Trauma Monthly
Volume:25 Issue: 1, Jan-Feb2020

Ankylosis of the temporomandibular joint (TMJ) is an intracapsular union between the mandibular condylar disc and the temporal articular surface that restricts mandibular functions. The management of TMJ ankylosis requires minimally invasive methods.

This study aims to present a new surgical method for restoring ramus height as much as possible after condylectomy of the TMJ due to ankylosis. Case Prsentation: Two patients with TMJ ankylosis participated in this investigation. Patients’ preoperative maximal mouth openings were 3 mm and 9 mm. A new method was used to separate the bony fusion between the condyle and the glenoid fossa. Then, the condylar head on the mandibular ramus was recontoured, and finally the temporalis musculofascial flap was employed as an interpositional graft. Patients were followed for six months. Both surgeries were performed at the Department of Oral and Maxillofacial Surgery of Taleghani Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran.

Both patients had an average maximal mouth opening of 35-40 mm postoperatively.

In patients who have TMJ ankylosis   the excessive bone between the condyle and the zygomatic arch can be removed by releasing the ankylotic site followed by routine gap arthroplasty so that the ramus becomes shorter than the other side. With this method, however, the condylar head is also recontoured, thus preserving more ramus length than with other techniques; future orthognatic surgery or distraction osteogenesis (DO), if necessary, will also be easier.

In the few past decades, the world has experienced numerous terrorist attacks.

We sought to review the mechanisms and patterns of injuries in terrorist attacks; the main goal being better management of victims of these attacks.

In current narrative review; electronic databases (PubMed, Wiley, EMBASE, ISI Web of Knowledge, and Scopus) were searched seeking relevant publications between 2000-2018. The keywords used when searching for articles included: violence, terrorism, disasters, trauma, trauma centers, war, mass casualties, wounds, and injuries. Searching, screening, and assessment of records were done separately by two authors; disagreements were resolved by discussion with a third reviewer.

Nine studies were found to be eligible for inclusion in this study. The most common device-related terrorist attacks were explosives and bombs. More than half of the victims suffered minor injured and could be treated promptly. The most common causes of mortality were head injuries, airway burns, and internal bleeding. The secondary and tertiary results of terrorist attacks were head and neck injuries. Pulmonary injuries were also common injuries in terrorist-attack victims. The most significant cause for emergency treatment was airway burns. The head, neck, pelvis, and hand were the most commonly exposed body areas. Limb amputation is a major result of complications and mortality. The mortality rate of victims that referred to a hospital was low; most deaths occurred at the scene of the attack. Aging victims, children, and women were most influenced by terrorist attacks. Immediate examination, long-term follow-up, and advanced therapeutics and psychological therapy are necessary.

Differences in the severity and type of injuries among victims of terrorist attacks depend upon the various causes of blast injuries, the power of the explosion, the open or enclosed location setting, the destruction of structures, and the interval between cases and the explosion. The current results showed that head and lung injuries are major causes of mortality in victims of terrorism. Appropriate emergency medical services and early management could increase patient survival rates and reduce complications.

Multi-ligament knee injury is common after knee dislocation. There are different approaches for treating multi-ligament knee injuries; however, choosing the best approach is a challenging issue.
This study aimed to investigate the efficacy of early reconstruction of collateral ligaments and delayed reconstruction of cruciate ligaments in multi-ligament knee injury.
In this prospective study, 24 patients who had a grade 3 tear in one collateral ligament in addition to tears in two other knee ligaments were enrolled. At the first stage, collateral ligaments were reconstructed; after the patient gained full range of motion, reconstruction was done for the cruciate ligaments. Patients were followed-up for one year and postoperative evaluations were conducted through clinical tests, International Knee Documentation Committee scores, and Lysholm scales.
Twenty-four patients were entered into the final analysis. Synchronous injury of anterior cruciate ligament, posterior cruciate ligament, medial collateral ligament, posterior oblique ligament, posterolateral corner, and lateral collateral ligament had the highest frequency (37.5%).
At the one-year follow-up, the average Lysholm and IKDC scores were 86.4 ± 3.5 and 83.8 ± 4, respectively. Range of motion was normal in all patients at the end of the study. Furthermore, in varus and valgus stress tests, the outcomes of reconstruction were better on the lateral side of the knee than on the medial side.
The results revealed that a two-stage surgery consisting of early reconstruction of collateral ligaments and delayed reconstruction of cruciate ligaments have good clinical and functional outcomes in multi-ligament knee injuries.

