Trauma Commons^™

Lost Fractures: Prevalence And Risk Factors For Missed Costosternal And Costal Cartilage Fractures Among Patients With Radiologic Chest Wall Injury., Joseph D Forrester, Mohamad Abou Chaar, Andrew T Barnes, Zachary M Bauman, Samy Bendjemil, Nizama N Betts, Benjamin Christie, Raaga Dasari, Devoe Wb, Michelle J Earley, Bradley Faliks, Tracy J Johns, Connie Johnson, Michelle S Junker, Brian D Kim, Jonathan M King, Ariel Whitney Knight, Alexis A Schweibinz, Daniel Stephens, Mary Stuever, Simeng Wang

Trauma and Acute Care Articles

BACKGROUND: Costosternal cartilages and the costal margin, collectively termed costal cartilage, are hyaline cartilage connecting ribs to the sternum and to adjacent ribs, respectively. Presence of intact costal cartilage is essential for elasticity of the chest wall. Anecdotally, costal cartilage injuries are underdiagnosed on trauma CT scan in patients with rib fractures. Our aim was to determine a baseline frequency of acute costal cartilage injury among patients presenting with rib fractures.

METHODS: We performed a retrospective cohort study of injured adult patients admitted to Level I/II trauma centers with rib fractures from January 2020 to July 2024. CT images obtained …

The Revised Risk Analysis Index Outperforms The 5-Factor Modified Frailty Index In Predicting Postoperative Morbidity After Pilon Fracture Fixation., Gabriel Deoliveira, Amber Park, Arsalaan Sayyed, Aruni Areti, Nithin Gupta, Taylor Manes, Morgan Turnow, Benjamin Taylor, Jack W Weick

Trauma and Acute Care Articles

BACKGROUND: Pilon fractures often result from high energy mechanisms resulting in long-term morbidity and postoperative complications. While there is extensive literature investigating frailty scales as tools for preoperative risk stratification in orthopedic surgery, there is no literature regarding their use in fixation of pilon fractures. The objective of this study was to compare the predictive ability and discriminative accuracy of the Revised Risk Analysis Index (RAI-rev) and the 5-Item Modified Frailty (mFI-5) in 30-day postoperative outcomes following surgical fixation of pilon fractures.

METHODOLOGY: The ACS-NSQIP database was used to identify patients undergoing surgical fixation of pilon fractures from 2015 to …

Utility Of Revised Risk Analysis Index As A Predictor Of Mortality And Morbidity In Orthopaedic Trauma., Chirag Soni, Victor Koltenyuk, Nithin Gupta, Haad A Arif, Aruni Areti, Taylor Manes, Luke A Lopas, Jan P Szatkowski, Christian A Bowers, Benjamin C Taylor, Jack W Weick

Trauma and Acute Care Articles

OBJECTIVES: The aim of this study was to determine the applicability of the Revised Risk Analysis Index (RAI-Rev) in orthopaedic trauma and compare the predictive discrimination for the RAI-Rev and the 5-Item Modified Frailty Index (mFI-5) for 30-day postoperative outcomes.

DESIGN: This is a retrospective cohort study.

SETTING: The American College of Surgeons National Surgical Quality Improvement database was used.

PATIENT SELECTION: All patients aged 18 or older who underwent surgical treatment for forearm, humerus, pelvis, acetabulum, femur, tibia, and hindfoot fractures from 2015 to 2020 were included.

OUTCOME: 30-day postoperative mortality, major complications, and wound complications consisting of surgical …

Surgical Management Of An Intracranial Injury Caused By A Handcrafted Arrow In Sub-Saharan Africa: A Global Neurosurgical Relevance., Allie L Heineman, Quinn Jackson, Chris Karas, Robert Galler, Victor Awuor, Hiren Patel

