Thoracic trauma: Clinical and paleopathological perspectives.

Objectives: Although trauma is one of the most significant areas of study in paleopathology, most studies focus on fractures of single anatomical elements. Paleopathological research on regional trauma, such as of the thorax, is rare. This paper explores the causes, complications, and consequences of adult thoracic trauma using clinical data in order to inform paleopathological research.

Lidocaine patches reduce pain in trauma patients with rib fractures.

Rib fracture pain is notoriously difficult to manage. The lidocaine patch is effective in other pain scenarios with an excellent safety profile. This study assesses the efficacy of lidocaine patches for treating rib fracture pain.

Bicycle commuter injury prevention: it is time to focus on the environment.

Background: Few data exist on the risk of injury while commuting to work or school by bicycle. The proportion of commuters choosing to travel by bike is increasing in the United States, and information on injury incidence and the influences of rider characteristics and environmental factors may suggest opportunities for prevention actions.

Methods: Bicycle commuters in the Portland, OR, metropolitan area were recruited via the websites and community advertising to participate in a 1-year study.

Rib fracture fixation: controversies and technical challenges.

Rib fractures are a common injury affecting more than 350,000 people each year in the United States and are associated with respiratory complications, prolonged hospitalization, prolonged pain, long-term disability, and mortality. The social and economic costs that rib fractures contribute to the health care burden of the United States are therefore significant. But despite this measurable impact on patients' quality of life, current treatment of the majority of patients in the United States with rib fracture syndromes is supportive only.

Long-term morbidity, pain, and disability after repair of severe chest wall injuries.

Long-term morbidity after severe chest wall injuries is common. We report our experience with acute chest wall injury repair, focusing on long-term outcomes and comparing our patients' health status with the general population. We performed a retrospective medical record review supplemented with a postal survey of long-term outcomes including the McGill Pain Questionnaire (MPQ) and RAND-36 Health Survey.

Surveyed opinion of American trauma, orthopedic, and thoracic surgeons on rib and sternal fracture repair.

Introduction: Rib and sternal fracture repair are controversial. The opinion of surgeons regarding those patients who would benefit from repair is unknown.

Methods: Members of the Eastern Association for the Surgery of Trauma, the Orthopedic Trauma Association, and thoracic surgeons (THS) affiliated with teaching hospitals in the United States were recruited to complete an electronic survey regarding rib and sternal fracture repair.

American College of Surgeons Guidelines Program: a process for using existing guidelines to generate best practice recommendations for central venous access.

Background: Many professional organizations help their members identify and use quality guidelines. Some of these efforts involve developing new guidelines, and others assess existing guidelines for their clinical usefulness. The American College of Surgeons Guidelines Program attempts to recognize useful surgical guidelines and develop research questions to help clarify existing clinical guidelines.

Rib fracture repair: indications, technical issues, and future directions.

Rib fracture repair has been performed at selected centers around the world for more than 50 years; however, the operative indications have not been established and are considered controversial. The outcome of a strictly nonoperative approach may not be optimal. Potential indications for rib fracture repair include flail chest, painful, movable rib fractures refractory to conventional pain management, chest wall deformity/defect, rib fracture nonunion, and during thoracotomy for other traumatic indication.

Biomechanical testing of a novel, minimally invasive rib fracture plating system.

Background: A novel rib fracture repair plating system was developed to provide durable fixation with a shorter length than standard systems and thus facilitate minimally invasive repair. We hypothesized that U-plate fixation would be at least equivalent in durability to standard anterior fixation.

Study: Twenty fresh frozen ribs (10 pairs) from two human cadavers were first tested for intact stiffness (force or deformation).

Diagnosis and management of blunt pancreatic ductal injury in the era of high-resolution computed axial tomography.

Background: Blunt pancreatic ductal injury is an uncommon but potentially morbid injury that can be difficult to diagnose and manage. Computed axial tomography (CAT) scan has historically been unreliable for the detection of ductal injury, but the advent of high-resolution CAT should improve diagnostic accuracy.

Methods: From our prospectively maintained trauma registry, consecutive patients who had a diagnosis of blunt pancreatic injury with or without a subsequent laparotomy during the time period from January 1995 through December 2004 were retrospectively reviewed.

Equestrian injury prevention efforts need more attention to novice riders.

Background: Equestrian injury is commonly seen at trauma centers and the severity of injury is often high. We sought to determine the risk, incidence, and the influence of skill and experience on injury during horse-related activity (HRA).

