Eur J Trauma Emerg S
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Eur J Trauma Emerg S · Jun 2007
Changing the Management from Olecranon Screw Traction to Percutaneous Wiring for Displaced Supracondylar Fractures of the Humerus in Children. A Justified Decision?
In this institution, the management of displaced (Gartland III) supracondylar fractures in children was changed from overhead olecranon screw traction to manipulation and percutaneous wiring in 1996. The purpose of this study was to compare the two methods of treatment and observe whether the decision to change management was justified. ⋯ Outcomes achieved from percutaneous wiring of displaced supracondylar fractures are similar to those from olecranon screw traction. The advantage of percutaneous wiring to both patient and provider is the reduced hospital stay. The decision to change management therefore appears to be justified. However, percutaneous wiring is generally a technically more demanding procedure and olecranon screw traction should remain a possible treatment option for the management of this injury.
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Following injuries to the pancreas and duodenum (PDI) patients often present in extremis and undergo immediate laparotomy for hemodynamic instability and peritoneal signs. Nonoperative management (NOM) may be offered in selected patients with lowgrade injuries. Precise mapping of the injury, most commonly by computed tomography, is a prerequisite for NOM because clinical symptomatology can be variable and misleading. ⋯ In these cases, the reported success rates vary from 74 to 95%. There are also a few severe pancreatic injuries that can be managed by stents with adequate reconstitution of the major pancreatic duct integrity and resolution of symptoms and without the need for operative management. Intensive monitoring and follow-up by clinical examination and repeat CT imaging is essential in these patients, as the risk of complications, and particularly a pseudocyst is high.
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Eur J Trauma Emerg S · Jun 2007
Complications after Intramedullary Stabilization of Proximal Femur Fractures: a Retrospective Analysis of 178 Patients.
Secondary dislocation, non-union, re-fracture and implant failure are generally known complications after intramedullary fixation of proximal femur fractures with the PFN(®) (Synthes GmbH, Solothurn, Switzerland). The goal of our study was to assess the impact of patient- and treatment-specific risk factors on these complications. Complex fracture type and poor bone quality were defined as patient-specific risk factors. ⋯ Complication rate in these patients highly depended on treatment-specific risk factors. We conclude that the PFN is a secure implant for the stabilization of simple cases. Stabilization of complex proximal femoral fractures with the PFN, however, has a relevant complication rate and should therefore be considered a challenge.
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Duodenal injuries are uncommon injuries but are associated with significant morbidity and mortality from a delayed diagnosis in the case of blunt trauma and associated major vascular injuries in penetrating trauma. A simplistic approach with primary repair or resection and anastomosis is ideal for the vast majority. Complex procedures such as pyloric exclusion with or without gastrojejunostomy may be indicated for delayed treatment or severe, high-grade combined pancreato-duodenal injuries. A high index of suspicion and a judicious treatment plan based on a careful consideration of all the available options are crucial for optimal outcome.
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Pancreatic fistula is usually a complication of acute and chronic pancreatitis but can also occur postoperatively or after abdominal trauma. Conservative treatment of pancreatic fistula is time-consuming and often fails. Endoscopic treatment has become the preferred first-line treatment in many centres. Surgery is necessary in few cases when endoscopy fails or is not technically possible.