J Trauma
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Review Case Reports
Malrotation after locked intramedullary tibial nailing: three case reports and review of the literature.
Malrotation after interlocked tibial nailing is rarely documented. ⋯ Malrotation may cause functional deficits, but the long-term consequences of rotational deformities in the tibia have not been thoroughly studied. Malrotation after tibial nailing is probably more common than reported. Intraoperative comparison with the uninjured leg may be the best means available for avoiding this postoperative complication.
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Blunt vascular neck injuries (BVNIs) are rare, often occult, and potentially devastating injuries. The purpose of this study was to identify a high-risk group, which would benefit from screening. ⋯ Screening should be undertaken for patients at increased risk for BVNI: those with risk factors identified in our regression analysis and factors previously reported.
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Comparative Study
Lung-sparing techniques are associated with improved outcome compared with anatomic resection for severe lung injuries.
Pulmonary tractotomy was introduced in 1994 as a novel concept for lung salvage after penetrating wounds. Recently, tractotomy has been suggested to increase morbidity and, thus, its practice has been challenged. The purpose of this study was to compare the morbidity and mortality associated with nonanatomic and anatomic lung resection in the management of severe pulmonary injuries. ⋯ Nonanatomic resection is associated with an improved morbidity and mortality compared with anatomic resection in the management of severe lung injuries. Although not a randomized study, these findings encourage the continued application of lung-sparing procedures when feasible.
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We hypothesized that clinical factors accurately identify those trauma patients at high risk for pelvic fractures making routine films unnecessary. ⋯ In the awake and alert patient, the need for a pelvic radiograph was readily identified by clinical examination. Because elimination of this film would result in financial savings, its routine use should be removed from standard trauma protocols in the minimally injured patient and limited to severely injured patients as recommended by the Advanced Trauma Life Support protocol.
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Optimizing intracranial pressure (ICP) and cerebral perfusion pressure (CPP) is important in the management of severe traumatic brain injury (TBI). In trauma patients with TBI and respiratory dysfunction, positive end-expiratory pressure (PEEP) is often required to support oxygenation. Increases in PEEP may lead to reduced CPP. We hypothesized that increases in PEEP are associated with compromised hemodynamics and altered cerebral perfusion. ⋯ In trauma patients with severe TBI, the strategy of increasing PEEP to optimize oxygenation is not associated with reduced cerebral perfusion or compromised oxygen transport.