Eur J Trauma Emerg S
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Eur J Trauma Emerg S · Feb 2008
Early Results of Scapular Fractures Treated Operatively at a Level One Trauma Center.
Certain scapular fractures are best treated with open reduction to restore form and function to the glenohumeral joint. The purpose of this study was to review the results of operative treatment of scapular fractures at a level one trauma center. ⋯ Open reduction and internal fixation is associated with anatomic reduction, a low complication rate, and satisfactory functional results at short-term follow-up.
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The need for surgical decompression for abdominal compartment syndrome is becoming more frequent in patients with severe acute pancreatitis, especially in association with massive fluid resuscitation at the early stages of the disease. Decompression can be achieved with either a full-thickness laparostomy that can be performed through a vertical midline or transverse subcostal incision, or by performing a subcutaneous linea alba fasciotomy. Following a fullthickness laparostomy the open abdomen can be best managed with some form of negative abdominal pressure dressing. ⋯ After a maturation period of 9-12 months definitive repair of the abdominal wall defect is performed utilizing the components separation technique, mesh repair, or a pedicular or microvascular tensor facia lata flap. Knowledge of the available decompression and reconstruction options is essential for individualized management of patients with severe acute pancreatitis and abdominal compartment syndrome. More research and comparative studies are needed to determine the most successful methods to be used.
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Eur J Trauma Emerg S · Feb 2008
Bilateral Avulsion Fractures of the Tibial Tuberosity: A Double Case for Open Reduction and Fixation.
Tibial tuberosity fractures are rare and occur mainly in adolescent males during vigorous quadriceps contraction. So far, only ten simultaneous bilateral fractures have been reported. We report the case of a 16-year-old male who avulsed both tibial tuberosities when he landed on his feet after a gymnastics routine. ⋯ He underwent bilateral open reduction and screw fixation with a good functional result after 3 months. While closed reduction and percutaneous fixation has been proposed by some, the intraoperative findings in our patient would have prevented correct adaptation of the fragments because of a flap of periosteum impinged in both fracture gaps. This case emphasizes that minimally invasive techniques may sometimes be inappropriate in the management of these types of fractures.
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Eur J Trauma Emerg S · Feb 2008
Late Recognized Vascular Injury after High-energy Fracture of the Proximal Tibia: a Pitfall to Know in Current Practice.
Failure to recognize associated soft-tissue injuries after high-energy proximal tibia fractures is not uncommon. Despite the progress in managing these complex injuries, a prompt diagnosis of associated arterial injuries still remains difficult. ⋯ Treatment protocols have been developed to reduce the previously reported high rates of amputation and permit an optimal management of soft-tissue and an acceptable functional outcome. We report here a well-documented case of a severely displaced proximal tibia fracture that illustrates the problem of diagnosing and managing the associated vascular injuries.
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Eur J Trauma Emerg S · Feb 2008
K-wire Arthrodesis and Coracoclavicular Augmentation of Complete Acromioclavicular Separations: Functional and Subjective Results.
In recent years, there has been a trend from operative to conservative management of complete acromioclavicular separations. Despite this, surgical treatment is still recommended to manual workers and athletes, who account for a large part of the patients. The objective of this study was to evaluate the functional outcome of type III separations according to Tossy managed by temporary arthrodesis of the acromioclavicular joint combined with coracoclavicular augmentation. Special attention was paid to sport exercising patients. ⋯ Surgical treatment of complete acromioclavicular separations by temporary arthrodesis with two k-wires and coracoclavicualar PDS-augmentation results in good to excellent function. It is associated with a low complication rate and a high patient contentedness. Particularly for athletes in non-contact sports this surgical technique can still be recommended.