J Trauma
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Fractures of the talar neck are relatively uncommon. The reported rates of avascular necrosis in Hawkins type II fractures vary from 34% to 50%. Various strategies have been adapted to prevent the occurrence of avascular necrosis. ⋯ The use of a vascularized cuboid pedicle bone graft and combined internal and external fixation can effectively prevent avascular necrosis of the talus in preliminary study. Further randomized control research is necessary to clarify the effectiveness of this technique.
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Comparative Study
Effects of fluid resuscitation with hypertonic saline dextrane or Ringer's acetate after nonhemorrhagic shock caused by pulmonary contusion.
Injured lungs are sensitive to fluid resuscitation after trauma. Such treatment can increase lung water content and lead to desaturation. Hypertonic saline with dextran (HSD) has hyperosmotic properties that promote plasma volume expansion, thus potentially reducing these side effects. The aim of this study was to (1) evaluate whether fluid treatment counteracts hypotension and improves survival after nonhemorrhagic shock caused by lung contusion and (2) analyze whether resuscitation with HSD is more efficient than treatment with Ringer's acetate (RA) in terms of blood oxygenation, the amount of lung water, circulatory effects, and inflammatory response. ⋯ Fluid treatment does not affect blood pressure or mortality in this model of nonhemorrhagic shock caused by lung contusion. However, our data indicate that HSD, when compared with RA, has advantages for the injured lung.
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Victims of violence are likely to become repeat victims of violence. Emergency department-based secondary prevention initiatives have been proposed to help break the cycle of violence for these youth. Trauma centers, by nature of their designation, are often charged with the responsibility of developing these prevention initiatives. We hypothesize that the majority of youth who are injured by violence are treated in nontrauma centers. Given the goal is to prevent recurrent injury, trauma center-based initiatives may be misdirected. ⋯ Given the vast majority of patients are not seen at trauma centers, any prevention initiatives located here will not achieve the goals of preventing recurrent injury on a population basis. Secondary prevention initiatives should be implemented and evaluated in nontrauma centers.
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Specific information about the supervision of young children with injuries related to falls is limited. In this study, we describe the supervision and physical environment of falls resulting in medical care in the emergency department. ⋯ Many children were supervised at the time of their fall. Most caretakers had visual contact, and up to a third were touching or within reach of the child. The strategies used in these apparently low-risk situations were insufficient to prevent the falls we report.
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Both high tidal volume (V(T)) ventilation and hemorrhage induce acute lung injury in adult rodents. It is not known whether injurious ventilation augments lung injury in infant rats exposed to severe hemorrhage. ⋯ High V(T) ventilation with low PEEP improves respiratory system mechanics without causing additional damage to healthy and hemorrhage-exposed infant rats after 4 hours of ventilation. This study highlights the tolerance to high V(T) ventilation in infant rats and underscores the need for age-specific animal models.