J Trauma
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Multicenter Study
Knee dislocations with vascular injury: outcomes in the Lower Extremity Assessment Project (LEAP) Study.
The purpose of this study is to report the clinical and functional results of a cohort of patients with knee dislocations associated with vascular injury. ⋯ Patients who sustain a limb-threatening knee dislocation have a moderate to high level of disability 2 years after injury. Nearly one in five patients who present to a Level I trauma center with a dysvascular limb associated with a knee dislocation will require amputation. Prolonged warm ischemia time was associated with a high rate of amputation. Patients who sustain vascular injuries associated with a knee dislocation need immediate transport to a trauma hospital, rapid assessment and diagnosis at presentation, and revascularization. Patients with these injuries can be effectively treated without angiography before surgery.
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Multicenter Study
Technical considerations in the operative management of femoral neck fractures in elderly patients: a multinational survey.
To identify current opinions among orthopedic traumatologists relating to technical aspects of internal fixation and arthroplasty for patients with femoral neck fractures. ⋯ A general lack of consensus exists among orthopedic trauma surgeons in the management of displaced femoral neck fractures. With an ever-growing emphasis upon the practice of evidence-based medicine, we have demonstrated several disparities in the technical aspects of fixation and perioperative care likely caused by a general lack of available evidence. We recommend the need for future research and large collaborative efforts.
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Multicenter Study
Early hyperglycemia predicts multiple organ failure and mortality but not infection.
Previous studies attempting to characterize the association between early hyperglycemia (EH) and subsequent outcome have been performed without utilization of a strict glycemic control protocol. We sought to characterize the clinical outcomes associated with EH in a cohort of severely injured trauma patients, when a strict glycemic control protocol was used. ⋯ These results suggest that EH is a marker of severe physiologic insult after injury, and that strict glycemic control may reduce or prevent the infectious complications previously shown to be associated with hyperglycemia early after injury.
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Mild head injury (MHI) implies a risk for traumatic brain injury and even a small risk for development of an intracranial hematoma. Head computed tomography (CT) is recommended for early detection of such pathologic findings. The present multicenter study was performed to investigate whether determination of protein S100B in serum could contribute to the selection of patients for CT scanning. ⋯ Determination of serum S100B cannot replace the clinical examination or use of CT for patients with minor head injury, but adding S100B measurement to the clinical evaluation might support selection of patients for CT scanning.
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The incidence of venous thromboembolism (VTE) without prophylaxis is as high as 80% after major trauma. Initiation of prophylaxis is often delayed because of concerns of injury-associated bleeding. As the effect of delays in the initiation of prophylaxis on VTE rates is unknown, we set out to evaluate the relationship between late initiation of prophylaxis and VTE. ⋯ Clinicians are reticent to begin timely VTE prophylaxis in critically injured patients. Patients are without VTE prophylaxis for half of all days within the first week of admission and this delay in the initiation of prophylaxis is associated with a threefold greater risk of VTE. The relative risks and benefits of early VTE prophylaxis need to be defined to better direct practice in this high-risk population.