摘要:

BackgroundAmong developed nations, the United States has the highest rate of civilian gun ownership, and the highest homicide rate. We examine whether the United States is merely an exception, or if a relationship between gun availability and homicide exists across all developed nations.MethodsHomicide rates for the early 1990s come from 26 of 27 of the highly industrialized or high-income countries with greater than 1 million population as classified by the World Bank. Two common proxies for gun availability are used, the percentage of suicides with a firearm, and the“Cook index,” the average of the percentage of suicides with a firearm and the percentage of homicides with a firearm.ResultsIn simple regressions (no control variables) across 26 high-income nations, there is a strong and statistically significant association between gun availability and homicide rates.ConclusionAcross developed countries, where guns are more available, there are more homicides.

ISSN:0022-5282    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

BackgroundUnstable pelvic ring disruptions are often associated with significant morbidity and mortality, especially in patients with multiple injuries. Early pelvic fixation provides stability and should diminish ongoing hemorrhage. A simple anterior single-pin pelvic external fixator can be applied rapidly and accurately to stabilize pelvic ring injuries as a part of the initial patient resuscitation of such patients. Simple anterior pelvic external fixation (SAPEF) frames can be used as either temporary, definitive, or supplementary fixation depending on the pelvic injury pattern.MethodsOver a 32-month period, 41 patients with unstable pelvic ring disruptions were stabilized using a simple anterior pelvic external fixator. Eight patients had open pelvic ring injuries and 13 others had genitourinary system disruptions. Fluoroscopic imaging was used to insert all of the fixation pins into the iliac crest between the iliac cortical tables to a depth of at least 5 cm. Each patient had closed manipulative reduction of the pelvic ring using external methods before SAPEF application.ResultsOne patient died less than 24 hours after injury because of torrential hemorrhage. Clinical evaluations and serial radiographs, including postoperative computed tomographic scans, were available for the other 40 patients postoperatively. Seventy-five of the 80 (94%) pins were completely contained between the iliac cortical tables, according to the computed tomographic scans. The initial pelvic closed reductions were maintained until the fixators were removed in 37 of 40 patients (93%). Only one deep pin track infection developed, mandating early frame removal and intravenous antibiotic therapy.ConclusionSimple anterior pelvic external fixation can be applied rapidly using fluoroscopic guidance to direct accurate pin insertion and closed manipulative reduction of the pelvis. Depending on the specific pelvic ring injury pattern and clinical scenario, SAPEF can serve as a resuscitative temporary fixation device, as definitive pelvic treatment, or as a supplement for pelvic internal fixation implants.

ISSN:0022-5282    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

BackgroundIn treatment of pertrochanteric femoral fractures with dynamic hip screws (DHSs) (135-degree, Synthes, Bettlach, Switzerland), damage was observed in removed lag screws, leading to the conclusion that the gliding mechanism must have been obstructed as a result of either inappropriate position of the implant or insufficient medial support in the fracture zone.MethodsThe forces and moments transmitted in the screw socket are calculated using a mathematical model to find the optimal position of the implant.ResultsThe forces and moments depend on the position and orientation of the lag screw as well as on the position of the contact point between the two main fragments. By changing the point of contact, a better decrease of the load to the DHS can be achieved than by changing the position and orientation of the screw. For a low contact point, the model shows the lowest values for the forces in the socket.ConclusionComplete agreement was found between the results of the presented calculations and our own clinical experience in removed DHSs.

ISSN:0022-5282    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:0022-5282    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

BackgroundFactors influencing the progression of physical impairment to patient-perceived disability are not well known. We sought to better understand this relationship in the setting of injury.MethodsWe followed a cohort of 302 patients with lower extremity fractures over a 1-year period. Physical impairment was assessed by range of motion, strength, and pain. Range of motion and strength were assessed together as a proportion of normal function of the extremity (impairment score). Pain was assessed using a Visual Analogue Scale (VAS) pain score. Disability was assessed using the Sickness Impact Profile (SIP), a widely used measure of patient-perceived limitations of everyday activities attributable to illness. The SIP was administered during hospitalization to assess preinjury baseline. Impairment assessment and readministration of the SIP were performed at 12 months after injury.ResultsImpairment in leg function (range of motion and strength) was highly correlated (p< 0.001) with overall SIP score at 12 months, but accounted for only 23% of the variance in overall SIP scores. Likewise, VAS pain score was highly correlated (p< 0.001) with overall SIP score at 12 months, but accounted for only 29% of the variance in overall SIP scores. In a multivariate linear regression analysis, variables that were independently associated with overall SIP score included impairment score, VAS pain score, preinjury SIP, poverty status, education status, social support, having hired a lawyer, and involvement with workers’ compensation. These variables accounted for 52% of the variance in overall SIP scores at 12 months.ConclusionThe degree of physical impairment accounts for only a small amount of the variance in disability from lower extremity fracture. Identifiable patient characteristics including age, socioeconomic status, preinjury health, and social support together with impairment account for over half of the variance in long-term disability. Further research is needed to increase understanding of other factors that influence the progression of impairment to disability, especially those factors that may be amenable to intervention.

ISSN:0022-5282    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

BackgroundSoft tissue reconstruction around the ankle has been a challenging problem. This article reports our experience using the extensor digitorum brevis muscle flap; some technical variations are discussed.MethodsThe extensor digitorum brevis muscle flap is vascularized by the well-defined lateral tarsal artery, a branch of the dorsalis pedis artery originating at the level of the inferior extensor retinaculum. This flap was used for coverage of soft tissue defects in the lower leg and the ankle in 10 patients with various injuries.ResultsAll flaps survived completely. Complications included delayed healing of donor skin in two cases. Flap elevation was possible even in the traumatized donor foot.ConclusionThe advantages of this flap include constant and reliable blood supply, easy and rapid flap dissection, adequate bulk, and one-stage procedure. However, disadvantages include the small size of the flap and the sacrifice of the dorsalis pedis artery.