Trauma and Acute Care Articles

This case report and literature review describe an intracranial injury resulting from a handcrafted arrow that required emergent surgical management in a patient treated at a public hospital in Sub-Saharan Africa. The authors are members of the non-profit organizations Chunilal Initiative and Kisumu Intuitive, which deliver charitable neurosurgical care to the region on a quarterly basis. This unique neurotrauma case, involving a penetrating, contaminated, metallic object, highlights the surgical and antibacterial management of intracranial arrow injuries and emphasizes the importance of neurosurgical missions to underserved regions globally. The patient is a 16-year-old male tribal member with no known or reported …

Accidental Ingestion Of Extended-Release Guanfacine In A Toddler., Dina R Assali, Alek Q Adkins, Jonathan Chang

Trauma and Acute Care Articles

This case report describes the clinical presentation and treatment following an exploratory ingestion of extended release (ER) guanfacine in a healthy toddler. Guanfacine, an alpha-2a agonist, can cause transient hypertension as it moves from the serum into the CNS where it causes the more commonly seen central nervous system (CNS) depression, hypotension, and bradycardia. Persistent hypertension requiring intravenous (IV) vasodilatory medication is a rare and life-threatening complication of an alpha-2 agonist with only one other published report. This case report re-emphasizes and further expands available literature on this rarely reported effect.

Epidemiology Of Hip Dislocations In The United States From 1990 To 2019: A Temporal Study Using The Global Burden Of Disease Database., Ambrose Loc T Ngo, Gabrielle Dykhouse, Taylor J Manes, Phillip C Mckegg, Cameron J Sabet, Brett Barthman, Robert Golden

Trauma and Acute Care Articles

Introduction Hip dislocations are devastating injuries that require urgent intervention to minimize the development of severe complications. This study aimed to evaluate the epidemiology of hip dislocations in the United States (U.S.) from 1990 to 2019. Methods This study is a descriptive retrospective epidemiological study. The Global Burden of Disease (GBD) database was used to collect epidemiological data on hip dislocation in the U.S. from 1990 to 2019. Data included years lived with disability (YLDs), prevalence, and incidence rates per 100,000 people. Data were regionally stratified into Northeast, Midwest, South, and West by the U.S. Census definition. Bartlett's test was …

The Development Of A Trauma Interventional Radiology Alert Protocol Reduces Time To Vessel Puncture In Cases Of Active Hemorrhage., Aahad Khan, Akhil Gangisetty, Steve Mitchell, Nick Daughtery, Brent Goslin, William B Devoe, John Bach

Trauma and Acute Care Articles

Introduction Trauma continues to be a major cause of death in the United States, with uncontrolled bleeding contributing to a significant portion of trauma-related fatalities. In recent years, the management of hemorrhagic trauma patients has expanded to include interventional radiology (IR). The American College of Surgeons Committee on Trauma recommends that Level 1 and 2 trauma centers ensure IR availability within 60 minutes of the decision to proceed with angiography. Delays in IR intervention are associated with poorer outcomes and increased mortality. To address this, our Level 2 trauma center developed and implemented an institutional protocol involving trauma surgeons, interventional …

The Role Of Adjunctive Medial Plating In Distal Femur Fractures And Distal Femur Fractures Nonunions., Jerrod Steimle, Jaron L Lohmeyer, Benjamin Taylor, Daniel T Degenova

Trauma and Acute Care Articles

PURPOSE: There exists controversy in the treatment of acute distal femur fractures as well as distal femur fracture nonunions. The objective of this study is to determine the clinical benefit of adjunctive medial plate application in the setting of acute distal femur fractures and distal femur fracture nonunions.

METHODS: This is a retrospective comparative study at a Level 1 academic trauma center, including 104 patients treated for acute distal femur fractures and 23 patients treated for distal femur nonunions between 2015 and 2019. The study compared dual plate fixation to other methods of fixation.

RESULTS: In the acute fracture setting, …

Multidisciplinary Emergent Control Of Traumatic Neovaginal Bleeding After Foreign-Body Insertion In The Early Postoperative Period After Gender-Affirming Vaginoplasty., Tanisha S Kashikar, Christopher D Mcclung, Michal A Radomski, Anand K Joshi, David C Evans

Trauma and Acute Care Articles

As gender-affirming surgery becomes more widespread, it is important that healthcare providers recognize complications related to gender-affirming surgery. Although rates of postoperative bleeding after gender-affirming vaginoplasty are relatively low, it is imperative that this potentially life-threatening complication is recognized and managed quickly. This case highlights the importance of a multidisciplinary approach to the management of neovaginal bleeding that was unable to be controlled intraoperatively by suture ligation.

