J Trauma
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Determine if laparotomy further destabilizes an unstable pelvic injury and increases pelvic volume, and if reduction and stabilization restores pelvic volume and prevents volume changes secondary to laparotomy. ⋯ We believe that the abdominal wall provides stability to an unstable pelvic ring injury via a tension band effect on the iliac wings. Our results demonstrate that a laparotomy further destabilized an open-book pelvic injury and subsequently increased pelvic volume and pubic diastasis. This could potentially increase blood loss from the pelvic injury and delay the tamponade effect of reduction and stabilization. A single-pin external fixator prevents the destabilizing effect of the laparotomy and effectively reduces pelvic volume. These data support reduction and temporary stabilization of unstable pelvic injuries before or concomitantly with laparotomy.
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Based on the findings in computed tomography scans, we defined a grading system that is well correlated to the changes of the brainstem and its perimesencephalic cistern during intracranial hypertension. ⋯ Our grading system is easy to use, and is well correlated to give an accurate prediction of outcome in cases with severe head injury based primarily on the results of an initial computed tomography scan, even without clinical information, and it should play a role in the classification of head injury.