Trauma Monthly
Volume:24 Issue: 6, Nov-Dec-2019

A 33-year-old patient presented to the Oxford Centre for Enablement for rehabilitation following severe electrical burn injuries requiring bilateral below elbow amputations, right below knee amputation and a left midfoot amputation.

Chronic pain at the amputation sites as well as phantom limb initially proved challenging to manage medically however were eventually controlled with careful consideration of analgesic regimens. Pain was measured using the Numeric Pain Rating Scale. A likely attributing cause for the pain was peripheral neuropathy.

A combination of neuropathic agents and opioids helped to control pain. These analgesic included amitriptyline, gabapentin, pregabalin, tramadol and morphine in various regimens. Paracetamol and ibuprofen were also used.

Rigorous search strategies were created which interrogated the MEDLINE, EMBASE, CINAHL, PsycINFO databases for studies reporting limb pain management in electrocution injuries. A total of 841 studies were found with 583 screened after removal of duplicates. No RCTs could be identified investigating limb pain management in electrical injuries. Case reports and case series have described various treatment options including nerve blocks, neuropathic analgesia, physiotherapy, botulinum toxin, fracture fixation and even the use of Virtual Reality headsets.  We discuss this available evidence. No consensus exists as to the optimum management approach of pain in such patients. From our experience with this patient we suggest that a multi- modal analgesic approach is likely to be needed in such patients and should therefore be considered. Level 1 research into pain management in electrocution injuries is required.

Vascular malformation as a cause of cubital tunnel syndrome has not yet been reported. Cubital tunnel syndrome (CuTS), the most common entrapment neuropathy of the ulnar nerve at elbow level, is also the second most common entrapment neuropathy in the upper extremity, regardless of carpal tunnel syndrome. Here, we report CuTS due to vascular malformation in a 63-year-old woman. The ulnar nerve at the distal part of tunnel was markedly compressed. There was no connection between the lesion and the ulnar nerve. The diagnosis was made by using histopathology, and thereafter the lesion was fully resected. Pain in her ring and little fingers disappeared one month after resection of the malformation.

Post-traumatic intradiploic leptomeningeal cyst (IDPTLC) manifests as an internal table disruption of the skull concomitant with a dural defect and intact external table after a previous skull fracture. It is very rare, especially in adults. We present a 30-year-old male with right occipital IDPTLC treated with duraplasty with allograft and cranioplasty with autograft ribs. Seventeen cases of IDPTLC in adulthood since 1978 were found in the literature; to the best of our knowledge, ours is the eighteenth case. Considering the possible etiology at the time of the first trauma, torn dura matter was not healed and retracted overtime. Also due to intracranial CSF pulsation, the disrupted inner table was widened and continuous force on the diploe caused a thinned swollen external table. We recommended performing overlying cranioplasty with autologous bone (rib or normal external table) with the edge of the duraplasty and the cranioplasty placed at different sites.

Millions of pedestrians are seriously injured, disabled, or lose their lives in road traffic accidents annually. The availability of a standard scale specifically for predicting road-crossing behaviors would be beneficial in research applications and in tailoring interventions. The purpose of the current research was to psychometrically evaluate the safe road-crossing behaviors scale based on the Prototype Willingness Model (PWM) among college students. In this cross-sectional study, a purposive and multi-stage sampling method was used to select 315 students from Kermanshah University of Medical Sciences (KUMS) during 2018. The studied social-cognitive determinants from the PWM included attitude, subjective norms, prototype, intention, and willingness. Participants completed a written self-report questionnaire. Data was analyzed using SPSS (ver. 20.0). Exploratory factor analysis (EFA) with VARIMAX rotation was applied to determine the number and composition of constructs. Five factors were extracted. The calculated Kaiser–Meyer–Olkin (KMO) value was 0.806. Overall, the PWM constructs explained 64.39% of the variance in the hypothesized model. Cronbach’s alpha for the measured constructs of attitude, subjective norms, prototype, intention, and willingness were 0.87, 0.81, 0.68, 0.71, and 0.61, respectively. The present study provides some support from among students at an Iranian university for the internal validity and reliability of the safe road-crossing behaviors scale. This scale could be used in planning interventions for the promotion of safe road-crossing behaviors among pedestrians.

Emergency medical services employees, the first people providing pre-hospital services for critically ill or injured patients, are constantly exposed to many stressful factors that can lead to job burnout in the long run. The level of job burnout varies according to employees' personality traits. The present study aimed to investigate job stress and job burnout based on the personality traits of emergency medical service technicians of the Tehran Disaster and Emergency Medical Management Center. This cross-sectional, descriptive study was conducted in 2018 on all operational staff of the Tehran Disaster and Emergency Medical Management Center (N = 1551). A sample of 308 personnel was selected using the stratified random sampling method proportional to size and simple random sampling method. The required data was collected using a four-part questionnaire which measured demographic characteristics and included the Health and Safety Executive Job Stress Questionnaire, the Maslach Burnout Questionnaire, and the revised Costa and McCrae NEO Five-Factor Inventory (NEO-FFI). The collected data was analyzed using SPSS 22.0. Reducing exhaustion, job stress, and neuroticism and strengthening conscientiousness and agreeableness among emergency medical services employees are very important issues. Reducing working hours, examining factors of dissatisfaction and stressors in the workplace, and improving welfare facilities can decrease job burnout among employees. Moreover, the heads and managers of pre-hospital emergency services should plan to provide continuous training in stress management skills at emergency bases in order to reduce job stress among employees.

One of the most common injuries and an important cause of mortality and morbidity in the elderly is intertrochanteric fracture. The dynamic hip screw (DHS) is one of the best procedures for fixation of these fractures; however, using DHS is accompanied by failure risk. Therefore, with the purpose of reducing failure risk, this study aimed to evaluate the correlation between post-operation CTD and TAD, NSA changes in patients with intertrochanteric fractures. In this case series study, patients with intertrochanteric fracture treated with DHS between September 2015 and January 2016 were included. The exclusion criteria were pathologic fracture, multiple fractures, greater trochanter fracture, soft-tissue issues, A3OTA type, patients who missed the follow-up period, history of previous hip fracture or dislocation, and TAD>25mm. Ultimately, 24 patients were included in this study. Two surgeons reviewed the anteroposterior (AP) and lateral (Lat) radiographs. The measures of TAD, CTD, and NSA after six-months of follow-up were assessed. In addition, variables such as demographic data, fracture side, duration of operation, blood loss volume, weight bearing day, and Harris hip score (HHS) were analyzed. The relationship between post-operation CTD and TAD, NSA changes after six months of follow-up was analyzed. All data was analyzed using SPSS 20 software (SPSS, IBM Inc., USA). The significance level for all tests was considered to be 0.05. This study evaluated 24 patients. The mean age of the patients was 69.9 ± 12.00 years, and 15 (62.5%) of them were male. No significant correlations were seen in the collected data, especially CTD and NSA changes after six-months of follow-up (p>0.05). Maximum and minimum TAD values after surgery were 25.6 and 11.0, respectively. Maximum and minimum TAD values at the six-month follow-up were 34.9 and 11.0, respectively. Mean TAD was constant at 19.8±5.3 in postoperative and follow-up measurements. This shows that patients experienced increases in TAD and others experienced decreases in TAD within the six months of follow-up. The results showed that despite the abnormal CTD after surgery, the risk of TAD changes increased. Generally, TAD is a well-established radiographic measurement for predicting the risk of cut-out. CTD and TAD can be used together or separately to predict the risk of DHS screw cut-out in patients with intertrochanteric fractures in future studies.