J Trauma
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Multicenter Study
Technical considerations in the operative management of femoral neck fractures in elderly patients: a multinational survey.
To identify current opinions among orthopedic traumatologists relating to technical aspects of internal fixation and arthroplasty for patients with femoral neck fractures. ⋯ A general lack of consensus exists among orthopedic trauma surgeons in the management of displaced femoral neck fractures. With an ever-growing emphasis upon the practice of evidence-based medicine, we have demonstrated several disparities in the technical aspects of fixation and perioperative care likely caused by a general lack of available evidence. We recommend the need for future research and large collaborative efforts.
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To improve our ability to identify physiologic deterioration caused by critical injury, we applied nonlinear analysis to the R-to-R interval (RRI) of the electrocardiogram of prehospital trauma patients. ⋯ Prehospital loss of RRI complexity, as evidenced by decreased entropy, was associated with mortality in trauma patients independent of GCS score or Injury Severity Score.
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Comparative Study
Computed tomography for early and safe discontinuation of cervical spine immobilization in obtunded multiply injured patients.
Evaluation of the cervical spine (c-spine) in obtunded severely injured trauma patients is controversial, and spine immobilization is frequently prolonged. We examined the effect of two different c-spine evaluation protocols on c-spine immobilization and clinical outcomes. ⋯ Discontinuation of c-spine precautions based on the normal findings of HCTrecon decreases the duration of c-spine immobilization in obtunded severely injured patients and is associated with fewer complications, fewer days of mechanical ventilation, and shorter stays in the ICU and hospital.
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Practice Guideline
Practice management guidelines for the screening of thoracolumbar spine fracture.
Fractures to the thoracolumbar spine (TLS) commonly occur because of major trauma mechanisms. In one series, 4.4% of all patients arriving at a Level I trauma center were diagnosed as having TLS fracture. Approximately 19% to 50% of these fractures in the TLS region will be associated with neurologic damage to the spinal cord. To date there are no randomized studies and only a few prospective studies specifically addressing the subject. The Eastern Association for the Surgery of Trauma organization Practice Management Guidelines committee set out to develop an EBM guideline for the diagnosis of TLS fractures. ⋯ Computed tomography (CT) scan imaging of the bony spine has advanced with helical and currently multidetector images to allow reformatted axial collimation of images into two-dimensional and three-dimensional images. As a result, bony injuries to the TLS are commonly being identified. Most blunt trauma patients require CT to screen for other injuries. This has allowed the single admitting series of CT scans to also include screening for bony spine injuries. However, all of the publications fail to clearly define the criteria used to decide who gets radiographs or CT scans. No study has carefully conducted long-term follow-up on all of their trauma patients to identify all cases of TLS injury missed in the acute setting.