European journal of trauma and emergency surgery : official publication of the European Trauma Society
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Eur J Trauma Emerg Surg · Jun 2015
ReviewThe pathophysiology, diagnosis and treatment of the acute coagulopathy of trauma and shock: a literature review.
The acute coagulopathy of trauma and shock is associated with significant mortality and, currently, there are no validated laboratory tests which allow for a rapid recognition and treatment of this condition. Therefore, early detection of any clot abnormality in trauma could improve the diagnosis of trauma-associated coagulopathy and subsequent interventions. ⋯ There is enough evidence to demonstrate that we urgently need a robust test, which would determine and quantify both the rate and the extent of coagulation abnormalities. This could help to tailor the treatment of coagulopathy according to the patient's needs.
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Nonoperative management has become the surgical treatment of choice in the hemodynamically stable patient with blunt hepatic trauma. The increased use and success of nonoperative management have been facilitated by the development of increasingly higher resolution computed tomography imaging, improved management of physiology and resuscitation (damage control), and routine availability of interventional procedures such as angiography and embolization, image-guided percutaneous drainage, and endoscopy. ⋯ A systematic and logical approach to the control of hemorrhage is required in the operating room. Thorough knowledge of the anatomy and surgical techniques, such as perihepatic packing, effective Pringle maneuver, hepatic mobilization, infrahepatic and suprahepatic control of the IVC, and stapled hepatectomy, is essential.
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The diagnosis, workup and management of blunt renal injury have evolved greatly over the past decades. Evaluation and management of blunt renal injury echoes the increasing success of nonoperative management in other blunt abdominal solid organ injury, such as liver and spleen. ⋯ Emerging techniques in highly sensitive imaging as well as interventional angiography have allowed safe nonoperative management in the appropriate patient. This review will focus on the contemporary workup and management of blunt renal injury while focusing on some of the emerging literatures in regard to refined imaging and grading of injuries as well as techniques to increase the success of nonoperative management.
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Eur J Trauma Emerg Surg · Jun 2015
Biomechanical properties of different external fixator frame configurations.
External fixators are easy to apply and maximize soft tissue preservation. However, frames need providing an adequate stiffness in order to avoid excessive interfragmentary movement during the healing period. We characterized the stiffness of four different configurations of the newly developed Hoffmann 3 external fixation system. ⋯ The diameter and the amount of used connecting rods as well as the adequate placement of these rods towards the main loading directions determine the construct stiffness. These results could help the surgeons estimating how different frames can potentially affect the interfragmentary motion. This information might help in choosing specific configuration when treating different fracture types on given patients.