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Blunt renal artery injuries
255
Abstracts
provides proximal arterial control and prevents sudden cardiac arrest as the abdominal wall tamponade is released. Ledgerwood A. M., Kazmers M. and Lucas C. E. (1976) The role of thoracic aortic occlusion for massive haemoperitoneum. Trauma 16, 610. Delayed
rupture
of the spleen
With aggressive methods of diagnosis (peritoneal lavage), the authors report only 6 cases of delayed rupture in 302 patients undergoing splenectomy following blunt abdominal trauma. This incidence is very much lower than usually reported and supports the idea that it is usually the making of the diagnosis that is delayed rather than the rupture. Benjamin C. I., Engrow L. H. and Perry J. H. jun. (1976) Delayed rupture or delayed diagnosis of rupture of the spleen. Swg. Gynecol. O&et. 142,171. Blunt
renal artery
injuries
This article includes a review of 53 previously reported cases of blunt renal pedicle injuries followed by a description of 4 cases seen by the authors in the course of one year. It is suggested that high dose intravenous urography (preferably with tomography) will select those patients who need angiography. Repair of the renal vessels is seldom successful if it is carried out more than 3 hours after injury. It is suggested that a bypass autologous vein graft is usually required even when the vessel remains in continuity and the lesion is an intimal tear accompanied by thrombosis of the artery. In difficult cases autotransplantation may be necessary. Although the success rate of conservative renal artery surgery following trauma is low, the authors believe that efforts to preserve renal function are worthwhile, particularly when there is bilateral renal injury. They emphasize the importance of continuing follow-up, in order that the onset of hypertension of renal origin may be detected early. Gothlin J., Ingemansson S., Lindstedt E. et al. (1976) Renal artery injuries following blunt trauma. Acta Chir. Stand. 142, 165.
Abdominal
stab wounds
This article (based on an experience of 57 patients with abdominal stab wounds) is a plea for the adoption of a selective conservative policy rather than automatic laparotomy following such injuries. Only 8 of the author’s 57 patients did not have the abdomen opened, but none suffered comnlications. However. 3b per cent of the ‘routine laparotbmies’ were negative; and although none of these cases in which the findings were negative suffered complications as a result, the author notes that other people’s experience has not been so happy. He advocates that laparotomy should be undertaken only if there is hypotension, evisceration, omental protrusion or clinical signs of peritonitis. This management requires meticulous supervision with repeated examinations. He notes the high frequency of stab wounds in the upper abdomen involving the liver, for which active treatment is not usually required. He does not mention the use of peritoneal lavage. Not every surgeon would agree with this highly selective policy. Risberg B. (1976) Abdominal stab wounds. Actu Chir. Stand.
142. 589.
Fractures Myositis
and dislocations
ossificans
The subject of myositis ossificans is reviewed. A group of 7 patients with post-traumatic, localized myositis is reported. These were treated, as soon as diagnosed by aspiration of the haematoma and injection of xylocaine, steroids and hyaluronidase. Results suggest that this regime, if undertaken before there is evidence of maturing bone and supported by the usual conservative measures, will lead to considerable limitation of disability. Molley J. C. and McGuirk R. H. (1976) Treatment of traumatic myositis ossificans circumscripta. Use of aspiration and steroids. Trauma 16, 851. Femoral shaft spica cast
fractures
treated
in a double
Blunt trauma accounts for less than 4 per cent of injuries to the colon. Steering-wheel compression and the lap straps of seat belts seem to predispose to colonic injury. Diagnosis is usually made at laparotomy. Nineteen patients seen over 9 years at 2 hospitals who had suffered this injury are reviewed. In surgical management, exteriorization should be favoured over primary repair for lesions involving the lumen. Most patients also had other injuries. Infectious sequelae are the major source of morbidity. Sixteen of the patients survived. Howell H. S., Bartizal J. F. and Freeark R. J. (1976) Blunt trauma involving the colon and rectum.
Three groups of children with femoral shaft fractures are compared: 18 had a closed fracture as a single injury and were treated from the start in a double spica; 14 had closed fractures with other injuries and were treated in traction followed by a spica when the general condition allowed; 15 children with isolated closed shaft fractures were treated by traction followed by a spica when immature consolidation had occurred. Analysis of management and results indicated few problems. The importance of attention to detail in application and supervision of a spica is emphasized. The cost of the methods was analysed and in combined hospital and professional cost, group 3 exceeded group 1 by a factor of 6.5. Allen B. L. jun., Kant A. P. and Emery F. E. (1977) Displaced fractures of the femoral diaphysis in children: definitive treatment in a double spica cast.
Trauma 16, 624.
Trauma 17, 8.
