Eur J Trauma Emerg S
-
Eur J Trauma Emerg S · Aug 2013
Management of chronic traumatic arteriovenous fistula of the lower extremities.
Vascular injuries secondary to blunt or penetrating trauma are a significant cause of morbidity and mortality, especially in war-afflicted areas. Due to the violent situations of Pakistan and the unavailability of vascular services in remote areas, we are witnessing an increase in the number of delayed/chronic post-traumatic arteriovenous fistulas (AVFs) of the extremities in our institution. The purpose of this study is to share our experience of post-traumatic AVF and the incidence, presentation, and outcomes of these patients. ⋯ Long-standing traumatic AVF is becoming common in Pakistan. Surgery remains the standard treatment.
-
Implant removal in children is still a standard procedure. Implants may disturb function, and some theoretical long-term risks like growth disturbance, foreign body reaction, chronic infection and corrosion are used as arguments for removal. Implant migration or interference with any other orthopaedic treatment over the later course of life is also a matter of debate. On the other hand, the difficulty in removing single implants as well as possible perioperative complications has induced discussion about the retention of implants in childhood. ⋯ Benefits have to outweigh the risks and complications in the individual case and the procedure should not require a more extensive procedure than insertion. It has to be an individual decision in view of the lack of evidence to support routine removal as well as to refute it.
-
Eur J Trauma Emerg S · Aug 2013
Cause of death and time of death distribution of trauma patients in a Level I trauma centre in the Netherlands.
The classical trimodal distribution of trauma deaths describes three peaks of deaths following trauma: immediate, early and late deaths. The aim of this study was to evaluate whether further maturation of the trauma centre and the improvement of survival have had an effect on the time of death distribution and resulted in a shift in causes of death. ⋯ The temporal distribution of trauma deaths in our hospital changed as maturation of the trauma centre occurred. There is one peak of trauma deaths in the first hour after admission, followed by a rapid decline; no trimodal distribution was observed. Over time, there was a decrease in exsanguinations and an increase of deaths due to CNS injury.