J Trauma
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Multicenter Study Comparative Study
Level I versus Level II trauma centers: an outcomes-based assessment.
Trauma centers improve outcomes compared with nontrauma centers, although the relative benefit of different levels of major trauma centers (Level I vs. Level II hospitals) remains unclear. We sought to determine whether there was a difference in the patient outcome in trauma victims taken to Level I versus Level II trauma centers. ⋯ Patients taken to Level I centers had improved survival and better functional outcomes compared with injured persons taken to Level II hospitals.
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Comparative Study
Functional outcomes of posttraumatic lower limb salvage: a pilot study of anterolateral thigh perforator flaps versus muscle flaps.
Functional outcomes of lower extremity reconstruction compared with amputation have been evaluated. However, there are little comparative data among the different reconstructive options. With the recent increase in perforator flaps, we compared the functional outcomes of muscle and perforator flaps. ⋯ Both muscle and perforator flaps provide vascularized coverage, which nourishes the fracture but muscle flaps pilfer a functional unit which may not be inconsequential in a patient trauma. This pilot study suggests that functional outcomes of perforator skin flaps are equal to muscle flaps and a larger prospective study is warranted.
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Optimizing human resources at trauma facilities may increase quality of care. The purpose of this study was to assess whether staffing changes within a Level I trauma center improved mortality and shortened length of stay (LOS) for trauma patients. ⋯ The presence of in-house core trauma surgeons and PAs improves management and outcome of critically injured trauma patients within a level I trauma center.
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Iliosacral screws are commonly used for fixation of pelvic ring injuries. Previous reports using different screw insertion techniques have reported high neurologic complication rates, leading to recommendations for intraoperative neurodiagnostic monitoring. The purpose of this study was to evaluate the neurologic complications after percutaneous iliosacral screw placement without neurodiagnostic monitoring. ⋯ Using a standardized technique, appropriate and reliable fluoroscopic landmarks are available in the vast majority of percutaneous iliosacral screw fixation procedures. Iliosacral screw placement without neurodiagnostic monitoring has a low rate of neurologic complications.
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For functional reconstruction of a thumb metacarpophalangeal joint defect with loss of opposition, we need to address both joint mobility and thumb opposition. Free vascularized second toe joint transplantation provides joint replacement, as well as extensor and flexor tendons for apprehensile thumb restoration. Furthermore, the extensor digitorum brevis (EDB) allows a simultaneous abductorplasty for the reconstruction of traumatized abductor pollicis brevis. ⋯ Simultaneous second toe EDB abductorplasty and vascularized second toe metatarsophalangeal joint transfer can provide a one-stage thumb MPJ composite defect reconstruction with apprehensile function.