Current Issue : April - June Volume : 2015 Issue Number : 2 Articles : 6 Articles
Purpose The therapy of distal radial fractures in children\nis expected to be as non-invasive as possible but also needs\nto deliver the definite care for gaining optimal reduction\nand stabilizing the fracture. Therefore, closed reduction and\nimmobilization is competing with routine Kirschner wire\nfixation. The aim of our study was to investigate if closed\nreduction and immobilization without osteosynthesis can\nensure stabilization of the fracture.\nMethods We chose a retrospective study design and analyzed\n393 displaced distal radial fractures in children from\n1 to 18 years with open epiphyseal plates studying medical\nfiles and X-rays. The Pearsonââ?¬â?¢s ?2 test was applied. Statistical\nanalysis was performed using IBM SPSS Statistics\n20.0. Statistical significance was set at an alpha level of\nP = 0.05.\nResults Of these studied fractures 263 cases were\ntreated with closed reduction and immobilization. Only\n38 of these needed secondary interventions, 28 of these\nunderwent reduction after redisplacement and ten patients\nreceived secondary Kirschner wire fixation. The last\nfollow-up examination after 4ââ?¬â??6 weeks revealed that\n96.4 % of fractures initially treated with closed reduction\nand immobilization were measured within the limits\nof remodeling. 104 of the studied fractures were treated\nwith cast immobilization alone when displacement was\nexpected to correct due to remodeling. Here 22.1 % of\npatients needed secondary reduction. Furthermore, primary\nKirschner wire fixation was performed in only 25 children with unstable fractures and only one received\nfurther treatment. Interestingly, operative reports of primary\nclosed reduction revealed that repeated maneuvers\nof reduction as well as residual displacement are risk factors\nfor redisplacement.\nConclusion For the treatment of displaced distal radial\nfractures in children closed reduction and immobilization\ncan be considered the method of choice. However, for cases\nwith repeated reduction maneuvers or residual displacement\nwe recommend primary Kirschner wire fixation to\navoid redisplacement....
Background: The mechanism and outcome of traumatic abdominal injury (TAI) varies worldwide. Moreover, data\ncomparing TAIs in each abdominal compartment are lacking. We aimed to assess from the academic point of view,\nTAI based on its anatomical compartments.\nPatients & methods: We conducted a retrospective study for TAI patients between 2008 and 2011 in Qatar.\nPatients were categorized according to the involved anatomical compartment (C): intrathoracic (ITC), retroperitoneal\n(RPC), true abdomen (TAC), and pelvic abdomen (PAC) group. Chi Square test, One-Way ANOVA and multivariate\nregression analysis were appropriately performed.\nResults: Of 6,888 patients admitted to the trauma unit, 1,036 (15%) had TAI that were grouped as ITC (65%), RPC (15%),\nTAC (13%), and PAC (7%). The mean age was lowest in ITC (29 �± 13) and highest in TAC (34 �± 11) group, (P = 0.001).\nMotor vehicle crash was the main mechanism of injury in all groups except for PAC, in which fall dominated. Vast\nmajority of expatriates had PAC and TAC injuries. The main abdominal injuries included liver (35%; ITC), spleen (32%;\nITC) and kidneys (18%; RPC). Extra-abdominal injuries involved the head in RPC and ITC, lung in ITC and RPC and\nextremities in PAC. Mean ISS was higher in RPC and ITC. Abdominal AIS was higher in TAC injuries. Overall hospital\nmortality was 10%: RPC (15%), TAC (11%), ITC (9.4%) and PAC (1.5%). Concurrent traumatic brain injury (OR 5.3;\nP = 0.001) and need for blood transfusion (OR 3.03; P = 0.003) were the main independent predictors of mortality.\nConclusion: In addition to its academic value, the anatomical approach of TAI would be a complementary tool for\nbetter understanding and prediction of the pattern and outcome of TAI. This would be possible if further research\nfind accurate, early diagnostic tool for this anatomical classification....
Background: Although extensive research for the optimal treatment of clavicle fractures has been performed,\ncomparative studies between monotrauma and polytrauma patients are lacking.\nObjective: To compare fracture distribution and treatment in monotrauma and polytrauma patients with a\nclavicle fracture.\nMethods: Single center retrospective cohort study. Fractures were classified by the Robinson classification.\nMonotrauma patients sustained only a clavicle fracture or a clavicle fracture plus a minor abrasion, hematoma,\nor superficial skin lesion leading to an Injury Severity Score (ISS) of 4 or 5 respectively. Polytrauma patients had\nan ISS ?16 as a result of injury in 2 or more Abbreviated Injury Scale (AIS) regions.\nResults: 154 monotrauma and 155 polytrauma patients with a clavicle fracture were identified. Monotrauma patients\nhad a higher incidence of Type IIB fractures (displaced midshaft) compared to polytrauma patients (P = 0.002). No\ndifference was observed regarding Type I (medial) and Type III (lateral) fractures. In monotrauma patients, Type IIB\nfractures were treated operatively more frequently (P = 0.004). The initial treatment for Type I and Type III fractures\ndid not differ between monotrauma and polytrauma patients.\nConclusions: Monotrauma patients had a higher incidence of displaced midshaft clavicle fractures compared to\npolytrauma patients, and monotrauma patients with displaced midshaft clavicle fractures were treated operatively\nmore frequently. No differences were found in the distribution and treatment of medial and lateral clavicle fractures....
