Clinical orthopaedics and related research
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The Alfred P. Murrah Federal Building in Oklahoma City was partially destroyed by a terrorist bomb on April 19, 1995. Injuries were sustained by 759 people, 168 of whom died. ⋯ The closer receiving hospitals used emergency department facilities and minor treatment areas. Few survivors were extricated from the bombing site more than 3 hours after the detonation. Mass casualty plans must provide for improved communications, diversion and retriage from facilities nearest the disaster site, and effective coordination of community and hospital resources.
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Clin. Orthop. Relat. Res. · May 2004
Review Comparative StudyTreatment of the mangled lower extremity after a terrorist blast injury.
Terrorist bombings, with resultant blast injuries, have been increasing in frequency during the past 30 years. Injury to the musculoskeletal system is common in victims who survive such attacks. Substantial injury to the limbs may occur through several different mechanisms, each of which may affect prognosis and alter the treatment algorithm. ⋯ This management protocol may improve the medical facility's ability to manage system resources while treating patients with severe blast injuries. The decision of whether to salvage or proceed with limb amputation is one of the most difficult in orthopaedic trauma. A basic education in the mechanisms of blast damage, a methodical approach to resuscitation, and mangled extremity treatment, likely can improve surgical success.
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Clin. Orthop. Relat. Res. · May 2004
ReviewTerrorism and blast phenomena: lessons learned from the attack on the USS Cole (DDG67).
Blast phenomena and injuries to the musculoskeletal system have been well documented for the past 50 years. The USS Cole was attacked in Aden Harbor in Yemen on October 12, 2000. Seventeen sailors were killed and 39 were wounded. ⋯ Fractures of the cranium, spine, pelvis, and long bones denoted increasing severity of injury to critical organ systems. Shipboard firefighting was successful in containing fires and there was very little morbidity from inhalational injuries or burns. Blast phenomena that affect ships or buildings that have been specifically built to absorb a blast attack likely will manifest a different mode and pattern of injury than those seen in traditional terrorist blast events.
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The world has been marked by a recent series of high-profile terrorist attacks, including the attack of September 11, 2001, in New York City. Similar to natural disasters, these attacks often result in a large number of casualties necessitating triage strategies. ⋯ By their very nature, trauma centers are best equipped to handle mass casualties resulting from natural and manmade disasters. Triage assessment tools and scoring systems have evolved to facilitate this triage process and to potentially reduce the morbidity and mortality associated with these events.
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The initial care of the patient with blunt polytrauma involves a systematic search for causes of hemodynamic instability. Bleeding most often occurs in the pleural space, peritoneal cavity, and retroperitoneum. Orthopaedic injuries also can contribute to instability after blunt trauma. ⋯ However, optimal care typically involves a coordinated multispeciality approach that sometimes includes concurrent operative procedures. Patients with severe physiologic derangements may require damage control techniques to decrease blood loss and operative time. Understanding the overall care of patients who are injured critically will facilitate the integration of the orthopaedic surgeon into the trauma team.