Does Mean Arterial Pressure Augmentation Improve Neurological Recovery Of Blunt Spinal Cord Injuries: An East Multicenter Trial., Aimee Lariccia, Stephanie Doris, Bhairav Shah, Tanisha Kashikar, Erik Teicher, Lindsey Perea, Jennifer Huber, Malia Eischen, H Akin Erol, Michael Steven Farrell, Lauren Colom, Stephanie Scott, Brian Daley, James Bardes, Gregory Schaefer, Melissa Moncrief, William Devoe, Ryan Peter Dumas, Caitlin Anne Fitzgerald, William Brigode, John D Berne, Dalier R Mederos, Scott Armen, Melissa Linskey Dougherty, Asanthi Ratnasekera, Emily Alberto, Alison Smith, Bradley M Dennis, Stephen Gadomski, Jeffry Nahmias, Claudia Alvarez, Salina Wydo, Jennifer Schweinsburg, Carlos H Palacio, M Chance Spalding, Joshua Hill

Trauma and Acute Care Articles

BACKGROUND: Treatment of blunt traumatic spinal cord injuries (SCIs) often includes maintaining elevated mean arterial blood pressures (MAP) to enhance perfusion to the spinal cord. Optimal hyperperfusion protocols and treatment algorithms have yet to be delineated due to a paucity of large volume prospective studies. This study aims to identify predictors of neurological improvement in American Spinal Injury Association (ASIA) impairment score following blunt SCI.

STUDY DESIGN: Prospective (January 10, 2021 to June 1, 2023) multicenter study included blunt SCI patients age >18 with complete neurological examination documented on hospital arrival. Patients were divided into two groups: neurological improvement and …

Mean Arterial Pressure (Map) Augmentation In Traumatic Spinal Cord Injuries: Early Hyperperfusion Treatment Influences Neurologic Outcomes., Aimee K Lariccia, Kimberly Sperwer, Michael L Lieber, M Chance Spalding

Trauma and Acute Care Articles

Context: Hyperperfusion therapy, mean arterial blood pressure (MAP) > 85 mmHg, is a recommended treatment of blunt traumatic spinal cord injury (SCI). We hypothesized the first 24 h of MAP augmentation would be most influential on neurological outcomes.Design: This retrospective study from a level 1 urban trauma center dating 1/2017 to 12/2019 included all blunt traumatic spinal cord injured patients receiving hyperperfusion therapy. Patients were grouped as "No improvement" vs "Improvement" measured by change in American Spinal Injury Association (ASIA) score during their hospitalization. MAP values for the first 12, first 24 and last 72 h were compared between the …

An Acute Hepatic Hydrothorax Causing Tension., Dina R Assali, Austin Richardson, Andrew Kalnow

Trauma and Acute Care Articles

Patients with advanced cirrhosis are at risk for numerous complications, including hepatic hydrothorax. Hepatic hydrothorax most commonly occurs in the right pleural space but less commonly can present on the left hemithorax. The exact pathophysiology is not fully understood, but there are several schools of thought for right-sided effusions. In this case report, we discuss the findings of a 76-year-old female who experienced a left-sided hydrothorax likely stemming from her underlying liver disease which created tension pathology in an otherwise stable patient. Interestingly, this accumulation occurred over a couple of weeks despite optimal medical management. A thoracentesis confirmed ascitic fluid. …

Surgical Opportunism For Hand Reconstruction Following A Mutilating Injury: A Case Report., Krishna A Patel, Tuna Özyurekoglu

