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1.
Ann R Coll Surg Engl ; 102(1): e4-e6, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31509003

RESUMO

Thoracoabdominal hernia following blunt trauma is extremely rare. Abdominal viscera are more likely to herniate into the thorax if there is traumatic diaphragmatic rupture. We report the case of a patient presenting with a traumatic thoracoabdominal hernia containing part of the right lobe of the liver and the hepatic flexure of the colon. The hernia migrated cranially, to protrude through a seventh intercostal defect despite the diaphragm remaining fully intact. The need for early multispecialty (thoracic and hepatobiliary) surgical repair is highlighted, with improvements in surgical outcome for a complex trauma case by using a novel chest-wall reconstruction technique.


Assuntos
Hérnia Diafragmática Traumática/cirurgia , Herniorrafia/métodos , Ferimentos não Penetrantes/cirurgia , Acidentes por Quedas , Hérnia Diafragmática Traumática/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas das Costelas/etiologia , Fraturas das Costelas/cirurgia , Telas Cirúrgicas , Técnicas de Sutura , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ferimentos não Penetrantes/etiologia
2.
Br J Sports Med ; 54(1): 23-26, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30988018

RESUMO

OBJECTIVES: To describe ocular injuries caused by badminton and to explore the implications for future prevention strategies. METHODS: We enrolled 85 patients with ocular trauma caused by badminton. Information collected from patients included type of game, instigator, instrument of injury and lessons in badminton from a professional, and ocular trauma information such as type of injury, treatment and final outcomes. RESULTS: The 85 patients (52 men, 33 women) were aged 15-65 years with an average age of 42.9 (±10.7) years. In 60 cases the player was hit by a shuttlecock and in 25 the player was hit by a racquet. 73 cases occurred in doubles matches and 10 in singles matches. In 31 cases the trauma was caused by an opponent and in 52 cases by a partner; 2 cases involved bystanders, not players. About 70% (43/61) of the injured and 82% (40/49) of the instigators had not received badminton lessons from a professional. 80 injuries were non-penetrating and 5 were penetrating. There were 58 cases with hyphaema, 36 with secondary glaucoma, 23 with lens subluxation and 2 with retinal detachment. Surgery comprised phacoemulsification or lensectomy and vitrectomy in 16 cases, silicone oil tamponade in 2 cases, trabeculectomy in 3 cases and direct cyclopexy in 5 cases. CONCLUSION: The vast majority of the badminton related eye injuries occurred among doubles players and were instigated by the injured person's partner. Non-penetrating injury was more frequent; penetrating injury was usually more serious. We recommend that badminton players use protective eyewear and receive safety education and professional coaching/instruction on techniques to protect against serious eye injuries.


Assuntos
Traumatismos Oculares/etiologia , Traumatismos Oculares/prevenção & controle , Esportes com Raquete/lesões , Adolescente , Adulto , Traumatismos Oculares/complicações , Traumatismos Oculares/cirurgia , Ferimentos Oculares Penetrantes/complicações , Ferimentos Oculares Penetrantes/etiologia , Ferimentos Oculares Penetrantes/prevenção & controle , Ferimentos Oculares Penetrantes/cirurgia , Dispositivos de Proteção dos Olhos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Ferimentos não Penetrantes/complicações , Ferimentos não Penetrantes/etiologia , Ferimentos não Penetrantes/prevenção & controle , Ferimentos não Penetrantes/cirurgia , Adulto Jovem
3.
Rev Port Cir Cardiotorac Vasc ; 26(3): 219-222, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31734975

RESUMO

Lung herniation is an uncommon entity which was fully classified in 1845 after the study of several case reports. Acquired lung hernia, especially traumatic, is the most common etiology. In the absence of clear guidelines, management of lung hernia is made in a case-by-case basis. We present an asymptomatic middle lobe hernia perceptible on physical examination, but diagnosed initially by imaging studies. Patient medical history included a blunt bull trauma fourteen years before.


