Clinical orthopaedics and related research
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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
Review Comparative StudyPulmonary aspects of treatment of long bone fractures in the polytrauma patient.
During the past decade, there have been significant advances in the treatment of long bone fractures in the polytraumatized patient. The major controversy in this area is whether definitive long bone stabilization needs to be done emergently. ⋯ The major benefits of fixation are: (1). improve mobilization to enhance pulmonary function; (2). decreased narcotic requirements with improved pain control after fixation; and (3). early aggressive fluid resuscitation associated with operative intervention. Patients with multisystem injury who are underresuscitated or are unstable should have early external fixation because temporizing skeletal stabilization until definitive fixation can be done.
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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 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 StudyThe treatment of fractures of the femur in patients with head injuries. 1973.