Trauma and Acute Care Articles

We report our management of a 53-year-old female who suffered a wood planer hand-mutilating injury with significant dorsal soft tissue loss and partial metacarpophalangeal joint (MCPJ) amputations of the thumb, index, and middle fingers. The middle finger was deconstructed for "spare parts" and a vascularized osteochondral graft was utilized to reconstruct the metacarpal articular surface of the index finger proximal phalanx, allowing the pedicled transposition of the index finger to the third metacarpal. The middle finger's distal interphalangeal joint was transplanted non-vascularly to recreate the thumb MCPJ and the elevation of a middle finger fillet flap allowed dorsal wound coverage. …

Injuries Related To Waterskiing Between 2012 And 2022: A National Database Study., Sean M Muir, Tyler Rizzieri, Andrew Brown, Cole Graham, Laken Fulmer, Ryan Scagliarini, Kristine Lombardozzi

Trauma and Acute Care Articles

We conducted an epidemiological study by using the National Electronic Injury Surveillance System (NEISS) database to assess and quantify waterskiing injuries between 2012 and 2022. A total of 898 injuries were reported, primarily among Caucasian males during competition. Head (177, 20%), face (93, 10%), and knee (70, 8%) were the most prevalent types of injuries. Common physical examination findings included muscle strains, ligament sprains, lacerations, and fractures. Although rare, there were reported cases of dental injury, hemorrhage, crushing, foreign body, and amputation as well. These findings suggest that protective equipment, particularly headgear, is necessary to reduce the incidence of waterskiing …

Suture Fixation Of Traumatic Rib Fracture Flail Segment With Klebsiella Osteomyelitis., Krishna Patel, Anthony N Rizzo, John Bach, William Devoe

Trauma and Acute Care Articles

We report the case of a 71-year-old male who initially presented with urosepsis and was found to have a rib fracture of his right 6th rib with a flail segment and an associated abscess. Given the concern for infection, surgical rib fixation with titanium plating was not pursued during the washout of his abscess and instead, he successfully underwent rib fracture stabilization with bilateral suture transfixation. He was continued on a prolonged course of antibiotics for Klebsiella pneumonia osteomyelitis and was discharged uneventfully with optimal pain control and adequate respiratory effort.

Evaluation And Treatment Of Gastrointestinal Bleeding In Patients Taking Anticoagulants Presenting To The Emergency Department., Adam J Singer, Neena S Abraham, Latha Ganti, W Frank Peacock, Janaé Dark, Hajirah Ishaq, Ana Negrete, Brandon Mount, James Neuenschwander

Trauma and Acute Care Articles

This manuscript is a consensus document of an expert panel on the Evaluation and Treatment of Gastrointestinal Bleeding in Patients Taking Anticoagulants Presenting to the Emergency Department, sponsored by the American College of Emergency Physicians.

Endovascular Covered Stent Graft Repair By Through-And-Through Snaring Of An Acute Traumatic Femoral-Femoral Arteriovenous Fistula Following A Gunshot Wound., Anthony N Rizzo, Krishna Patel, Jordyn Perdue, Jon C Henry

Trauma and Acute Care Articles

Arteriovenous fistula (AVF) formation after penetrating injury underscores a rare and challenging complication of vascular trauma. Traumatic AVFs have various clinical presentations and reported methods of repair. Although open surgical repair is the most frequently used method of repair, the advancement of endovascular techniques has been increasingly used during the past 3 decades. We report a case of an acute traumatic AVF of the superficial femoral artery and superficial femoral vein from a gunshot wound repaired with a unique endovascular technique involving snaring to establish through-and-through access to allow deployment of a covered stent graft.

Fat Malabsorption: An Underrecognized Challenge From Pancreatic Disease To Trauma, Critical Care, And Beyond., David C Evans

Trauma and Acute Care Articles

No abstract provided.