Assuntos
Traumatismos em Atletas/complicações , Hérnia/etiologia , Pneumopatias/etiologia , Ferimentos não Penetrantes/etiologia , Animais , Bovinos , Humanos , Masculino
4.
Am Surg ; 85(10): 1142-1145, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31657311

RESUMO

The ACS Committee on Trauma specifies prehospital criteria that trigger trauma team activation (TTA). The study aims to define the relationship between TTA and time of day, mechanism of injury, and need for operative intervention. All trauma patients presenting to LAC+USC (January 2008-July 2018) after triggering TTA were screened. Patients were excluded if time of ED arrival was undocumented. Demographics, injury data, and outcomes were analyzed. After exclusions (<1%), 54,826 patients were enrolled. The median age was 35 [IQR 23-53]. The median Injury Severity Score was 4 [1-10]. The most common mechanisms of injury were falls (n = 14,166; 31%), auto versus pedestrian collisions (n = 11,921; 26%), and motor vehicle collisions (n = 11,024; 24%). Penetrating trauma comprised 16 per cent (n = 8,686). The busiest hour for TTAs was 19:00 to 20:00, although penetrating trauma was most common between 23:00 and 01:00. Emergent surgical intervention in absolute numbers was most frequent between 20:00 and 01:00. As a proportion of the number of TTAs per hour, emergent operative intervention was most frequent between 23:00 and 06:00. In conclusion, the volume of TTAs and the triggering mechanism of injury vary significantly by time of day. The need for operative intervention is highest overnight. This information can be used to help increase hospital preparedness and allocate resources accordingly.


Assuntos
Serviços Médicos de Emergência/estatística & dados numéricos , Fatores de Tempo , Centros de Traumatologia/estatística & dados numéricos , Ferimentos não Penetrantes/etiologia , Ferimentos Penetrantes/etiologia , Escala Resumida de Ferimentos , Adulto , California/epidemiologia , Tratamento de Emergência/estatística & dados numéricos , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Triagem , Ferimentos não Penetrantes/epidemiologia , Ferimentos não Penetrantes/mortalidade , Ferimentos não Penetrantes/cirurgia , Ferimentos Penetrantes/epidemiologia , Ferimentos Penetrantes/mortalidade , Ferimentos Penetrantes/cirurgia , Adulto Jovem
5.
Cir Cir ; 87(S1): 53-57, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31501625

RESUMO

There are few reported cases of small bowel injury due to blunt abdominal trauma. We describe the clinical presentation and surgical management of these lesions. This is the clinical case of a polytraumatized male with a duodenal injury IIID3 according to AAST, who underwent resection of the intestinal segment with duodeno-duodenum anastomosis with favorable results. The infrequent presentation of injuries to the small intestine due to blunt trauma may lead the clinician to overlook the need for intentional interrogation about the kinematics of the trauma, while at the same time neglecting the taking of complementary diagnostic imaging studies, this because of a lack of clinical suspicion. It is important to analyze the patient's context, which will allow us to assess the need to delve into diagnostic studies in order to optimize their treatment.


Assuntos
Traumatismos Abdominais/cirurgia , Duodeno/lesões , Ferimentos não Penetrantes/cirurgia , Traumatismos Abdominais/diagnóstico por imagem , Traumatismos Abdominais/etiologia , Acidentes de Trânsito , Adulto , Colectomia , Duodeno/irrigação sanguínea , Duodeno/cirurgia , Gastrostomia , Hematoma/classificação , Hemoperitônio/etiologia , Humanos , Íleo/irrigação sanguínea , Isquemia/etiologia , Isquemia/cirurgia , Jejunostomia , Lacerações/classificação , Fígado/lesões , Masculino , Mesentério/lesões , Nutrição Parenteral , Pneumoperitônio/diagnóstico por imagem , Pneumoperitônio/etiologia , Ferimentos não Penetrantes/etiologia
6.
J Craniofac Surg ; 30(7): e683-e687, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31503126

RESUMO

Injury to the orbital region represents a significant proportion of emergency department attendances and it is a common injury in patients with multisystem trauma. To date, trauma remains a leading cause of monocular blindness.Traumatic optic neuropathy may be caused by direct trauma to the optic nerve and from compression caused by foreign bodies and bone fragments. Indirect trauma can lead to visual loss from transmitted force to the optic canal by blunt facial trauma without associated fractures. Occasionally traumatic optic neuropathy is due to reversible changes, such as edema or contusion.High-dose intravenous steroids and surgical decompression of the optic canal have been advocated for the management of acute traumatic optic neuropathy, but the efficacy and safety of these treatments have been questioned.The authors present 3 patients with traumatic optic nerve injury, 1 due to a gunshot wound to the face and 2 caused by blunt facial trauma, where fragments of bone intrude into the orbit leading to compression of its content. These injuries where successfully treated with both preoperative intravenous steroids followed by acute surgical decompression of the orbit with return of visual function.


