J Trauma
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Randomized Controlled Trial Comparative Study Clinical Trial
Surgical stabilization of internal pneumatic stabilization? A prospective randomized study of management of severe flail chest patients.
We compared the clinical efficacy of surgical stabilization and internal pneumatic stabilization in severe flail chest patients who required prolonged ventilatory support. ⋯ This study proved that in severe flail chest patients, surgical stabilization using Judet struts has beneficial effects with respect to less ventilatory support, lower incidence of pneumonia, shorter trauma intensive care unit stay, and reduced medical cost than internal fixation. Moreover, surgical stabilization with Judet struts improved percent forced vital capacity from the early phase after surgical fixation. Also, patients with surgical stabilization could return to their previous employment quicker than those with internal pneumatic stabilization, even in those with the same severity of flail chest. We therefore concluded that surgical stabilization with Judet struts may be preferably applied to patients with severe flail chest who need ventilator support.
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Patients with diabetes mellitus may be at increased risk of accidents, mainly because of hypoglycemia. A variety of approaches have been adopted in an attempt to quantify this risk, but there has not been, to date, a systematic study using a national trauma register. In this study, we report findings from the Scottish Trauma Audit Group database. ⋯ This study confirms that patients taking insulin are at increased risk of accidents. Among the different types of injury, only low-impact falls were significantly increased. This is most likely related to an increased tendency for insulin-treated patients to fall during a hypoglycemic episode. However, patients with diabetes may also be at higher risk of sustaining a fracture after a fall. The number of car crashes involving drivers with insulin-dependent diabetes is small, and the rate is not significantly greater than that of the background population. Further study of the causes and consequences of falls in diabetic patients is warranted.