J Trauma
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Comparative Study
Can acute care surgeons perform emergency colorectal procedures with good outcomes?
Acute care surgeons (ACS) perform emergency colorectal procedures but may have lower case volumes when compared with their general surgical and colorectal colleagues, which may compromise outcomes. In the acute populations, the elderly may be at particular risk. ⋯ ACS caring for colorectal emergencies encounter critically ill patients with significant comorbidities, often from extended care facilities. If patient characteristics are considered when scrutinizing outcomes of emergency colorectal procedures, ACS perform as well as their colleagues who perform a higher volume of elective resections.
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Comparative Study
Decompressive craniectomy in 14 children with severe head injury: clinical results with long-term follow-up and review of the literature.
Decompressive craniectomy (DC) is a controversial therapeutic measure used in patients with intractable intracranial hypertension after severe head injury. This study describes the morbidity and mortality of DC in 14 children with a mean follow-up of 3.2 years. We review published evidence from the past 10 years on the indications for DC in pediatric brain trauma. We also examine timing, surgical technique, and the results of this procedure. ⋯ DC reduces ICP in pediatric patients with traumatic brain injury. The mortality rate is low and long-term prognosis in survivors is good. Complications related to surgery are frequent. Wide craniectomy with duraplasty seems to be the most common technique. Defining the most appropriate indications and timing for DC in pediatric patients should be the objective of future prospective studies.
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Comparative Study
Modified posterior closing wedge osteotomy for the treatment of posttraumatic thoracolumbar kyphosis.
Posttraumatic thoracolumbar deformities can occur in patients after conservative or inadequate surgical treatment. Anterior, posterior, or combined anterior and posterior procedures of Smith-Peterson osteotomy technique have been developed to correct thoracolumbar kyphosis to various degrees. Recently, many reports have addressed the specific problem of local posttraumatic thoracolumbar deformity; however, there is significant controversy over the ideal management. The objectives are to illustrate the technique of modified closing wedge osteotomy for the treatment of posttraumatic kyphosis and to report the radiographic results and clinical outcome of patients treated with the technique. ⋯ The modified wedge closing osteotomy achieves satisfactory kyphosis correction and good fusion with less blood loss and complications than other approaches, implying an alternative method in patients with posttraumatic kyphosis.
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The "palm tree-like wiring" introduced by Kapandji and its modifications for proximal humeral fractures should be given the generic name "retrograde intramedullary multiple pinning through the deltoid 'V'" (IMPV). IMPV is still preferable for treating valgus-impacted four-part fractures in which K-wires have the advantage of working as an internal fixation material as well as a tool in fracture reduction. ⋯ IMPV is considered to be a preferable reducing and stabilizing method for valgus-impacted four-part fractures regardless of patient age. Additionally beneficial is being able to use the intramedullary pins as a tool for bone fragment reduction.
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Although most combat-related amputations occur early for unsalvageable injuries, >15% occur late after reconstructive attempts. Predicting which patients will abandon limb salvage in favor of definitive amputation has not been explored. The purpose of this study was to identify factors contributing to late amputation for type III open tibia fractures sustained in combat. ⋯ Patients definitively managed with late amputation were more likely to have soft tissue injury requiring flap coverage and have their limb salvage course complicated by infection.