European journal of trauma and emergency surgery : official publication of the European Trauma Society
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Eur J Trauma Emerg Surg · Dec 2016
ReviewEmergency resuscitative thoracotomy performed in European civilian trauma patients with blunt or penetrating injuries: a systematic review.
Emergency resuscitative thoracotomy (ERT) is a lifesaving procedure in selected patients. Indications are still being debated, but outcome in blunt trauma is believed to be poor. Recent reports from European populations, where blunt trauma predominates, have suggested favorable outcome also in blunt trauma. Our aim was to identify all European studies reported over the last decade and compare reported outcomes to existing knowledge. ⋯ The reported outcome after ERT in European civilian trauma populations is favorable, with one in every four ERTs in the ED surviving. Notably, outcome is at variance with previously reported collective data, in particular for blunt trauma. Multicenter, prospective, observational data are needed to validate the modern role of ERT in blunt trauma.
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Eur J Trauma Emerg Surg · Dec 2016
It is the lateral head tilt, not head rotation, causing an asymmetry of the odontoid-lateral mass interspace.
Asymmetry in odontoid-lateral mass interspace in trauma patients is a common finding that regularly leads to additional diagnostic work-up, since its dignity is not entirely clear. There is little evidence in the literature that atlantoaxial asymmetry is associated with C1-C2 instability or (sub) luxation. Asymmetry in odontoid-lateral mass interspace seems to occur occasionally in healthy individuals and patients suffering a cervical spine injury. Congenital abnormalities in odontoid-lateral mass asymmetry may mimic an atlantoaxial asymmetry. The center of C1-C2 rotation is based in the peg of dens axis; therefore, a C1-C2 rotational influence seems unlikely. So far, no study examined the influence of C0-C1-C2 tilt to an asymmetry in odontoid-lateral mass interspace. ⋯ We conclude that an atlantoaxial asymmetry revealed in CT scans of the cervical spine occurs occasionally. Since head tilt correlates with an atlantoaxial asymmetry, it is crucial to perform cervical spine CT scans in a precise straight head position.
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Eur J Trauma Emerg Surg · Dec 2016
ReviewIndications and anatomic landmarks for the application of lower extremity traction: a review.
Fractures of the lower extremity, particularly of the femur and acetabulum, may be difficult to immobilize with splinting alone. These injuries may be best stabilized with the application of various types of skeletal traction. Often, traction is applied percutaneously in an emergent setting, making the knowledge of both superficial and deep anatomy crucial to successful placement. ⋯ By palpating and marking superficial landmarks and observing specific anatomic relationships, safe application of traction pins can be performed while minimizing iatrogenic injury to vital anatomic structures, and avoiding intra-articular placement which could potentially lead to joint infection.
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Eur J Trauma Emerg Surg · Dec 2016
Femoral shaft fractures in young children (<5 years of age): operative and non-operative treatments in clinical practice.
Femoral shaft fractures comprise around 4 % of all long-bone fractures in childhood. There is controversy about the treatment of fractures in children below 5 years, between those preferring non-operative methods, such as casting or traction, and those supporting elastic stable intramedullary nailing (ESIN). ⋯ Spica casting of femoral shaft fractures or, in some cases, traction is still the preferred treatment in the first and second years of life. In the third year, children are treated operatively as well as non-operatively, although now there is no current evidence of better short-term outcomes in operatively treated children. But elastic stable intramedullary nailing is the standard treatment for femoral shaft fractures in children older than 3 years of age.
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Eur J Trauma Emerg Surg · Dec 2016
Management of haemodynamically stable patients with penetrating abdominal stab injuries: review of practice at an Australian major trauma centre.
The management of haemodynamically stable patients who present following a penetrating abdominal injury (PAI) remains variable between mandatory surgical exploration and more selective non-operative approaches. The primary aim of this study was to assess compliance with an algorithm guiding selective non-operative management of haemodynamically stable patients with PAI. The secondary aim was to examine the association between compliance and unnecessary laparotomies. ⋯ Among haemodynamically stable patients presenting with PAI, compliance with an algorithm guiding selective non-operative management was low, but associated with lower laparotomy and lower unnecessary laparotomy rates. Improved compliance with algorithms directed towards selective non-operative management of PAI should be encouraged with stringent vigilance towards patient safety.