Survivors of improvised explosive device attacks often have traumatic brain injuries (TBIs). Those recovering from TBIs often find they must coordinate services across multiple systems of care, ...something that would be difficult even without cognitive challenges. This report documents RAND’s assessment of a program designed to facilitate care coordination for such individuals.
It has been shown that those who have served in both combat missions and peacekeeping operations are at increased risk for Traumatic Brain Injury (TBI). Research suggests that this may result from ...their "wounds of war". Some wounds may be "invisible", such as depression, stress, and chronic pain, while others, such as physical disabilities, are more obvious. In February 2011, 35 scientists and representatives from NATO and Partner countries met in Vienna, Austria for a three-day NATO Advanced Research Workshop entitled "Wounds of War: Coping with Blast-Related Traumatic Brain Injury in Returning Troops". The aim of this publication, which presents papers from that workshop, is to critically assess the existing knowledge and to identify directions for future actions. The book addresses four key questions:1. Characterization of TBI: Which characteristics make up and help to classify TBI?2. Diagnosis and Assessment Issues Surrounding TBI: Which methods are used to diagnose and assess TBI? 3. Treatment of TBI: What are the latest treatment and therapy opportunities for soldiers after they have been diagnosed with TBI? 4. Quality of Life: How are the lives of TBI patients affected and in what ways can their quality of life be increased?.
Trauma is an exhausting platelet experience Holinstat, Michael
Journal of thrombosis and haemostasis,
September 2022, 2022-09-00, 20220901, Letnik:
20, Številka:
9
Journal Article
In this collaboratively authored work, five distinguished sociologists develop an ambitious theoretical model of "cultural trauma"—and on this basis build a new understanding of how social groups ...interact with emotion to create new and binding understandings of social responsibility. Looking at the "meaning making process" as an open-ended social dialogue in which strikingly different social narratives vie for influence, they outline a strongly constructivist approach to trauma and apply this theoretical model in a series of extensive case studies, including the Nazi Holocaust, slavery in the United States, and September 11, 2001.
Posterior malleolar involvement can drastically affect patient outcomes. Literature has supported the use of preoperative Computed Tomography (CT) to assess posterior malleolar fracture morphology. ...The purpose of this study is to determine whether preoperative CT is associated with significant improvement in surgical time, postoperative complications, reoperation rates in trimalleolar ankle fractures. Surgeons were also asked to complete survey regarding use of CT scans to gauge utility preoperatively.BackgroundPosterior malleolar involvement can drastically affect patient outcomes. Literature has supported the use of preoperative Computed Tomography (CT) to assess posterior malleolar fracture morphology. The purpose of this study is to determine whether preoperative CT is associated with significant improvement in surgical time, postoperative complications, reoperation rates in trimalleolar ankle fractures. Surgeons were also asked to complete survey regarding use of CT scans to gauge utility preoperatively.Adult patients with trimalleolar ankle fractures who underwent operative fixation between 2018-2020 were retrospectively reviewed. Primary outcomes included surgical time, postoperative complications, and reoperations. Secondary outcome was presence of posterior malleolar fixation. 15 surgeons who performed ankle ORIF were surveyed to gain information regarding why or why not preoperative CT scan was obtained.MethodsAdult patients with trimalleolar ankle fractures who underwent operative fixation between 2018-2020 were retrospectively reviewed. Primary outcomes included surgical time, postoperative complications, and reoperations. Secondary outcome was presence of posterior malleolar fixation. 15 surgeons who performed ankle ORIF were surveyed to gain information regarding why or why not preoperative CT scan was obtained.288 patients with trimalleolar ankle fractures were included, 94 had preoperative CT scans (32.6%). No significant differences found in patient age, gender, BMI, smoking status between the groups that did and did not have preoperative CT scan. No significant differences were observed in AO/OTA classification between groups. Average surgical time was significantly higher in group that received a preoperative CT (114 without CT vs. 145 with CT, p<0.05). Complications (10.3% no CT vs 7.4% with CT, p=0.55) and reoperations (6.7% without CT vs. 7.4% with CT, p=0.16) not significantly different between groups. No significant difference was observed in rate of posterior malleolus fixation between groups (43.8% without CT vs 39.4% with CT; p=0.52). Of surveyed surgeons, 87% reported they don't routinely obtain preoperative CT scan for trimalleolar ankle fractures. Most common reasons for preoperative scans were deciding on approach/positioning, assessing for impaction, determining the size of the posterior malleolus.Results288 patients with trimalleolar ankle fractures were included, 94 had preoperative CT scans (32.6%). No significant differences found in patient age, gender, BMI, smoking status between the groups that did and did not have preoperative CT scan. No significant differences were observed in AO/OTA classification between groups. Average surgical time was significantly higher in group that received a preoperative CT (114 without CT vs. 145 with CT, p<0.05). Complications (10.3% no CT vs 7.4% with CT, p=0.55) and reoperations (6.7% without CT vs. 7.4% with CT, p=0.16) not significantly different between groups. No significant difference was observed in rate of posterior malleolus fixation between groups (43.8% without CT vs 39.4% with CT; p=0.52). Of surveyed surgeons, 87% reported they don't routinely obtain preoperative CT scan for trimalleolar ankle fractures. Most common reasons for preoperative scans were deciding on approach/positioning, assessing for impaction, determining the size of the posterior malleolus.Although preoperative CT scans are obtained in one third of patients with operative trimalleolar ankle fractures, we did not find an improvement in surgical time, complications, and reoperation. Level of Evidence: III.ConclusionAlthough preoperative CT scans are obtained in one third of patients with operative trimalleolar ankle fractures, we did not find an improvement in surgical time, complications, and reoperation. Level of Evidence: III.
