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C T Born

Publications and source records attributed to C T Born.

27 records · Page 2Linked to original sources
PubMed1992

Clinical predictors of unstable cervical spinal injury in multiply injured patients.

All victims of major blunt trauma have been said to be at risk of cervical spinal injury. In a prospective study of 410 such patients at our institution, we identified 13 patients (6.12 per cent) with unstable cervical spines. Loss or defect of consciousness following injury (regardless of duration), neurological deficit consistent with cervical cord or nerve root injury and neck tenderness were significantly predictive of an unstable cervical spine. Immediate radiographic investigation of the cervical spine is mandatory in such patients, but may not be required in patients without these signs.

Adolescent↗
PubMed1990

Dynamic computerized tomography of the occiput-atlas-axis complex in trauma patients with odontoid lateral mass asymmetry.

Over a 23-month period, 25 patients aged 11 to 74 years presented to our Level I trauma center with odontoid lateral mass asymmetry of 2 to 5 mm on properly centered AP open-mouth X-rays: 32% of patients were asymptomatic, 68% had cervical pain, and 32% had limited range of motion. Patients with cervical spine fractures or dislocations and those with fixed deformity were excluded. The clinical significance of asymmetry was determined utilizing dynamic axial CT scanning of the occiput (C0), atlas (C1) and axis (C2) with the head neutral and with 15 degrees to 30 degrees active rotation. Nineteen patients demonstrated greater than 5 degrees of relative motion of C1 on C2 bilaterally. Three patients had less than 5 degrees of relative motion bilaterally and three patients had less than 5 degrees relative motion with left rotation only. No patient had formal treatment and all had nearly normal cervical range of motion on clinical examination at the time of hospital discharge. The finding of an asymmetric odontoid-lateral mass interspace on properly centered open-mouth AP X-rays in the presence of otherwise normal cervical spine X-rays, in conscious patients without fixed deformity, appears to be incidental and requires no further evaluation or treatment.

Adolescent↗
PubMed1989

Ender nail fixation in long bone fractures: experience in a level I trauma center.

Early fixation of extremity fractures in polytrauma patients is a well accepted and desirable treatment. In our patient population, the indications for immediate Ender nail fixation was for Grade I and Grade II open long bone fractures and closed long bone fractures in patients with small intramedullary canals. Ender nails were also used in patients in whom reaming was undesirable. This included patients with open physes for immediate fracture fixation and in those with Grade III open wounds in a delayed fashion. These flexible nails were also implemented for use to minimize anesthesia time as a life saving measure in the severely injured. This study is a retrospective review of a 30-month period in which 68 patients with 91 fractures underwent Ender intramedullary nailing. The mean Injury Severity Score (ISS) was 12.4. There were 16 humerus fractures, 26 femur fractures, and 49 tibia fractures. Thirty-three per cent (30 fractures) were open fractures. The average operating time per fracture was 70 minutes (range, 15 to 150 minutes). The estimated blood loss per fracture was 150 cc with a range of 25 to 500 cc. The average followup is currently 19 months (range was 8 to 29 months). This approach achieved an excellent result in 95% of the patients treated. There were no wound, soft-tissue, or bony infections experienced. Major complications were seen in five patients: three nonunions and two malunions.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

Delayed identification of skeletal injury in multisystem trauma: the 'missed' fracture.

Delay in diagnosis of musculoskeletal injury in multiply injured patients may potentially lead to functional or cosmetic disability in survivors. In an 18-month prospective study to determine the incidence and spectrum of delayed recognition of skeletal injury at our Level I trauma center, delayed diagnosis of 39 fractures was made in 26 of 1,006 consecutive blunt trauma patients. The delay in recognition ranged from 1-91 days. Twenty-one (55%) of the fractures were not X-rayed at the time of admission, but nine (23%) fractures were clearly visible on admission films. Four (10%) fractures were missed because of technically inadequate X-rays, and five (13%) had adequate X-rays but could not be identified on admission films. In only two instances was a second anesthetic exposure required for operative therapy. For the patients in this series, the delay of fracture identification was not felt to contribute to additional long-term cosmetic, functional, or neurologic problems. Continued clinical and radiologic surveillance is required in multiply injured patients to prevent musculoskeletal diagnostic failure.

