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1.
John Kuckelman Riyad Karmy-Jones Elizabeth Windell Seth Izenberg Jean-Stephane David William Long Matthew J. Martin 《American journal of surgery》2018,215(5):794-800
Background
Traumatic Rib Cage Hernias (TRCH) requiring operative repair are rare and there is currently no literature to guiding surgical management.Methods
Perioperative review of TRCH over 32 years. Five operative grades were developed based on extent of tissue/bone damage, size, and location.Results
Twenty-four patients (20 blunt, 4 penetrating) underwent operative repair. Lung was the herniated organ in 88% with a median of 4 rib fractures and average size of 60.25?cm. Types of operation were well clustered by assigned TRCH grade. The majority required mesh (75%) and/or rib plating (79%). Complex tissue flap reconstruction was required in 10%. Full range-of-motion was maintained in 88% with79% returning to pre-injury activity levels. Five patients had continued pain at final follow up (mean?=?7months).Conclusion
The size and degree of injury has important implications in the optimal surgical management of TRCHs. These operative grades effectively direct surgical care for these rare and complex injuries. 相似文献2.
Areg Grigorian Jeffrey Milliken Joshua K. Livingston Dean Spencer Viktor Gabriel Sebastian D. Schubl Allen Kong Cristobal Barrios Victor Joe Jeffry Nahmias 《American journal of surgery》2019,217(4):639-642
Background
Blunt cardiac injury (BCI) can occur after chest trauma and may be associated with sternal fracture (SF). We hypothesized that injuries demonstrating a higher transmission of force to the thorax, such as thoracic aortic injury (TAI), would have a higher association with BCI.Methods
We queried the National Trauma Data Bank (NTDB) from 2007-2015 to identify adult blunt trauma patients.Results
BCI occurred in 15,976 patients (0.3%). SF had a higher association with BCI (OR?=?5.52, CI?=?5.32–5.73, p?<?0.001) compared to TAI (OR?=?4.82, CI?=?4.50–5.17, p?<?0.001). However, the strongest independent predictor was hemopneumothorax (OR?=?9.53, CI?=?7.80–11.65, p?<?0.001) followed by SF and esophageal injury (OR?=?5.47, CI?=?4.05–7.40, p?<?0.001).Conclusion
SF after blunt trauma is more strongly associated with BCI compared to TAI. However, hemopneumothorax is the strongest predictor of BCI. We propose all patients presenting after blunt chest trauma with high-risk features including hemopneumothorax, sternal fracture, esophagus injury, and TAI be screened for BCI.Summary
Using the National Trauma Data Bank, sternal fracture is more strongly associated with blunt cardiac injury than blunt thoracic aortic injury. However, hemopneumothorax was the strongest predictor. 相似文献3.
Michael Derickson Cody Phillips Morgan Barron John Kuckelman Matthew Martin Mia DeBarros 《American journal of surgery》2018,215(5):887-890
Introduction
Bariatric surgery results in massive weight loss, leaving many patients with redundant skin that can cause significant physical and psychosocial limitations. We sought to identify variables associated with postoperative complications and adjuncts associated with the mitigation of postoperative complications.Methods
A retrospective review was performed of all post-bariatric surgery patients who underwent panniculectomy over a 10-year period.Results
Total 706 patients included. Overall complication rate was 56%: dehiscence (24%), surgical site infection (22%), seroma (18%), and post-operative bleeding (5%). Return to operating room rate was 12%. Significant factors were: BMI >26 (p?<?0.01), fleur-de-lis panniculectomy (p?<?0.01), concomitant hernia repair (p?<?0.01). Multivariate regression analysis demonstrated ASA class >2 (OR 1.97, p?<?0.05) and incision type (OR 1.64, p?<?0.05) to be independent predictors of morbidity.Conclusion
High morbidity for post-bariatric panniculectomy is primarily local wound complications. Potentially modifiable factors that increase the complication risk profile include higher BMI, higher ASA class, and the use of fleur-de-lis incision. 相似文献4.