ISSN:0022-5282    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

BackgroundSevere, high-energy, periarticular elbow injuries producing a “floating joint” are a major surgical challenge. Their reconstruction and rehabilitation are not well documented. Therefore, the following reports our experience with treating such injuries caused by war wounds.MethodsSeven adults with compound open peri- and intra-articular elbow fractures were treated in hybrid ring tubular fixation frames. After debridement, bone stabilization, and neurovascular reconstructions, early controlled daily movements were started in the affected joint.ResultsThese seven patients had together seven humeral, five radial, and six ulnar fractures. All fractures united at a median time of 180 days. No deep infection developed. The functional end results assessed by the Khalfayan functional score were excellent in two, good in one, and fair in four of these severely mangled upper extremities. None was amputated.ConclusionsThe Mangled Extremity Severity Score has been shown to be unable to provide a reliable assessment for severe high-energy limb injuries surgically managed with the modular hybrid thin wire tubular external fixation system. This hybrid system is a very useful addition to the surgical armamentarium of orthopedic trauma surgeons. It both allows complex surgical reconstructions and reduces the incidence of deep infections in these heavily contaminated injuries. The hybrid circular (thin wire) external fixation system is very modular and may provide secure skeletal stabilization even in cases of severely comminuted juxta-articular fractures on both sides of the elbow joint (floating elbow) with severe damage to soft tissues. This fixation system allows individual fixation of forearm bone fractures, thus allowing the preservation of pronation-supination movements.

ISSN:0022-5282    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

BackgroundIn a recent study of fatal chest impacts by baseballs, 28% of the children were wearing a chest protector. This study evaluates the effectiveness of chest protectors in reducing the risk of commotio cordis.MethodsFive commercially available chest protectors were placed on a three-rib structure simulating the chest and impacted at 40, 50, 60, and 70 miles per hour by a standard baseball. Ten repeated tests were conducted on each vest in random order, and on the control (unprotected chest). The viscous response (or viscous criterion [VC]) was used to assess differences in fatality risk.ResultsOne vest had a statistically lower VC (average, 50.6%,p< 0.05) for all impact speeds. Three averaged 18.7% to 27.7% lower VC, but were significantly different only at higher speeds. One vest had an average 34.2% higher VC, and was significantly higher at 40 to 50 miles per hour (p< 0.05). A method was proposed linking laboratory test results to real-world incidents of ventricular fibrillation.ConclusionsThe majority of commercially available chest protectors fail to provide consistent reductions in commotio cordis risk. Nonetheless, there are benefits from their use in baseball until improved safety equipment is developed and standard tests are established to assess sport equipment effectiveness.

ISSN:0022-5282    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

BackgroundTo determine the role of physical examination, chest radiography, and angiography in the management of periclavicular penetrating trauma.MethodsA retrospective review of the last 100 patients who suffered periclavicular penetrating trauma was performed. Patients with hard signs of vascular injury went either directly to the operating room or first to the angiography suite depending on their hemodynamic stability. All others underwent angiography and subsequent intervention if needed. The results were examined to determine the role of arteriography in the absence of hard signs of vascular injury.ResultsOf the 100 patients in the study, there were 81 without hard signs of vascular injury. All underwent angiography, with 11 “occult” injuries discovered. Each of these patients exhibited some physical examination or chest radiographic finding that may have predicted the presence of vascular injury. Using clinical criteria, physical examination was found to have a sensitivity of 82%, a specificity of 91%, a positive predictive value of 60%, and a negative predictive value of 96%. When coupled with the chest radiographic findings, these numbers were 100%, 80%, 44%, and 100%, respectively. Using these criteria would have eliminated the need for angiography in 56 (69%) patients and would not have missed any injuries.ConclusionsIn patients with periclavicular penetrating trauma, a normal physical examination and chest radiographic excludes vascular injury. Proximity alone does not warrant angiography, although the test may be useful for therapeutic interventions or to plan operative approaches. A prospective study is essential to validate these findings.

ISSN:0022-5282    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

BackgroundSignificant blood loss continues to plague early tangential excision of the burn wound. Although various techniques to reduce intraoperative blood loss have been described, there is an absence of uniformity and consistency in their application. Furthermore, it is unclear whether these techniques compromise intraoperative tissue assessment and wound outcome. The purpose of this study was to evaluate the effects of a comprehensive intraoperative blood conservation strategy on blood loss, transfusion requirements, and wound outcome in burn surgery.MethodsAn intraoperative blood conservation strategy (CONSV) that included donor site and burn wound adrenaline tumescence, donor site and excised wound topical adrenaline, and limb tourniquets was prospectively evaluated and compared with a historical control group (HIST) where only topical adrenaline and thrombin were applied to donor sites and excised wounds.ResultsEstimated blood loss was reduced from 211 ± 166 mL per percentage body surface area excised and grafted in the HIST group to 123 ± 106 mL in the CONSV group (p= 0.02). Similarly, the intraoperative transfusion requirement in the HIST group was reduced from 3.3 ± 3.1 units per case to 0.1 ± 0.3 units per case in the CONSV group (p< 0.001). There was no compromise in wound outcome in the CONSV group, which had a mean skin graft take rate of 96 ± 4.2%.ConclusionThe application of a strict and comprehensive intraoperative blood conservation strategy during burn excision and grafting resulted in a profound reduction in blood loss and transfusion requirements, without compromising wound outcome.

ISSN:0022-5282    

出版商:OVID    

年代:2000

数据来源: OVID