This study aimed to demonstrate the feasibility of lag screw exchange for painful lateral soft tissue impingement in patients initially treated with cephalomedullary nailing (CMN) for an ...intertrochanteric hip fracture.BackgroundThis study aimed to demonstrate the feasibility of lag screw exchange for painful lateral soft tissue impingement in patients initially treated with cephalomedullary nailing (CMN) for an intertrochanteric hip fracture.Ten patients initially treated with CMN for unstable intertrochanteric fractures presenting with persistent pain and radiographic evidence of lag screw lateral migration were treated with exchange of original screw with shorter lag screw buried in the lateral cortex to prevent impingement. Patients were evaluated for resolution of pain and achievement of pre-fracture ambulatory status at 6 months post-operatively.MethodsTen patients initially treated with CMN for unstable intertrochanteric fractures presenting with persistent pain and radiographic evidence of lag screw lateral migration were treated with exchange of original screw with shorter lag screw buried in the lateral cortex to prevent impingement. Patients were evaluated for resolution of pain and achievement of pre-fracture ambulatory status at 6 months post-operatively.Average age was 71.5 years (range: 62-88). Average length of follow-up was 24.9 months. All patients were female, with an average Charlson Comorbidity Index of 1.0 (0-3) and average Body Mass Index of 22.2 (16.0-31.1). Five of ten patients (50.0%) were treated with a cortisone injection in the trochanteric bursa prior to screw exchange with temporary pain relief. Five (50.0%) patients presented with limited range of hip motion. Five (50.0%) had history of prior or current bisphosphonate use. Average lag screw prominence was noted to be 12.2mm (7.9-17.6mm) on radiographic evaluation. Screw exchange was performed at an average of 18.6 months (5.4-44.9 months) following the index procedure. Average operating time of the screw exchange procedure was 45.3 minutes (34-69 minutes) and blood loss was <50mL in all cases. Replacement lag screws were an average of 16.0mm (10-25mm) shorter than the initial screw. All patients achieved complete or significant resolution of lateral thigh pain, and nine (90%) returned to pre-fracture ambulatory status by eight weeks after screw exchange. All patients remained pain free at six months after screw exchange.ResultsAverage age was 71.5 years (range: 62-88). Average length of follow-up was 24.9 months. All patients were female, with an average Charlson Comorbidity Index of 1.0 (0-3) and average Body Mass Index of 22.2 (16.0-31.1). Five of ten patients (50.0%) were treated with a cortisone injection in the trochanteric bursa prior to screw exchange with temporary pain relief. Five (50.0%) patients presented with limited range of hip motion. Five (50.0%) had history of prior or current bisphosphonate use. Average lag screw prominence was noted to be 12.2mm (7.9-17.6mm) on radiographic evaluation. Screw exchange was performed at an average of 18.6 months (5.4-44.9 months) following the index procedure. Average operating time of the screw exchange procedure was 45.3 minutes (34-69 minutes) and blood loss was <50mL in all cases. Replacement lag screws were an average of 16.0mm (10-25mm) shorter than the initial screw. All patients achieved complete or significant resolution of lateral thigh pain, and nine (90%) returned to pre-fracture ambulatory status by eight weeks after screw exchange. All patients remained pain free at six months after screw exchange.Lag screw exchange is a efficacious method to address the mechanical irritation of laterally protruding lag screws following IT hip fracture, while also prophylaxing against subsequent femoral neck fractures. Level of Evidence: IV.ConclusionLag screw exchange is a efficacious method to address the mechanical irritation of laterally protruding lag screws following IT hip fracture, while also prophylaxing against subsequent femoral neck fractures. Level of Evidence: IV.
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