Roshan Givergis Swapna Munnangi Katayoun Fayaz M Fomani Anthony Boutin Luis Carlos Zapat LD George Angus 《中华创伤杂志(英文版)》2018,21(5):261-266
Purpose
To evaluate massive transfusion protocol practices by trauma type at a level I trauma center.Methods
A retrospective analysis was performed on a sample of 76 trauma patients with MTP activation between March 2010 and January 2015 at a regional trauma center. Patient demographics, transfusion practices, and clinical outcomes were compared by type of trauma sustained.Results
Penetrating trauma patients who required MTP activation were significantly younger, had lower injury severity score (ISS), higher probability of survival (POS), decreased mortality, and higher Glasgow Coma scale (GCS) compared to blunt trauma patients. Overall, the mortality rate was 38.16%. The most common injury sustained among blunt trauma patients was head injury (36.21%), whereas the majority of the penetrating trauma patients sustained abdominal injuries (55.56%). Although the admission coagulation parameters and timing of coagulopathy were not significantly different between the two groups of patients, a significantly higher proportion of penetrating trauma patients received high plasma content therapy relative to blunt trauma patients (p < 0.01).Conclusion
Despite the use of the same MTP for all injured patients requiring massive transfusion, significant differences existed between blunt trauma patients and penetrating trauma patients. These differences in transfusion characteristics and outcomes following MTP activation underscore the complexity of implementing MTPs and warrant vigilant transfusion practices to improve outcomes in trauma patients. 相似文献5.
Andres X. Samayoa Thai Vu Tanya Olszewski Michael Bova Qi Yan Orlando Kirton 《American journal of surgery》2018,215(6):1000-1003
Introduction
Managing trauma in the elderly is challenging and requires a multidisciplinary team approach. The aim of this study is to characterize and compare outcomes in patients 90 years and older in the last two decades.Methods
Retrospective review of trauma patients 90 years and older admitted from 1996 to 2015. The patients were divided into two groups: Early Decade (ED) and Late Decade (LD).Results
A total of 1697 patients were recorded, 551 (ED) and 1146 (LD). The mean age was 92.92?±?8(90–108)[ED] and 92.9?±?2.7(90–105)[LD] years. The most common mechanism and type of injury was falls and extremity trauma. Hospital length of stay (LOS) was shorter in the LD. There was no significant difference in in-hospital mortality or ICU LOS.Conclusion
Trauma admission has increased in the last decade. However, in-hospital mortality remains low. It is important for multidisciplinary teams to allocate resources to treat this elderly population. 相似文献6.
M. Decavèle N. Gault T. Gauss S. Pease J.D. Moyer C. Paugam-Burtz A. Foucrier 《British journal of anaesthesia》2018,120(6):1158-1164
Background
The significance of cardiac troponin I (cTnI) elevation after trauma is debated. We therefore explored the association between cTnI elevation at admission after trauma and ICU mortality.Methods
We performed a retrospective analysis from a prospectively constituted database, of patients admitted to ICU after trauma at a single centre, over a 36 month period. According to cTnI plasma concentration at admission, patients were categorised into three groups: normal (<0.05 ng ml?1), intermediate (0.05–0.99 ng ml?1), or high concentration (≥1.0 ng ml?1). Associations of pre-hospital conditions or cTnI elevation and mortality were analysed by multivariate logistic regression.Results
Among the 994 patients, 177 (18%) had cTnI elevation at ICU admission. Of this total, 114 (11%) patients died in the ICU. The cTnI release was an independent predictor of ICU mortality with a concentration–response relationship [odds ratio (OR) 4.90 (2.19–11.16) and 14.83 (4.68–49.90) for intermediate and high concentrations, respectively] and Day 2 mortality [OR 2.23 (1.18–5.80) and 7.49 (2.77–20.12) for intermediate and high concentrations, respectively]. The severity of thoracic trauma [OR 2.25 (1.07–4.55) and 3.23 (2.00–5.27) for Abbreviated Injury Scale scores 1–2 and ≥3, respectively], out-of-hospital maximal heart rate ≥120 beats min?1 [OR 2.22 (1.32–3.69)], and out-of-hospital shock [OR 2.02 (1.20–3.38)] were independently associated with cTnI elevation.Conclusions
Release of cTnI was an independent predictor of ICU mortality, suggesting that this biomarker can be used in daily practice for early stratification of the risk of ICU death. Thoracic trauma was strongly associated with cTnI elevation. 相似文献7.