Methods: Members of horse clubs and individual equestrians in a three-state region (Oregon, Washington, and Idaho) were recruited via mailings and community advertisements to take a survey regarding their horse contact time and injuries over their entire riding career.

Hypercoagulability is most prevalent early after injury and in female patients.

Background: Hypercoagulability after injury is a major source of morbidity and mortality. Recent studies indicate that there is a gender-specific risk in trauma patients. This study was performed to determine the course of coagulation after injury and to determine whether there is a gender difference.

The distinct and secondary harmful effect of pelvic and extremity injury on the outcome of laparotomy for trauma.

Hypothesis: Extra-abdominal injury negatively affects the outcome of abdominal injury following trauma laparotomy.

Design: Retrospective review of 920 consecutive patients receiving laparotomy for trauma who survived more than 24 h between January 1989 and May 1998 at a Level 1 trauma center. Major abdominal complications (MAC) were defined as: abdominal compartment syndrome (ACS), abscess/peritonitis, enterocutaneous fistula, necrotizing fasciitis, and necrotizing pancreatitis.

Tracheostomy after anterior cervical spine fixation.

Background: Patients with cervical spine injury may require both anterior cervical spine fusion and tracheostomy, particularly in the setting of associated cervical spinal cord injury (SCI). Despite the close proximity of the two surgical incisions, we postulated that tracheostomy could be safely performed after anterior spine fixation. In addition, we postulated that the severity of motor deficits in patients with cervical spine injury would correlate with the need for tracheostomy.

Enterocutaneous fistula and ventral hernia after absorbable mesh prosthesis closure for trauma: the plain truth.

Hypothesis: The severity of abdominal injury is the determining factor for the development of enterocutaneous fistula and ventral hernia after absorbable mesh prosthesis closure (AMPC) for trauma.

Methods: We conducted a retrospective analysis of case series that included 140 consecutive trauma patients with AMPC surviving more than 48 hours from October 1, 1989, to March 31, 2000, at a Level I trauma center. The days until abdominal wall reconstruction was used as a measure of exposure of the viscera to the mesh.

Blunt carotid artery injury: the futility of aggressive screening and diagnosis.

Background: Blunt carotid artery injury (BCI) remains a rare but potentially lethal condition. Recent studies recommend that aggressive screening based on broad criteria (hyperextension-hyperflexion mechanism of injury, basilar skull fracture, cervical spine injury, midface fracture, mandibular fracture, diffuse axonal brain injury, and neck seat-belt sign) increases the rate of diagnosis of BCI by 9-fold. If this recommendation becomes a standard of care, it will require a major consumption of resources and may give rise to liability claims.

Blunt thoracic trauma: flail chest, pulmonary contusion, and blast injury.

Blunt thoracic trauma can result in significant morbidity in injured patients. Both chest wall and the intrathoracic visceral injuries can lead to life-threatening complications if not anticipated and treated. Pain control, aggressive pulmonary toilet, and mechanical ventilation when necessary are the mainstays of supportive treatment.

Initial management of the trauma patient.

Critical care specialists should be familiar with the initial management of injured patients. Dividing the evaluation and treatment of the patient into the primary, secondary, and tertiary surveys ensures that the multiply injured patient will be managed expeditiously. The primary survey identifies the acute life-threatening problems that must be managed immediately.

Absorbable plates for rib fracture repair: preliminary experience.

Background: Absorbable prostheses are currently used in a variety of bone reconstructions and fixations.

Methods: This is a case series of rib fracture fixation using absorbable plates and screws consisting of 70:30 poly(L-lactide-co-D,L-lactide) from April 2001 through November 2002.

Results: Ten patients underwent rib fracture fixation with absorbable plates and screws.

Mechanism of acute ascites formation after trauma resuscitation.

Background: Severely injured patients have been observed to acutely develop ascites; however, the pathogenesis of this rare phenomenon is poorly understood.

Objectives: To report the factors common among severely injured patients developing ascites and to formulate a hypothesis regarding its origin.

Methods: Retrospective review of case series.

Rib fracture pain and disability: can we do better?

Objective: The purpose of this study was to determine the magnitude and duration of pain and disability in patients with rib fractures treated using current standard therapy. This was a prospective case series.

Methods: Injured patients with a chest radiographic diagnosis of one or more rib fractures between June 1, 2001, and October 31, 2001, were asked to participate.