European journal of trauma and emergency surgery : official publication of the European Trauma Society
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Eur J Trauma Emerg Surg · Dec 2024
Pseudoaneurysms of lower limb of orthopaedic traumatological origin: a literature review and our experience of 18 cases.
Arterial pseudoaneurysm is a rare yet potentially life-threatening complication that can arise as a late sequelae of penetrating injuries or orthopaedic procedures. We aim at sharing our institutional experience of managing 18 cases of lower limb arterial pseudoaneurysms in orthopaedic practice and to provide technical tips for emergency management of severe bleeding. A comprehensive literature review resulting from fractures and orthopaedic surgeries is also presented. ⋯ Iatrogenic arterial injuries contributed to more than 60% of the cases as per the literature review. The most frequent mechanisms related to instrumentation were the placement of the third and fourth screws of the DHS plate, and the distal screw of a short nail in treating pertrochanteric fractures. This can be avoided by external rotation and abduction of the limb during distal screw insertion. A high index of clinical suspicion is needed especially when bleeding from the hardware site is noted. A swelling in the previously operated site should raise a suspicion of pseudoaneurysm and incision and drainage must be avoided without further imaging (Duplex USG or CT angiography). This study highlights the importance of cautious surgical techniques to minimize the occurrence of vascular injuries during orthopaedic surgeries.
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Eur J Trauma Emerg Surg · Dec 2024
ReviewAssault rifle injuries in civilians: ballistics of wound patterns, assessment and initial management.
Wounds from assault rifles and their commercial offspring have been encountered with increasing frequency in civilian practice. Our aim is to summarize wound ballistics related to the main injury patterns that can also affect management strategies. ⋯ Wound ballistics provides a system for evaluation of injuries from assault rifles and risk analysis of shooting incidents. Lessons learned from armed conflicts can improve the management of victims, with due consideration given to characteristics of civilian injuries. Further research is required to define the impact on survival by key life-saving procedures in the prehospital setting, in order to prioritize these interventions.
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Eur J Trauma Emerg Surg · Nov 2024
ReviewInitial surgical management of injuries to the lower extremities in patients with multiple and/or severe injuries - A systematic review and clinical practice guideline update.
Our aim was to develop new evidence-based and consensus-based recommendations for the initial inhospital management of lower-extremity injuries in patients with multiple and/or severe trauma. This guideline topic is part of the 2022 update of the German Guideline on the Treatment of Patients with multiple and/or severe Injuries. ⋯ This systematic literature review and subsequent expert consensus process resulted in the following new key recommendations. It is recommended that isolated and multiple lower-extremity fractures are managed with primary definitive fixation in patients whose condition is stable. Patients condition is not considered stable should be managed with primary temporary fixation. In addition, it is recommended that dislocations of the lower extremities are reduced and immobilised as early as possible.