Articles: trauma.
-
We investigated mechanisms of axis ring fractures due to simulated head impacts. ⋯ We observed asymmetrical fractures of the axis ring including fractures of the superior and inferior facets, laminae, posterior wall of the vertebral body, pars interarticularis, and pedicles. The fracture patterns were related to the morphology of the axis as a transitional vertebra of the upper cervical spine. Understanding the mechanisms of axis ring fractures may help in choosing the optimal reduction technique and stabilization method based upon the specific fracture pattern.
-
Observational Study
Prehospital use in emergency patients of a laryngeal mask airway by ambulance paramedics is a safe and effective alternative for endotracheal intubation.
In Dutch ambulance practice, failure or inability to intubate patients with altered oxygenation and/or ventilation leaves bag-valve mask ventilation as the only alternative, which is undesirable for patient outcome. A novel Laryngeal Mask Airway Supreme (LMA-S) device may be a suitable alternative. ⋯ Ensuring ventilation support by using LMA-S by paramedics in prehospital emergency practice is safe and effective.
-
The purpose of this study is to determine whether discrepant patterns of horse-related trauma exist in mounted vs. unmounted equestrians from a single Level I trauma center to guide awareness of injury prevention. ⋯ This evaluation of trauma in mounted vs. unmounted equestrians indicates different patterns of injury, contributing to the growing body of literature in this field. We find interaction with horses to be dangerous to both mounted and unmounted equestrians. Intervention with increased safety equipment practice should include helmet usage while on and off the horse.
-
Lisfranc fracture-dislocation can be a devastating injury with significant long-term sequelae, including degenerative joint disease, progressive arch collapse, and chronic pain that can be potentiated if not effectively treated. We present a case to demonstrate our preferred surgical approach, consisting of combined medial column primary arthrodesis, middle column open reduction internal fixation, and lateral column pinning, with the primary goal of minimizing common long-term complications associated with Lisfranc injuries. We present the case of a typical patient treated according to this combined surgical approach to highlight our patient selection criteria, rationale, surgical technique, and operative pearls. ⋯ Lisfranc fracture-dislocations often exhibit primary dislocation to the medial column and are conducive to arthrodesis to stabilize the tarsometatarsal complex. The middle column frequently involves comminuted intra-articular fractures and will often benefit from less dissection required for open reduction internal fixation instead of primary fusion. We propose that this surgical approach is a viable alternative technique for primary treatment of Lisfranc fracture-dislocation injuries.
-
The purpose of this study was to quantify the incidence, patient profile, and outcomes associated with massive transfusion in paediatric trauma patients prior to establishing a massive transfusion protocol. ⋯ This study is the first to describe the incidence, complications, and outcomes associated with massive transfusion in paediatric trauma patients prior to a massive transfusion protocol. Massive transfusion occurred in 3% of patients and was associated with coagulopathy and poor outcomes. Protocols are needed to ensure that resuscitation occurs in a coordinated fashion and that patients are given appropriate amounts of fresh frozen plasma, platelets, and cryoprecipitate.