John Kuckelman Mike Derickson Cody Phillips Morgan Barron Shannon Marko Matthew Eckert Matthew Martin 《American journal of surgery》2018,215(5):832-835
Introduction
Tension pneumothorax (tPTX) remains a major cause of preventable death in trauma. Needle decompression (ND) has up to a 60% failure rate.Methods
Post-mortem swine used. Interventions were randomized to 14G-needle decompression (ND, n?=?25), bladed trocar with 36Fr cannula (BTW, n?=?16), bladed trocar alone (BTWO, n?=?16) and surgical thoracostomy (ST?=?11). Simulated tPTX was created to a pressure(p) of 20?mmHg.Results
Success (p?<?5?mmHg by 120?s) was seen in 41 of 68 (60%) interventions. BTW and BTWO were consistently more successful than ND with success rates of 88% versus 48% in ND (p?<?.001). In successful deployments, ND was slower to reach p?<?5?mmHg, average of 82s versus 26s and 28s for BTW and BTWO respectively (p?<?.001). Time to implement procedure was faster for ND with an average of 3.6s versus 16.9s and 15.3s in the BTW and BTWO (p?<?.001). Final pressure was significantly less in BTW and BTWO at 1.7?mmHg versus 7?mmHg in ND animals (p?<?.001).Conclusion
Bladed trocars can safely and effectively tPTX with a significantly higher success rates than needle decompression. 相似文献8.
James W. Davis Rachel C. Dirks Krista L. Kaups Phu Tran 《American journal of surgery》2018,215(4):682-685
Background
Base Deficit (BD) and lactate have been used as indicators of shock and resuscitation. This study was done to determine the association of BD and lactate and to determine if one is superior.Methods
A retrospective review from 3/2014–12/2016 was performed. Data included demographics, systolic BP, ISS, BD, lactate, blood transfusion, and outcomes. BD and lactate were modeled continuously and categorically and compared.Results
1191 patients were included. BD and lactate correlated strongly (r?=?-0.76 p?<?0.001). Higher lactate and more negative BD were associated with transfusion and mortality. On multivariate regression, only BD was associated with transfusion (OR?=?0.8, p?<?0.001). As a categorical variable, worsening BD was associated with decreased BP, higher ISS, increased transfusions and worse outcomes.Conclusions
BD and lactate are strongly related. BD was superior to lactate in assessing the need for transfusion. The BD categories discriminate high risk trauma patients better than lactate. 相似文献9.
10.
Cassie A. Barton Marissa Hom Nathan B. Johnson Jon Case Ran Ran Martin Schreiber 《American journal of surgery》2018,215(5):775-779
Introduction
Life-threatening bleeding can complicate warfarin therapy. Rapid anticoagulant reversal via replacement of vitamin-K dependent clotting factors is essential for hemostasis. We compare two methods of rapid factor replacement for warfarin reversal.Methods
A retrospective cohort study of warfarin-treated patients experiencing life-threatening bleeding who received a reversal protocol comprised of 4F PCC or 3F PCC and rFVIIa was performed. Demographic, clinical and anticoagulant reversal information, and all adverse events attributed to warfarin reversal were recorded.Results
195 patients were included in final analysis. While baseline demographics were similar between groups, the 3F-PCC group had a longer ICU LOS and higher in-hospital mortality (p?<?.01, .01).Pre-reversal INR was similar between both groups, but post-reversal INR was significantly lower in the 3F-PCC group, 0.8 versus 1.3 (p?<?.01). Significantly more patients experienced thromboembolic complications in the 3F-PCC group than the 4F-PCC group (p?<?.01). Receipt of rFVIIa was significantly associated with thromboembolic complications.Discussion
A 4F PCC reversal strategy is efficacious in INR reversal and provides lower thromboembolic risk as compared to 3F PCC with rFVIIa. 相似文献11.
