Management of thrombocytopenia-absent radius (TAR) syndrome.

Thrombocytopenia-absent radius (TAR) syndrome is defined by bilateral absence of the radius and hypomegakaryocytic thrombocytopenia (<150,000/mm3). Lower extremity and nonorthopaedic anomalies also are frequently present. Charts and radiographs of 23 patients with TAR syndrome were reviewed, with extremity and other anomalies documented. Upper and lower extremity management, which included surgery and multiple attempts at orthotic and prosthetic fitting, was evaluated. Upper extremity prostheses were generally rejected, as most patients were able to perform tasks by approximating themselves closely enough to an object to use their own hands. Adaptive devices for feeding, dressing, and toileting were well tolerated. In the lower extremity, most affected patients either rejected any lower extremity intervention or had involvement that eventually precluded functional ambulation, necessitating power wheelchair or motorized cart use. The greatest degree of independence for these patients comes not from surgical, prosthetic, or orthotic intervention, but from the use of simple adaptive devices and powered mobility aids if required.

Long bone fractures in the polytrauma patient. The role of early operative fixation.

The role of early operative fixation in polytrauma patients with long bone fractures was analyzed by comparing length of stay, intensive care unit days and ventilator days, incidence of pulmonary complications, infectious complications, orthopedic complications, and mortality in three groups: traction only, operative fixation later than 48 hours after admission, and operative fixation within 48 hours of admission. Patients in all groups were similar in mode of injury, age, and Injury Severity Scores. Patients with early operative fixation of long bone fractures had significantly (P less than .05) fewer pulmonary complications than either the traction or the late operative fixation group. No group routinely required ventilator support, even with attendant abdominal and chest trauma. Operative fixation of long bone fractures within 48 hours of admission in the multiply injured patient reduces pulmonary complications.