摘要:

One hundred eight femoral shaft fractures in one hundred six adults were treated by closed intramedullary interlocked nailing. Ninety-two fractures were severely comminuted and 16 fractures were segmental. The procedures were done with the patients in the supine position. A modification of the cylinder guide for fixation of the distal screws is described. All the fractures healed in an average of 18 weeks (range, 12–24 weeks). Dynamization was performed in 15 fractures. There were two postoperative complications, which did not ultimately affect the clinical results. No infections or delayed unions were observed. Closed intramedullary interlocked nailing seems to be the treatment of choice for comminuted and segmental fractures of the femoral shaft provided that all the technical details are followed by the surgeon.

ISSN:0022-5282    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

The pin-bone interface is the weakest link in the mechanical stability of external skeletal fixation. In this investigation, a canine model was used to characterize the nature of cortical bone reactions at the pin-bone interface. Unilateral external fixators were applied to the tibiae of 61 dogs using six tapered cortical half-pins. The pins were inserted after predrilling both cortices, and pin insertion torque was measured. A transverse or oblique osteotomy was performed in each tibia and stabilized under different gap conditions. Unrestricted weight bearing was allowed immediately after surgery. Sequential functional evaluations of the animals and biweekly roentgenograms of the pin tracks were done. Pin removal torques were recorded at the time the animals were killed at different time periods. Pin tracks were analyzed using quantitative tetracycline histomorphometry and microradiography. The results showed that cortical bone undergoes extensive creeping substitution around external fixation half-pins. New bone accounted for approximately 43% of the intracortical space along the pin track, and cortical bone porosity showed a fourfold increase compared with intact bone value. This cortical bone remodeling resulted in a timerelated decrease of pin removal torque (p< 0.001). In inherently unstable oblique osteotomies, and less in stable rigidly fixed transverse osteotomies, immediate postoperative weight bearing caused bone thread resorption and adverse cortical bone remodeling at the entry cortex of external fixation half-pins. The unicortical loosening of half-pins that became evident during the first month of fixation obviously represents a consequence of micromotion and local bone yielding failure caused by high dynamic stresses of the pin-bone interface. Effective precautions should be taken to reduce such stresses.

ISSN:0022-5282    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

BackgroundControl of motor vehicle-related injuries depends upon passage of mandatory safety belt and other injury control laws. Unfortunately, state legislators often oppose these laws.MethodsIn 1988, a 62-item questionnaire was mailed to the 97 Colorado legislators who voted on a 1987 safety belt law to identify factors (knowledge, experiences, attitudes, and beliefs) associated with “yes” and “no” votes. To test for associations between these attributes and the legislators' recorded votes, odds ratios (OR) and 95% confidence intervals (Cls) were calculated. A stepwise logistic regression identified independent predictors of “vote.”ResultsFifty-three (55%) of the legislators responded. Responders and nonresponders were demographically similar. “Vote” was not associated with age; sex; having young children in the family; perceived injury risk; recent traffic tickets; family or personal crash experience; or knowledge of the fatality risk reductions attributable to wearing safety belts. Ninety-six percent of the legislators knew that safety belts reduce the risk of death and 87% believed a safety belt law would save lives. The strongest predictors of a “yes” vote were impression that constituents favored the law (OR=31, CI 95=3.5, 270); belief that a mandatory safety belt law will save lives (OR=20, CI 95=2.1, 203); and “extreme” importance paid in the voting decision to effectiveness of the law in reducing deaths (OR=19, CI 95=3.5, 107). Legislators who considered restrictions on individual freedoms an “extremely” important decision criterion were 43 times (CI 95=7, 267) more likely to vote “no.” In the logistic model only extreme importance assigned to individual freedoms (beta=-3.7; OR=.025;p=0.002) and policy effectiveness (beta=+3.1; OR=22;p=0.01) predicted “vote.” The logistic model correctly predicted 90% of legislators' votes.ConclusionsIn this study the strongest predictors of voting behavior were concern for individual freedoms, perceived constituents' support and attention paid to policy effectiveness. Those seeking to persuade legislators to vote for mandatory safety belt laws must pay attention to attitudes and values in addition to scientific facts.

ISSN:0022-5282    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

This article, part of a recently completed research project on safety belts, presents results on neck injuries. A total of 3927 injured front-seat occupants (drivers and passengers) involved in two-car crashes were studied. Among them, 725 sustained neck sprains (ICD-9 code 847.0); some of them may have sustained other injuries as well. The more serious injuries to the cervical spine were more prevalent among the unbelted occupants. Neck sprains were relatively more numerous among belted occupants compared with unbelted ones, with a relative risk estimate of 1.68. Similar results hold also for subsets of the data on different types of collisions; the relative risks ranged from 1.39 to 2.42. A log linear model was constructed for the odds ratio (neck sprain vs. no neck sprain) taking into account the following factors: (1) seatbelt use, (2) direction of impact, (3) authorized speed limit, and (4) vehicle weight. The resulting relative risk estimate (belted vs. unbelted) became 1.58. The results raise questions about seatbelts and their protection against neck sprains.

ISSN:0022-5282    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Treating casualties in a chemically hazardous environment constitutes a unique problem. Physical protection of the medical personnel may impair their performance and potentially affect patients' prognoses. The present study examined the effect of prolonged physical protection on the accomplishment of medical tasks related to trauma management. Sixty one emergency medical technicians, acclimatized to operating in protective gear, underwent four rounds of testing during eight hours of continuously wearing either a chemical protective suit or regular fatigues. The quality of the designated medical tasks, including sterility, was maintained throughout the study. A significant reduction in speed of performance was noted (∼30% slowing,p< 0.0001 in multivariate analysis) because of protective clothing. There was no additional decrement in performance following a prolonged stay in the protective gear. We conclude that in a chemically contaminated area, fully protected medical personnel are capable of treating trauma patients reasonably well, and for a relatively long period of time. The importance of pretraining and proper instruction is emphasized.

ISSN:0022-5282    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

A case of acute closed brain trauma is presented in which the patient developed a right middle cerebral artery infarction, while frequent measurements of the arteriojugular lactate difference (AVDL) remained normal, failing to disclose ischemia. To our knowledge, this is the first report on sequential AVDL measurements during evolving cerebral infarction.

ISSN:0022-5282    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

A case history of a young man with a bowing fracture of the forearm is presented. The fracture was reduced and stabilized using shortened Ender's nails. Both soft tissues and fractures healed uneventfully and complete restoration of function resulted.

ISSN:0022-5282    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

A method of reconstructing a chest wall defect following non-guided air-to-surface missile injury is described. The wall defect was simply closed with a polytetrafluoroethylene patch. The high risk of infection following use of the described method is well recognized. No infection occurred in this case. It could be stated that under the exigencies of the moment the use of prosthetic material to reconstruct the chest is not invariably followed by infection. However, when the patient is stable this latter problem can then be addressed by a variety of standard methods. It is concluded that the described method is particularly suitable in war circumstances, when it is usually necessary to attend to a large number of patients in a short period of time.

ISSN:0022-5282    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

We report a case of a gunshot wound to the lower abdomen in which a 22-caliber bullet was lodged in the bladder and was subsequently voided with no genitourinary consequences.

ISSN:0022-5282    

出版商:OVID    

年代:1993

数据来源: OVID

ISSN:0022-5282    

出版商:OVID    

年代:1993

数据来源: OVID