J Trauma
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The purpose of this study was to determine the percentage of amputee soldiers who sustained their injury during the current conflicts in Afghanistan and Iraq and have returned to duty. In addition, the authors plan to identify the factors that influence the amputee's likelihood to return to duty. ⋯ During the 1980s, 11 of 469 amputees returned to active duty (2.3%). The number of amputees returning to duty has increased significantly, from 2.3% to 16.5%, due to advancements in combat casualty care and the establishment of centralized amputee centers.
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For patients sustaining torso gunshot wounds (GSWs) who undergo a trial of nonoperative management (NOM), the optimal observation time required to exclude a hollow viscus injury before discharge is unknown. The purpose of this study was to analyze a continuous series of patients undergoing NOM after sustaining a GSW to the torso to determine the safe period of observation before discharge. ⋯ For patients undergoing NOM of their torso GSWs, all patients who failed and required a laparotomy did so within 24 hours of admission. Patients undergoing selective NOM required a minimum of 24 hours of close observation before discharge.
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Because of an increasing life expectancy of patients and the rising number of joint replacements, peri- and interprosthetic femoral fractures are a common occurrence in most trauma centers. This study was designed to answer two primary questions. First, whether the fracture risk increases with two intramedullary implants in one femur; and second, whether a compression plate osteosynthesis is sufficient for stabilizing an interprosthetic fracture. ⋯ Two intramedullary implants reduce the fracture strength significantly. If an interprosthetic fracture occurs, sufficient stability can be achieved by a lateral compression plate. Because two intramedullary implants in the femur may decrease the fracture strength, the treatment of supracondylar femoral fractures with a retrograde nail in cases with preexisting ipsilateral hip prosthesis should be reconsidered.
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There are many complications involved in the immobilization of unconscious patients with potential cervical spine injuries. In February 2005, the Intensive Care Society (ICS), United Kingdom, produced consensus guidelines to evaluate spinal injuries in unconscious victims of blunt multiple injuries to address this important clinical problem. ⋯ A unit policy ensures that current recommendations are followed. Despite the ICS guidelines being published 4 years ago, over half of the individual intensive care units have no policy in place. A lack of adequate guidance for junior doctors can lead to steps in the process of clearance being omitted and potential injuries being missed. We recommend that the national organization do more to facilitate a wider dissemination of these guidelines.
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The lack of knee flexion is an increasingly recognized complication of femoral and periarticular knee fractures. This is a significant challenge for both surgeon and patients. ⋯ Modified Thompson quadricepsplasty is a promising procedure with satisfactory results. It provides significantly results if it is performed earlier and in more severe extension contracture.