J Trauma
-
Comparative Study
Liver dysfunction by model for end-stage liver disease score improves mortality prediction in injured patients with cirrhosis.
Cirrhosis is associated with poor outcomes in the trauma setting. We aimed to evaluate the utility of Model for End-Stage Liver Disease (MELD) in assessing additional mortality risk in trauma patients with cirrhosis. ⋯ In trauma patients with cirrhosis, a score that evaluates the degree of liver dysfunction enhances the ability of ISS alone to predict mortality. The MELD score is more readily available than the CTP score for the prediction of mortality in trauma patients.
-
Comparative Study
Results of a computed tomography protocol evaluating distal third tibial shaft fractures to assess noncontiguous malleolar fractures.
Intra-articular tibia fractures are reported to occur in 1% to 25% of tibia diaphyseal fractures. The objective of this study was to create a standard protocol to evaluate noncontiguous malleolar fractures associated with distal third tibial diaphyseal fractures using computed tomography (CT). ⋯ Plain radiographs are often insufficient for detecting posterior malleolus fractures in conjunction with ipsilateral distal third diaphyseal tibia fractures. Using a preoperative CT protocol for tibial shaft fractures can significantly improve the ability to diagnose associated intra-articular fractures that may not be evident on plain radiographs. Knowledge of these associated intra-articular fractures may prompt fracture stabilization and can prevent displacement during intramedullary nailing of tibia shaft fractures.
-
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.
-
Comparative Study
The proximal femur nail antirotation: an identifiable improvement in the treatment of unstable pertrochanteric fractures?
The optimal surgical treatment of patients with an unstable extracapsular proximal femoral fracture is yet to be found. From the biomechanical point of view, the use of an intramedullary device in combination with a dynamic femoral head/neck stabilization implant seems an optimal technique. One of these intramedullary devices, the Proximal Femoral Nail (PFN), has several drawbacks in practice. The Proximal Femur Nail Antirotation (PFNA) has been designed to address these. We hypothesized that the placement of one femoral head/neck fixation device in the PFNA would improve positioning of the implant in the femoral head compared with the PFN and reduce the number of reoperations in both short and long term. ⋯ This study shows that osteosynthesis with the PFNA does not improve the position of the implant in the femoral head compared with the PFN. However, the risk of a secondary complication and the necessity of a late reoperation are significantly higher in patients treated with a PFN compared with patients treated with a PFNA.