Trauma Monthly
Volume:24 Issue: 3, May-Jun2019

Diabetes mellitus (DM) has a broad spectrum of complications and comorbidities. Delayed wound healing is a major reason for infections and further life-threatening complications; the process of vascularization and tissue regeneration as well as anti-inflammatory and anti-oxidant reactions of the body are impaired in DM. Matricaria Chamomilla (MC) is a herbal medicine which has antimicrobial, antioxidant and wound healing potentials.

In this study, these potentials are evaluated on full thickness diabetic excisional skin wounds by using stereological methods.

In this experimental study, 48 male Wistar rats with streptozotocin (STZ)-induced diabetes (50 mg/kg intraperitoneally) were divided into 4 groups (n = 12) randomly: MC 5% gel treated, MC 10% gel treated, gel-base treated group, and the control group receiving no treatment. After creating 1 cm2 wounds, rats were treated every 24 hours for 15 days. Volume densities of collagens, wound closure rate, volume density, length density, and mean diameter of vessels, and fibroblast proliferation, were examined and analyzed. P ≤ 0.05 was mentioned as statistically significant.

MC gels receiving groups showed hastened wound area reduction in contrast with gel-base and control groups (P < 0.05). Numerical density of fibroblasts, mean diameter and length densities of the vessels in MC groups were significantly higher than the control and the base groups (P < 0.05).

It is demonstrated that MC has the ability to improve wound healing by enhancing fibroblast proliferation and revascularization in diabetic skin injuries and has the potential to be considered as an alternative treatment.

Type V and VI tibial plateau fractures are severe fractures that can compromise knee structure and function.

We discuss the therapeutic results of external fixator (Ilizarov) for these fractures.

In this study, 44 patients with high-energy type V and VI tibial plateau fractures treated with Ilizarov external fixator were enrolled. The considered variables were age, sex, fracture type, open or close fracture, soft tissue damage, subjective knee score, knee society score (KSS), and functional knee score (FKS). The obtained data were analyzed using SPSS, version 21.

Thirty-four (77.28%) male and 10 (22.72) female patients with the total mean age of 36.38 years were included. Seventeen (38.63%) patients had open fractures, 38.63% of which were type V and 61.36% were type VI. Complete union was achieved in all the patients (mean union time of 16.95 weeks). Three patients had a flexion limit of up to 10 degrees, and in one patient, extension was limited to 5 degrees. Although pin-site infection was detected in 47.72% of the patients, no cases of osteomyelitis or septic arthritis were encountered. Based on the functional outcomes at the last follow-up, 86.36%, 9.09%, and 4.54% were excellent, good, and fair, respectively.

Based on our findings, Ilizarov technique can be used for the treatment of type V and VI tibial plateau fractures as an effective method with low complications.

Silver sulfadiazine cream is used extensively for burns, nonetheless, several adverse reactions and side effects are presented in multiple cases. The aim of this study was to compare the healing effect of nano silver-aloe vera composition and silver sulfadiazine on burns in experimental rat models.

The experimental studywas performed on15male Sprague-Dawley rats to compare the burn treatmentwith nano silveraloe vera combination and silver sulfadiazine in the animal laboratory.

Two deep second degree burns on both sides of the abdomen were created. One side was covered by cream and the other by 1% silver sulfadiazine. Response to treatment was assessed by digital photography on day 28. Histological parameters, such as angiogenesis, fibrosis, epithelialization, and inflammatory reactions, were evaluated.

The average burn size in the nano silver aloe vera group was significantly lower compared to the average burn size of the silver sulfadiazine group (P < 0.05). Upon pathologic assessment, the re-epithelialization of the epidermis on the fourteenth day in the nano silver group was significantly higher. In addition, this difference in terms of fibrosis and angiogenesis was observed on the fourteenth day and it was higher in the nano silver group (P < 0.05).

The use of nano silver compounds in combination with aloe vera compared to silver sulfadiazine cream can expedite re-epithelialization and wound healing in rats.

A 7.3-magnitude earthquake recently shook the Ezgeleh district, located about 143 km from Kermanshah city (12/11/2017), in the western part of the country. Due to the severity of the earthquakes and the infrastructure of the nearby cities and villages, a large number of victims needed medical treatment. Since earthquakes are natural disaster, the state of unpreparedness of the health care systems against natural disasters is unusual. Therefore, the aim of this paper was to assess this critical situation and better prepare for subsequent earthquakes.