Attempted Repair Of Chest Wall Injury Following Penetrating Injury With Surgical Stabilization Rib And Autologous Bone Graft: A Case Report., Vincent E Serapiglia, Krishna A Patel, Jaya Sai V Varre, Brian T Dusseau, William B Devoe

Trauma and Acute Care Articles

Rib fractures are one of the most common injuries following blunt trauma. When associated with penetrating trauma, the projectile velocity and immense energy transfer cause significant rib fracture displacement and fragmentation. As a result, these patients are potentially exposed to an even higher risk of complications compared to those seen in more simple rib fractures. Unfortunately, there is limited research regarding technical considerations for surgical stabilization of rib fractures (SSRF) in severely displaced rib fractures with bone loss following penetrating injury. We present the case of a 21-year-old male gunshot wound victim with severely displaced and comminuted rib fractures in …

Prospective Validation Of A Hospital Triage Predictive Model To Decrease Undertriage: An East Multicenter Study., Elise A Biesboer, Courtney J Pokrzywa, Basil S Karam, Benjamin Chen, Aniko Szabo, Bi Qing Teng, Matthew D Bernard, Andrew Bernard, Sharfuddin Chowdhury, Al-Hasher E Hayudini, Michal A Radomski, Stephanie Doris, Brian K Yorkgitis, Jennifer Mull, Benjamin W Weston, Mark R Hemmila, Christopher J Tignanelli, Marc A De Moya, Rachel S Morris

Trauma and Acute Care Articles

BACKGROUND: Tiered trauma team activation (TTA) allows systems to optimally allocate resources to an injured patient. Target undertriage and overtriage rates of

METHODS: The model was previously developed and internally validated using data from 31 US trauma centers. Data were collected prospectively at five sites using a mobile application which hosted the NEI-6 model. A weighted multiple logistic regression model was used to retrain and optimize the model using the original data set and a portion of data from one of the prospective sites. The remaining data from the five sites were designated for external validation. The area under the …

Failure Rates Of Nonoperative Management Of Low-Grade Splenic Injuries With Active Extravasation: An Eastern Association For The Surgery Of Trauma Multicenter Study., Kristen Spoor, John David Cull, Banan W Otaibi, Joshua P Hazelton, John Chipko, Jessica Reynolds, Sam Fugate, Claire Pederson, Linda B Zier, Lewis E Jacobson, Jamie M Williams, Thomas S Easterday, Saskya Byerly, Caleb Mentzer, Edward Hawke, Daniel C Cullinane, Julianne B Ontengco, Nikolay Bugaev, Madison Leclair, Pascal Udekwu, Cooper Josephs, Matthew Noorbaksh, James Babowice, Catherine Garrison Velopulos, Shane Urban, Anna Goldenberg, Gaby Ghobrial, John M Pickering, Steven D Quarfordt, Alia F Aunchman, Aimee K Lariccia, Chance Spalding, Richard D Catalano, Jordan E Basham, Philip M Edmundson, Jeffry Nahmias, Erika Tay, Scott H Norwood, Katelyn Meadows, Yee Wong, Claire Hardman

Trauma and Acute Care Articles

OBJECTIVES: There is little evidence guiding the management of grade I-II traumatic splenic injuries with contrast blush (CB). We aimed to analyze the failure rate of nonoperative management (NOM) of grade I-II splenic injuries with CB in hemodynamically stable patients.

METHODS: A multicenter, retrospective cohort study examining all grade I-II splenic injuries with CB was performed at 21 institutions from January 1, 2014, to October 31, 2019. Patients >18 years old with grade I or II splenic injury due to blunt trauma with CB on CT were included. The primary outcome was the failure of NOM requiring angioembolization/operation. We determined …

Advancing The Practice Of Trauma: Utilizing Advanced Practice Providers To Improve Patient Outcomes Through A Collaborative Team Approach., Alaina M Lasinski, Allysen Shaughnessy, Benjamin Reynolds, Raquel Forsythe, Annika B Kay, Brian K Yorkgitis, Brandy N Younge, Ashley B Christmas, Jeffrey A Claridge

Trauma and Acute Care Articles

Advanced practice providers (APPs) have become essential to trauma teams in the United States during the last few decades. The optimal utilization of APPs is not yet known and is likely highly variable secondary to many factors. We discuss three aspects of the multidisciplinary approach to caring for trauma patients. First, a review of the literature demonstrates that APPs in trauma improve quality of care, patient throughput, and decrease cost. We then report on models of APP utilization by comparing five trauma centers across the country, concluding that utilization remains highly variable due to several system and provider factors. The …