Tsutomu Akazawa Shingo Kuroya Masahiro Iinuma Kota Asano Yoshiaki Torii Tasuku Umehara Toshiaki Kotani Tsuyoshi Sakuma Shohei Minami Sumihisa Orita Kazuhide Inage Kazuki Fujimoto Yasuhiro Shiga Gen Inoue Masayuki Miyagi Wataru Saito Seiji Ohtori Hisateru Niki 《Journal of orthopaedic science》2018,23(1):45-50
Background
The aim of this study was to conduct an investigation into spinal fusion with Harrington instrument (HI) in patients with adolescent idiopathic scoliosis (AIS) and to survey pulmonary function and thoracic deformity outcomes many years after surgery.Methods
Subjects comprised 194 patients diagnosed with AIS and treated with spinal fusion using HI between 1968 and 1987. Patients who gave their informed consent were subjected to a complete standing spine X-ray, chest CT, and pulmonary function tests. Eighteen patients were eligible for inclusion. Mean age at the time of follow-up was 49.9 years and the mean duration of follow-up was 35.3 years. CT axial image was used at the apex of the main thoracic curve. Apical vertebral rotation was determined from RA sag measured by the method of Aaro et al. Thoracic cage deformities were measured as follows: Rib hump index (RHi) according to the method of Aaro et al. and posterior hemithoracic symmetry ratio (PHSr) according to the method of Campbell et al.Results
Pulmonary function tests revealed mean forced vital capacity (FVC) of 2.28 (range: 1.00–3.04) L and mean %FVC of 83.5% (range: 35.6%–117.8%). Restrictive ventilation disorder with %FVC <80% was seen in 5 patients (27.7%). %FVC had strong negative correlations with RA sag (r = ?0.798), RHi (r = ?0.820, p < 0.001), PHSr (r = ?0.705), and proximal thoracic curve (r = ?0.721). Main thoracic curve (r = ?0.674) and apical vertebral rotation of thoracic curve (r = ?0.685) showed moderate negative correlations. Multiple regression analysis revealed RHi was a most significant factor on %FVC.Conclusions
In AIS patients examined 27 years or longer after surgery, restrictive ventilation defects were observed in 27.7%. Factors aggravating %FVC were large rib humps and large vertebral rotations. Three-dimensional correction of the spine and thoracic cage deformities is vital in order to avoid pulmonary function impairment many years after surgery. 相似文献12.
Emrah Kovalak Hanife Özdemir Cenk Ermutlu Abdullah Obut 《Acta orthopaedica et traumatologica turcica》2018,52(3):196-200
Objectives
The aim of this study was to evaluate how fatty atrophy (FA) of the hip abductors in operated and non-operated hips affected the functional outcome following arthroplasty.Methods
Forty-four hips of 22 patients (8 males and 14 females; mean age: 60?±?14.4 (range: 24–84)) who matched the inclusion criteria and willing to participate in the study were retrospectively evaluated. The mean follow-up was 13.8?±?2.3 (range: 10–18) months Magnetic resonance imaging (MRI) and Harris Hip Score (HHS) were used to evaluate muscle degeneration and functional outcome after unilateral THA through a posterolateral approach. The FA grade was evaluated using Goutallier grading system. Non-operated hips of subjects were used as the control. Age, duration after the operation, gluteal muscle FA, and the relationships with HHS were evaluated.Results
FA was more evident in the operated hip (p?<?0.05), and was more in the gluteus minimus than in the gluteus medius in both hips (p?<?0.05). Patients' age was not correlated with gluteal muscle FA in the operated hip (p?>?0.05), whereas there was a positive correlation with the contra-lateral hip (p?<?0.05). Duration after surgery did not affect gluteal muscle FA in the operated hip. Older age and FA of either the operated or healthy hip resulted in poorer HHS (p?<?0.05). HHS had the strongest correlations with patient age (p?<?0.001) and FA (p?=?0.026) of the gluteus minimus of contralateral hip.Conclusion
Following THA, there was marked FA in the operated hip compared to that in the contralateral hip. In these cases, degree of FA in the replaced hip did not correlate with patients' age. Fatty atrophy of the gluteus minimus precedes that of gluteus medius. FA of the contralateral gluteus minimus and patient age are strongly correlated with lower HHS. Level of evidence: Level IV, diagnostic study.Level of evidence
Level IV, diagnostic study. 相似文献13.