Assuntos
Traumatismos Faciais/cirurgia , Traumatismos do Nervo Óptico/cirurgia , Transtornos da Visão/cirurgia , Adulto , Descompressão Cirúrgica , Traumatismos Faciais/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Traumatismos do Nervo Óptico/complicações , Crânio/cirurgia , Transtornos da Visão/etiologia , Acuidade Visual , Ferimentos por Arma de Fogo/cirurgia , Ferimentos não Penetrantes/etiologia , Ferimentos não Penetrantes/cirurgia , Adulto Jovem
8.
BMC Surg ; 19(1): 91, 2019 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-31299958

RESUMO

BACKGROUND: Pancreatic trauma accounts for only 0.2% of blunt trauma and 1-12% of penetrating injuries. Injuries to other organs, such as spleen, liver, or kidney, are associated with 50.5% of the cases. The isolated complete traumatic transection of the pancreatic neck is rare. In the past, pancreatoduodenectomy or distal pancreatectomy and splenectomy was the standard care for patients with traumatic transection of the pancreatic head, duodenum or distal pancreas, and pancreatic neck. However, limited cases have been reported on the central pancreatectomy for pancreatic neck injuries. We present a rare case of a 21-year-old male patient who received central pancreatectomy for isolated complete traumatic transection of the pancreatic neck. CASE PRESENTATION: A 21-year-old male patient with mild abdominal pain and showed no apparent abnormality in the initial abdominal computed tomography (CT) was brought to the local hospital's emergency department due to a traffic accident. The patient's abdominal pain became progressively worse during observation in the hospital that led to the patient being referred to our hospital. The patient's vital signs were stable, and a physical examination revealed marked tenderness and rebound pain throughout the abdomen. The patient's white blood cells were increased; The serum amylase and lipase levels were elevated. The abdominal computed tomography revealed pancreatic neck parenchymal discontinuity, peripancreatic effusion, and hemorrhage. The patient underwent exploratory laparotomy. Intraoperative examination identified the neck of the pancreas was completely ruptured, and no apparent abnormalities were observed in the other organs. The patient underwent central pancreatectomy and Roux -Y pancreaticojejunostomy. The patient was treated with antibiotics, acid inhibition and nutritional supports for 10 days after surgery. Symptoms of the patient were significantly relieved, and white blood cells, serum amylase, and lipase levels returned to normal. The patient underwent follow up examination for 6 months with no evidence of exocrine or endocrine insufficiency. CONCLUSIONS: Central pancreatectomy is an effective pancreas parenchyma preserving procedure, may be a promising alternative to distal pancreatectomy and splenectomy for this complex pancreatic trauma in hemodynamically stable patients. Patient selection and surgeon experience are crucial in the technical aspects of this procedure.


Assuntos
Pâncreas/lesões , Pâncreas/cirurgia , Pancreatectomia/métodos , Pancreaticojejunostomia/métodos , Ferimentos não Penetrantes/cirurgia , Acidentes de Trânsito , Humanos , Laparotomia , Masculino , Pâncreas/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Ferimentos não Penetrantes/diagnóstico por imagem , Ferimentos não Penetrantes/etiologia , Adulto Jovem
9.
Am J Surg ; 218(4): 755-759, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31351577

