J Trauma
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Comparative Study
Delayed flap reconstruction with vacuum-assisted closure management of the open IIIB tibial fracture.
Vacuum-assisted closure (VAC) therapy has been shown to be effective at reducing bacterial counts in wounds until definitive bony coverage. However, there is continued debate over timing and type of definitive wound coverage even with VAC therapy application. ⋯ The VAC therapy may help to reduce the flap size and need for a flap transfer for type IIIB open tibial fractures. However, prolonged periods of VAC usage, greater than 7 days, should be avoided to reduce higher infection and amputation risks.
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The "golden hour" of trauma care is irrelevant in rural areas. We studied the effect of distance and remoteness on major trauma patients transferred by the Royal Flying Doctor Service from rural and remote Western Australia. ⋯ There is an excess of a fourfold increase in the risk of major trauma death in patients transferred to Perth from remote and very remote Western Australia. Remoteness, as measured by the ARIA, is more important than distance, in the risk of death.
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Induced hypothermia after cardiac arrest is an accepted neuroprotective strategy. However, its role in cardiac arrest during acute trauma care is not yet defined. To characterize recent experience with this technique at our center, we undertook a detailed chart review of acute trauma patients managed with induced hypothermia after cardiac arrest. ⋯ Mild induced hypothermia can be beneficial in a selected group of trauma patients after cardiac arrest. Prospective trials are needed to explore the effects of targeted temperature management on coagulation in this patient group.
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Comparative Study
Variations in bone mineral density of proximal femora of elderly people with hip fractures: a case-control analysis.
Bone mass as represented by bone mineral density (BMD) is the most important factor determining bone strength. Elderly people with and without hip fractures were compared with the BMD of the proximal femora. The correlation between hip fractures in elderly patients and osteoporosis was investigated. ⋯ The severity of osteoporosis may affect the risk of hip fractures in elderly people. The risk of intertrochanteric fractures may be determined simply by BMD, but the risk of femoral neck fractures may be determined by multiple factors. Intertrochanteric fractures may start at the greater trochanter due to its low BMD.