فهرست مطالب
Archives of Trauma Research
Volume:7 Issue: 1, Jan-Mar 2018
- تاریخ انتشار: 1397/01/13
- تعداد عناوین: 8
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Page 2BackgroundThere is an ongoing debate if bone graft substitutes (BGSs) are beneficial in the treatment of displaced intra-articular calcaneal fractures (DIACFs). The purpose of this study was to evaluate the effect of an injectable calcium sulfate/hydroxyapatite BGS (CERAMENTTM iBONE VOID FILLER, BONESUPPORT AB, Lund, Sweden) in internal fixation of calcaneal fractures.MethodsThe records of patients presenting with calcaneal fractures type Sanders III and IV and treated with internal fixation plus BGS were reviewed. Radiographs were analyzed using different measurements (including Böhler's angle and calcaneal facet height). The clinical outcome was evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale.ResultsA total of 20 fractures were available for radiographic and clinical examination at a minimum follow-up of 12 months. No decrease in Böhler's angle was recorded in six fractures, a reduction ofConclusionsThe study results support the use of an injectable, in situ hardening calcium sulfate/hydroxyapatite BGS in DIACFs. The BGS is easy and safe to use as an augment to open reduction and internal fixation.Keywords: Bone graft substitute, calcium sulfate, hydroxyapatite, intraarticular calcaneal fracture, open reduction, internal fixation calcaneus
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Page 7Background And ObjectivesThis study aimed at investigating the burden of injuries, including spinal cord injuries and limb amputation, caused by the Bam earthquake.Materials And MethodsThe data related to morbidity of spinal cord injuries were collected from records provided by State Welfare Organization of Iran. Then, morbidity and mortality data for amputation and also mortality of spinal cord injuries were obtained from a previous study using the network scale-up method. Then, we followed the World Health Organization guidelines to assess the burden of this disease, and then years of life lost (YLL) and years of life lost due to disability (YLD) were calculated.ResultsThe disability-adjusted life years (DALYs) caused by the spinal cord injury were 15,435 years. YLL due to premature mortality was 13,134 and YLD was 2301 years and the number of DALY caused by limb amputation was equal to 2184, all of which were due to YLD.ConclusionsAccording to the results of the present study, spinal cord injuries and amputations resulting from the earthquake impose many burdens on society. This provides outcomes and evidence for policymaking and planning in the field of health care for policymakers.Keywords: Amputation, disability?adjusted life years, spinal cord injury, years of life lost due to disability, years of life lost due to premature mortality
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Page 11ObjectiveVenous thromboembolism (VTE) which includes deep vein thrombosis (DVT) and pulmonary embolism is a preventable complication in hospitalized trauma patients. Currently, the VTE guideline is the standard of care. However, underutilization of the guideline was reported. This study aimed to report the adherence to the VTE guideline in a Level 1 trauma center in Thailand.MethodsA retrospective review was performed on adult trauma patients admitted between January and December 2013. The inclusion criteria were Injury Severity Score ≥9 and admission in the hospital ≥7 days. The patients were classified into very high risk of DVT, high risk of DVT, and high risk of bleeding groups according to the hospital guideline. Adherence to the guideline, utility of the prophylaxis, and VTE occurrence were recorded.ResultsDuring a 12-month period, 352 cases met the inclusion criteria. The overall adherence to the guideline was 28.9%, 5.2% in the very high risk of DVT group, 18.4% in the high risk of DVT group, and 57.9% in the high risk of bleeding group. VTE occurrence was 11 incidences in 10 patients (2.8%). The high risk of bleeding group had the highest in VTE occurrence (10 of 11 incidences).ConclusionsThe adherence to the VTE prophylaxis guideline in Thailand was higher than previous studies. The pharmacological prophylaxis should be initiated as soon as possible.Keywords: Prevention, control, venous thromboembolism, venous thrombosis
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Page 15BackgroundThe aim of this study was to assess the accuracy of high-resolution ultrasonography (USG) in the evaluation of rotator cuff tendinopathies and tears with magnetic resonance imaging (MRI) correlation to determine its sensitivity and specificity.Materials And MethodsThe prospective study was conducted on 40 patients referred to the Department of Radiology for the evaluation of rotator cuff pathologies over a period of 18 months. All the patients underwent high-frequency USG followed by MRI. Variables such as sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and accuracy of high-frequency USG and MRI were evaluated.ResultsThe sensitivity, specificity, NPV, PPV, and accuracy of high-frequency USG in the evaluation of rotator cuff pathologies in comparison to MRI as standard were 90.6%, 87.5%, 96.6%, 70%, and 90%, respectively.ConclusionHigh-frequency USG is almost equally sensitive and specific as MRI for the diagnosis of rotator cuff pathologies, and due to its cost-effectiveness, easy affordability, ease of evaluating contralateral shoulder, more patient compliance, noninvasiveness, and wider applications, we recommend it to be used as a primary modality for evaluating rotator cuff. MRI should be performed in case some extra information is required.Keywords: High‑frequency ultrasonography, magnetic resonance imaging, rotator cuff tears, rotator cuff tendinopathies
