J Trauma
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Comparative Study
Skeletal traction versus external fixation in the initial temporization of femoral shaft fractures in severely injured patients.
: Damage control with external fixation (DC-EF) of femoral shaft fractures in polytrauma patients is becoming standard treatment in many trauma centers. However, skeletal traction (ST) has long been used in the temporization of fractures. The purpose of this study was to compare the major physiologic clinical outcomes of provisional ST with DC-EF of femoral shaft fractures in severely injured patients. ⋯ : DC-EF of femur fractures in severely injured patients offers no significant advantage in clinical outcomes compared with ST. Unless initially subjected to general anesthesia for life saving procedures, the use of ST as a temporization method remains a practical option.
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Controlled Clinical Trial
Measuring tissue oxygen saturation via spectrometer in children.
: Near-infrared spectroscopy is a new noninvasive method of monitoring oxygen saturation at a tissue level. The purpose of this study was to evaluate new near-infrared tissue spectrometer InSpectra (Hutchinson Technology Inc.) in children and to determine preferable areas of the body to measure tissue oxygen saturation (StO2). ⋯ : Bicep and deltoid muscles are the most appropriate areas to measure StO2 using the 25-mm transducer in children of different ages. The use of near-infrared spectroscopy on the thenar eminence, which is usually used for measurement in adults, has varied results in children depending on the age, weight, and presence of fever.
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: Intraoperative contouring of long bridging plates for stabilization of flail chest injuries is difficult and time consuming. This study implemented for the first time biometric parameters to derive anatomically contoured rib plates. These plates were tested on a range of cadaveric ribs to quantify plate fit and to extract a best-fit plating configuration. ⋯ : A small set of anatomic rib plates can minimize the need for intraoperative plate contouring for fixation of ribs 3-9. Anatomic rib plates can therefore reduce the time and complexity of flail chest stabilization and facilitate spanning of flail segments with long plates.
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Controlled Clinical Trial
Cervical spine clearance in obtunded blunt trauma patients: a prospective study.
: An acceptable algorithm for clearance of the cervical spine (C-spine) in the obtunded trauma patient remains controversial. Undetected C-spine injuries of an unstable nature can have devastating consequences. This has led to reluctance toward C-spine clearance in these patients. ⋯ : Our results indicate that CT of the C-spine is highly sensitive in detecting the vast majority (99.75%) of clinically significant C-spine injuries. We recommend that CT be used as the sole modality to radiographically clear the C-spine in obtunded trauma patients and do not support the use of flexion-extension radiographs as an ancillary diagnostic method.
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Clinical Trial
Patients education of a self-reduction technique for anterior glenohumeral dislocation of shoulder.
: Anterior dislocation of the shoulder (glenohumeral joint) is one of the most prevalent dislocations. Following a first dislocation recurrence rates of up to 80% have been reported. Many patients will seek medical assistance for reduction of the shoulder after each of these recurrent dislocations. We describe the results of reduction of anterior glenohumeral dislocation using a modified self manipulated Milch technique that can be performed by the patients themselves after simple guidance and demonstration. This method is directed to patients who are not willing or cannot have surgical stabilization and may be in a place where medical assistance is not available. ⋯ : The results illustrate the fact that most patients are able to reliably and reproducibly reduce glenohumeral dislocations by themselves. Subsequent dislocations can be reduced promptly decreasing the dislocation time thus avoiding further damage to the shoulder, achieving immediate pain relief, and removing the immediate necessity for medical attendance.