2017-18 HSC Section 3 Green Book

Shiroff AM, Gale SC, Martin ND, et al. Penetrating neck trauma: a review of management strategies and discussion of the “No Zone” approach. Am Surg . 2013; 79(1):23-29. EBM level 5............................................................................................56-62 Summary : Algorithms developed in the 1970s focused on anatomic neck “zones” to distinguish triage pathways resulting from the operative constraints associated with very high or very low penetrations. A “No Zone” paradigm eliminating “neck zone” differentiation during triage and management utilizes both physical examination and CT angiography to effectively identify vascular and aerodigestive injury after penetrating neck trauma. Tessler RA, Nguyen H, Newton C, Betts J. Pediatric penetrating neck trauma: hard signs of injury and selective neck exploration. J Trauma Acute Care Surg . 2017; 82(6):989- 994. EBM level 4.........................................................................................................63-68 Summary : This is a single institution, retrospective cohort of 44 pediatric patients with penetrating neck injuries. The study identified hard and soft clinical signs of injury which correlated to high sensitivity and specificity for vascular injury. The use of CT angiography in the evaluation was also investigated. Of the 44 patients, 90% were discharged home and two patients died. The management was similar to that of adult patients with penetrating neck injuries. D. Orbital trauma Aldekhayel S, Aljaaly H, Fouda-Neel O, et al. Evolving trends in the management of orbital floor fractures. J Craniofac Surg . 2014; 25(1):258-261. EBM level 3..........69-72 Summary : This article is a combined 10-year literature review and surgeon survey about management of orbital fractures. Factors identified that influence operative management included enophthalmos, hypophthalmos, positive forced duction, defect size, mobility restriction, and persistent diplopia. Approaches and implant types also are discussed. Andrews BT, Jackson AS, Nazir N, et al. Orbit fractures: identifying patient factors indicating high risk for ocular and periocular injury. Laryngoscope . 2016; 126 Suppl 4:S5-S11. EBM level 3................................................................................................73-79 Summary : This article is a retrospective review of 279 subjects with orbit fractures. Characteristics of their orbit fractures, including mechanism of injury, physical examination findings, and radiological findings were correlated with ocular injury to identify risk factors for concomitant ocular injury in patients with orbital trauma. Patients with penetrating trauma, visual acuity deficits, afferent pupillary defect, and fracture involvement of the posterior orbit were at the highest risk for vision loss.