Injury
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Duodenopancreatic trauma is rare and presents high morbidity and mortality rates. Pancreaticoduodenectomy (PD) is the only possible treatment indicated for the most complex injuries (grades IV and V). Although, it is commonly a one-stage procedure, damage control surgery corroborates with a two-stage PD performed on unstable trauma victims. ⋯ There were no differences in mortality rates when comparing two and one-stage PD in hemodynamic unstable patients, who had duodenopancreatic lesions (grades IV or V).
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The aim of this article is to discuss the diagnosis, management and pitfalls of bony injuries around the skeletally immature knee. Each within their own right is a relatively uncommon injury but associated with potential complications. Distal femoral physeal fractures can result in growth arrest and vascular injury. ⋯ Fixation can be complicated by growth arrest and subsequent recurvatum deformity. Finally, patella sleeve injuries are often missed and this can also threaten the extensor mechanism. We discuss the approach to clinical and radiological assessment of these injuries, and evidence based recommendations as to how they are best managed to avoid complications.
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Review Historical Article
Tudor military surgery and the management of Sir Martin Frobisher's gunshot wound: Comparison with current treatment.
Sir Martin Frobisher (ca 1535-1594), the famous Elizabethan explorer and privateer, sustained a bullet to the outer plate of his ilium from a low-velocity bullet wound fired at close range from an arquebus, an early form of musket. The bullet was removed, but he subsequently died from gas gangrene. This paper looks at the management of this injury in Tudor times and compares it to current practice. ⋯ Guidelines on managing gunshot wounds, and most research, is focussed on high-velocity injuries where removal of foreign material (clothing) is mentioned. Low-velocity injuries are treated as "outpatients" and the importance of removing foreign material, especially when the bullet is left in situ, is not mentioned. The inexperienced surgeon of today risks making the same error as Frobisher's surgeon.
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Scapular neck and body fractures are typically treated nonoperatively, with operative treatment traditionally focused on intraarticular fractures or double disruptions of the shoulder suspensory complex. The objective of this study was to systematically examine and compile the existing literature in regard to operative and conservative treatment of extraarticular fractures of the scapula. ⋯ Patients with extraarticular fractures of the scapula have excellent outcomes following either nonoperative or operative management. There is a need for high quality comparative studies to determine the optimal treatment strategy for these injuries.