J Trauma
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Though, volar fixed-angle plating has become increasingly popular to treat distal radius fractures no studies are available comparing the mechanical properties of different screw configurations to fix the plate to the shaft. The aim of the present study was to evaluate the effect of an additional locking screw directly proximal to the fracture site and to assess if such a screw might be protective against secondary loss of reduction after volar fixed-angle plating. ⋯ This study showed the mechanical superiority of volar fixed-angle plates with a "protection screw" in an extra-articular fracture model. Further clinical investigation is needed to verify the results.
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The objective of our study was to assess the impact of injury intentionality on the outcomes and healthcare resource utilization of severely injured patients in the United States. ⋯ Patients who are treated for self-inflicted injury have higher risk-adjusted mortality and utilize comparatively higher levels of healthcare resources than victims of assault or patients sustaining unintentional injury. The findings of our study emphasize the need for trauma center participation in the development and maintenance of aggressive primary and secondary suicide prevention programs.
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As outcome to severe trauma is frequently affected by massive blood loss and consecutive hemorrhagic shock, replacement of red blood cell (RBC) units remains indispensable. Administration of RBC units is an independent risk factor for adverse outcome in patients with trauma. The impact of massive blood transfusion or uncrossmatched blood transfusion on the patients' immune response in the early posttraumatic period remains unclear. ⋯ We exhibited for the first time a serial, sequential screening analysis of monocyte messenger RNA expression patterns in patients with multiple trauma indicating a strongly significant association between the patients' genomic response in blood monocytes and massive or uncrossmatched RBC substitution.
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Spinal injury in pediatric trauma is associated with significant morbidity and mortality, but no current consensus exists on the safest and most effective method of clearance in the high-risk pediatric trauma patient. ⋯ There is a need for an evidence-based protocol for the clearance of the spine in the obtunded and high-risk pediatric trauma patient. High-resolution CT with sagittal and coronal reconstructions should be the basis for cervical spinal clearance, in combination with the interpretation of films by an expert radiologist. All spinal regions should be imaged, and clearance should be formally documented. The role of magnetic resonance imaging in routine clearance remains controversial. Multicenter prospective studies are needed to develop consensus for an evidenced-based protocol for clearance in this high-risk group.