J Trauma
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The purpose of our study was to evaluate the objective and subjective outcomes, as well as the radiographic results after elbow hemiarthroplasty (HA) for comminuted distal humerus fractures in elderly patients. ⋯ Elderly patients treated with elbow HA revealed good to excellent short-term clinical outcomes. A high rate of complications occurred but most complications found were minor and reoperation rate was low. Our results must be regarded as a report on our first experience with HA. As cartilage wear is just a question of time especially in active patients, we cautiously recommend HA only for elderly and multimorbid low-demand patients.
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Low-velocity pelvic gunshot injuries occur commonly in urban trauma centers, occasionally involving concomitant intestinal viscus injury leading to potential fracture site contamination. Surgical debridement of the fractures may be necessary to prevent osteomyelitis, although not routinely performed in many centers. The purpose of this study was to determine whether fracture debridement should be done to prevent osteomyelitis in these injuries. ⋯ Extra-articular gunshot pelvic fractures do not require formal orthopedic fracture debridement even in cases with concomitant intestinal viscus injury. However, debridement with bullet removal should be done in cases with intra-articular involvement, particularly if there are retained bullet fragments in the joint, to prevent deep infection.
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Pelvic ring injuries can be associated with severe blood loss and hemodynamic instability. The increase in pelvic volume in disrupted pelvic ring injuries is thought to cause accumulation of large volumes of blood in the retroperitoneal cavity. Extra abdominal compression for reduction of the pelvic ring may affect intrapelvic pressure. We examined the effects of pelvic volume changes on retroperitoneal pressures (RPP) and intra-abdominal pressures (IAPs) in the intact and unstable pelvic ring. ⋯ In the intact pelvis, RPP rises rapidly with increasing volume. The results seem to support the idea that disrupted pelvic ring fractures may lead to a significant volume uptake that is reversed during reduction.
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Among many aspects, wound healing depends on early restoration of venous blood flow across wound margins. The type of surgical occlusion of vein stumps during operations was assumed to have an influence on the early postoperative reunion of vein stumps and thereby on wound healing. Currently, there are different methods of vein stump occlusion available: ligation (e.g., Vicryl), closure using metal clips (e.g., LigaClip), coagulation using manually controlled bipolar forceps, and the use of a computer-controlled bipolar system (e.g., BiClamp). The aim of this study was to surgically and histologically compare the healing process, including new vessel formation after vein occlusion using one of the methods listed. ⋯ If a reconnection of the venous flow is desirable, the use of Vicryl and LigaClip might be superior to using electrothermic occlusion methods. In contrast, electrothermic methods cause less new vessel formation as well as less inflammatory reaction.
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One of the important causes of death after blast injuries is reduced blood volume, which typically results from hemorrhage but may also result from nonhemorrhagic causes. Hemoconcentration is one such alternate cause of reduced blood volume, but its mechanism is unclear. Because blood is condensed after chest-abdomen blast injuries in rabbits, a series of experiments was conducted to clarify this phenomenon. ⋯ The preliminary results indicate that microvessels in the lungs and kidneys are the key targets of blast injuries. The damage to the microvessels leads to leakage of albumin, which is one of the important reasons for hemoconcentration in the absence of active bleeding after a blast injury. Treatment should be initiated in victims of blast injuries who are severely wounded as soon as possible after the explosion during the earliest stages of the injury to avoid the occurrence of shock or other severe complications.