Road traffic accident is one of the most important causes of disability and death in the young population. A significant number of people injured in road traffic accidents die after they arrive at the hospital.
This study aimed to assess the trend of mortality in road traffic accidents and forecast it for the coming years using time series modeling.
This study investigated the trend of road traffic accidents and their victims in Najafabad, Iran, between 2011 and 2017. The ARIMA time series model was fitted on the obtained data and the best model was selected based on the least mean square error. Moreover, the model’s goodness of fit was investigated by residuals ACF and PACF plots as well as Ljung-Box chi-square statistics.
The trend analysis and ARIMA models were investigated, and the results showed a descending trend of fatalities due to traffic accident during 2011-2017. Afterwards, some models were fitted and ARIMA was selected (0, 1, 1), because it had the lowest mean square error value. By fitting the best model, the trend of traffic accident mortality was forecasted for five years (2018 to 2022). Finally, the forecasted values showed that future traffic accident mortalities had a decreasing trend.
The trend of mortality due to road traffic injuries declined, indicating a decreasing trend in deaths for the upcoming years. Therefore, the interventions that have been applied in recent years may be considered as useful.

Injuries from traffic accident are the second cause of premature death (after ischemic heart disease) in Iran. In 2004 and 2010, two laws (Articles 92 and 36) were passed by the parliament addressing free health service delivery to victims of traffic accidents (financed by third party insurance premiums). The current study explored the challenges and complexities related to problems in the implementation of Articles 92 and 36. This qualitative study was conducted using the framework analysis method. Thirty-six experts, managers, and policy-makers were selected using snowball sampling. Data was collected through semi-structured interviews in 2016. Data saturation supported the sample size, and Atlas.Ti5.2 software were used. Four main themes were identified in the data analysis namely policy content, policy context, policy processes, and policy makers. Nine sub-themes emerged during the analysis history and the necessity of legislation. Enforcing out-of-coverage financial loads on basic insurance companies and accident victims along with generalization in providing service packages are the most important challenges hampering implementation.

Trauma is considered one of the major causes of death around the world. Increased costs of healthcare and differences in the quality of services among trauma centers indicate that measuring the performance of trauma care is necessary. the present study aimed to develop some trauma care performance indicators. This study was implemented between September 2017 and October 2018 in a four-stage process: a comprehensive literature review, sessions with a panel of five experts, two focus group discussions, sixteen semi-structured interviews, and a two-round Delphi survey. The study setting was East Azerbaijan province, Iran. Forty-six experts in different fields of medical sciences confirmed applicable indicators for trauma care assessment. A total of 140 indicators were found through a comprehensive literature review. After conducting expert panels, focus group discussions, and interviews, the number of indicators decreased to 57 cases and were entered into the Delphi survey. In the first phase of the Delphi survey, content validity ratio (CVR), content validity indicator (CVI), and modified kappa values were 0.64, 0.85, and 0.83, respectively. Sixteen indicators were changed or deleted and 6 indicators were separated. The members of the final expert panel agreed on 50 indicators in the second phase of the Delphi survey after omitting 7 indicators. Performanceindicators for trauma care evaluation were introduced in this study. They can be used by policymakers and health service providers to assess and improve performance and compare trauma centers in Iran and developing countries that have health systems similar to the Iranian health system.

Based on the Haddon matrix, several factors such as environment, host, and agent can affect the severity of traffic-related injuries.
This study aimed to determine the factors affecting the severity of injuries due to traffic accidents using the Haddon matrix.
In this cross-sectional study, all traffic accident victims (n=2015) referred to Imam Khomeini Hospital in Urmia during 2015-2016 were selected by the census method. Demographic data of the patients and data regarding Haddon risk factors was collected and then analyzed by descriptive statistics, chi-square test, and multivariate logistic regression using the SPSS 18 software.
The mean age of the participants was 33.63±18.53 years. Most of the victims of traffic accidents were male (age range, 17-30 years) with severe and critical injuries. The most common mechanisms of injury were car-pedestrian collisions (27.9%), car overturning (31.1%), and collisions between two cars (26.3%). Violation of speed limit (73.2%) and violation of right-of-way (17.9%) were the most common moving violations. Additionally, the results of the multivariate analysis regarding vehicle safety devices showed that there was a significant relationship between the time and location of the accident and the severity of the injury (p<0.001).
The findings of this study reveal that many factors, including using vehicle safety tools and time and location of the accidents have been implicated in the severity of accident-related injuries. Hence, appropriate planning and training and national and international measures can be helpful in reducing injury severity.