Allan E. Stolarski Claire P. Miller Ashar Ata Kimberly Owens Lauren Evans Carl Rosati Steven C. Stain Marcel Tafen 《American journal of surgery》2019,217(1):29-33
Background
Anticoagulant and antiplatelet agents (ACAP) have been shown to negatively affect trauma patients.Methods
Outcomes in adults with rib fractures were reviewed. Pearson chi-square test was used for analysis. Multivariate logistic regression was used to adjust for potential confounders.Results
Of the 1448 included patients, 149 (10.3%) took preinjury ACAP; these patients were significantly older than non-anticoagulated patients (72 vs. 54 years, P?≤?0.05). There was no difference in pulmonary complications, ICU admissions or ICU LOS. The preinjury ACAP group had a significantly longer LOS (12.03 vs. 9.33 days, P?=?0.004), fewer pulmonary contusions (15.43% vs. 22.94%, P?=?0.037), and fewer thoracic drainage procedures (10.74% vs. 18.17%, P = 0.023). Multivariate adjustment for possible confounders revealed that patients taking warfarin had a significantly longer LOS (+7.38 days). After adjustment there was no difference in mortality.Conclusion
Preinjury ACAP use does not increase mortality or morbidity in patients with rib fractures.Summary
We demonstrated that preinjury anticoagulation and antiplatelet agents do not increase mortality or morbidity in patients with rib fractures. However, they lead to a longer hospital length of stay, particularly in patients on warfarin. 相似文献14.
Benjamin C. Jordan Joseph Brungardt Jared Reyes Stephen D. Helmer James M. Haan 《American journal of surgery》2018,215(1):48-52
Background
The specific contribution of dementia towards mortality in trauma patients is not well defined. The purpose of the study was to evaluate dementia as a predictor of mortality in trauma patients when compared to case-matched controls.Methods
A 5-year retrospective review was conducted of adult trauma patients with a diagnosis of dementia at an American College of Surgeons-verified level I trauma center. Patients with dementia were matched with non-dementia patients and compared on mortality, ICU length of stay, and hospital length of stay.Results
A total of 195 patients with dementia were matched to non-dementia controls. Comorbidities and complications (11.8% vs 12.4%) were comparable between both groups. Dementia patients spent fewer days on the ventilator (1 vs 4.5, P = 0.031). The length of ICU stay (2 days), hospital length of stay (3 days), and mortality (5.1%) were the same for both groups (P > 0.05).Conclusions
Dementia does not appear to increase the risk of mortality in trauma patients. Further studies should examine post-discharge outcomes in dementia patients. 相似文献15.
Serpil Savaş Esra Erkol İnal Dudu Dilek Yavuz Fuat Uslusoy Selman Hakkı Altuntaş Mustafa Asım Aydın 《Journal of hand therapy》2018,31(2):250-254
Study Design
Prospective cohort study.Introduction
Identification of risk factors for CRPS development in patients with surgically treated traumatic injuries attending hand therapy allows to watch at-risk patients more closely for early diagnosis and to take precautionary measures as required.Purpose of the Study
The aim of this study was to evaluate the risk factors for the development of complex regional pain syndrome (CRPS) after surgical treatment of traumatic hand injuries.Methods
In this prospective cohort, 291 patients with traumatic hand injuries were evaluated 3 days after surgery and monitored for 3 months for the development of CRPS. The factors assessed for the development of CRPS were age, sex, manual work, postoperative pain within 3 days measured on a Pain Numerical Rating Scale (0-10), and injury type (crush injury, blunt trauma, and cut laceration injury).Results
CRPS was diagnosed in 68 patients (26.2 %) with a duration of 40.10 ± 17.01 days between the surgery and CRPS diagnosis. The mean postoperative pain score was greater in patients with CRPS than in those without CRPS (P < .001). Patients with pain scores ≥ 5 had a high risk of developing CRPS compared with patients with pain scores <5 (odds ratio: 3.61, confidence interval = 1.94-6.70). Patients with crush injuries were more likely to develop CRPS (odds ratio: 4.74, confidence interval = 2.29-9.80).Conclusions
The patients with a pain score of ≥5 in the first 3 days after surgery and the patients with crush injury were at high risk for CRPS development after surgical treatment of traumatic hand injuries.Level of Evidence
II b. 相似文献16.
