J Trauma
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Comparative Study
A comparative biomechanical analysis of fixation devices for unstable femoral neck fractures: the Intertan versus cannulated screws or a dynamic hip screw.
First introduced in 2005, the "Intertan" (IT), an intramedullary nail with two cephalocervical screws, has become an increasingly popular option for treating intertrochanteric fractures. The purpose of this study was to identify the utility of this device for stabilization of unstable femoral neck fractures compared with cannulated screws (CS) and a dynamic hip screw (DHS). ⋯ Our results suggest that (1) none of the tested devices restore a comparable mechanical strength in the fractured specimens compared with the intact femurs, and (2) the "IT" possesses some biomechanical benefits for internal fixation of unstable femoral neck fractures compared with DHS and CS. Because the IT constructs failed with an inferior femoral neck fracture, complicating the mandatory anchorage of a prosthetic stem in a revision operation, more biomechanical experiments using the IT in the presence of a posterior comminution defect are required, along with clinical outcome studies.
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Respiratory change in pre-ejection period (ΔPEP) has been described as a potential parameter for monitoring cardiac preload dependency in critically ill patients. This study was designed to describe the relationship between ΔPEP and pulse pressure variation (PPV) in pigs submitted to severe hemorrhagic shock. ⋯ Available correlations between PPV and ΔPEP at each time of the study were observed, meaning that ΔPEP is a reliable parameter to estimate and track the changes in cardiac preload dependency. Moreover, during the severe hemorrhagic shock period, ΔPEP measurements were more reproducible than PPV values.
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The tibial segmental fractures usually follow high-energy trauma and are often associated with many complications. We designed a two-stage protocol for these complex injuries. The aim of this study was to assess the outcome of tibial segmental fractures treated according to this protocol. ⋯ Use of the two-stage procedure for treatment of segmental tibial fractures is recommended. Surgeons can achieve good reduction with stable temporary fixation, soft-tissue reconstruction, ease of subsequent definitive fixation, and high union rates. Our patients obtained excellent knee and ankle joint motion, good functional outcomes, and a comfortable clinical course.
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To evaluate whether older injured motor vehicular crash (MVC) occupants' access to trauma centers (TC) reflects the lower threshold suggested in triaging recommendations. ⋯ In contrast to the American College of Surgeons triaging recommendations, injured MVC occupants older than 60 years are less likely to be transported to a TC than their younger counterparts. Further studies should establish whether the lower access to TC experienced by the older population is a function of geographical factors, emergency medical services unconscious bias, or other factors.
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Microscopic hematuria is an extremely important sign in blunt abdominal trauma (BAT) patients. Controversies still exist in the literature on whether microscopic hematuria is a sign of intra-abdominal extrarenal organ injury and is an indication for radiographic assessment of BAT patients. In this study, a new BAT rat model was developed, and we tried to determine the relationships between microscopic hematuria and extrarenal intra-abdominal organ injury. ⋯ Microscopic hematuria could serve as a predictor of the severity of trauma and intra-abdominal organ injury. This study would support the use of abdominal imaging and attentive assessment for intra-abdominal organ injury in stable BAT patients with hematuria. The laparotomy threshold may be lowered for unstable BAT patients with hematuria.