J Trauma
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To describe trends over 20 years in (1) number of admissions for hip fracture, (2) patients' demographics, type of fractures sustained by the patients, and their health status at admission, (3) surgical delays, and (4) acute care outcomes. ⋯ The tremendous increase in the volume of older and sicker patients admitted for hip fracture has put an enormous demand on our Level I trauma center. The changes in clinical management implemented to face this challenge have helped improve acute care outcomes.
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Comparative Study
Cleavage of SIgA by gram negative respiratory pathogens enhance neutrophil inflammatory potential.
Secretory immunoglobulin A (SIgA), the principle immune defense at respiratory and other mucosal sites in the body, is highly dependant on its molecular structure for effective antibody function. Previous studies have demonstrated that gram-negative but not gram-positive isolates from patients with nosocomial pneumonia have IgA protease activity that contributes to the development of infection. We postulate that SIgA cleavage by bacteria would also affect anti-inflammatory properties of IgA and studied this in vitro. ⋯ IgA cleavage by gram-negative respiratory isolates may lead to the development of pneumonia and the subsequent severity of the infection as a result of uncontrolled inflammatory responses by the host.
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Comparative Study
How severe are initially undetected injuries to the knee accompanying a femoral shaft fracture?
Fractures of the femur are severe injuries that quickly attract the physician's attention. Previous reports have shown that injuries to the ipsilateral knee can occur. In most cases, such injuries were diagnosed on delay. Excluding cases in which a knee injury was apparent already at admission, we sought to investigate the number and severity of initially undetected lesions to the knee concomitant with a femoral shaft fracture and give an overview of the literature referring to these combined injuries. ⋯ Physical examinations under anesthesia, arthroscopy and magnetic resonance imaging have shown lesser correlation among each other than one would expect. More severe injuries to the knee with femoral shaft fractures are more likely to be detected early, than minor ones. Pain about the knee communicated by the awake patient should be the indication for further apparative examination by magnetic resonance imaging or arthroscopy.
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It is known that tibial diaphyseal fractures are often associated with the posterior malleolar fracture (PMF). There are a few studies on tibial shaft fractures with respect to posterior malleolus fracture. However, we found that the incidence of PMF was higher than the previously reported. ⋯ Spiral fractures of the distal tibia commonly have an associated occult posterior malleolus fracture. Even the careful radiographic examination of the ankle joint, that is mandatory before surgery, may not detect this injury. CT scan or MRI may be a compensative method to detect these injuries. CT scan should be routinely performed in clinical practice.
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High-energy injuries may result in a femur fracture with resultant bending of a previously placed intramedullary femoral nail. A bend of the nail in the sagittal plane presents unique challenges for nail extraction and subsequent exchange nailing. The described surgical technique illustrates a simple method to straighten the sagittal plane bend in situ and performs exchange nailing although maintaining symmetric femoral length and rotation.