European journal of trauma and emergency surgery : official publication of the European Trauma Society
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Eur J Trauma Emerg Surg · Dec 2021
Multicenter StudyAugmentation plating leaving the nail in situ is an excellent option for treating femoral shaft nonunion after IM nailing: a multicentre study.
In recent years, plate augmentation over a retained intramedullary (IM) nail has been shown to be an effective option for managing femur fracture nonunions because it improves the biomechanical environment of the fracture site without causing additional biological damage. In the current study, we present outcome data from 22 consecutive patients treated with plate augmentation for femoral shaft nonunion leaving the nail in situ. ⋯ Augmentation plating leaving the nail in situ is an excellent option for treating femoral shaft nonunion after IM nailing, with a high union rate and few complications. We believe the technique should gradually replace exchange nailing as the standard of care for the majority of femoral shaft nonunions that occur after IM nailing.
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Eur J Trauma Emerg Surg · Dec 2021
ReviewValue of repeat CT for nonoperative management of patients with blunt liver and spleen injury: a systematic review.
To evaluate the effectiveness of routine repeat computed tomography (CT) for nonoperative management (NOM) of adults with blunt liver and/or spleen injury. ⋯ Systematic reviews and meta-analyses, Level II.
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Eur J Trauma Emerg Surg · Dec 2021
Different classifications concerning fractures of the lateral humeral condyle in children.
Fractures of the lateral condyle are the second most frequent elbow fractures in children. Although the pathobiomechanism is well known and different fracture classifications exist, there are still adverse clinical results. This raises the questions how precise classifications predict fracture stability, especially in the context of choosing the best therapy. It also remains unclear how these classifications can be applied in practice. ⋯ Classifying fractures according to the Jakob-Classification has limitations if notable rotation without lateral displacement occurs. Hasler/v. Laer's classification appears most adequate but can sometimes not be applied due to missing X-ray 4 days after trauma. The Finnbogason- and Song-Classification performs best in prediction of instability based on the X-ray at the time of accident because of considering the fracture pathobiomechanism. All in all, we recommend the classification of Hasler and v. Laer, because it is the best predictive classification.
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Eur J Trauma Emerg Surg · Dec 2021
Multicenter StudyNailing the fibula: alternative or standard treatment for lateral malleolar fracture fixation? A broken paradigm.
Despite the fact that open reduction and internal fixation with a plate, either non-locked or locked, is the standard of care for managing lateral malleolus fractures, intramedullary (IM) fixation of the fibula has been recently introduced as an alternative, mainly for some potential complicated situations. We hypothesized that almost all patterns of distal fibula fracture can be safely fixed with an IM device, with the potential benefit of providing biomechanical efficiency, but using a soft-tissue friendly implant. Here, we present a multicenter case series based on a proposed algorithm. ⋯ In this multicenter case series, intramedullary fixation for the lateral malleolus fracture presented itself as a viable and safe option for the treatment of almost all patterns of fibula fracture in adults. Overall, we were able to demonstrate the potential indications of the proposed algorithm for the choice of IM implant for the lateral malleolus fracture in terms of the Lauge-Hansen staged classification.
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There is no evidence supporting intubation for a Glasgow Coma Scale (GCS) of 8. We investigated the effect of intubation in trauma patients with a GCS 6-8, with the hypothesis that intubation would increase mortality and length of stay. ⋯ Among patients with GCS of 6 to 8, intubation on arrival was associated with an increase in mortality and with longer ICU and overall length of stay. The use of a strict threshold GCS to mandate intubation should be revisited.