The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Feb 2012
Nonisthmal femoral shaft nonunion as a risk factor for exchange nailing failure.
Although nail exchange with a larger diameter nail after additional reaming is typically considered the gold standard for failed femoral nailing, some reports question the role of exchange nailing. The purpose of this study was to evaluate the risk factors affecting the outcome of exchange nailing for femoral shaft nonunion after initial nailing. ⋯ Although exchange nailing is an excellent choice for aseptic isthmal femoral shaft nonunion occurring after the initial nailing, other treatment options such as augmentative plating should be considered for nonisthmal femoral shaft nonunions.
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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.
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The majority of type I coracoid fractures set out in Ogawa's classification constitute double disruption of the superior shoulder suspensory complex (SSSC) as proposed by Goss, frequently resulting in healing delay and adverse functional consequences.However, there are few reports alluding to strategies or concrete treatment methods of such injuries. The purpose of this report is to introduce our surgical strategy for treating the type I coracoid fracture with concurrent injuries and to describe our treatment method with their outcomes. ⋯ Although the majority of cases with type I coracoid fractures suffered double disruptions of SSSC, satisfactory results have been obtained with surgical treatment focusing on the assured reconstruction of a firm scapuloclavicular union.
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Severe pelvic hemorrhage after low-energy trauma has been described in some reports of single cases only. However, it might not be as rare and unique as generally expected. The aim of this study was therefore to present a case series of 11 patients with severe pelvic hemorrhage after sustaining low-energy trauma and to discuss relevant considerations for the management of these patients. ⋯ Geriatric patients are prone to arterial hemorrhage after low-energy pelvic trauma. They should be admitted as an inpatient for observation with repeated control of the Hb level to diagnose hemorrhage at an early stage. Contrast-enhanced CT scans is the preferred imaging method for the assessment of pelvic hemorrhage, whereas arterial embolization is highly successful in terms of hemostasis.
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J Trauma Acute Care Surg · Feb 2012
CPSI-121 pharmacologically prevents intestinal barrier dysfunction after cutaneous burn through a vagus nerve-dependent mechanism.
We have recently demonstrated the protective effects of electrical stimulation of the vagus nerve in prevention of gut injury after severe burn. Here we evaluate the potential for a pharmacologic agonist of the vagus nerve as an approach to regulate outcomes in preclinical models. We tested a new generation of guanylhydrazone-derived compounds, CPSI-121; a compound that may activate the parasympathetic nervous system through poorly understood mechanisms to determine whether we could prevent intestinal mucosal barrier breakdown. ⋯ Similar to direct electrical VNS, CPSI-121 effectively protects the intestinal mucosal barrier from breakdown after severe burn. We suggest that this could represent a noninvasive therapy to prevent end-organ dysfunction after trauma that would be administered during resuscitation.