Objectives:
To evaluate the relationship between timing of definitive fixation, injury severity, and the development of systemic complications in severely injured patients with pelvic ring injuries.
Design:
Retrospective review.
Settings:
Level 1 trauma center.
Patients:
One hundred eighteen severely injured [Injury Severity Score (ISS) ≥ 16] adult patients with pelvic ring injuries undergoing definitive fixation, excluding patients treated with external fixation for hemodynamic instability.
Intervention:
Early fixation (≤36 hours) in 37 patients and delayed fixation (>36 hours) in 81 patients.
Main Outcome Measurements:
Systemic complications (acute respiratory distress syndrome, pulmonary embolism, deep venous thrombosis, sepsis, multi-organ failure, and death).
Results:
The delayed fixation group had a higher ISS and had more patients with chest injuries. There was no detectable difference in the number of patients with systemic complications between early versus delayed fixation groups [8 (22%) vs. 29 (35%), P = 0.1]. The only difference detected in specific complications was a higher incidence of pneumonia with delayed fixation [16 (20%) vs. 0 (0%), P = 0.004] with 11 of the 16 cases being associated with chest injury. Univariate analysis showed an association between complication and time to fixation, ISS, Glasgow Coma Scale, pH, base excess, and injuries to the head, chest, and abdomen. On multivariate analysis, only ISS remained significantly associated with the development of complications [Odds ratio 2.6 per 10 point increase, 95% confidence interval (CI), 1.4–4.4].
Conclusions:
These data suggest that the severity of injury is most highly associated with systemic complications after definitive fixation of pelvic ring injuries.
Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Potential singlet-triplet surface crossings for the ring opening of 4,6-dimethylidenebicyclo[3.1.0]hex-2-ene derivatives were explored using density functional theory (DFT) and complete active space self-consistent field (CASSCF) methods. Since these ring openings involve relatively high energy species that lead to relatively stable aromatic species, a good scenario for potential nonadiabatic events, we posited that the reaction paths of these ring openings might come close to or cross excited state surfaces. At the DFT level of theory, all reaction paths exhibited characteristics suggestive of singlet-triplet intersections along their paths. 6-Methylidenebicyclo[3.1.0]hex-3-en-2-one and a closely related derivative (4-methylidenebicyclo[3.1.0]hex-2-en-6-one) were explored at the CASSCF level of theory; CASSCF results were qualitatively similar to DFT results and yielded spin-orbit couplings of 1.1-1.4 cm(-1) at the singlet-triplet crossing points.
Objective: To evaluate rates of complications in patients with bilateral femur fractures treated with intramedullary nailing (IMN) during either 1 single procedure or 2 separate procedures.Design: A multicenter retrospective review of patients sustaining bilateral femur fractures, treated with IMN in single or 2-stage procedure, from 1998 to 2018 was performed at 10 Level-1 trauma centers.
Objectives: To examine clinical gait parameters, hip muscle strength, pelvic functional outcomes, and psychological outcomes after surgical fixation of OTA/AO 61-B and 61-C pelvic ring injuries.Design: Retrospective review identified 10 OTA/AO 61-B patients and 9 OTA/AO 61-C patients for recruitment who were between 1 and 5 years after pelvic fixation. Gait and strength assessments, and patient-reported outcome scores were performed/collected and analyzed.
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