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Vascular injuries: are angiograms required?
372
Injury:
International
no significant differences between the groups in relation to specific post-traumatic or other major psychatric symptoms, but there was a trend towards poorer outcome in the intervention group. These findings indicate that an early psychological debriefing was not effective in reducing later psychiatric symptoms in RTA victims. Although comparisons are confounded by their higher ISS, the evidence suggests that those patients receiving an early psychological intervention may have done worse than those in the control group. Caution is needed in the application of early psychological debriefing for injured victims, and further research is necessary. M. S. Walsh, P. G. Pratt, F. W. Cross, R. J. Ham, 0. Chan (London, UK) Vascular injuries: are angiograms required? The aim of this study was to review the spectrum of vascular injuries and to assess the role of angiography in their management. A retrospective review of patients admitted to The Royal London Hospital with vascular injuries between 1 October 1990 to 30 September I994 was performed. Fifty-one patients (39 men and 12 women with a mean age of 39 years) with vascular injuries were identified. The mortality was 25 (49 per cent). The mean Injury Severity Score (ISS) in non-survivors was 39 and in survivors was 18 (P
Journal
of the Care of the Injured
Vol. 27, No. 5, 1996
control values obtained from 13 healthy volunteers with no injuries 49 f 15 rig/ml, s-ICAMwere: SE-selectin 243 f 59 rig/ml, elastase 22 f lOpg/l and IL-6 was not detectable. In all 13 patients, IL-6 levels showed an initial peak, median 154 pg/ml (range IS-317 pg/ml) in the first 24 h following injury, decreasing thereafter over a period of a week. Both the adhesion molecules s-ICAM-I and s-E-selectin were within the normal range. At day 7 the expression of SICAM-I was significantly greater (PC 0.001) as compared to the initial values obtained. The initial elastase levels were elevated, with a median of 140 pg/l (range 120-1400 pg/l) decreasing to normal levels at day 7. The 13 patients were divided into two groups according to the severity of injury sustained: group A (N= 5) ISS > 16 and group B (N= 8) ISS < 16. Six hours after injury IL-6 and elastase values were significantly greater (PC 0.05) in group A than in group B. These results demonstrate that injury produces a rapid increase in both the plasma elastase and IL-6 levels, indicating polymorphonuclear leukocyte activation. Increased expression of adhesion molecules particularly at day 7 after injury takes place and the level of these responses correlates with the ISS. H. G. Pandit, S. Y. Bhojraj, P. D. Sonsale (Ormskirk, UK) Coexistence of fraumatic locked cervical facets and disc herniation retrospective study of fen patienfs. The coexistence of traumatic locked cervical facet dislocation and disc herniation is not well described despite the incidence being as high as 60 per cent. The traditional protocol for cervical facet dislocation suggests closed reduction (CR) using traction and/or manipulation. In the event of unsuccessful CR, open reduction and stabilization by the posterior approach is the usual procedure. In the event of concurrent disc injury this may in fact increase the neurological compression. Out of ten patients of disc injury associated with facet dislocation, two had uni-facet and eight had bi-facet dislocation. Disc herniation was documented by magnetic resonance imaging (MRI) in nine patients and by myelography in one patient. In six cases open reduction by the posterior approach was followed by anterio; discectomy and fusion. In two cases only anterior discectomy and fusion was performed. In the remaining two cases only the posterior approach was used. Functional recovery was obtained in six patients, five of which were from the combined procedure group, the sixth one from the anterior discectomy and fusion group. This series illustrates the importance of using MRI to document the presence of herniated discs during the initial evaluation of patients with locked cervic facets. If MRI demonstrates disc bulge or herniation it is always advisable to combine anterior discectomy and fusion with posterior reduction and stabilization. M. A. Green, T. D. Robertston, D. S. Marks, A. J. Stirling, A. G. Thompson (Birmingham, UK) The use of the Olerud pedicular screw sysfem in verfebral fracture fixation We report our experience with the Olerud pedicular screw fixator in the management of I9 patients since 1991. Thirteen men and six women presented as tertiary referrals from other units with spinal fractures. Their mean age was 39 years and 5 months (range, 19-80 years). The majority (12) sustained their accident while falling from a height, two by falling downstairs, and five were involved in road traffic accidents. There were 11 thoracolumbar fractures (this included one patient who had a double burst at two different levels), two thoracic and seven lumbar.