RESUMO

BACKGROUND: We sought to determine if clinician suspicion of injury was useful in predicting injuries found on pan-body computed tomography (PBCT) in clinically intoxicated patients. METHODS: We prospectively enrolled awake, intoxicated patients with low-energy mechanism of injury. For each of four body regions (head/face, neck, thorax and abdomen/pelvis), clinician suspicion for injury was recorded as "low index" or "more than a low index". The reference standard was the presence of any pre-defined significant finding (SF) on CT. Sensitivity, specificity, positive (LR+) and negative (LR-) likelihood ratios were calculated. RESULTS: Enrollment of 103 patients was completed. Sensitivity, specificity, LR+ and LR-for clinician index of suspicion were: 56%, 68%, 1.75, 0.64 (head/face), 50%, 92%, 6.18, 0.54 (neck), 10%, 96%, 2.60, 0.94 (thorax) and 67%, 93%, 9.56, 0.36 (abdomen/pelvis). CONCLUSION: Clinician judgement was most useful to guide need for CT imaging in the neck and abdomen/pelvis. Routine PBCT may not be necessary. SUMMARY: For awake, stable intoxicated patients after falls and assaults, clinician index of suspicion was most useful to guide the need for CT imaging in the neck and abdomen/pelvis. Our findings support selective use of CT if the index of suspicion is low. Routine PBCT may not be necessary.


Assuntos
Intoxicação Alcoólica/complicações , Intoxicação Alcoólica/diagnóstico por imagem , Competência Clínica , Tomada de Decisão Clínica , Tomografia Computadorizada por Raios X , Ferimentos não Penetrantes/diagnóstico por imagem , Acidentes por Quedas , Adulto , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Violência , Ferimentos não Penetrantes/etiologia
10.
Forensic Sci Int ; 301: 358-370, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31212143

RESUMO

Hammer blows cause serious, often fatal injuries, especially when massive blunt violence is targeted at the head region. The evaluation of the injury potential depends not only on the body region hit, but also on the characteristics of the hammer as a weapon and on the physical characteristics of the attacker. This study aimed at elucidating the dependency between the physical constitution of a perpetrator and the intensity of hammer blows, thus to verify or refute this seemingly obvious interrelation sometimes expressed in the saying that a "strong hand strikes harder". For this purpose, 113 volunteers of different ages and sexes took part in different experimental settings. While, as expected, clear differences between male and female were detectable in the striking power of single and multiple strokes, there were no age or sex differences with regard to the maximum number of strokes per time unit. Strength differences in slamming with a hammer between men and women exceeded expectations in this study. Using the fracture forces as described by Sharkey et al. in an exemplary manner, one can expect a fracture of the skull in 9 out of 10 cases with a 300 g hammer by men for intensively executed single strokes, whereas this was only the case for approx. 2/10 women in this study. The maximum circumference of the upper arm and the width of the shoulder girdle correlate significantly with the achievable impact forces of individual hammer blows in both sexes. A simple measurement of the hand force with a manometer using the regression formula y [kN] = 0.144 × manual grip force -1.08 can be used as a rough estimation parameter for the theoretically achievable impact force. If one strikes repeatedly with the same hammer for 1 min, the magnitude of a single strike decreases continuously from 4.5 kN to 2.6 kN on average. If a 1500 g hammer is used instead of a 300 g hammer, one does not get the fivefold impact force you might expect at first sight, but only on the order of twice the impact force, about 14 kN on average. The results prove the importance of physical experiments, whose results can help to better interpret the magnitude and effects of hammer blows as a form of potentially life-threatening violence.


Assuntos
Composição Corporal , Força Muscular , Fraturas Cranianas/etiologia , Armas , Ferimentos não Penetrantes/etiologia , Adolescente , Adulto , Feminino , Medicina Legal , Humanos , Cinética , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Fatores Sexuais , Extremidade Superior/anatomia & histologia , Adulto Jovem
11.
J Cardiovasc Med (Hagerstown) ; 20(10): 709-717, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31246700

RESUMO

: Traumatic mitral valve regurgitation is a rare and often insidious condition. Clinical presentation is variable and influenced by the anatomic structures injured; when papillary muscles are damaged, the clinical presentation is often acute, whereas, in the case of involvement of other anatomic structures of the valvular apparatus (e.g. chordae tendinae), the onset of symptoms may be delayed (days, weeks, or months). Therefore, diagnosis may be belated because of the heterogeneous clinical presentation. Traumatic mitral valve injury should be excluded in patients admitted to the emergency services with blunt chest trauma, in particular when signs or symptoms of acute heart failure occur. Echocardiography, particularly with the transoesophageal approach, may play a pivotal role in this setting. Herein, we present a case of severe mitral regurgitation because of blunt chest trauma and a systematic review of the literature. We examined 192 described cases, classified according to epidemiology, aetiology, anatomic features, clinical presentation, diagnosis, surgical/clinical management and prognosis.


