J Trauma
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Comparative Study
Treatment of complex elbow injuries with a postoperative custom-made progressive stretching static elbow splint.
Complex elbow injuries consist of fractures of one or several of the bony stabilizers of the elbow, including the radial head, proximal ulna, coronoid process, collateral ligaments, and capsular complex. These injuries, if not properly treated, were reported to have a poor prognosis with recurrent instability, stiffness, posttraumatic arthrosis, and pain. This study was conducted to review clinical outcomes after fracture stabilization and ligament repair with a postoperative custom-made progressive stretching (CMPS) elbow splint in the treatment of complex elbow injuries. ⋯ The dilemma in managing complex elbow injuries is that extended immobilization leads to stiffness, but without proper reconstruction of the stabilizer, joint instability recurs. Our surgical protocol included removal of all loose bodies within the joint, stable fixation of fracture fragments if possible, and use of suture anchors to repair medial or lateral ulnar collateral ligaments. CMPS static elbow splints provided both postoperative protection and ROM movement. In our experience, if the stabilizers were reconstructed, hinged elbow external skeletal fixator is usually not necessary, and progressive stretching by CMPS splint can result in good ROM.
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PlasmaLyte is a family of balanced crystalloid solutions with multiple different formulations available worldwide according to regional clinical practices and preferences. It closely mimics human plasma in its content of electrolytes, osmolality, and pH. These solutions also have additional buffer capacity and contain anions such as acetate, gluconate, and even lactate that are converted to bicarbonate, CO2, and water. ⋯ A unique concern is that most formulations contain magnesium, which may affect peripheral vascular resistance, heart rate, and worsen organ ischemia. There are few studies on its use in trauma or hypovolemic shock. There is no evidence that PlasmaLyte is superior to other crystalloids for the prehospital management of traumatic hypovolemia.
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Comparative Study
Postinjury vagal nerve stimulation protects against intestinal epithelial barrier breakdown.
Vagal nerve stimulation (VNS) can have a marked anti-inflammatory effect. We have previously shown that preinjury VNS prevented intestinal barrier breakdown and preserved epithelial tight junction protein expression. However, a pretreatment model has little clinical relevance for the care of the trauma patient. Therefore, we postulated that VNS conducted postinjury would also have a similar protective effect on maintaining gut epithelial barrier integrity. ⋯ Postinjury VNS prevents gut epithelial breakdown when performed within 90 minutes of thermal injury. This could represent a therapeutic window and clinically relevant strategy to prevent systemic inflammatory response distant organ injury after trauma.