Injury:
International
no significant differences between the groups in relation to specific post-traumatic or other major psychatric symptoms, but there was a trend towards poorer outcome in the intervention group. These findings indicate that an early psychological debriefing was not effective in reducing later psychiatric symptoms in RTA victims. Although comparisons are confounded by their higher ISS, the evidence suggests that those patients receiving an early psychological intervention may have done worse than those in the control group. Caution is needed in the application of early psychological debriefing for injured victims, and further research is necessary. M. S. Walsh, P. G. Pratt, F. W. Cross, R. J. Ham, 0. Chan (London, UK) Vascular injuries: are angiograms required? The aim of this study was to review the spectrum of vascular injuries and to assess the role of angiography in their management. A retrospective review of patients admitted to The Royal London Hospital with vascular injuries between 1 October 1990 to 30 September I994 was performed. Fifty-one patients (39 men and 12 women with a mean age of 39 years) with vascular injuries were identified. The mortality was 25 (49 per cent). The mean Injury Severity Score (ISS) in non-survivors was 39 and in survivors was 18 (P
Journal
of the Care of the Injured
Vol. 27, No. 5, 1996
control values obtained from 13 healthy volunteers with no injuries 49 f 15 rig/ml, s-ICAMwere: SE-selectin 243 f 59 rig/ml, elastase 22 f lOpg/l and IL-6 was not detectable. In all 13 patients, IL-6 levels showed an initial peak, median 154 pg/ml (range IS-317 pg/ml) in the first 24 h following injury, decreasing thereafter over a period of a week. Both the adhesion molecules s-ICAM-I and s-E-selectin were within the normal range. At day 7 the expression of SICAM-I was significantly greater (PC 0.001) as compared to the initial values obtained. The initial elastase levels were elevated, with a median of 140 pg/l (range 120-1400 pg/l) decreasing to normal levels at day 7. The 13 patients were divided into two groups according to the severity of injury sustained: group A (N= 5) ISS > 16 and group B (N= 8) ISS < 16. Six hours after injury IL-6 and elastase values were significantly greater (PC 0.05) in group A than in group B. These results demonstrate that injury produces a rapid increase in both the plasma elastase and IL-6 levels, indicating polymorphonuclear leukocyte activation. Increased expression of adhesion molecules particularly at day 7 after injury takes place and the level of these responses correlates with the ISS. H. G. Pandit, S. Y. Bhojraj, P. D. Sonsale (Ormskirk, UK) Coexistence of fraumatic locked cervical facets and disc herniation retrospective study of fen patienfs. The coexistence of traumatic locked cervical facet dislocation and disc herniation is not well described despite the incidence being as high as 60 per cent. The traditional protocol for cervical facet dislocation suggests closed reduction (CR) using traction and/or manipulation. In the event of unsuccessful CR, open reduction and stabilization by the posterior approach is the usual procedure. In the event of concurrent disc injury this may in fact increase the neurological compression. Out of ten patients of disc injury associated with facet dislocation, two had uni-facet and eight had bi-facet dislocation. Disc herniation was documented by magnetic resonance imaging (MRI) in nine patients and by myelography in one patient. In six cases open reduction by the posterior approach was followed by anterio; discectomy and fusion. In two cases only anterior discectomy and fusion was performed. In the remaining two cases only the posterior approach was used. Functional recovery was obtained in six patients, five of which were from the combined procedure group, the sixth one from the anterior discectomy and fusion group. This series illustrates the importance of using MRI to document the presence of herniated discs during the initial evaluation of patients with locked cervic facets. If MRI demonstrates disc bulge or herniation it is always advisable to combine anterior discectomy and fusion with posterior reduction and stabilization. M. A. Green, T. D. Robertston, D. S. Marks, A. J. Stirling, A. G. Thompson (Birmingham, UK) The use of the Olerud pedicular screw sysfem in verfebral fracture fixation We report our experience with the Olerud pedicular screw fixator in the management of I9 patients since 1991. Thirteen men and six women presented as tertiary referrals from other units with spinal fractures. Their mean age was 39 years and 5 months (range, 19-80 years). The majority (12) sustained their accident while falling from a height, two by falling downstairs, and five were involved in road traffic accidents. There were 11 thoracolumbar fractures (this included one patient who had a double burst at two different levels), two thoracic and seven lumbar.