Titratable Partial Aortic Occlusion: Extending Zone I Endovascular Occlusion Times., David Gomez, Asad Naveed, Joao Rezende, Bradley M Dennis, Rishi Kundi, Elizabeth Benjamin, Ryan Lawless, Jonathan Nguyen, Juan Duchesne, Chance Spalding, Stephanie Doris, Candice Van Skike, Ernest E Moore, Andrew Beckett

Trauma and Acute Care Articles

BACKGROUND: Extending the time to definitive hemorrhage control in noncompressible torso hemorrhage (NCTH) is of particular importance in the battlefield where transfer times are prolonged and NCTH remains the leading cause of death. While resuscitative endovascular balloon occlusion of the aorta is widely practiced as an initial adjunct for the management of NCTH, concerns for ischemic complications after 30 minutes of compete aortic occlusion deters many from zone 1 deployment. We hypothesize that extended zone 1 occlusion times will be enabled by novel purpose-built devices that allow for titratable partial aortic occlusion.

METHODS: This is a cross-sectional analysis describing pREBOA-PRO …

Go With The Flow: An Experimental Analysis With Tubing Alternative With Irrigation., Scott S Hyland, Daniel T Degenova, Joseph P Scheschuk, Benjamin C Taylor

Trauma and Acute Care Articles

BACKGROUND AND AIMS: Literature regarding alternative tubing for fluid delivery in irrigation and debridement procedures is lacking. The purpose of this study was to compare three different apparatuses with varying quantities of irrigation fluid to assess efficiency of administration and evaluate overall time for fluid administration.

METHODS: This model was designed to compare available methods of gravity irrigation used in practice. Fluid flow time was measured for three types of tubing: single-lumen cystoscopy tubing, Y-type double-lumen cystoscopy tubing, and nonconductive suction tubing. Irrigation times were assessed for varying volumes of 3, 6, and 9 L to investigate the relationship between …

Prehospital Shock Index Predicts Outcomes After Prolonged Transport: A Multicenter Rural Study., James M Bardes, Bradley S Price, Hannah Bailey, Alexander Quinn, Zachary D Warriner, Andrew C Bernard, Aimee Lariccia, M Chance Spalding, Melissa B Linskey Dougherty, Scott B Armen, Alison Wilson

Trauma and Acute Care Articles

BACKGROUND: Shock index (SI) predicts outcomes after trauma. Prior single-center work demonstrated that emergency medical services (EMSs) initial SI was the most accurate predictor of hospital outcomes in a rural environment. This study aimed to evaluate the predictive ability of SI in multiple rural trauma systems with prolonged transport times to a definitive care facility.

METHODS: This retrospective review was performed at four American College of Surgeons-verified level 1 trauma centers with large rural catchment basins. Adult trauma patients who were transferred and arrived >60 minutes from scene during 2018 were included. Patients who sustained blunt chest or abdominal trauma …

Expandable Intravertebral Implants In Post-Traumatic Vertebral Necrosis - New Classification Suggestion., Diogo Lino Moura, Josué Pereira Gabriel

Trauma and Acute Care Articles

The progressive evolution of post-traumatic vertebral necrosis and consequent loss of structural integrity of the vertebral body along with neurological risk, makes it one of the most feared and unpredictable pathologies in spine traumatology. Several studies have addressed the role of vertebroplasty, kyphoplasty, and corpectomy in its treatment; however, it remains a controversial concept without a defined therapeutic algorithm. The recent emergence of expandable intravertebral implants, which allow, by a percutaneous transpedicular application, the capacity for intrasomatic filling and maintenance of the height of the vertebral body, makes them a viable option, not only in the treatment of acute vertebral …

Multidisciplinary Simulation Of Trauma In Pregnancy With Resuscitative Endovascular Balloon Occlusion Of The Aorta (Reboa) Utilization., Peter Hopmann, Jaya Sai Varre, Gary Duncan, William B Devoe, Brad D Gable

