Is There a Role for CT Pan-Scans in the Initial Workup of Fragility Fracture Patients?
Introduction/UNASSIGNED:Computed tomography (CT) pan-scans have become increasingly commonplace as part of the initial diagnostic workup for patients sustaining traumatic injuries. They have proven effective in improving diagnostic accuracy in those with high-energy mechanisms of injury. However, the utility of pan-scans in the geriatric population sustaining low-energy traumatic injuries remains unproven. Methods/UNASSIGNED:A retrospective review was conducted of patients who sustained a fragility fractureÂ at a level-1 trauma center over a 15-month period. Radiologist interpretations of any CT pan-scans were reviewed for acute findings, and charts were reviewed for resulting changes in orthopedic and nonorthopedic management. Additionally, mechanism of injury, definitive management, time to surgery, length of stay, level of care at discharge, and demographic data were compared against similar patients who did not receive a pan-scan. Results/UNASSIGNED:This study found that only 1 of the included patients had a change in orthopedic management and 12 had a change in nonorthopedic management, despite over half of the study population being found to have additional findings. Furthermore, patients who underwent a pan-scan did not have expedited surgical intervention or earlier discharges compared to those who were not pan-scanned. Conclusion/UNASSIGNED:This study demonstrates whole-body CT imaging provides little benefit in geriatric patients who sustain fragility fractures and should be utilized judiciously and in a targeted fashion instead of as a routine part of trauma surgery or emergency department protocol in this patient population. Level of Evidence/UNASSIGNED:Level III Retrospective Study.
Clavicular Fracture Associated with Life-Threatening Hemorrhage: A Case Report
CASE/METHODS:A sixty-four-year-old woman sustained a displaced midshaft clavicular fracture. Shortly after admission to the hospital, she developed symptoms of hypovolemic shock as well as neurologic compromise of the ipsilateral upper extremity. Her workup demonstrated a large periclavicular hematoma. She underwent surgical exploration, during which a subclavian artery laceration was identified and repaired. CONCLUSION/CONCLUSIONS:This case serves as a reminder to the treating physician to maintain an appropriate index of suspicion for associated injuries when treating clavicular fractures.
Dietary iron and exposure to lead influence susceptibility to seizures
Previous work in this laboratory showed that concurrent consumption of an iron-deficient diet and exposure to lead caused seizure activity in Albany heterogeneous (HET) stock mice. In the present investigation, 26 Albany HET mice (ages 35 to 57 days of age) ate either an American Institute of Nutrition approved iron-sufficient (30 ppm) diet or an iron-deficient (less than 3 ppm) diet and drank either a 0.5% lead solution or distilled water for 12 weeks. We measured several activities in an open-field, hole-board apparatus, and spontaneous seizures which occurred during testing, changes in body weight, and hemoglobin levels. Replicating previous findings, mice fed the iron-deficient diet and treated with lead had more seizures with longer durations and longer postictal periods than animals given the iron-sufficient diet but also treated with lead. Mice not exposed to lead did not seize. Both lead-treated groups had lower rates of body-weight gain over the 3-mo. period and lower hemoglobin values than nonlead-treated animals. Changes in activity were observed in the open field as a function of diet and exposure to lead.