摘要:

Twenty-five civilians with combined neurovascular and musculo-skeletal trauma to 27 extremities were studied retrospectively. The mechanism of injury was crushing in 16, avulsion in six, and penetrating in three. Autogenous saphenous vein was used to restore arterial circulation in the majority. Nine patients had concurrent repair of venous injuries. Fractures were immobilized by a variety of techniques, the Hoffman external skeletal fixation being preferred. Immediate fasciotomy was performed in five patients and delayed fasciotomy in four. All patients had soft-tissue debridement and initial wound closure with split-skin grafts as biologic dressings.Three immediate amputations were the result of irreversible neurovascular and soft-tissue trauma. Sepsis played a role in three late amputations; delayed primary treatment, irreversible neurologic injuries and extensive soft-tissue damage contributed. A carefully individualized multidisciplinary approach resulted in salvage of 20 of 27 severely injured extremities.

ISSN:0022-5282    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

Although most reports of civilian gunshot injuries consist mainly of wounds inflicted by handguns, shotgun wounds deserve special consideration. Longrange shotgun wounds rarely pose a problem; however, medium- and closerange wounds of the penetrating and perforating type may inflict substantial soft-tissue loss, bone defects and comminution, and loss of nerve and vessel continuity. Because of the complex and multiple system involvement by shotgun wounds, a greater challenge exists to obtain a successful, functional result. The challenge is most appropriately met by an aggressive approach of early operative exploration and debridement of the wound, internal stabilization of the bony fragments, vascular repair when indicated, and exploration and identification of nerve deficits, followed by an early wound closure.

ISSN:0022-5282    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

It has been suggested that patients sustaining blunt chest injury severe enough to result in significant bony injury to the thorax may have traumatic aneurysms of the thoracic aorta in the absence of a widened mediastinum on plain film. To test the validity of this hypothesis, we performed aortograms on 14 patients with severe blunt chest injury but an otherwise normal chest X-ray. None of these patients was found to have an aortic injury. By contrast, of 21 patients with severe chest injury and a widened mediastinum who underwent thoracic aortography eight were found to have traumatic aneurysms of the thoracic aorta. These results suggest that in the absence of a widened mediastinum, severe chest wall injury is not an indication for aortography.

ISSN:0022-5282    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

This report presents three studies of post-traumatic pulmonary insufficiency (PTPI). In the first no significant pulmonary hemodynamic or ventilatory changes in severely shocked baboons resuscitated with shed fresh blood or stored blood were observed over 48 or 84 hours. Second, a post-mortem study of patients receiving more than 5 units of blood within 24 hours of death showed some microemboli in the lungs in about two thirds. Patients with multiple microthrombi had received an average of 20.6 units of blood; patients with some or no microemboli 15.5 and 6.3, respectively. Third, in a review of the respiratory complications of 153 multiple-trauma patients, it was shown that the formerly severe problems with PTPI were now well managed clinically, that persistent respiratory failure was now occurring much later after injury, and occurred almost exclusively in patients with sepsis.Relation of the above data to previous reports in the literature led to the conclusion that the clinical significance of microaggregates in stored blood, if any, is low, and that ultrafiltration to remove microemboli only makes sense if it does not impede the rate of blood infusion and does not increase cost.

ISSN:0022-5282    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

The frequency of supraorbital rim fractures is increasing as incidence of motorcycle and bicycle accidents increases. These fractures are frequently depressed, comminuted, and often extend into the frontal sinus. Open reduction and internal fixation are the treatment of choice. Adequate debridement and cleansing with preservation of periosteum and blood supply are recommended. Unstable fragments can be fixed to the frontal bone or stabilized by suturing the torn periosteum. Severely comminuted supraorbital frontal sinus fractures may require stabilization via frontal sinus pack or balloon. We feel the latter is preferable and both Foley and Fogarty catheters have been successfully used.

