J Trauma
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Damage control resuscitation targets acute traumatic coagulopathy with the early administration of high-dose fresh frozen plasma (FFP). FFP is administered empirically and as a ratio with the number of packed red blood cells (PRBC). There is controversy over the optimal FFP:PRBC ratio with respect to outcomes, and their hemostatic effects have not been studied. We report preliminary findings on the effects of different FFP:PRBC ratios on coagulation. ⋯ Interim results from this prospective study suggest that FFP:PRBC ratios of ≥1:1 do not confer any additional advantage over ratios of 1:2 to 3:4. Hemostatic benefits of plasma therapy are limited to patients with coagulopathy.
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The rates of nonunion after internal fixation for femoral neck fractures have been reported to range from 0% to 59%. Existing treatment options are osteotomy (with or without graft), osteosynthesis using various implants and grafting techniques (muscle pedicle, vascularized, and nonvascularized fibula), or arthroplasty. The objective of this study was to assess the outcome results of revision internal fixation and nonvascular fibular bone grafting for symptomatic aseptic femoral neck nonunion. ⋯ This study showed that revision internal fixation and fibular autograft have resulted into a better and faster union rate than fibular allografts.
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Benefits of high ratios of fresh frozen plasma (FFP) to packed red blood cells (pRBC) in massively transfused trauma patients have been reported previously. This study aimed to assess the effect of higher FFP:pRBC ratios on outcome in patients receiving less than massive transfusion during acute trauma care. ⋯ Trauma patients receiving less than massive transfusion might also benefit from higher FFP:pRBC ratios, as these were associated with significantly lower mortality rates and decreased blood product utilization during subsequent ICU treatment, whereas morbidity was comparable among groups. Additional prospective trials are necessary.
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In light of recent data, controversy surrounds the apparent 30-day survival benefit of patients achieving a fresh frozen plasma (FFP) to packed red blood cell (PRBC) ratio of at least 1:2 in the face of massive transfusions (MT) (≥10 units of PRBC within 24 hours of admission). We hypothesized that initial studies suffer from survival bias because they do not consider early deaths secondary to uncontrolled exsanguinating hemorrhage. To help resolve this controversy, we evaluated the temporal relationship between blood product administration and mortality in civilian trauma patients receiving MT. ⋯ Improved survival was observed in patients receiving a higher plasma ratio over the first 24 hours. However, temporal analysis of mortality using shorter time periods revealed those who achieve early high-ratio are in less shock and less likely to die early from uncontrolled hemorrhage compared with those who never achieve a high-ratio. Thus, the proposed survival advantage of a high-ratio may be because of selection of those not likely to die in the first place; that is, patients die with a low-ratio not because of a low-ratio.