J Trauma
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Reamed intramedullary nailing is the current gold standard for the treatment of diaphyseal fractures of the femur and tibia. Current concepts of orthopedic damage control surgery for patients with multiple injuries have placed an emphasis on appropriate surgical timing, limiting blood loss, and the duration of the initial operative procedure(s). Proponents of unreamed nailing have stated that reaming places polytraumatized patients "at risk," in part because it adds to the length of the surgical procedure and may exacerbate the severity of a patient's pulmonary injury. The purpose of this study was to determine how many minutes reaming actually takes and what percentage of operative time reaming comprises during intramedullary nailing of femoral and tibial shaft fractures. ⋯ Our results show that reaming comprises a small percentage of the operative time and the total time a patient spends in the operating room.
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The objective of our study was to assess the impact of injury intentionality on the outcomes and healthcare resource utilization of severely injured patients in the United States. ⋯ Patients who are treated for self-inflicted injury have higher risk-adjusted mortality and utilize comparatively higher levels of healthcare resources than victims of assault or patients sustaining unintentional injury. The findings of our study emphasize the need for trauma center participation in the development and maintenance of aggressive primary and secondary suicide prevention programs.
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Many trauma centers use the pan-computed tomography (CT) scan (head, neck, chest, and abdomen/pelvis) for the evaluation of blunt trauma. This prospective observational study was undertaken to determine whether a more selective approach could be justified. ⋯ In this small sample, physicians were willing to omit 27% of scans. If this was done, two injuries requiring immediate actions would have been missed initially, and other potentially important injuries would have been missed in 17% of patients.
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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.