J Trauma
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Case Reports
Delayed hemothorax after blunt thoracic trauma: an uncommon entity with significant morbidity.
To describe the nature of delayed hemothorax occurring after blunt thoracic trauma and to identify the population at risk for this complication. ⋯ Delayed hemothorax after blunt trauma is a unique entity occurring in patients with multiple or displaced rib fractures. Vigilance for the recognizable prodrome in the high-risk population should allow early remediation of this complication.
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We determined the ability of a packaged fibrin glue (FG) product to terminate severe bleeding in a new porcine model of complex hepatic injury. ⋯ FG stopped bleeding and eliminated the need for packing in a model of severe liver injury. Further work in the clinical arena is warranted to determine the potential benefits of FG in arresting hemorrhage in hypotensive, hypothermic, coagulopathic trauma patients with complex visceral injuries.
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Hypothermia is considered harmful in trauma patients. In surgery, hypothermia is occasionally used to reduce metabolism and protect the brain. Recent studies in animals have also shown protective effects of hypothermia in hemorrhagic shock. The aim of this study was to evaluate the metabolic and endocrine effects of induced hypothermia in hemorrhagic shock. ⋯ In porcine hemorrhagic shock, induced hypothermia increases arterial oxygen tension and stabilizes serum levels of potassium and catecholamines.
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Comparative Study
Treatment of clavicular aseptic nonunion: comparison of plating and intramedullary nailing techniques.
The aim of this retrospective study was to investigate and compare the effects of plating and intramedullary nailing in the treatment of clavicular aseptic nonunion. ⋯ Intramedullary nailing may have a higher union rate with a lower complication rate than plating (p > 0.05). At least in common situations, it is not inferior to plating. Whenever possible, therefore, intramedullary nailing should be used preferentially to treat clavicular aseptic nonunion without previous operative treatment. Nevertheless, both techniques have relatively higher nonunion rates in the treatment of clavicular nonunion than in the treatment of other long-bone nonunions. Gentle handling of surrounding soft tissues to reduce bony fragments should be strictly executed.
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Trauma patients with multiple extremity injuries (MEI) make heavy demands on hospital resources and face long-term difficulties in rehabilitation, yet the literature contains little about their treatment as a distinct group. ⋯ The study emphasizes the need for injury scoring systems that better predict the needs of patients with MEI and that will serve as a basis for equitable funding of trauma centers.