J Trauma
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Definitive trauma team leadership, although difficult to measure, has been shown to improve trauma resuscitation performance. The purpose of this study was to evaluate the effect of an identified command-physician on resuscitation performance. In addition, the leadership capability of four physician combinations functioning as command-physician was studied. ⋯ An identified command-physician enhances trauma resuscitation performance. Completion of the primary and secondary survey is not affected by the physician combination. Prompt formulation of a definitive plan is facilitated by the active involvement of an attending traumatologist or a properly mentored trauma fellow.
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The role of plate fixation in the management of fresh displaced midclavicular fractures is unsettled. The objective of this study was to evaluate the drawbacks and pitfalls of this treatment method. ⋯ Patient noncompliance with the postoperative regimen could be suspected to have been a major cause of the failures. The high complication rate supports a reserved attitude toward plate fixation of fresh midclavicular fractures. The method should be reserved for patients who have trustworthy personal motives for quick pain relief and functional recovery.
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The distal abdominal aorta is rarely injured after blunt trauma but a direct blow to the abdomen from a seatbelt or handlebars may cause intimal dissection or rupture. We present the diagnosis and surgical management of aortoiliac dissection in a 16-year-old boy injured in a motorcycle accident. The technical aspects of vascular repair are emphasized.
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The purpose of the present study was to test the association between on-site intravenous fluid replacement and mortality in patients with severe trauma. The effect of prehospital time on this association was also evaluated. The design was that of an observational quasi-experimental study comparing 217 patients who had on-site intravenous fluid replacement (IV group) with an equal number of matched patients for whom this intervention was not performed (no-IV group). ⋯ The results of this observational study have shown that the use of on-site intravenous fluid replacement is associated with an increase in mortality risk and that this association is exacerbated by, but is not solely the result of, increased prehospital times. Our findings are consistent with the hypothesis that early intravenous fluid replacement is harmful because it disrupts the normal physiologic response to severe bleeding. Although this evidence is against the implementation of on-site intravenous fluid replacement for severely injured patients, further studies including randomized controlled trials are required to provide a definitive answer to this question.
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Case Reports
Posterior fracture-dislocation of the shoulder with infraspinatus interposition: the buttonhole phenomenon.
We present a case with a posterior fracture-dislocation in which interposition of the infraspinatus precluded closed reduction by means of standard manipulation. The fractured greater tuberosity included the lesser tuberosity, allowing the infraspinatus to dislocate anterior to the dislocated humeral head and interpose between the humeral head and the glenoid cavity. ⋯ Traction in the zero-position was thus required for resolution of constriction and subsequent reduction. Computed tomography was useful to demonstrate interposition of the infraspinatus and to plan the treatment.