Blunt
trauma
to the colon
Abstracts
provides proximal arterial control and prevents sudden cardiac arrest as the abdominal wall tamponade is released. Ledgerwood A. M., Kazmers M. and Lucas C. E. (1976) The role of thoracic aortic occlusion for massive haemoperitoneum. Trauma 16, 610. Delayed
rupture
of the spleen
With aggressive methods of diagnosis (peritoneal lavage), the authors report only 6 cases of delayed rupture in 302 patients undergoing splenectomy following blunt abdominal trauma. This incidence is very much lower than usually reported and supports the idea that it is usually the making of the diagnosis that is delayed rather than the rupture. Benjamin C. I., Engrow L. H. and Perry J. H. jun. (1976) Delayed rupture or delayed diagnosis of rupture of the spleen. Swg. Gynecol. O&et. 142,171. Blunt
renal artery
injuries
This article includes a review of 53 previously reported cases of blunt renal pedicle injuries followed by a description of 4 cases seen by the authors in the course of one year. It is suggested that high dose intravenous urography (preferably with tomography) will select those patients who need angiography. Repair of the renal vessels is seldom successful if it is carried out more than 3 hours after injury. It is suggested that a bypass autologous vein graft is usually required even when the vessel remains in continuity and the lesion is an intimal tear accompanied by thrombosis of the artery. In difficult cases autotransplantation may be necessary. Although the success rate of conservative renal artery surgery following trauma is low, the authors believe that efforts to preserve renal function are worthwhile, particularly when there is bilateral renal injury. They emphasize the importance of continuing follow-up, in order that the onset of hypertension of renal origin may be detected early. Gothlin J., Ingemansson S., Lindstedt E. et al. (1976) Renal artery injuries following blunt trauma. Acta Chir. Stand. 142, 165.
Abdominal
stab wounds
This article (based on an experience of 57 patients with abdominal stab wounds) is a plea for the adoption of a selective conservative policy rather than automatic laparotomy following such injuries. Only 8 of the author’s 57 patients did not have the abdomen opened, but none suffered comnlications. However. 3b per cent of the ‘routine laparotbmies’ were negative; and although none of these cases in which the findings were negative suffered complications as a result, the author notes that other people’s experience has not been so happy. He advocates that laparotomy should be undertaken only if there is hypotension, evisceration, omental protrusion or clinical signs of peritonitis. This management requires meticulous supervision with repeated examinations. He notes the high frequency of stab wounds in the upper abdomen involving the liver, for which active treatment is not usually required. He does not mention the use of peritoneal lavage. Not every surgeon would agree with this highly selective policy. Risberg B. (1976) Abdominal stab wounds. Actu Chir. Stand.
142. 589.
Fractures Myositis
and dislocations
ossificans
The subject of myositis ossificans is reviewed. A group of 7 patients with post-traumatic, localized myositis is reported. These were treated, as soon as diagnosed by aspiration of the haematoma and injection of xylocaine, steroids and hyaluronidase. Results suggest that this regime, if undertaken before there is evidence of maturing bone and supported by the usual conservative measures, will lead to considerable limitation of disability. Molley J. C. and McGuirk R. H. (1976) Treatment of traumatic myositis ossificans circumscripta. Use of aspiration and steroids. Trauma 16, 851. Femoral shaft spica cast
fractures
treated
in a double
Blunt trauma accounts for less than 4 per cent of injuries to the colon. Steering-wheel compression and the lap straps of seat belts seem to predispose to colonic injury. Diagnosis is usually made at laparotomy. Nineteen patients seen over 9 years at 2 hospitals who had suffered this injury are reviewed. In surgical management, exteriorization should be favoured over primary repair for lesions involving the lumen. Most patients also had other injuries. Infectious sequelae are the major source of morbidity. Sixteen of the patients survived. Howell H. S., Bartizal J. F. and Freeark R. J. (1976) Blunt trauma involving the colon and rectum.
Three groups of children with femoral shaft fractures are compared: 18 had a closed fracture as a single injury and were treated from the start in a double spica; 14 had closed fractures with other injuries and were treated in traction followed by a spica when the general condition allowed; 15 children with isolated closed shaft fractures were treated by traction followed by a spica when immature consolidation had occurred. Analysis of management and results indicated few problems. The importance of attention to detail in application and supervision of a spica is emphasized. The cost of the methods was analysed and in combined hospital and professional cost, group 3 exceeded group 1 by a factor of 6.5. Allen B. L. jun., Kant A. P. and Emery F. E. (1977) Displaced fractures of the femoral diaphysis in children: definitive treatment in a double spica cast.
Trauma 16, 624.
Trauma 17, 8.
Blunt
trauma
to the colon