J Trauma
-
We evaluated the types and mechanisms of hip dislocation sustained while snowboarding and skiing, a subject about which there have been few studies. ⋯ Hip dislocations are much more common in snowboarders than in skiers. Furthermore, the causes and types of hip dislocation differ between snowboarding and skiing.
-
Blunt vascular trauma in an extremity is an uncommon diagnosis. Considering the complexity of these injuries, it is worthwhile to determine how select factors affect the outcome of the limb and the patient. The objectives of this study were to review the diagnosis, management, and outcomes of patients who sustained blunt vascular injuries in the extremities and relate factors in their treatment to the outcome of the injured extremity. ⋯ Blunt vascular injuries in the lower extremities occur most commonly in the anteroposterior tibial arteries; injured arteries in the proximal upper and lower extremity require resection with interposition grafting, whereas those in the forearm or calf are usually ligated; the amputation rate in 65 injured extremities with blunt vascular trauma was 18.%, which is at least three times that for those who sustain penetrating injury; and delays in diagnosis and treatment are uncommon in these patients with multiple injuries.
-
Aggressive screening for blunt cerebrovascular injury (BCVI) has uncovered an astonishing incidence of vertebral artery injuries (VAIs) and associated stroke rate. Stroke incidence is reduced with early recognition and prompt anticoagulation. Because of the proximity of the cervical spine and vertebral arteries, we queried whether all patients with cervical spine fractures required arteriography to rule out VAI. ⋯ Blunt vertebral artery injury is associated with complex cervical spine fractures involving subluxation, extension into the foramen transversarium, or upper C1 to C3 fractures. Routine screening should incorporate these findings to maximize yield while limiting the use of invasive procedures.
-
The gradient of end-tidal CO2 to arterial CO2 (Pa-ET)CO2 has been identified as a predictor of mortality in patients undergoing emergency trauma surgery. In an effort to further elucidate this phenomena, we accumulated additional data on trauma patients undergoing emergency surgery. ⋯ (Pa-ET)CO2 can be used as a predictor of mortality and may be useful as an intraoperative tool for assessing the physiologic conditions of the patient. This predictor of mortality was valid even in patients that died greater than 24 hours after surgery. This information is almost always already available and may be used to further guide the decisions regarding patient care, particularly in decisions regarding damage control surgery.