ABSTRACT
A 51-year-old man sustained an anterior shoulder dislocation during a motor vehicle accident. Radiographs and noncontrast magnetic images were obtained. resonance images were obtained.
Subject(s)
Ligaments/injuries , Ligaments/surgery , Shoulder Fractures/diagnosis , Shoulder Fractures/surgery , Shoulder Injuries , Humans , Ligaments/pathology , Magnetic Resonance Imaging , Male , Middle Aged , Shoulder Joint/pathology , Shoulder Joint/surgery , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Due to the lack of adequate controlled trials, the off-label use of recombinant factor VIIa (rFVIIa) to control hemorrhage in trauma patients remains controversial. The decision regarding when to initiate rFVIIa therapy is particularly problematic. Whereas most reports and trials have delayed use until significant bleeding has occurred, there is some evidence that coagulopathy develops early in some trauma patients, raising the possibility that early rFVIIa use may be more clinically efficacious. Herein, we report the case of a hemodynamically unstable patient with massive blood loss from multiple gunshot wounds and who had a potentially salvageable upper extremity. Rapid hemorrhage despite efforts to surgically control the bleeding resulted in virtual exhaustion of the facilities' limited blood component supply. Hemorrhage was controlled when rFVIIa was added to hypotensive resuscitation allowing salvage of the arm and significant conservation of blood products. This case raises the question as to whether earlier off-label use of this agent should be considered when amputation for hemorrhage control is being considered and/or conservation of limited blood assets is needed.
Subject(s)
Factor VIIa/therapeutic use , Hemorrhage/drug therapy , Limb Salvage , Salvage Therapy , Wounds, Gunshot/drug therapy , Adult , Blood Transfusion , Hemorrhage/blood , Humans , Male , Off-Label Use , Recombinant Proteins/therapeutic use , Wounds, Gunshot/bloodABSTRACT
Temporary external fixation of femur fractures, used at civilian trauma centers for patients who cannot tolerate more extensive procedures, also is planned for use in military field hospitals to provide temporary stabilization and allow for safe transport of a patient to the next level of care. The purpose of the current study was to evaluate three constructs: an external fixator made by one manufacturer and two Hoffman II constructs: uniplanar and biplanar. The study consisted of two parts: a biomechanical study of each of the three constructs and the application of each of the two Hoffmann II constructs to separate cadaver thighs by resident surgeons. Five resident surgeons participated in the study using five pairs of cadaver thighs. The biplanar construct was stiffer in axial and torsional stability when compared with the uniplanar construct. There was no difference in the amount of time needed to apply the constructs nor was either construct found to be subjectively easier to apply by the surgeons. There was an increased number of unicortical pins and plunges (when a pin inadvertently slips over the side) with the uniplanar construct when compared with the biplanar. The biplanar construct is biomechanically more stable and appears to allow for more accurate placement of pins.
