European journal of trauma and emergency surgery : official publication of the European Trauma Society
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Eur J Trauma Emerg Surg · Jun 2016
ReviewPharmacological adjuncts to stop bleeding: options and effectiveness.
Severe trauma and massive haemorrhage represent the leading cause of death and disability in patients under the age of 45 years in the developed world. Even though much advancement has been made in our understanding of the pathophysiology and management of trauma, outcomes from massive haemorrhage remain poor. This can be partially explained by the development of coagulopathy, acidosis and hypothermia, a pathological process collectively known as the "lethal triad" of trauma. ⋯ Tranexamic acid, the most commonly used antifibrinolytic agent, has been successfully incorporated into most trauma management protocols effectively reducing mortality and morbidity following trauma. In this review, we discuss the current literature with regard to the management of haemorrhage following trauma, with a special reference to the use of pharmacological adjuncts. Novel insights, concepts and treatment modalities are also discussed.
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Damage control resuscitation describes an approach to the early care of very seriously injured patients. The aim is to keep the patient alive whilst avoiding interventions and situations that risk worsening their situation by driving the lethal triad of hypothermia, coagulopathy and acidosis or excessively stimulating the immune-inflammatory system. It is critical that the concepts and practicalities of this approach are understood by all those involved in the early management of trauma patients. This review aims to summarise this and discusses current knowledge on the subject. ⋯ Given that interventions are so time dependent in the severely injured, it is likely that by further improving trauma systems and protocols, improvements in outcome can still be made. Further research work in this area will allow us to target these approaches more accurately to those patients who can benefit most.
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Paediatric trauma is the leading cause of mortality in children. Paediatric trauma resuscitation is the first and foremost step towards a successful treatment and subsequent recovery. Significant advances have taken place in the last years in relation to this field of trauma care. ⋯ The current evidence although emerging is still sparse and high-quality studies are needed to shed more light on most of the above domains of resuscitation.
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Eur J Trauma Emerg Surg · Jun 2016
Is augmentation plating an effective treatment for non-union of femoral shaft fractures with nail in situ?
There are few reports of non-union femur shaft fractures treated with plate fixation with the nail in situ. This study reports our results in 40 cases. ⋯ Plating is an effective treatment for non-union of diaphyseal femur fractures after intramedullary fixation with the nail in situ.
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Eur J Trauma Emerg Surg · Jun 2016
Clinical and radiologic outcomes associated with the use of dynamic locking screws (DLS) in distal tibia fractures.
The locked screw plate construct is often cited as being too rigid and prolonging healing in patients with metaphyseal fractures. The newly introduced dynamic locking screws (DLS) allow 0.2 mm of axial motion, which should optimize healing near the near cortex. The purpose of this study was to analyze the clinical results of dynamic locking screws in distal tibia fractures. ⋯ Dynamic fracture fixation might be a promising concept to reduce the frequency of metaphyseal non-unions in distal tibia fractures. But nevertheless, the dynamic construct cannot compensate for insufficient reduction.