J Trauma
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(1) To independently validate the Trauma and Injury Severity Score-Like (TRISS-Like) model derived by Offner et al. (Revision of TRISS for intubated patients. J Trauma. 1992;32:32-35) in a population of Canadian blunt trauma victims, and (2) to compare the ability of this model to predict mortality in early and late trauma deaths. ⋯ TRISS-Like demonstrated similar performance to that reported with the standard TRISS model but with the additional advantage that it is more generalizable because it can be applied to intubated patients. TRISS-Like demonstrated substantially superior performance in early trauma deaths compared with those that occurred late. This differential performance may be because the model does not include risk factors for late mortality.
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Management of deep dermal hand burns represents a difficult clinical problem for the burn team because bedside estimation of burn depth is unreliable. Early identification of full-thickness injury and prolonged healing times might result in the decision to perform surgical excision of eschar and skin grafting of the wounds. Such a strategy may improve overall functional and cosmetic results of hand burn treatment. ⋯ Laser Doppler flowmetry may serve as a valuable adjunct to the prediction of the need for grafting and time to wound closure. Standardization of flowmetry data and techniques of evaluation are desirable. Spontaneous healing should be the goal in the majority of deep dermal hand burns.
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A case of delayed presentation of a traumatic false aneurysm in the left arm 50 years after penetrating injury sustained during World War II is described. The original injury resulted in brachial artery occlusion and complete median nerve palsy. The false aneurysm presented with a spontaneous, contained rupture. ⋯ Duplex ultrasound was also used intraoperatively to facilitate localization of the aneurysm neck and to confirm absence of flow in the sac after repair. A brief historical review of traumatic false aneurysms caused by combat injuries, is provided. The progress in the treatment of such injuries gained by wartime experience is reviewed.
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An unusual indication--not previously reported--for surgical treatment of a clavicle fracture, in a 56-year-old male, is presented. The proximal fragment had been entrapped under the coracoid, and there were symptoms from impairment of the musculocutaneous nerve. Reduction by closed means proved unsuccessful, and an open procedure was necessary for this rare type of the common clavicle fracture.