Canadian journal of surgery. Journal canadien de chirurgie
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Reconstruction of long-bone fractures with compression plates may give rise to stress shielding under the metal plate, which may be associated with late clinical problems due to insufficiency fractures around the implants. Therefore, it is common practice to remove forearm plates after fracture healing is completed. ⋯ A retrospective review of the management of 111 forearm diaphyseal fractures at a major Canadian centre confirmed a substantial complication rate in elective forearm-plate removal. Because the true incidence of late insufficiency fracture is not well defined, elective forearm-plate removal may be contraindicated in the asymptomatic patient.
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Review Case Reports
[Traumatic tricuspid insufficiency with a right-to-left shunt and heart luxation].
Traumatic tricuspid insufficiency (TTI) with a right-to-left shunt through a patent foramen ovale associated with a cardiac herniation was identified in a 39-year-old man with severe hypoxemia. All reported cases of TTI with a right-to-left shunt are reviewed, the technical aspects of repair described and the physiologic mechanisms discussed.
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Aortobifemoral bypass (ABF) has been available as a method for treating patients with aortoiliac occlusive or aneurysmal disease for 40 years. ABF has been successful in alleviating the symptoms of claudication and critical ischemia. The long-term patency rates have been excellent with low operative morbidity and mortality. ⋯ With careful follow-up the natural history of a patient who undergoes ABF is known. Predicting outcome is now possible and a cost:benefit analysis can be made. ABF has proved to be a successful and enduring procedure.
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Small-volume resuscitation with hypertonic saline is an attractive modality but is still at an early stage of experimental and clinical investigation. Aggressive resuscitation from traumatic, hypovolemic shock could be facilitated during the prehospital phase, but hypotension remains a physiological and beneficial compensatory mechanism to minimize active bleeding until definitive care is provided. Despite encouraging results, the author concludes that, at present, hypertonic saline cannot be considered a truly "magic potion" for resuscitation of the trauma patient.
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Emergency airway management in the patient with blunt trauma is a clinical dilemma. Many of these patients require immediate airway management, but each method carries its own set of risks and benefits. ⋯ In this article, the issues surrounding selection of an appropriate technique for airway management are reviewed critically. Recommendations are made for management of the airway in this high-risk group of patients with injury to the cervical spine.