ISSN:0022-5282    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

In a retrospective study of 82 subtrochanteric fractures of the femur in the St. Paul-Ramsey Hospital, there were 32 treated by traction, 50 by open reduction and internal fixation. In adults, 50% of those treated by traction had undesirable results using strict criteria for varus, shortening, and rotational deformity: 21% of those treated by operation had undesirable results due to varus, rotational deformity, medial migration of the distal fragment, and nonunion. Good results are related to stable reduction and individualization of a particular implant based on the fracture pattern, including reconstruction of the medial cortical wall, and close contact of the fracture fragments during healing. If reduction is not achievable, bone grafting and extra protection are required. If reduction can be predicted as not achievable, good results can be obtained with traction although the healing period is longer. In the presence of a residual gap in the medial surface of the femur in the region of the lesser trochanter, poor results are frequent.

ISSN:0022-5282    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

A 2-year survey of burn victims in a 15-county region was conducted to help define the need for a burn unit. There were 1,165 patients hospitalized for burn care; 58 patients were transferred; 32 to more sophisticated facilities, 15 out of state. The mean hospitalization rate was 33/100,000; 95/100,000 for persons under 2 years old. The 42 hospitals in the region treated an average of 14 burn patients each year. Scalds accounted for 39% of all burns and 85% of burns in children under 2. Burn-related deaths numbered 143; 4/100,000. House fires were responsible for 90 deaths.Despite incomplete records and the lack of firm criteria for burn severity, regional burn data describe the health care system, as it relates to burns, and identify high risk groups. The range in severity of thermal injuries is great; the quality of care provided is difficult to assess.

ISSN:0022-5282    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

Because of its flexibility and structure, the cervical spine is disposed to various mechanisms of injury: although not so common as injuries caused by head impacts, cervical fractures and/or fracture-dislocations have been reported without direct impact to the head. Some cervical injuries reported have been sustained by wearers of lap and shoulder belts in auto accidents; however, we do not consider belt use a potential hazard because ample evidence has accrued in the medical and engineering literature to document general injury and fatality reduction by use of seatbelts. We believe that in many instances occupants would be more seriously injured or killed were belts not worn.The present paper reviews reports of cervical injuries without head impact found in the literature and case histories of such injuries from the Highway Safety Research Institute of The University of Michigan, as well as experimental studies in animals, cadavers, and volunteer subjects.

ISSN:0022-5282    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

Thoracobiliary fistulas are rare complications of thoracoabdominal trauma, with high morbidity and potentially high mortality. Our experience with four cases and 12 other cases collected from the literature are reviewed. All patients were male and average age was 25 years. Five had blunt trauma, three had stab wounds, and eight, gunshot wounds. All had diaphragmatic and hepatic injuries. Bronchobiliary fistulas with biliptysis developed in seven patients. Fever, cough, chest and RUQ pains were the most common presenting symptoms. Pleural effusion and elevated right hemidiaphragm were the most common X-ray findings. Bile empyema developed in 2/3 of the patients. Early diagnosis, tube thoracostomy with adequate drainage of all subphrenic bilious collections, and secure closure of all diaphragmatic perforations are essential in successful management of most of these fistulas. Thoracotomy, however, is indicated in chronic and complicated fistulas, and should not be delayed beyond 3 weeks. Judicious use or appropriate antibiotics is a necessary adjunct to adequate surgical management of these fistulas. All 16 patients survived.

ISSN:0022-5282    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

A case is described of abdominal trauma and rupture of a left-sided liver in a patient with Kartagener's syndrome (situs inversus, bronchiectasis, sinusitis). Exploratory laparotomy, left thoractomy, cholecystectomy and hepatic artery ligation were necessary to control hemorrhage. Special attention was paid to the patient's respiratory condition postoperatively via physiotherapy and analgesia. The importance of identifying this three-part syndrome and especially the bronchiectasis is emphasized.

ISSN:0022-5282    

出版商:OVID    

年代:1978

数据来源: OVID