European journal of trauma and emergency surgery : official publication of the European Trauma Society
-
Eur J Trauma Emerg Surg · Oct 2022
ReviewPenetrating colon trauma - outcomes related to single versus multiple colonic suture injuries.
There is no conclusive evidence to guide surgical management in the presence of multiple colonic injuries as opposed to a single colonic injury, and whether multiple colonic suture lines are associated with worse outcomes than single suture lines. ⋯ It appears that there is no appreciable difference in outcome between patients with a single colonic suture line compared to patients with more than one suture line following trauma laparotomy. In light of this, each injury should be treated on its own merit, in the context of the patient's overall physiological condition, without undue fear of leaving the patient with more than one colonic suture line. However, judicious use of diversion remains advisable.
-
Eur J Trauma Emerg Surg · Oct 2022
ReviewContrast study after gastric repair: a review of incidence, outcomes and risk factors at an adult level 1 trauma center.
The role of contrast study after traumatic gastric repair, continues to be controversial. To that end, we aim to review the incidence, outcomes, and risk factors of patients undergoing contrast study after traumatic gastric repair. ⋯ Gastric leak after repair is rare and there is no statistically significant difference in clinical outcomes when comparing patients who underwent contrast study to those who did not. Routine contrast study after traumatic gastric repair may not be necessary and further evidence is warranted to determine the risk factors for a selective contrast study.
-
Physical examination, laboratory tests, ultrasound, conventional radiography, multislice computed tomography (MSCT), and diagnostic laparoscopy are used for diagnosing blunt abdominal trauma. In this article, we investigate and evaluate the usefulness and limitations of various diagnostic modalities on the basis of a comprehensive review of the literature. ⋯ MSCT is the gold standard diagnostic modality for blunt abdominal trauma because of its high sensitivity and specificity in detecting relevant intra-abdominal injuries. In many cases, however, clinical, laboratory and imaging findings must be interpreted jointly for an adequate evaluation of a patient's injuries and for treatment planning since these data supplement and complement one another. Patients with blunt abdominal trauma should be admitted for clinical observation over a minimum period of 24 h since there is no investigation that can reliably rule out intra-abdominal injuries.
-
Eur J Trauma Emerg Surg · Oct 2022
ReviewBallistic peripheral nerve injuries: basic concepts, controversies, and proposal for a management strategy.
Ballistic injuries to peripheral nerves are devastating injuries frequently encountered in modern conflicts and civilian trauma centers. Such injuries often produce lifelong morbidity, mainly in the form of function loss and chronic pain. However, their surgical management still poses significant challenges concerning indication, timing, and type of repair, particularly when they are part of high-energy multi-tissue injuries. ⋯ Conversely, large defects require conventional nerve grafting, and proximal injuries may require nerve transfers, especially at the brachial plexus level. Additionally, combined or early secondary tendon transfers are helpful in certain injuries. Finally, ideal timing for nerve repair is proposed, based on the defect length, associated injuries, and risk of infection, which correlate intimately to the projectile velocity.
-
Eur J Trauma Emerg Surg · Oct 2022
ReviewBiomechanical analysis of fixation methods in acetabular fractures: a systematic review of test setups.
Optimal anatomical reduction and stable fixation of acetabular fractures are important in avoiding secondary dislocation and osteoarthritis. Biomechanical studies of treatment options of acetabular fractures aim to evaluate the biomechanical properties of different fixation methods. As the setup of the biomechanical test can influence the experimental results, this review aimed to analyze the characteristics, comparability and clinical implications of studies on biomechanical test setups and finite element analyses in the fixation of acetabular fractures. ⋯ The limited comparability and restricted clinical implications should be kept in mind when interpreting the results of biomechanical studies and when designing test setups to evaluate fixation methods for acetabular fractures.