J Trauma
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Neglected or chronic rupture of the Achilles tendon usually needs a reconstruction procedure. Many graft sources have been reported for this procedure, such as a proximal V-Y gastrocnemius tendon flap, flexor hallucis longus tendon, fascia lata, plantaris tendon, synthetic materials, and peroneus brevis. However, how to fix the graft at the calcaneal site remains controversial. ⋯ Our technique reuses two small central incisions, thus, preserving skin integrity as much as possible to reduce wound breakdown or infection. The management of chronic or neglected Achilles tendon rupture by autogenous peroneal longus tendon with EndoButton-CL fixation at the calcaneal site is an anatomic and safe, but technically demanding technique.
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Is bigger better? The effect of obesity on pelvic fractures after side impact motor vehicle crashes.
Previous research has identified nearside impacts, intrusion, gender, age, and body mass index (BMI) as associated with pelvic fractures in motor vehicle crashes. This study assesses the role of BMI in predicting pelvic fracture and whether BMI modifies the effect of other potential risk factors. ⋯ BMI status influences other variables associated with pelvic fracture. Redesign of interior door panels, hardware, armrests, and the center console may be appropriate for motor vehicle manufacturers to consider in prevention of pelvic fracture during nearside impacts.
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Airway compromise secondary to isolated injury at the atlas (C1) and axis (C2) without an associated spinal cord injury is a rare, but recognized phenomenon that results in significant morbidity and mortality. No previous study in the literature has reported the incidence of this potentially lethal complication of these relatively common fractures. ⋯ Approximately 5% of patients with isolated C1 and C2 fractures developed airway compromise. All patients with these injuries should be assessed for the risk of developing this complication and some will require close monitoring to detect this problem at an early stage.
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It is agreed that missed compartment syndrome is associated with significant morbidity, but controversy regarding its diagnosis remains. To our knowledge, no one has analyzed the effect of individual surgeon variation on the diagnosis of compartment syndrome. ⋯ The diagnosis of compartment syndrome is difficult, and the data reported herein show that significant practice variation is likely, even within a single institution. It is unknown what the "true" rate of compartment syndrome should be, considering that a rate that is too high indicates unnecessary surgery and a rate that is too low means missing a devastating injury. Our data indicate lack of consensus in practice regarding the diagnosis of compartment syndrome, even at a high-volume level I trauma center, and emphasize the possibility of false-positive results of compartment pressure checks in clinical practice.