Jabor O.B., Bosse MF, Hudson MC et al (Carolinas Med. Ctr., Charlotte NC, Univ of North Carolina at Charlotte)
Does Bacteremia Occur During High Pressure Lavage of Contaminated Wounds.
Clin Orthop 347: 117-121. 1998
This study on 20 dogs investigates the risk of bacteremia secondary to high pressure lavage of contaminated wounds.
The dogs were divided randomly into 4 groups. In groups A and B, the wound was contaminated with 1.4 x 10 9 staphylococcus aureus and were followed 75 minutes later with high pressure lavage or bulb syringe irrigation. Groups C and D underwent the same treatment but without contamination.
No detectable bacteremia occurred in the contaminated wounds. However bacteremia was detected in 18 of 20 control dogs. High pressure lavage reduced bacterial levels by 70% and bulb irrigation by 44%.
It is concluded that high pressure lavage reduced wound bacteria more consistently than bulb irrigation did.
RN Town Seud, T Lheureau, J Protetch et al
Timing Fracture Repair in Patients with Severe brain line Injury Trauma :
Injury Infective Critcare 44: 977 -982, 1998
For patients with severe head injury and femoral fracture, orthopedic surgery is best deferred until risks are minimized by adequate resuscitation. Patients undergoing earlier fracture repair are at increased risk of secondary brain injury. Delaying surgery for 24 hours.
McGovern MK, Murphy RX Jr, et al (Lehigh Valley Hosp, Allentown, Pa)
Influence of Air Bags and Restraining Devices on Extremity Injuries in Motor Vehicle Collisions
Ann Plast Surg 44: 481-485, 2000
The authors assessed (retrospectively), the relationship between the use of restraining devices especially air bags and the rate of extremity injuries in motor vehicle collisions.
Restraining devices were categorized as (i) air bag alone (ii) air bag and seat belt (iii) seat belt or carseat without air bag and (iv) no restraining device.
There was a significant reduction in the incidence of upper and lower extremity injuries in patients who used restraining devices versus those who used no restraining devices.
However, air bags were associated with an increased incidence of upper and lower extremity trauma (when compared with no restraints or with patients who were restrained). The laceration rate was similar whether a seat belt or airbag was used. The laceration rate was higher when no air bag or seat belt was used.
McCormack RG, Brien D, et al (Univ of Calgary, Canada; St Michael’s Hosp, Toronto)
Fixation of Fractures of the Shaft of the Humerus by Dynamic Compression Plate or Intramedullary Nail: A Prospective Randomised Trial
J Bone Joint Surg Br 82-B: 336-339, 2000
The authors compared 2 methods of repair with open reduction and internal fixation of humeral shaft fractures viz (i) Fixation by a dynamic compression plate (DCP) (ii) Intramedullary nail (IMN).
Forty-four patients were studied prospectively and follow-up was for a minimum of 6 months.
Neither pain nor function scores differed significantly between the 2 groups. However the complications rate was higher in the IMN group (13 patients), while the DCP group had only 3.
Hence the authors recommended DCP fixation as the treatment of choice for unstable fractures of the humeral shaft.
Urwin SC, Parker MJ, et al (Peterborough District Hosp, UK)
General Versus Regional Anaesthesia for Hip Fracture Surgery: A Meta-analysis of Randomized Trials
Br J Anaesth 84: 450-455, 2000
A meta-analysis performed on 15 randomized trials included 2162 patients, in whom different anesthetic techniques used during hip fracture repair were compared. Morbidity and mortality rates were also studied.
The incidence of deep vein thrombosis and survival at 1 month were significantly lower with regional anesthesia than with general anesthesia (GA). The length of operation was slightly but significantly shorter with GA than with regional anesthesia.
The authors conclude that the use of regional anesthesia for hip fracture repair is associated with lower morbidity, fewer early deaths and a reduced tendency to deep vein thrombosis.