Instructional course lectures
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Pelvic ring disruption is part of a complex wounding pattern that challenges our ability to diagnose and manage hemorrhage. The conventional methods of diagnosis and control of abdominopelvic bleeding--peritoneal lavage and exploratory laparotomy--should be replaced by exploratory abdominopelvic angiography and transcatheter embolization. Angiography should be performed as soon as possible after the patient is admitted to the emergency room, and shock should not delay transfer of the patient to the angiography suite.
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During a seven-year prospective study, 158 humeral shaft fractures in 157 patients were treated with closed intramedullary nailing. Only humeral fractures not responsive to closed reduction and immobilization and those in noncomplaint patients were eligible. No immobilization was used postoperatively. ⋯ The remaining three had been severed by missiles and needed further attention. Nail withdrawal occurred in eight patients; five of these needed nail revision. Final range of motion for the elbow averaged 132 degrees and shoulder abduction-external rotation averaged 168 degrees.