Assuntos
Acidentes de Trabalho , Traumatismos Cardíacos/etiologia , Insuficiência da Valva Mitral/etiologia , Valva Mitral/lesões , Ferimentos não Penetrantes/etiologia , Traumatismos Cardíacos/diagnóstico por imagem , Traumatismos Cardíacos/fisiopatologia , Traumatismos Cardíacos/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Valva Mitral/fisiopatologia , Valva Mitral/cirurgia , Anuloplastia da Valva Mitral , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/fisiopatologia , Insuficiência da Valva Mitral/cirurgia , Recuperação de Função Fisiológica , Índice de Gravidade de Doença , Resultado do Tratamento , Ferimentos não Penetrantes/diagnóstico por imagem , Ferimentos não Penetrantes/fisiopatologia , Ferimentos não Penetrantes/cirurgia
13.
BMJ Case Rep ; 12(6)2019 Jun 09.
Artigo em Inglês | MEDLINE | ID: mdl-31178435

RESUMO

Gel blasters fire a hydrated gel polymer and are developed to circumvent the restrictions placed on paintball and airsoft guns. Because there are no reported cases of injury caused by gel blasters in the literature, some Australian jurisdictions have categorised them as a toy. Presented here are two cases of potentially blinding blunt ocular trauma which question the misguided notion they are a harmless toy. Two children each with a macrohyphaema were managed at a tertiary ophthalmology centre within 2 weeks of each other after being struck by a gel blaster projectile. Their vision ultimately returned to normal, but both face lifelong risks of ocular complications. These cases highlight the need for vigilance, and the appropriate restriction of powerful weapons, with the inherent need for eye protection when operating any such projectiles reiterated. It is recommended their licensing is made congruous with paintball guns to prevent false reassurance of their safety.


Assuntos
Traumatismos Oculares/etiologia , Jogos e Brinquedos/lesões , Ferimentos não Penetrantes/etiologia , Adolescente , Austrália , Pré-Escolar , Traumatismos Oculares/complicações , Humanos , Masculino , Recuperação de Função Fisiológica , Centros de Atenção Terciária , Acuidade Visual , Ferimentos não Penetrantes/complicações
17.
Cir Cir ; 87(2): 183-189, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30768058

RESUMO

Introduction: Trauma is a leading cause of morbimortality in the world. Intraabdominal compartment is the third most affected anatomical region and bleeding from this origin is difficult to identify, therefore the importance to predict possible lesions to the abdominal cavity. Objective: To describe and analyze the sociodemographic profile and injuries found in patients with abdominal trauma in a western hospital in Mexico. Method: Consecutive patients included in the local registry GDL-SHOT were analyzed. Results: From 4961 patients, 91.4% were men, with a mean age of 28.7 years. Regarding the mechanism of trauma, 39.7% were stab wounds, 33% blunt abdominal trauma and 27.3% gunshots. The most affected organs were: small bowel (20.9%), liver (18.2%), and colon (14.2%). The mean hospital stay was 6.95 days with a mortality of 6.74%. Conclusion: In Mexico, abdominal trauma represents an important cause of morbidity and mortality, especially in young patients. We found an important amount of penetrating trauma.


