Articles from Clinical orthopaedics and related research 2004 May

Clin. Orthop. Relat. Res. · May 2004

Review Comparative Study

Fluid resuscitation and blood replacement in patients with polytrauma.

Hemorrhage is the most common cause of shock in patients with polytrauma, leading to cellular hypoxia and death. A large body of experimental and clinical research has greatly expanded our knowledge of cellular mechanisms and clinical outcomes in resuscitation of patients with hypovolemic shock. However, the fundamental principles of fluid resuscitation have not changed during the past few decades. ⋯ Massive resuscitations, however, are associated with specific complications such as hypothermia, coagulopathy, and abdominal compartment syndrome. Novel blood substitutes, hypertonic saline, and minimally invasive hemodynamic monitoring techniques have the potential of optimizing fluid resuscitation in patients with polytrauma. Additional research using standardized animal models and randomized clinical trials is needed.

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Clin. Orthop. Relat. Res. · May 2004

Review

Initial care of the patient with blunt polytrauma.

The initial care of the patient with blunt polytrauma involves a systematic search for causes of hemodynamic instability. Bleeding most often occurs in the pleural space, peritoneal cavity, and retroperitoneum. Orthopaedic injuries also can contribute to instability after blunt trauma. ⋯ However, optimal care typically involves a coordinated multispeciality approach that sometimes includes concurrent operative procedures. Patients with severe physiologic derangements may require damage control techniques to decrease blood loss and operative time. Understanding the overall care of patients who are injured critically will facilitate the integration of the orthopaedic surgeon into the trauma team.

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Clin. Orthop. Relat. Res. · May 2004

Comparative Study

Effect of postoperative delirium on outcome after hip fracture.

Nine-hundred twenty-one community-dwelling patients 65 years of age or older, who sustained an operatively treated hip fracture from July 1, 1987 to June 30, 1998 were followed up for the development of postoperative delirium. The outcomes examined in the current study were postoperative complication rates, in-hospital mortality, hospital length of stay, hospital discharge status, 1-year mortality rate, place of residence, recovery of ambulatory ability, and activities of daily living 1 year after surgery. Forty-seven (5.1%) patients were diagnosed with postoperative delirium. ⋯ Patients who had postoperative delirium develop had a significantly longer length of hospitalization. They also had significantly higher rates of mortality at 1 year, were less likely to recover their prefracture level of ambulation, and were more likely to show a decline in level of independence in basic activities of daily living at the 1-year followup. There was no difference in the rate of postoperative complications, in-hospital mortality, discharge residence, and recovery of instrumental activities of daily living at 1 year.