摘要:

Sixty-two patients underwent resection of the distal ulna because of pain or limited motion after wrist trauma. The median length of resection was 23 mm. Injury to the distal radioulnar joint occurred primarily during fractures of the distal radius. Followup time averaged 87 months. The primary surgical indication was pain, but some procedures were performed in an effort to increase motion. All patients improved after surgery. Three patients had residual pain, 25 had mild pain, and 34 had no pain. Supination was greatly improved, with only modest improvement in other wrist motions. Four patients developed ulnar translation of the carpus (from 1 to 3 mm). Pseudoarticulation and ulnar regrowth of the carpus were noted, but neither pseudoarticulation nor regrowth was clinically symptomatic. Grip strength improved significantly after surgery, the average from 45.3 to 78.9% of the unaffected wrist. The presence or absence of radiocarpal arthritis preoperatively had no significant effect on the patients' estimates of results. Overall, 51 patients (82%) had satisfactory results. The primary gains were pain relief, increased supination, and increased strength.

ISSN:0022-5282    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

Calcium balances in ten enterally or parenterally hyperalimented trauma victims were compared as protein intake was manipulated from 50.5 ± 12.8 to 128.0 ± 17.4 gm/day during an isocaloric metabolic balance study. Calciuresis increased as protein intake increased in all subjects, resulting in an average reduction in daily calcium balance of 195 ± 65 mg/day (p< 0.001). There was no difference in fecal calcium in the enterally fed subgroup. Total and “corrected” total serum calcium were lowered, and indirect evidence suggests that ionized calcium was lowered as well. The mechanism of the increase in urinary calcium is not fully elucidated, although it appears to be a direct effect on the kidney rather than an indirect influence of calcium homeostasis. It is suggested that a calorie/nitrogen ratio of about 360 be maintained in enteral and parenteral alimentation of trauma victims. Thus nitrogen balance can be maintained by the increased nonprotein calorie availability, and possible complications of increased calcium mobilization and excretion can be avoided.

ISSN:0022-5282    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

Intramuscular tissue pO2, pCO2, and pH were monitored distal to a pneumatic tourniquet in a dog hindleg preparation. A severe state of tissue hypoxia, hypercarbia, and acidosis was quantitated. The recovery time for tissue gases following release increased with increasing tourniquet time. Elevated c.p.k. and lactic acid values were noted at 2 hours of ischemia, reflecting the muscle changes at that time. Histologic sections revealed early signs of degeneration by 1 hour which progressively increased with increased tourniquet ischemia. On the basis of this study, we conclude that ischemia should not exceed 1 to 1½ hours if significant pathophysiologic tissue changes are to be avoided. If longer time is required, intermittent release of the tourniquet for 10 minutes at the end of each hour of inflation will avoid complications.

ISSN:0022-5282    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

The effects of thermal injury on circulation, respiration, and complement activity was studied in dogs. An aggregation of platelets in the blood and trapping in the lung were observed following burn injury. Leukopenia appeared first, then leukocytosis. Hemolysis of red cells corresponding to a destruction of about 30% of the erythrocytes was observed. A blood pressure decrease and a tracheal insufflation pressure increase followed thermal injury. Blood gas and lactate changes like those seen during a low perfusion state were recorded, but signs of impaired oxygenation of arterial blood were also observed. A possible mechanism by which denatured proteins might initiate some of the symptoms seen after thermal injury is suggested and its relation to complement activation is evaluated.

ISSN:0022-5282    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

In ten patients with a femoral shaft fracture, arterial plasma amino acids and glucagon, blood glucose, and serum insulin were measured after an overnight fast on the third, fifth, and seventh days following injury. Ten normal subjects were controls. On all days, concentrations of the key glucogenic amino acid, alanine, were the same in both groups, but levels of another glucogenic amino acid, glycine, were significantly less in the fracture patients. Other amino acid changes following injury were maximal at 7 days, with significant elevations of phenylalanine, methionine, tyrosine, ornithine, lysine, arginine, valine, isoleucine, and leucine. Increased levels of insulin, glucose, valine, isoleucine, and leucine on the fifth and seventh days after injury implied insulin resistance.Plasma glucagon was elevated on the third (p< 0.05) and seventh (p< 0.01) days after injury, but the concentrations measured are insufficient to explain the impaired carbohydrate tolerance following a fracture.

