J Trauma
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Despite the good and reliable results of the dynamic hip screw (DHS) for stable fracture patterns, complications of excessive sliding of the lag screw and inadequate bone anchorage occur frequently in elderly patients with unstable intertrochanteric fractures. Although polymethylmethacrylate (PMMA) bone cement has been widely used as a secondary fixation to facilitate fixation stability, there has been no prospective study on the clinical significance of PMMA cement to prevent these two complications in unstable fracture patterns. ⋯ With the meticulous augmentation technique demonstrated in this study, the PMMA cemented DHS proved to have better outcome than a conventional DHS for unstable intertrochanteric fractures in elderly patients. Typical complications related to a conventional DHS device for the treatment of such fractures were successfully prevented.
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Pharmacologic thromboprophylaxis (PTP) may exacerbate intracranial hemorrhage (ICH) in patients with traumatic brain injury (TBI). We examined risk factors for hemorrhage progression in patients with blunt TBI and hypothesized that PTP would increase ICH progression in a subset of these patients. ⋯ These findings suggest that PTP use is associated with a 13-fold increased odds of further hemorrhage progression in patients whose F/U CT within 1 day of admission showed ICH progression; 16% of this risk can be attributed to receiving PTP. Conversely, PTP may be safe in a subgroup of patients with TBI with no ICH progression on initial F/U CT.
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Comparative Study
Improved trauma system multicasualty incident response: comparison of two train crash disasters.
Two train crash multicasualty incidents (MCI) occurred in 2005 and 2008 in Los Angeles. A postcrash analysis of the first MCI determined that most victims went to local community hospitals (CHs) with underutilization of trauma centers (TCs), resulting in changes to our disaster plan. To determine whether our trauma system MCI response improved, we analyzed the distribution of patients from the scene to TCs and CHs in the two MCIs. ⋯ A trauma system performance improvement program allowed us to significantly improve our response to MCIs with improved utilization of TCs and improved distribution of victims according to injury severity and needs.
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Little data exist examining the impact of positive pressure ventilation on safe thoracostomy tube removal. We sought to evaluate the impact of positive-pressure ventilation (PPV) on recurrent pneumothoraces (PTX) after removal of thoracostomy tubes (TT). ⋯ The rate of recurrent PTX or TT replacement after removal is not associated with PPV status. The slightly lower recurrence rate on PPV combined with the smaller proportion of patients with stable small PTX before removal may reflect more careful clinician selection of ideal patients or technique of TT removal among patients on PPV. Prospective data are needed to clarify these associations.
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No evidence of infection after retrograde nailing of supracondylar femur fracture in gunshot wounds.
The aim of the study was to determine whether osteomyelitis of the femur or septic arthritis of the knee develops after retrograde intramedullary nailing of the femur performed within 7 days of supracondylar femur fracture, secondary to gunshot wounds, without skin defects. ⋯ Retrograde intramedullary nailing of the femur can be performed in patients with supracondylar fractures of the femur due to gunshot wounds, and without skin defects, in the first 7 days after the trauma. Neither osteomyelitis of the femur nor septic arthritis of the knee develops in these patients.