Introduction: Hepatic pseudoaneurysm (HPA) is a rare complication after liver trauma, yet it is potentially fatal, as it\ncan lead to sudden severe haemorrhage. The risk of developing posttraumatic HPA is one of the arguments for\nperforming follow-up CT of patients with liver injuries. The aim of this study was to investigate the occurrence of\nHPA post liver trauma.\nMethods: A retrospective study from 2000-2010 of conservatively treated patients with blunt liver trauma was\nperformed to investigate the incidence and nature of HPA. After the initial CT scan patients were admitted to the\ndepartment and if not clinically indicated prior a follow-up CT was performed on day 4-5.\nResults: A total of 259 non-operatively managed patients with liver injury were reviewed. 188 had a follow-up CT\nor US and in 7 patients a HPA was diagnosed. All aneurysms were treated with angiographic embolization and\nthere were no treatment failures. There was no correlation between the severity of the liver injury and development\nof HPA. 5 out of 7 patients were asymptomatic and would have been discharged without treatment if the protocol\ndid not include a default follow-up CT.\nConclusions: In conclusion, this study shows that HPA is not correlated to the severity of liver injury and it\ndevelops in 4% of patients after traumatic liver injury. In order to avoid potentially life-threatening haemorrhage\nfrom a post trauma hepatic pseudoaneurysm, it seems appropriate to do follow-up CT as part of the conservative\nmanagement of blunt and penetrating liver injuries....
Purpose Mortality prediction models for patients with\nperforated peptic ulcer (PPU) have not yielded consistent\nor highly accurate results. Given the complex nature of this\ndisease, which has many non-linear associations with outcomes,\nwe explored artificial neural networks (ANNs) to\npredict the complex interactions between the risk factors of\nPPU and death among patients with this condition.\nMethods ANN modelling using a standard feed-forward,\nback-propagation neural network with three layers (i.e., an\ninput layer, a hidden layer and an output layer) was used to\npredict the 30-day mortality of consecutive patients from a\npopulation-based cohort undergoing surgery for PPU. A\nreceiver-operating characteristic (ROC) analysis was used\nto assess model accuracy.\nResults Of the 172 patients, 168 had their data included\nin the model; the data of 117 (70 %) were used for the\ntraining set, and the data of 51 (39 %) were used for the\ntest set. The accuracy, as evaluated by area under the ROC\ncurve (AUC), was best for an inclusive, multifactorial\nANN model (AUC 0.90, 95 % CIs 0.85ââ?¬â??0.95; p\\0.001).\nThis model outperformed standard predictive scores,\nincluding Boey and PULP. The importance of each variable\ndecreased as the number of factors included in the\nANN model increased.\nConclusions The prediction of death was most accurate\nwhen using an ANN model with several univariate\ninfluences on the outcome. This finding demonstrates that\nPPU is a highly complex disease for which clinical prognoses\nare likely difficult. The incorporation of computerised\nlearning systems might enhance clinical judgments to\nimprove decision making and outcome prediction....
Background: Optimal care of multiple trauma patients has to be at a high level around the clock. Trauma care\nalgorithms and guidelines are available, yet it remains unclear if the time of admission to the trauma room affects\nthe quality of care and outcomes. Hence the present study intends to compare the quality of trauma room care of\nmultiple severely injured patients at a level-1 trauma center depending on the time of admission.\nMethods: A total of 394 multiple trauma patients with an ISS ? 16 were included into this study (observation\nperiod: 52 months). Patients were grouped by the time and date of their admission to the trauma room [business\nhours (BH): weekdays from 8:00 a.m. to 4:00 p.m. vs. non-business hours (NBH): outside BH]. The study analysed\ndifferences in patient demographics, trauma room treatment and outcome.\nResults: The study sample was comparable in all basic characteristics [mean ISS: 32.3 �± 14.3 (BH) vs. 32.6 �± 14.4 (NBH),\np = 0.853; mean age: 40.8 �± 21.0 (BH) vs. 37.7 �± 20.2 years (NBH), p = 0.278]. Similar values were found for the time\nneeded for single interventions, like arterial access [4.8 �± 3.9 min (BH) vs. 4.9 �± 3.4 min (NBH), p = 0.496] and\nquality-assessment parameters, like time until CT [28.5 �± 18.7 min (BH), vs. 27.3 �± 9.5) min (NBH), p = 0.637]. There\nwas no difference for the 24 h mortality and overall hospital mortality in BH and NBH, with 13.5% vs. 9.1%\n(p = 0.206) and, 21.9% vs. 15.4% (p = 0.144), respectively. The Glasgow Outcome Scale (GOS) comparison revealed no\ndifference [3.7 �± 1.6 (BH) vs. 3.9 �± 1.5 (NBH), p = 0.305]. In general, the observed demographic, injury severity, care\nquality and outcome parameters revealed no significant difference between the two time periods BH and NBH.\nConclusions: The study hospital provides multiple trauma patient care at comparable quality irrespective of time of\nadmission to the trauma room. These results might be attributable to the standardization of the treatment process\nusing established principles, algorithms and guidelines as well as to the resources available in a level-1 trauma center....
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