ISSN:0022-5282    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

The records of 50 patients having thoracic aortic aneurysms and a remote history of severe chest trauma were reviewed. Time intervals between thoracic trauma and operation varied from 3 months to 32 years (average, 11.9 years). In 25 patients (50%) this interval was greater than 10 years and in six (12%) greater than 20 years. Surgical correction was accomplished with low mortality and morbidity. Detection and diagnosis of chronic traumatic thoracic aortic injuries may not become clinically evident in some cases for many years. This diagnosis should be considered in all patients with a history of severe thoracic trauma, no matter how remote.

ISSN:0022-5282    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

A series of 70 consecutive patients with pertrochanteric fractures of the femur treated by condylo-trochanteric (C-T) nailing is reported. Patients' ages ranged from 54 to 96 years, and they were followed up for 4 to 32 months. The mortality rate was 1.4%, and the overall complication rate among survivors 20.3%, but all complications were minor and transient. The fracture healed in every case, and the functional and anatomic results were good. The results are thought to be due to the superiority of indirect methods of fixation, which are in general technically easy and involve no major surgical intervention. This fact is highly favorable in this group of elderly and frail patients, among whom a major osteosynthesis would certainly carry a risk of high operative mortality.

ISSN:0022-5282    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

Twenty-four of 576 consecutive patients with spinal cord injuries developed acute gastroduodenal ulceration and hemorrhage. Twenty-two were males and two were females: 88% were 12 to 25 years old. Seventeen patients sustained injuries to the spinal cord in sports and recreation related activities. Twenty-three patients had lesions of the spinal cord above the sympathetic outflow. Twenty patients developed gastroduodenal perforation or bleeding within 4 weeks following the injury. Ten patients developed perforation of gastric or duodenal ulcer and “shoulder tip” pain was a symptom of perforation in six patients. Six patients of seven who had gastroscopy and upper GI series were found at laparotomy to have ulcers. Gastric (nine) and duodenal (seven) ulcers were evenly distributed. There were no deaths due to gastroduodenal hemorrhage in the present series. A single cause for the pathogenesis of gastroduodenal ulceration and hemorrhage cannot be pinpointed. However, ischemia of gastric mucosa produced in various ways and altered equilibrium between the parasympathetic and sympathetic neural pathways following trauma to the spinal cord seem to be important in initiating the process.

ISSN:0022-5282    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

An experimental study in 39 ankles of the mechanisms of lateral ankle sprains was carried out using a simple qualitative apparatus. The mechanisms studied were: 1) supination-inversion, which was divided into ankle in plantar flexion and ankle in neutral position, since the orientation and tension of the ankle capsule and ligaments are related to the ankle position; 2) supination-internal rotation; and 3) supination-plantar flexion. Fresh amputation specimens were used. It was concluded that complete rupture of the anterior fibulotalar ligament is always the first lesion to occur in the lateral ankle sprain except when a supination force is applied to the ankle in neutral position when an incomplete tear of the fibulocalcaneal ligament may precede the total rupture of the anterior fibulotalar ligament. A partial rupture of the anterior deep fibers of the deltoid ligament can occur in extreme degrees of internal rotation or plantar flexion. A four-part grading system is suggested.

ISSN:0022-5282    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

Six cases of complete occlusion of the main renal artery and one case of incomplete renal artery occlusion secondary to blunt abdominal trauma are reported, and the literature reviewed. The reported cases are analyzed as to clinical and radiographic findings, and mechanism of injury.Left renal artery occlusion occurs due to intimal fracture secondary to deceleration forces on the abdomen. Right renal artery occlusion results from direct epigastric trauma and compression of the artery against the vertebral column. An intravenous urogram with nonvisualization of the affected kidney should lead to immediate angiography.Arteriography is diagnostic, showing abrupt occlusion of the renal artery several centimeters beyond its origin, or before occlusion, an intimal flap.

ISSN:0022-5282    

出版商:OVID    

年代:1979

数据来源: OVID