Assuntos
Traumatismos Abdominais/epidemiologia , Ferimentos por Arma de Fogo/epidemiologia , Ferimentos não Penetrantes/epidemiologia , Ferimentos Perfurantes/epidemiologia , Traumatismos Abdominais/etiologia , Traumatismos Abdominais/mortalidade , Adulto , Colo/lesões , Feminino , Mortalidade Hospitalar , Humanos , Intestino Delgado/lesões , Tempo de Internação/estatística & dados numéricos , Fígado/lesões , Masculino , México/epidemiologia , Distribuição por Sexo , Fatores Socioeconômicos , Baço/lesões , Ferimentos por Arma de Fogo/etiologia , Ferimentos por Arma de Fogo/mortalidade , Ferimentos não Penetrantes/etiologia , Ferimentos não Penetrantes/mortalidade , Ferimentos Perfurantes/etiologia , Ferimentos Perfurantes/mortalidade
19.
Ann Vasc Surg ; 57: 272.e15-272.e17, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30684606

RESUMO

We treated an 89-year-old patient affected by a descending thoracic aorta lesion due to a rib fracture with a penetrating costal stump. An urgent combined thoracic and endovascular surgical approach was performed, removing the rib fragment and positioning an aortic endoprosthesis simultaneously. Postoperative angio-computed tomography scan demonstrated the correct position of the endoprosthesis without any leakage or periaortic hemorrhage.


Assuntos
Aorta Torácica/cirurgia , Implante de Prótese Vascular , Procedimentos Endovasculares , Fraturas das Costelas/etiologia , Lesões do Sistema Vascular/cirurgia , Ferimentos não Penetrantes/cirurgia , Idoso de 80 Anos ou mais , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/lesões , Aortografia/métodos , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares/instrumentação , Feminino , Humanos , Fraturas das Costelas/diagnóstico por imagem , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/etiologia , Ferimentos não Penetrantes/diagnóstico por imagem , Ferimentos não Penetrantes/etiologia
20.
Ann Vasc Surg ; 57: 35-40, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30684614

RESUMO

BACKGROUND: Early identification of peripheral vascular injuries is crucial to prevent acute limb ischemia and amputation. We sought to identify predictors of vascular injury in patients with blunt lower extremity fractures. METHODS: A single institutional retrospective analysis of patients with blunt lower extremity fractures at a university-affiliated, county hospital over a 2-year period was performed. Patients with lower extremity vascular injury were compared to patients without lower extremity vascular injury. Multivariate logistic regression analysis was performed to identify independent predictors of vascular injury. RESULTS: Two hundred seventy-four patients were identified. The mean age was 37.2 ± 17.6 years, and 73.7% were male. The most common mechanisms were auto versus pedestrian/bicycle (44.2%) and motor vehicle accidents (27.7%). Twenty-two patients (8.0%) had vascular injuries, of which the most commonly injured arteries were the anterior tibial artery (8, 36.4%) and the posterior tibial artery (8, 36.4%). Patients with vascular injuries were more likely to have a tibia-fibula fracture (90.9% vs 52.4%, P < 0.01), an open fracture (63.6% vs 21.8%, P < 0.01), and a mid-shaft fracture (59.1% vs 19.4%, P < 0.01). Amputation was required in 3 patients (13.6%) with a vascular injury. On multivariate analysis, a tibia-fibula fracture (odds ratio [OR] = 5.48, 95% confidence interval [CI] = 1.15-26.1, P < 0.05), an open fracture (OR = 3.87, 95% CI = 1.37-11.0, P = 0.01), and mid-shaft fracture (OR = 2.91, 95% CI = 1.04-8.1, P < 0.05) were associated with the presence of a vascular injury. CONCLUSIONS: Open tibia-fibula fractures particularly those involving a mid-shaft location are independent predictors of vascular injuries in patients with blunt lower extremity fracture. These findings may help identify patients requiring diagnostic and surgical intervention.


Assuntos
Fíbula/lesões , Traumatismos da Perna/etiologia , Extremidade Inferior/irrigação sanguínea , Fraturas da Tíbia/etiologia , Lesões do Sistema Vascular/etiologia , Ferimentos não Penetrantes/etiologia , Adulto , Amputação , Feminino , Fíbula/diagnóstico por imagem , Fíbula/cirurgia , Fixação de Fratura , Humanos , Traumatismos da Perna/diagnóstico por imagem , Traumatismos da Perna/cirurgia , Salvamento de Membro , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fraturas da Tíbia/diagnóstico por imagem , Fraturas da Tíbia/cirurgia , Procedimentos Cirúrgicos Vasculares , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/cirurgia , Ferimentos não Penetrantes/diagnóstico por imagem , Ferimentos não Penetrantes/cirurgia , Adulto Jovem
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