Injury
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The biomechanical properties of extra-articular fractures of the distal humerus have not been researched sufficiently. The aim of the study was to examine three different models of osteosynthesis for extra-articular distal humerus fractures. Osteosynthesis with two parallel or perpendicular plates is a common method of osteosynthesis for those fractures. We wanted to examine the biomechanical performance of a newly designed Y plate, and compare it to the previously used osteosynthesis methods. ⋯ The displacements that appeared in all three plating systems are minimal and within the limits that meet the requirements of sufficient biomechanical stability in the usual time for the healing of fractures in that region. The newly designed Y-shaped plate for extra-articular fractures of the distal humerus is a possible alternative to the usual method of osteosynthesis with two plates in the case of an extra-articular fracture of the distal humerus. Further biomechanical studies are needed for a decisive conclusion.
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Case Reports
First successful complete replantation of a traumatic hemipelvectomy: follow-up after 30 months.
Traumatic hemipelvectomy is a severe, however rare injury associated with high lethality. Up to now, immediate surgical completion of the amputation has been recommended as a lifesaving therapy. We present a case of near complete hemipelvectomy with open fracture of the ileosacral joint, wide open symphysis and severe soft tissue trauma including a decollement around the pelvis. ⋯ In the further hospital course, numerous revisions of the soft tissue injury and reconstructive surgery were needed. Thirty months later, the patient's condition is physically and psychologically stable and he is able to walk using crutches. The key point of successful management was skilled emergency damage control surgery followed by dedicated surgical care to avoid septic complications.
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Retained haemothorax (RH) is a problematic sequela of thoracic trauma, reported in up to 20% of patients following chest injury. RH is associated with a higher severity of thoracic trauma and may portend the onset of other serious post-traumatic complications, including pneumonia. The development of pneumonia has previously been reported to be as high as 19.5% in the setting of traumatic RH. The purpose of this study was to identify risk factors for the development of pneumonia as a complication in RH. ⋯ To our knowledge, our current study is the largest attempt to identify the independent predictors for pneumonia in this population. Our data show that elevated ISS, blunt thoracic trauma, and failure to administer peri-procedural antibiotics on tube thoracostomy placement are the statistically significant independent risk factors.
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Lung injury is one of the complications of cardiopulmonary resuscitation (CPR). This is the first study to describe the MDCT and radiographic findings of lung injuries secondary to CPR. ⋯ Lung injuries are frequent complications in patients who underwent CPR. Compared with radiography, MDCT has benefits for the detection and characterisation of CPR-associated lung injuries. The most common findings of lung injuries after CPR were bilateral ground glass opacity and consolidation, usually in the dependent area of both lungs.
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Injury sustained in rural areas has been shown to carry higher mortality rates than trauma in urban settings. This disparity is partially attributed to increased distance from definitive care and underscores the importance of proper primary trauma management prior to transfer to a trauma facility. The purpose of this study was to assess Advanced Trauma Life Support (ATLS) guideline adherence in the management of adult trauma patients transferred from rural hospitals to a level I facility. ⋯ Key aspects of ATLS resuscitation guidelines are frequently missed during transfer of trauma patients from the periphery to level I trauma centres. Comprehensive quality improvement initiatives, including targeted education, telemedicine and trauma team training programmes could improve quality of care.