Zhamak Khorgami William J. Fleischer Yuen-Jing A. Chen Nasir Mushtaq Michael S. Charles C. Anthony Howard 《American journal of surgery》2018,215(4):727-734
Background
The Oklahoma Trauma Registry (OTR) collects data from all state-licensed acute care hospitals. This study investigates trends and outcomes of trauma in Oklahoma using OTR.Methods
107,549 patients (2005–2014) with major severity and one of the following criteria were included: length of hospital stay ≥48?h, dead on arrival or death in the hospital, hospital transfer, ICU admission, or surgery on the head, chest, abdomen, or vascular system. Patient characteristics, mechanisms of injury, and outcomes of trauma were analyzed.Results
Hospital admissions due to falls increased with an annual percent change of 4.0% (95%CI: 3.1%–4.9%) while hospital admissions due to motor vehicle crashes decreased. The number of overall deaths per year remained stable except for the fall-related deaths, which increased proportionate to the increase in the incidence of fall. Fall-related mortality was 4.2% and intracranial bleeding was present in 60% in these patients.Conclusion
Falls are significantly increasing as a mechanism of trauma admissions and trauma-related deaths in Oklahoma. Analysis of state-based trauma registries can identify trends in etiologies of injuries and may indicate a reference point to prioritize preventive plans. 相似文献17.
William G. Hamilton Deborah J. Ammeen Nancy L. Parks Nitin Goyal Gerard A. Engh C. Anderson Engh 《The Journal of arthroplasty》2017,32(6):1803-1807
Background
Little data exist on the influence of patellar thickness on postoperative motion or complications after total knee arthroplasty (TKA). This study addresses the following questions: Is postoperative motion influenced by change in composite patellar thickness? Is change in patellar thickness associated with more complications? And do more complications occur in the knees with a patellar bone remnant (<12 mm) and a native patellar thickness <18 mm?Methods
In total, 3655 TKAs were performed by 3 surgeons over a 28-year interval. All knees had caliper measurement of patellar thickness before the patellar cut, after implantation of the component and postoperative motion recorded in the database 1 or 2 years after TKA.Results
Patellar composite thickness was the same (1034 knees), thicker (1617 knees), and thinner (1004 knees). A significant but weak relationship was identified between the change in patellar thickness and motion (P < .01, ρ = ?0.046); an increase in “composite patellar thickness” of 10 mm would result in a 3° loss of knee motion. Significant differences were identified between change in thickness and manipulations (P < .05), ruptures (P = .01), and patellar clunk/crepitus (P < .01). Examining knees with bone remnant thicknesses (<12 mm/≥12 mm), there was no difference in fractures (P = .26). No extensor ruptures occurred in knees with remnant thickness <12 mm. Comparing knees with native bone thickness (≤18 mm/>18 mm), significant differences were found in fractures (P < .01) and patellar radiolucencies (P = .01).Conclusion
As this data does not demonstrate a strong tendency toward losing motion when the patellar thickness is increased, the authors recommend avoiding compromise of the patellar bone stock and tendon insertion. When native patellar bone is thin (<18 mm), we recommend maintaining 12 mm of patellar bone stock and accept the increase in composite thickness. 相似文献18.
Joachim Gülke Barbara Leopold Daniel Grözinger Björn Drews Stephan Paschke Nikolaus J. Wachter 《Journal of hand therapy》2018,31(1):20-28
Study Design
Prospective cohort randomized controlled trial.Purpose of the Study
Is either a home exercise (HE) program or traditional physical therapy (PT) more effective in the postoperative management of metacarpal fractures?Methods
Sixty patients suffering from nonthumb metacarpal fractures who received mobilization-stable open reduction and internal fixation were included. All patients were prospectively randomized into either the PT group or the HE group. Follow-up examinations at 2, 6 and 12 weeks postoperatively.Results
After 2 weeks, the range of motion (ROM) in both groups was still severely reduced. Twelve weeks after surgery the ROM improved to 245° (PT) and 256° (HE). Grip strength after 6 weeks was 68% (PT) and 71% (HE) when compared to the non-injured hand, improving to 91% (PT) and 93% (HE) after 12 weeks.Conclusion
Study results show that both HE program and traditional PT are effective in the postoperative management of metacarpal fractures.Level of Evidence
II. 相似文献19.
Mario Schietroma Beatrice Pessia Sara Colozzi Francesco Carlei Gianfranco Amicucci 《The surgeon》2018,16(2):94-100