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Page 24BackgroundPostmortem examination is indispensable to ascertain the cause of an unnatural death and as such is mandatory by the law. From ages, traditional autopsy (TA) has proved its worth in establishing the cause of death in the deceased despite some inherent difficulties and challenges and has enjoyed an insurmountable status. The increasing use of application of the modern-day radiology for postmortem examination has however opened a new arena overcoming some of the difficulties of the TA. There are conflicting reports in the published literature regarding superiority of one modality of the postmortem over the other.ObjectiveThe objective of this study was to compare the findings of postmortem computed tomography (CT) scan and TA in the victims of traumatic deaths and to analyze whether postmortem CT can be used to replace TA.Materials And MethodsAll patients with a history of trauma that were declared brought dead on arrival in the emergency department were subjected to full-body CT scan. An experienced radiologist reported the findings of CT scan. Subsequently, a forensic expert subjected the patients to TA. The physician who performed autopsy was blinded to the findings of CT scan and vice versa. An individual who was not part of the radiology or forensic team then entered the findings of CT scan and autopsy in a predesigned Pro forma. An unbiased assessor finally compared the findings of the two modalities and analyzed the results. McNemar's test was used to ascertain the level of significance between the findings reported by these two modalities considering P = 0.05 as statistically significant. The agreement or disagreement on cause of death reported by these two modalities was also assessed.ResultsAbout 95% of the deceased were males. The mean age of the corpses was 35 years (range 1667 years). CT was found superior in picking up most of the bony injuries, air-containing lesions, hemothorax, and hemoperitoneum. However, autopsy was found more sensitive for soft-tissue and solid visceral injuries. Both modalities were equally helpful in identifying extremity fractures. Statistically significant agreement (>95%) on cause of death by both modalities was not achieved in any patient of trauma.ConclusionPostmortem CT scan is promising in reporting injuries in traumatic deaths and can significantly complement the conventional autopsy. However, at present, it cannot be considered as a replacement for TA.Keywords: Autopsy, postmortem computerized tomographic, postmortem examination, postmortem computed tomography scan, virtopsy, virtual autopsy
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Page 30Circular saws and angle grinders are two of the most dangerous pieces of electrical equipment on a worksite. Besides the danger that any high-powered, sharp piece of equipment possesses, these pieces use circular saw blades that can splinter into projectile fragments. A 60-year-old male was cutting a steel pipe with a circular saw when a fragment of the 12-inch blade flew off, impaling him in the upper face just to the right of the midline. He was wearing eyeglasses, the bridge of which was driven into his skull on impact of the fragment. He was brought to the trauma center where he underwent imaging of his face and head. This revealed that the blade and his glasses had penetrated 1.2 cm into the right frontal lobe of the brain, resulting in facial fractures and intraparenchymal hemorrhage. He underwent bifrontal craniotomy, removal of the blade and his glasses, evacuation of hematoma, and dural reconstruction. Postoperatively, he was awake with a Glasgow Coma Scale of 15 and no neurologic deficits. The complex nature of craniofacial injuries makes a multidisciplinary approach to these patients essential. Prompt diagnosis and treatment by the appropriate specialists are vital to optimize patient outcomes.Keywords: Brain injuries, cranial trauma, craniocerebral trauma, head injuries, head trauma, missile, missile injuries, penetrating
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Page 33Simultaneous dislocation of the thumb carpometacarpal and metacarpophalangeal joints is an uncommon injury. Stability is the most important factor in the decision of treatment in these rare injuries. The treatment methods range from closed reduction and maintaining reduction with cast or percutaneous k-wires to complex reconstruction surgeries. In this paper, a case of 28-year-old female with complete dislocation of the left thumb metacarpal has been reported. She was treated with closed reduction and cast immobilization with excellent result. Treatment decision should be based on postreduction stability in complete dislocation of thumb metacarpal; cast immobilization is a management option in case of stable reduction.Keywords: Dislocation, metacarpal, thumb