Trauma and Acute Care Articles

Background Studies have demonstrated the use of resuscitative endovascular balloon occlusion catheters of the aorta (REBOA) in the setting of postpartum hemorrhage and traumatic hemorrhagic shock. However, REBOA is infrequently utilized leading to a lack of clinician comfort. This study's aim was to demonstrate the utility of REBOA in a hemorrhaging pregnant trauma patient and improve clinician comfort with the placement of REBOA while emphasizing collaboration between medical specialties. Methods A multidisciplinary in-situ simulation was developed for the management of a pregnant patient with an abdominal gunshot wound evaluated by obstetrics and surgery teams. A trauma survey, emergency c-section, massive …

Surgical Stabilization Versus Nonoperative Treatment For Flail And Non-Flail Rib Fracture Patterns In Patients With Traumatic Brain Injury., Jonne T H Prins, Esther M M Van Lieshout, Francis Ali-Osman, Zachary M Bauman, Eva-Corina Caragounis, Jeff Choi, D Benjamin Christie, Peter A Cole, William B Devoe, Andrew R Doben, Evert A Eriksson, Joseph D Forrester, Douglas R Fraser, Brendan Gontarz, Claire Hardman, Daniel G Hyatt, Adam J Kaye, Huan-Jang Ko, Kiara N Leasia, Stuart Leon, Silvana F Marasco, Allison G Mcnickle, Timothy Nowack, Temi D Ogunleye, Prakash Priya, Aaron P Richman, Victoria Schlanser, Gregory R Semon, Ying-Hao Su, Michael H J Verhofstad, Julie Whitis, Fredric M Pieracci, Mathieu M E Wijffels

Trauma and Acute Care Articles

PURPOSE: Literature on outcomes after SSRF, stratified for rib fracture pattern is scarce in patients with moderate to severe traumatic brain injury (TBI; Glasgow Coma Scale ≤ 12). We hypothesized that SSRF is associated with improved outcomes as compared to nonoperative management without hampering neurological recovery in these patients.

METHODS: A post hoc subgroup analysis of the multicenter, retrospective CWIS-TBI study was performed in patients with TBI and stratified by having sustained a non-flail fracture pattern or flail chest between January 1, 2012 and July 31, 2019. The primary outcome was mechanical ventilation-free days and secondary outcomes were in-hospital outcomes. …

Systematic Review To Evaluate Algorithms For Reboa Use In Trauma And Identify A Consensus For Patient Selection., Amelia Walling Maiga, Rishi Kundi, Jonathan James Morrison, Chance Spalding, Juan Duchesne, John Hunt, Jonathan Nguyen, Elizabeth Benjamin, Ernest E Moore, Ryan Lawless, Andrew Beckett, Rachel Russo, Bradley M Dennis

Trauma and Acute Care Articles

BACKGROUND: Patient selection for resuscitative endovascular balloon occlusion of the aorta (REBOA) has evolved during the last decade. A recent multicenter collaboration to implement the newest generation REBOA balloon catheter identified variability in patient selection criteria. The aims of this systematic review were to compare recent REBOA patient selection guidelines and to identify current areas of consensus and variability.

METHODS: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted a systematic review of clinical practice guidelines for REBOA patient selection in trauma. Published algorithms from 2015 to 2022 and institutional guidelines from a seven-center …

A Modern "Nightstick Fracture" Induced By Contemporary Ballistics During The George Floyd Protests., Braden J Passias, Benjamin C Taylor, Devon Myers, John Casey

Trauma and Acute Care Articles

A 28-year-old male presented to the emergency department with an isolated ulnar shaft fracture secondary to a ballistic injury with a wooden pellet gun. This injury is also known as a "nightstick fracture," which is a common eponym in orthopedic surgery used to describe a fracture of the ulnar shaft. The eponym gained its title for the injury commonly seen when in a defensive position while being attacked with a wooden club. It is widely accepted that this infamous injury was popularized in the 1960s as a sequela of the many race-related riots across the United States. This case details …