J Trauma
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To assess the teaching effectiveness of the Advanced Trauma Life Support (ATLS) Program among senior medical students. ⋯ Using highly reliable trauma OSCE stations we have demonstrated trauma management skills acquisition by senior medical students after the ATLS course.
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Seventy-five patients with 81 femoral shaft fractures were treated with unreamed antegrade intramedullary nailing using a titanium alloy implant (AIM femoral nail, ACE Medical) with static interlocking. There were 73 closed fractures and 8 open fractures. Six patients had bilateral femoral shaft fractures. ⋯ Two patients died of severe head injuries and one patient died of multiple organ failure. The infection rate was 0%, and uneventful consolidation of the fractures was seen in all cases within a mean of 3.8 months. Neither in the case of nails nor in the case of interlocking bolts did an implant failure occur.
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To measure the functional outcome we analyzed 723 consecutive patients with multiple injuries (Abbreviated Injury Scale (AIS)/Injury Severity Score (ISS) > or = 16, mean ISS 30.1) treated at the University Hospital Groningen, the Netherlands, between 1985 and 1989. Age, sex, type of accident, AIS/ISS, discharge destination, length of hospital stay and functional outcome (measured by the Glasgow Outcome Scale) are described. The patients were young (mean age 33.4 years) and 186 died (25.7%) mainly because of severe head injuries. ⋯ These injuries, together with spinal cord injuries, appeared to be responsible for the majority of permanent disabilities. Although the functional outcome deteriorated linearly with increasing AIS/ISS, the final functional result was good: in the first half year after injury there was considerable recovery; after that there was further slight recuperation. Two years after injury, 68% had mild or no disabilities, 19% were moderately disabled, and 7% severely disabled.
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Risk factors for thoracolumbar fracture (TLF) and occurrence of back pain/tenderness detection (BPTD) in TLF patients have not been fully evaluated. Of 4142 blunt trauma patients directly admitted to a level I trauma center, 183 (4.4%) had a TLF. Risk factors for TLF (p < or = 0.05) were major non-TLF injuries (Abbreviated Injury Scale score > or = 3) and a fall mechanism of injury. ⋯ In patients with GCS scores of 13 to 15, decreased BPTD is simultaneously related to both cognitive dysfunction and major injuries (p = 0.005). In conclusion, major injuries and falls are risks for TLF and cognitive deficit and major injury impedes BPTD in TLF. Thoracolumbar x-ray films should be carefully considered in patients with altered mentation or major injury.
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Typical bilateral cheiro-oral syndrome was encountered in a 74-year-old man who had bilateral subdural hematoma after a minor head injury. The delayed grave neurologic deficits occurred 1 month later without expansion of the hematoma. Removal of the lesions reversed both cheiro-oral syndrome and his late-onset neurological disabilities.