J Trauma
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Fixation of intra-articular calcaneal fractures has traditionally been guided by intraoperative fluoroscopy. Recent reports indicate that there is a role for subtalar arthroscopy in surgical fixation of these fractures. The earliest reports described the use of subtalar arthroscopy for joint assessment during late hardware removal. It then served as an adjunct for joint inspection in open reduction and internal fixation. In its final permutation, percutaneous arthroscopy was performed with minimally invasive reduction and fixation, minimizing soft tissue complications commonly associated with the open approach. In practiced hands, this technique yields good results with minimal morbidity. ⋯ Subtalar arthroscopy augments intraoperative fluoroscopy in anatomic reduction of the posterior calcaneal facet of the subtalar joint and is most useful for Sanders type II, AO-OTA 83-C2 fractures. The percutaneous approach further avoids soft tissue complications associated with open reduction. However, this procedure has a steep learning curve, and conversion to open reduction must be considered when percutaneous reduction fails.
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Postacute care is an essential component of medical care aimed at returning trauma patients to their preinjury functional status. Rehabilitation services, skilled nursing facilities, and home care all play a role in facilitating the healing process. Access to such care may be limited based on insurance status, leaving the uninsured with limited resources to reach full recovery. We hypothesized that access to specialized postacute care is less available to patients who lack health insurance. ⋯ Insurance status is an important predictor of hospital disposition and access to specialized posthospital care. Uninsured patients are less likely to have access to the full range of medical care available to ensure complete recovery from traumatic injuries.
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Comparative Study
In-hospital mortality and surgical utilization in severely polytraumatized patients with and without spinal injury.
Patients who sustain major trauma experience multisystem injuries including those affecting the spine. We hypothesize that recovery after spinal injuries differs from those affecting other systems. The purpose of our study was to compare in-hospital mortality and surgical resource utilization in severely polytraumatized patient with and without spinal injury. ⋯ In this study, we conclude that the presence of a spinal injury in the setting of severe polytrauma (ISS>15) is associated with a prolonged course of ventilatory support, ICU, and in-hospital LOS. Trauma hospitals treating patients with spinal fracture should be aware of differences in the use of health services for this patient population.
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The purpose of this study was to assess the feasibility and accuracy of computer-assisted surgery (CAS) for screw placement in different pelvic regions using intraoperative three-dimensional (3D) imaging and to evaluate the influence of surgeons' experience with such a system on procedure time, radiation time, radiation dose, and misplacement rate. ⋯ The 3D fluoroscopic navigated procedure in pelvic surgery seems to be a useful tool for all surgeons and especially for less experienced ones. Furthermore, the intraoperative reconstruction of multiplanar 3D images allows a secure control of implant positioning.
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Arterial base deficit (ABD) measurement is a standard test for assessment of the trauma patient's metabolic response to shock. Venous blood is readily available earlier during the trauma resuscitation. The aim of this study is to analyze the difference (correlation, agreement, clinical significance) between the first peripheral venous base deficit (pVBD) and the first ABD during trauma resuscitation. ⋯ There is near perfect correlation and clinically acceptable agreement between pABD and pVBD values on simultaneous testing. pVBD is an acceptable test to assess trauma patients' initial metabolic status when occult blood loss suspected.