Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · May 2004
Review Comparative StudyFluid 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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The Alfred P. Murrah Federal Building in Oklahoma City was partially destroyed by a terrorist bomb on April 19, 1995. Injuries were sustained by 759 people, 168 of whom died. ⋯ The closer receiving hospitals used emergency department facilities and minor treatment areas. Few survivors were extricated from the bombing site more than 3 hours after the detonation. Mass casualty plans must provide for improved communications, diversion and retriage from facilities nearest the disaster site, and effective coordination of community and hospital resources.
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Clin. Orthop. Relat. Res. · May 2004
Comparative StudyRisk factors for pulmonary emboli after total hip or knee arthroplasty.
Because it is difficult to predict which patients may sustain a pulmonary embolism after total hip or knee arthroplasty, we assessed multiple thrombophilic and hypofibrinolytic parameters to identify risk factors. Twenty-nine patients who survived a known pulmonary embolism after total knee or total hip arthroplasty were matched by age, gender, race, arthritic diagnosis, procedure, and surgery date with 29 patient-controls who had a total hip or knee arthroplasty but who did not have a symptomatic known pulmonary embolism or deep vein thrombosis. Twenty-one serologic measures and five genes associated with thrombophilia, hypofibrinolysis, or both were assessed without knowledge of group assignment. ⋯ Preoperatively, to identify patients at high risk of pulmonary embolism, plasminogen activator inhibitor activity, dilute Russell's viper venom time, prothrombin time, and cholesterol levels were most predictive. Using at least one abnormality of these four measures as a screening test to detect risk of pulmonary embolism, the test is sensitive (100%), and the predictive value of a negative test is high (100%). After additional prospective study, this may allow identification of patients at low risk (the majority of patients) in whom anticoagulation may not be required and a small group of patients at high risk for pulmonary embolism in whom prophylactic anticoagulation should be provided.
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Clin. Orthop. Relat. Res. · May 2004
Review Comparative StudyThe treatment of fractures of the femur in patients with head injuries. 1973.
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Clin. Orthop. Relat. Res. · May 2004
Review Comparative StudyAcute knee dislocations and their complications. 1969.