J Trauma
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Posttraumatic pseudoaneurysms of the hepatic artery are rare and usually occur as a complication of open abdominal trauma. Even less common is the coexisting presence of enteric fistulization. We report a patient with upper gastrointestinal hemorrhage occurring 3 years after blunt abdominal trauma resulting from a pseudoaneurysm of the proper hepatic artery with duodenal fistulization. The patient was treated successfully by ligation of the proper hepatic artery and closure of the duodenal opening.
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A motor vehicle passenger sustained an acute traumatic lumbar hernia caused by an improperly positioned seat belt. Diagnosis was confirmed on computed tomographic scan, and the defect repaired primarily.
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The goal of this study was to describe the epidemiology, clinical presentation, diagnostic methods, and outcome in a large series of children with blunt cardiac injury (BCI). ⋯ Pediatric BCI is usually diagnosed in the context of severe multiple system trauma and is less commonly an isolated event. Because of the lack of a standard, various diagnostic tests are used in the diagnosis of BCI, and these tests rarely agree. In hospitalized pediatric patients with BCI, unanticipated complications are rare. Significant sequela, although uncommon, do occur and follow-up of children with BCI should be ensured.
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Twenty-seven patients with complex femoral fractures (combined shaft and proximal femoral fractures) were treated with a modified Grosse-Kempf slotted locking nail (cephalomedullary nail), wherein two screws were inserted in the hip. Four types of complex, multifocal femoral fractures were represented in the series. Eleven of the femoral shaft fractures were secondary to a previous, internally fixed, not yet united hip fracture (type I). ⋯ Two nails were removed. The end result was excellent in ten patients, good in seven, and fair in one (2-cm shortening and 20-degree external rotation). We conclude that a locked intramedullary construct with locking screws in femoral neck and distal femur controls a complex fracture situation well.
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Scapulothoracic dissociation, although rare, causes significant morbidity and mortality by completely disrupting the attachments of the scapula to the axial skeleton with the skin remaining intact. The defining constellation of injuries is subclavian or axillary vascular disruption, lateral displacement of the scapula, separation of the clavicular articulations with or without fracture of the clavicle, and cervical nerve root avulsion or brachial plexus injury. Orthopedic stabilization, vascular repair, and brachial plexus exploration are mandatory. Above elbow amputation, either primarily or within 24 hours, is recommended for the flail extremity.