J Trauma
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In three patients with elbow dislocations after falls on an outstretched upper extremity, concurrent perilunate dislocation was found. Closed reduction of the elbow dislocation achieved excellent functional results. Open reduction and internal fixation for perilunate dislocation provided anatomic reduction and satisfactory functional recovery in two patients. In the third, a delay in diagnosis of a perilunate dislocation necessitated proximal row carpectomy at 6 weeks.
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The use of preventive antibiotics has become the standard of care in the management of patients with multiple trauma who have injuries at risk for infection. In many areas of surgical practice, preventive antibiotic utilization has been restricted to the perioperative period only. In this study we reviewed a series of trauma patients with combined blunt chest injuries and extremity fractures to determine whether the duration of postoperative antibiotic administration would have adverse effects upon nosocomial pneumonia rates and severity.
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Respiratory failure may complicate multiple trauma and can add significant morbidity, mortality, and cost to the care of such patients. We used extracorporeal life support (ECLS) to treat 24 patients with multiple trauma who, after their injury, developed respiratory failure refractory to conventional ventilatory management. Injuries in these patients were the result of motor vehicle crashes (16 patients), pedestrian versus car collisions (3 patients), gunshots (2 patients), stabs (1 patient), and a recreational vehicle crash (1 patient). ⋯ Fifteen patients survived to be discharged from the hospital (63% survival). Early intervention (mechanical ventilation < or = 5 days prior to ECLS) was associated with good outcome. Despite risks of anticoagulation in patients with multiple injuries, ECLS can be life-saving in cases of respiratory failure refractory to conventional mechanical ventilation.
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Excessive overtriage prompted a review of all stable blunt trauma victims < or = age 65 years transported to our trauma center from 1990 through 1992 only by virtue of mechanism of injury. Of 4392 blunt trauma patients, 2298 (52%) met review criteria. In this group 1712 (75%) were discharged home from the emergency room, and 586 were hospitalized: 367 (63%) for < or = 1 day; 465 (79%) for < or = 2 days. ⋯ Early open reduction/internal fixation of extremity fractures was done in 22 other patients (0.96%). Initial trauma team evaluation of hemodynamically stable blunt trauma victims whose only reason for trauma center transport is mechanism of injury is needlessly labor intensive and is not cost effective. Rather, a competent trauma center emergency medicine physician should be able to safely perform an initial assessment of such patients and summon the surgery team for specific clinical or radiologic indicators.
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"Burn-like" propane thermal injury is produced by evaporative heat loss causing damage to vital structures. Acute appearance is that of heat burn with progressive vascular compromise. Histopathologic study demonstrates epidermal and dermal necrosis followed by vascular thrombosis. Physicians should be aware of this injury and its consequence in light of the widespread use of pressurized propane storage.