J Trauma
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Our objectives were to determine whether persistent hyperglycemia was predictive of outcome in critically ill trauma patients. ⋯ Trauma patients with persistent hyperglycemia have a significantly greater degree of morbidity and mortality. A prospective randomized controlled study instituting aggressive hyperglycemic control is warranted.
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While the treatment for displaced femoral neck fractures in the elderly (Garden types III and IV) is quite clear, the procedure for impacted or undisplaced femoral neck fractures (Garden types I and II) is still a subject of controversy. ⋯ Osteosynthesis with cannulated screws fixation is a simple, safe, economical, and reasonably effective procedure for the treatment of undisplaced femoral neck fractures in patients older than 80 years.
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Comparative Study
Early patellofemoral osteoarthritis caused by an osteochondral defect after retrograde solid nailing of the femur in sheep.
Retrograde femoral nailing (RFN) is an increasingly used technique for internal fixation of femoral fractures. Geometrically and empirically, the nail entry zone is close to the center of the femoral groove, causing concern about the development of patellofemoral osteoarthritis. ⋯ RFN can cause patellofemoral osteoarthritis. Care should be exercised to use RFN in isolated supracondylar or shaft fractures of the femur in healthy young adults.
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The intimate relationship between the pelvis and related vasculature can lead to life-threatening arterial hemorrhage after blunt trauma. Unfortunately, hemorrhage related to pelvic fracture is often associated with other serious injuries, complicating clinical decision making. Previous clinical reviews have associated fracture geometry with arterial hemorrhage, specifically implicating those injuries with evidence of major ligamentous disruption (MLD). ⋯ The findings in this study suggest that pelvic fracture pattern does not consistently correlate with the patient's need for urgent embolization and should not be used as the sole determinant for angiography. Furthermore, variables such as age and gender should be further investigated, as they may potentially have a predictive value in this clinical setting.
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Several models that integrate trauma and emergency general surgery (EGS) have been proposed to provide a diverse and challenging operative practice for trauma surgeons and improve recruitment. In July 2002, our institution established a 24/7 EGS consult service, staffed primarily by critical care/trauma surgeons (CCTS). The objective of this report was to evaluate the impact of this new service on CCTS, general surgeons (GS) and the hospital. ⋯ Departmental restructuring to include an EGS service: 1) increased CCTS volume despite decreased CCTS trauma admissions and operations; 2) increased elective GS volume; 3) generated increased use of ICU and operating room resources; and 4) demonstrated that CCTS with broad operative GS backgrounds and critical care knowledge can effectively staff an EGS service.