Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Oct 1995
Comparative StudyThe Frank Stinchfield Award. Pulmonary fat embolism in revision hip arthroplasty.
Unilateral cemented hip hemiarthroplasty was done on 16 dogs who subsequently had revision arthroplasty and who were divided into 1 control and 3 experimental groups: The first group had cement extraction using osteotomes; the second, using a high speed burr; the third, an ultrasonic tool. Hemodynamic and transesophageal echocardiographic monitoring were done. Postmortem pulmonary specimens were examined for differences in the quantity of fat emboli. ⋯ In these young dogs, minimal hemodynamic changes and no cardiac dysrhythmias occurred, which in part may be attributed to their good health. These changes may remain subclinical for patients with good cardiorespiratory reserve, or may become life threatening for those with poor reserve. By outlining the mechanisms of fat embolism in revision total hip arthroplasty, it may be possible to decrease future morbidity, especially in patients who frequently have cardiopulmonary disease.
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Polytrauma care in Germany is well organized and follows clear-cut demands: (1) to reduce the therapy-free interval, (2) to ensure qualified and sufficient preclinical treatment, (3) to minimize transportation time, and (4) to immediately transport the patient to an adequate level trauma center. These concepts include wide use of rescue helicopters that are based in 51 stations and cover the entire country. In addition, there is a countrywide system of emergency physician ambulances. ⋯ In addition to stopping mass bleeding, basic concepts include aggressive infusion shock therapy, early machine oxygenation, and instant stabilization of all open, all major pelvic, and all lower limb long bone fractures. These management concepts have decreased the lethality numbers in polytrauma from 40% in 1972 to 18% in 1991. Most polytrauma survivors can be rehabilitated socially to an excellent to acceptable degree.
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Clin. Orthop. Relat. Res. · Sep 1995
Treatment of the polytraumatized patient in the United Kingdom.
Studies of the incidence and management of trauma in the United Kingdom have shown a decline in the numbers of seriously injured patients as a result of tougher government legislation. Great Britain now has fewer fatalities from road accidents than most countries. This has been achieved, however, despite an inadequate trauma system. Current studies suggest that the best British trauma units are gaining results which are equivalent to those of average trauma centers in the United States, and there seems no doubt that greater resources and improved organization are required if these results are to be improved.
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Clin. Orthop. Relat. Res. · Sep 1995
Comparative StudyEmergent treatment of pelvic fractures. Comparison of methods for stabilization.
The emergent care of an unstable pelvic ring disruption in the patient who is hemodynamically unstable includes rapid application of military antishock trousers or an external fixator in an attempt to control bleeding and hemodynamically stabilize the patient. However, use of the military antishock trousers is limited in that it restricts access to the abdomen and lower extremities. The external fixator is limited at many institutions by the need to apply it in the operating room. ⋯ Based on their ability to restore pelvic volume and reduce pubic diastasis and their application time, the 3 devices performed similarly. Complications in applying each device were noted but were of less clinical significance for the external fixator. Surgeon practice on cadavera before clinical use will help ensure safe application of either experimental device in the trauma room.
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Clin. Orthop. Relat. Res. · Sep 1995
A rational approach to pelvic trauma. Resuscitation and early definitive stabilization.
The patient with polytrauma and an unstable pelvic ring injury is a treatment challenge. The orthopaedic surgeon should be involved in the care when the patient is brought into the hospital. ⋯ A team approach using open communication among the various subspecialties allows coordinated care and optimizes outcome. Early, definitive pelvic internal fixation is difficult yet beneficial.