Adolescent↗
PubMed1988

Early use of the Brooker-Wills interlocking intramedullary nail (BWIIN) for femoral shaft fractures in acute trauma patients.

During a 33-month period, 40 multiply injured patients underwent 43 Brooker-Wills interlocking intramedullary nailings (BWIIN) for femur fractures in the setting of a Level I trauma unit. There were 12 open fractures (28%), 66% of the closed fractures underwent BWIIN within the first 24 hours of injury, and 33 fractures (77%) had comminution of Winquist-Hansen Type II or greater, and either static or dynamic locking techniques were used in 38 (88%) of the cases. There were three intraoperative technical problems. The estimated blood loss and operative times were consistent with other reported series for interlocking nailing techniques. The average followup was 65 weeks. Only one fracture went on to nonunion. There were no problems with angulation or rotation. One patient had 1.5 cm of shortening. There were four major (9%) and four minor (9%) complications. Rod removal was successful in 17 of 18 cases. Mechanical failure (deformation and/or fracture) of the proximal end of the rod was found in four (22%) of the extracted nails and caused failure of removal in one. The Brooker-Wills nail is a versatile device which can be used to treat complex fractures of the entire femoral shaft in acutely injured patients.

Adolescent↗
PubMed1987

Clearing the cervical spine: initial radiologic evaluation.

The identification of unstable cervical spine injury (UCSI) in blunt high-energy transfer injury (BHETI) patients is critical to management. In a prospective study of BHETI patients identified to be at high risk for UCSI, the use of lateral cervical spine view (LCV), three-view cervical spine series (FCS), and limited computerized tomography (CT) in the initial evaluation of these patients was analyzed. Thirteen of 204 patients sustained UCSI. Sensitivity of the LCV alone was 0.85 and the predictive value of the negative test was 0.97. Sensitivity and predictive value of a negative study were maximized by the use of FCS combined with CT when plain X-rays were inadequate. We conclude that technically adequate, normal FCS can be safely used to eliminate the presence of UCSI. If these studies are technically inadequate, the addition of a limited CT can be used to "clear" the spine.

Adolescent↗
PubMedDate not supplied

Train injuries in children.

OBJECTIVE: To describe the pattern of injuries sustained in pediatric victims of train accidents. DESIGN: Retrospective review of patients identified in a search of two trauma registries for the years 1984-1994. SETTING: Two pediatric level one trauma centers in one metropolitan area. PATIENTS: Between 1984 and 1994, seventeen children were identified as treated for injuries sustained in train accidents. Children pronounced dead at the scene and those injured when a car was struck by a train were excluded. INTERVENTION: ATLS protocols were followed. All open musculoskeletal injuries were treated with multiple operative irrigation and debridement procedures and broad spectrum antibiotics. MAIN OUTCOME MEASUREMENTS: Variables included the following: age, sex, mechanism of injury, circumstances surrounding the injuries, all injuries sustained, operations performed during the acute hospitalization, subsequent operations, level of amputation(s), complications, and cost and length of hospitalization. RESULTS: Presenting injuries included eight patients with ten complete amputations and eight patients with ten near-complete amputations. The average number of operative procedures for the survivors during the initial hospitalization was 5.7 (range three to sixteen). Five patients (five extremities) required amputation revision to a more proximal level after the initial surgical intervention but prior to definitive wound closure. Secondary surgical procedures have been required in 50% of survivors to date. The financial cost of these injuries is substantial, with acute hospitalization costs averaging $61,000. CONCLUSION: Pediatric survivors of train-pedestrian accidents are likely to suffer isolated musculoskeletal injuries, the majority of which are amputations of the lower extremity. These injuries require multiple operative debridements and frequent revision to higher levels of amputation are expected. The percentage of these injuries in children at play around railroad tracks emphasizes the need for limitation of access to railroad areas and for prevention through public education.

Accidents↗