Journal of orthopaedic trauma
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Multicenter Study
Preinjury status: are orthopaedic trauma patients different than the general population?
To describe the preinjury health-related quality of life (HRQL) of orthopaedic trauma patients admitted to Level I trauma centers relative to the general population. ⋯ Establishing the preinjury HRQL of trauma patients is important for evaluating the quality of orthopaedic trauma patient outcomes. Reliance on population norms for this purpose may lead to an underestimation of the impact of injury in particular age and sex subgroups, but given the size of the differences seen, any underestimation would be small. Where individual preinjury data cannot be collected, population norms could be used as a reasonable estimate of preinjury patient status for assessing quality of recovery.
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Extremity wounds and fractures traditionally comprise the majority of traumatic injuries in US armed conflicts. Little has been published regarding the extremity wounding patterns and fracture distribution in the current conflicts in Iraq and Afghanistan. The intent of this study was to describe the distribution of extremity fractures during this current conflict. ⋯ The burden of wounds sustained in OIF/OEF is extremity injuries, specifically soft-tissue wounds and fractures. These results are similar to the reported casualties from previous wars.
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Case Reports
Extended (16-hour) tourniquet application after combat wounds: a case report and review of the current literature.
We present a case of emergency tourniquet use of unusually long duration. The patient was wounded during combat operations, and the subsequent battle and evacuation caused a significant delay in surgical treatment of his wounds. Emergency tourniquets can be lifesaving, but are not benign interventions. ⋯ We conducted a search of the published literature including the Medline database, and present a review of the relevant articles concerning emergency tourniquet use, tourniquet injury, and mitigating treatments. Given the widespread use of tourniquets in ongoing military operations, it seems likely that tourniquets will transition to civilian use. Thus it is important for physicians to understand tourniquet injury and appreciate that even extended tourniquet application times does not necessarily doom the affected limb.
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External fixation for pelvic stabilization is an important component of the overall treatment of patients with high-energy pelvic fractures. Traditional constructs include single and multiple pin placements in several locations in each iliac crest. ⋯ Pins in this location are more stable biomechanically, allow for pelvic reduction in the transverse plane of deformity, facilitate concurrent or subsequent laparotomy procedures, and may allow improved reduction of the posterior elements with a femoral distractor as a compressor. We describe the technique for placement of supraacetabular external fixation pins, pelvic reduction, and compression using a femoral distractor.