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

摘要:

An analysis of the number of gunshot wound victims seen at a Los Angeles County Hospital both before and after the Los Angeles riot of 1992 was undertaken. Since the riot, the gang truce between the “Bloods” and the “Crips” has resulted in a significant decrease in the number of gunshot wound victims seen at a level I trauma center in Los Angeles.

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

摘要:

Fractures of the femur caused by gunshots are increasingly common. There is no standard treatment of these fractures since there are no clear guidelines relating these injuries to open fracture classification. We reviewed our experience with such fractures, which included 65 patients who had an immediate reamed intramedullary nail placed as treatment. The soft-tissue injury, vascular injury, missile velocity, and length of hospital stay were evaluated. We found that all patients healed with no infections. The overall morbidity and average hospital stay were decreased compared with studies advocating delayed intramedullary nailing and prolonged intravenous antibiotics. We recommend that patients with fractures of the femur caused by gunshots are candidates for immediate reamed intramedullary nailing providing that there is only mild to moderate soft-tissue contamination and no evidence of major devitalization.

ISSN:0022-5282    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Eighty-one patients with comminuted femoral shaft fractures were treated by closed unlocked Küntscher nailing and functional cast bracing for 1 to 4 weeks postoperatively depending on the degree of comminution. The mean follow-up period was 27.6 months. The average time required for fracture healing was 14 weeks. There was one delayed union. One fracture united with more than 10 degrees of rotational malalignment; shortening of more than 1 cm was present in four cases. Two patients had more than 20 degrees of limitation of hip and knee movement.

ISSN:0022-5282    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

From January 1987 through December 1990, 28 consecutive distal tibial complicated open fractures in adults treated with primary external fixation and secondary closed Grosse-Kempf interlocking nails were prospectively studied and followed up for at least 1 year. All fractures were type IIIb open fractures and local soft-tissue coverage was performed at 3 to 5 days. The external fixation was maintained for an average of 22 days. The closed interlocking nails were inserted about 2 weeks after Hoffmann pins were removed. The results revealed a union rate of 85.7% (24 of 28) with a period to union of 5.8±1.4 months. Complications included 14.3% nonunion rate and a 7.2% deep infection rate, which were not difficult to treat. We conclude that secondary closed interlocking nailing is a simple and effective technique in treating distal tibial complicated open fractures.

ISSN:0022-5282    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Transverse process fractures of the cervical vertebrae have been considered rare and insignificant. In a retrospective study of 216 patients with cervical fractures evaluated by plain films and computed tomography, we found that transverse process fractures were common. Transverse process fractures were present in 24% of patients with cervical fractures and accounted for 13.2% of all cervical fractures. Cervical radiculopathy and brachial plexus palsy were present in 10% of patients with transverse process fractures. In 78% of transverse process fractures, CT scanning showed that the fracture extended into the transverse foramen. Vertebral angiography, performed in eight patients with fractures involving the transverse foramen, showed dissection or occlusion of the vertebral artery in seven (88%) instances. Two of these seven patients had clinical evidence of vertebral-basilar artery stroke. Vertebral angiography should be considered when patients with transverse process fractures extending into the transverse foramen develop signs and symptoms of vertebral-basilar artery insufficiency.

ISSN:0022-5282    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

From a review of the literature and in the authors' practice, fractures of the hook of the hamate (hamulus) are rare and commonly not identified in the acute phase. When fractures are found initially, plaster immobilization has resulted in healing in 46% of cases. However, excision has given a good result when selected in 42% of acutely treated fractures. The method of treatment chosen depends on the lifestyle requirements of the patient.

ISSN:0022-5282    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

The relationships of hormonal mediators to the systemic hypermetabolism and catabolism of head injury were studied in 15 patients with severe head injuries. Resting energy expenditure (REE), urinary nitrogen balance, and plasma glucose concentration were measured daily for the first 2 weeks after injury as the major indicators of hypermetabolism. These dependent variables were correlated with daily measurements of urinary epinephrine, norepinephrine, metanephrine, normetanephrine, dopamine, and cortisol, and with plasma levels of insulin, glucagon, and C-reactive protein. Urinary catecholamine and cortisol excretion were markedly elevated in these patients throughout the 2 weeks of study. Catecholamine excretion peaked between days 7 and 10, whereas cortisol excretion tended to be highest on day 5 after injury. Urinary levels of norepinephrine, normetanephrine, and cortisol were highest in the two patients with Glasgow Coma Scale scores of 4. Plasma insulin and glucagon concentrations were elevated on day 1 after injury and tended to increase throughout the 2-week period of study. The variables significantly associated with REE were the severity of injury, reflected by the GCS score, the urinary excretion of norepinephrine during the first 2 days after injury, and the urinary excretion of epinephrine and norepinephrine during days 3 to 7 after injury. A negative nitrogen balance was associated with the urinary excretion of epinephrine and norepinephrine, with caloric balance, and with plasma C-reactive protein during days 1 and 2 after injury. During days 3 to 7, a negative nitrogen balance was associated with the urinary excretion of epinephrine and norepinephrine and with caloric balance, and during days 8 to 14, a negative nitrogen balance was associated primarily with urinary cortisol excretion.

ISSN:0022-5282    

出版商:OVID    

年代:1993

数据来源: OVID