J Trauma
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To report our experience with the diagnosis and treatment of aortoiliac vascular injuries caused by misplaced orthopedic fixation screws. ⋯ Vascular injuries related to misplacement of fixation screws are relatively infrequent but potential life and limb-threatening complications that require early recognition with prompt repair of vascular lesions and screw reposition.
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The original Trauma and Injury Severity Score (TRISS) methodology from the Major Trauma Outcome Study (MTOS) is the most widely used outcome prediction model. The coefficients from the MTOS cohorts are still used in the Japan Trauma Data Bank for evaluating the quality of patient care. The purposes are to determine whether the database of this institution is well matched to the MTOS study and whether the original TRISS coefficients are accurate predictors of the patient outcome in Japan. ⋯ The trauma populations in this study differed significantly from the MTOS. The Modified TRISS coefficients should be adapted for outcome assessment based on the location of the injured population. This is the first report of an M-study from Japan to be published in the English literature.
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Our goal was to analyze whether radiographic fracture pattern correlates with mortality of patients with lateral compression type 1 (LC1) fractures. ⋯ Sacral fracture pattern does not seem to be predictive of mortality for patients with LC1 pelvic fractures The presence of associated injuries seems to be the key driver of mortality.
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The challenge of closing extremity fasciotomy wounds is well known to every trauma and orthopedic surgeon. We developed a new, easy, and inexpensive dermatotraction technique based on the simple use of Ty-Raps and report on the first pilot study using this novel technique for the closure of 23 extremity fasciotomy wounds. The Ty-Rap system consists of several combinations of two Ty-Raps and four surgical staples. ⋯ We regard the use of Ty-Raps a good alternative for the current closing techniques of extremity fasciotomy wounds. We value its low cost, general availability, effectiveness, and the fact that, in this pilot study, both the application and the tightening of the Ty-Raps were well tolerated by our patients with a minimal need for secondary procedures. Knowledge of this technique is a useful adjunct to the existing surgical array for every trauma and orthopedic surgeon for the closure of extremity fasciotomy wounds, especially in austere or military environments.
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Ampicillin-sulbactam is guideline-recommended treatment for early-onset ventilator-associated pneumonia (VAP). However, intensive care unit clinicians are encountering increasing resistance to ampicillin-sulbactam. We sought to analyze the time period for early-onset VAP in our trauma population by using daily evaluation of resistance to ampicillin-sulbactam. ⋯ Ampicillin-sulbactam is not an effective empiric therapy for early-onset VAP in our rural trauma population. The utility of ampicillin-sulbactam should be reviewed at other institutions to assess for appropriate empiricism.