study
Extrication collars can result in abnormal separation between vertebrae in the presence of a dissociative injury.
Cervical collars are applied to millions of trauma victims with the intent of protecting against secondary spine injuries. Adverse clinical outcomes during the management of trauma patients led to the hypothesis that extrication collars may be harmful in some cases. The literature provides indirect support for this observation. The purpose of this study was to directly evaluate cervical biomechanics after application of a cervical collar in the presence of severe neck injury. ⋯ This study was consistent with previous evidence that extrication collars can result in abnormal distraction within the upper cervical spine in the presence of a severe injury. These observations support the need to prioritize additional research to better understand the risks and benefits of cervical stabilization methods and to determine whether improved stabilization methods can help to avoid potentially harmful displacements between vertebrae.