The journal of trauma and acute care surgery
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Plasma gelsolin depletion has been associated with poor outcome of critically ill patients. However, there is a paucity of data available on circulating plasma gelsolin concentration in traumatic brain injury (TBI). Thus, we sought to investigate change in plasma gelsolin level after TBI and to evaluate its relation with disease outcome. ⋯ Decreased plasma gelsolin level is associated with GCS scores and an independent prognostic marker of mortality after TBI. Reversing plasma gelsolin deficiency may be an effective treatment for TBI.
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J Trauma Acute Care Surg · Feb 2012
Impact of secondary transfer on patients with severe traumatic brain injury.
Within a trauma network in the Netherlands, neurosurgical facilities are usually limited to Level I hospitals. Initial transport to a district hospital of patients who are later found to require neurosurgical intervention may cause delay. The purpose of this study was to assess the influence on outcome and time intervals of secondary transfer in trauma patients requiring emergency neurosurgical intervention. ⋯ Patients requiring an emergency neurosurgical intervention appear to have a clinically relevant worse outcome after secondary transfer to a neurosurgical service. Therefore, patient care can probably be improved by better triage on-scene and standardized procedures in case of a secondary transfer.
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Traumatic hematomas in the posterior fossa are rare, especially traumatic posterior fossa subdural hematomas (SDHs), which account for <1% of head injured patients. The aim of this study was to investigate the features of traumatic posterior fossa SDHs. ⋯ IV.
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J Trauma Acute Care Surg · Feb 2012
Potential of polymethylmethacrylate cement-augmented helical proximal femoral nail antirotation blades to improve implant stability--a biomechanical investigation in human cadaveric femoral heads.
Cement augmentation may improve fixation stability and reduce cut-out rate in the treatment of intertrochanteric hip fractures. The aim of this study was to compare the number of cycles to failure of polymethylmethacrylate (PMMA)-augmented helical blades with nonaugmented ones in human cadaveric femoral heads. ⋯ Implant augmentation with small amounts of PMMA enhances the cut-out resistance in proximal femoral fractures. Especially in osteoporotic bone, the procedure may improve patient care.
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J Trauma Acute Care Surg · Feb 2012
Osteosynthesis of symptomatic nonunions of type II fractures of the distal clavicle using modified locking T-plate and bone grafting.
Type II distal clavicle fractures are generally unstable and hence prone to nonunion because of their specific biomechanical configuration. Nonunion of type II distal clavicle fractures sometimes poses a difficult problem causing pain and functional impairment of the shoulder girdle and upper limb. Therefore, operative treatment should be performed for symptomatic nonunions. However, there is very little information in the literature on nonunions of type II distal clavicle fractures to date. ⋯ Osteosynthesis using modified oblique locking T-plate and autogenous iliac bone graft results in good to excellent outcomes with the functional improvement for symptomatic nonunions of type II fractures of the distal clavicle. Our method may be primarily considered an useful alternative for symptomatic nonunions of type II distal clavicle fractures, and bone grafting should be considered in all cases.