European journal of trauma and emergency surgery : official publication of the European Trauma Society
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Eur J Trauma Emerg Surg · Aug 2017
Gustilo type IIIC open tibia fractures with vascular repair: minimum 2-year follow-up.
Salvage or amputation for grade 3C open fracture of tibia is not well responded question universally because of surgical innovations, cultural believes, difficulties in estimate the outcome, coasts, and different results in the literature. The aim of this study was to evaluate the surgical outcomes of Gustilo grade 3C open tibia fractures with at least two years follow-up in non-military adults. ⋯ Scoring systems and the ischemic time are not the only predictors of amputation. The decision of the treatment mode should be made by the patient and the care team after discussing the options and outcomes rather than relying on a scoring system.
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Eur J Trauma Emerg Surg · Aug 2017
Observational StudyThe characteristics and pre-hospital management of blunt trauma patients with suspected spinal column injuries: a retrospective observational study.
Pre-hospital spinal immobilisation by emergency medical services (EMS) staff is currently the standard of care in cases of suspected spinal column injuries. There is, however, a lack of data on the characteristics of patients who received spinal immobilisation during the pre-hospital phase and on the adverse effects of immobilisation. The objectives of this study were threefold. First, we determined the pre-hospital characteristics of blunt trauma patients with suspected spinal column injuries who were immobilised by EMS staff. Second, we assessed the choices made by EMS staff regarding spinal immobilisation techniques and reasons for immobilisation. Third, we researched the possible adverse effects of immobilisation. ⋯ Spinal immobilisation was applied in 96.3 % of all included patients based on pre-hospital criteria. We found that consensus among EMS staff on how to interpret the criterion 'distracting injury' was lacking. Furthermore, the adverse effects of spinal immobilisation were incompletely documented in pre-hospital care reports. To provide validated information on potential symptoms of SCI, a uniform EMS scoring system for motoric assessment should be developed.
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Eur J Trauma Emerg Surg · Aug 2017
ReviewVolume replacement during trauma resuscitation: a brief synopsis of current guidelines and recommendations.
Intravascular volume and fluid replacement are still cornerstones to correct fluid deficits during early trauma resuscitation, but optimum strategies remain under debate. ⋯ Volume replacement at a reduced level in severely injured and bleeding trauma patients is advocated (permissive hypotension) until the bleeding is controlled. ATLS principles with Hb, BE, and/or lactate can assess perfusion, estimate/monitor the extent of bleeding/shock, and guide therapy. Isotonic crystalloid solutions are first-line and specific recommendations apply for patients with TBI.
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Eur J Trauma Emerg Surg · Aug 2017
ReviewCompression therapy after ankle fracture surgery: a systematic review.
The main purpose of this systematic review was to investigate the effect of compression treatment on the perioperative course of ankle fractures and describe its effect on edema, pain, ankle joint mobility, wound healing complication, length of stay (LOS) and time to surgery (TTS). The aim was to suggest a recommendation to clinicians considering implementing compression therapy in the standard care of the ankle fracture patient, based on the existing literature. ⋯ Compression therapy has a beneficial effect on edema reduction and probably a positive effect on pain and ankle joint mobility, but with the methodological limitations in the included studies it is not possible to make a solid conclusion on the effect on wound healing, LOS and TTS.
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Eur J Trauma Emerg Surg · Aug 2017
Preventable and potentially preventable deaths in severely injured patients: a retrospective analysis including patterns of errors.
Analyzing preventable and potentially preventable deaths is a well-known procedure for improving trauma care. This study analyzes preventable and potentially preventable deaths in German trauma patients. ⋯ Preventable and potentially preventable errors still occur in the treatment of severely injured patients. Errors in hemorrhage control and airway management are the most common human treatment errors. The knowledge of these errors could help to improve trauma care in the future.