Posterior interosseous nerve (PIN) palsy gives rise to various symptoms. The PIN due to lipoma is rare. Here, we report a case of progressive loss of finger extension due to a giant painless parosteal lipoma.

A 52-year-old patient with progressive weakness of finger extension with diagnosis of posterior interosseous nerve (PIN) palsy was referred to our clinic. Electrophysiological studies showed a right PIN neuropathy at the level of the forearm. The patient had no history of trauma of the hand. The patient underwent surgery for tumor removal and nerve decompression. The loss of finger extension due to PIN palsy gradually recovered after tumor removal and the nerve recovered from the motor deficits. The patient showed no recurrence of motor deficit after the surgery in the follow-up.

Since PIN palsy may arise from lipoma early surgical exploration and the excision of deep-seated lipoma in the proximal forearm is recommended in order to avoid permanent damage to PIN or other branches of the radial nerve.

ZMC fractures are the second most common trauma of the face. Therefore, their treatment (including methods of fixation) is of clinical significance.

Due to the lack of studies on many resorbable and non-resorbable fixations of the zygoma, this finite element analysis assessed for the first time displacements and dynamics of the zygoma fixed using three 1-point resorbable and three non-resorbable plates under normal and severe mastication forces.

After creating the 3Dmodelof the zygoma and its adjacent bones basedon aCT scanof amale patient,with linearfractures but without severe dislocations, three one-point resorbable and three similar one-point non-resorbable mini-plates were used to fix the zygoma with miniscrews. The zygomaticomaxillary buttress (ZMB), infraorbital rim, and frontozygomatic (FZ) suture were stabilized using L-shaped four-hole, curved five-hole, four-hole miniplates, respectively. The simulated zygoma was subjected to 150N and 750N loads. Minimum and maximum of stresses, strains, displacements, and rotational displacements of the zygoma were measured.

All four parameters were much smaller in non-resorbable fixations compared to resorbable ones. In severe maxillary force, the parameters stress, strain, and displacement increase considerably. Among these, FZ might cause smaller displacements. Resorbable plates might not be optimum choices for one-point fixation of cases with the heavy mastication loads.

Flexor tendon damagemakes up a small number of total hand injuries; butmanagement of these injuries often poses a surgical challenge because the results remain unpredictable despite all efforts. The results of flexor tendon repair damage of both deep and superficial injuries, especially in zone II, despite using various methods, still remains poor.

This study aimed to assess results of flexor digitorum profundus (FDP) repair with resection of flexor digitorum superficialis (FDS) stump in a setting where both tendons are transected. Lack of human studies for FDP repair alone makes the decision difficult.

Files of patients, who were referred to the research hospitals with flexor tendon rupture between April 2014 and April 2016 were studied. Patients, who had recent concurrent FDP and FDS rupture in zone II were included. After six months, range of motion (ROM), pinch strength, and disabilities of the arm, shoulder and hand (DASH) score were measured.

Twenty patients were studied; three were excluded due to missing follow-ups. Seventeen patients remained in the study. Thirteen were males and four were females. Ages were between 17 and 55, with mean age of 23.7 years old. According to the DASH score, 13 patients were placed in mild disability group (score one to seven) and four patients showed no disability (score zero).

The results suggest the outcomes of FDP repair alone in zone II is comparable to repairing both tendons.

Blunt chest trauma is the third most important injury in patients with multiple trauma, thus the appropriate diagnosis is critical. Although chest X-rays (CXRs) are the most common diagnostic method, the physician should detect the imaging necessity and modality. Accordingly, NEXUS chest and thoracic injury rule-out criteria (TIRC) have been developed to prevent unnecessary radiographs in traumatized patients.

In this study, the diagnostic accuracy of these two guidelines was compared in patients with multiple trauma.

In this cross-sectional study, eligible patients with chest blunt trauma, who referred to the Emergency Department of Imam Hossein Hospital from July 2016 to March 2018, were recruited. Demographic data, trauma and clinical information, and radiographic reports were recorded and the necessity of CXR was determined based on NEXUS chest and TIRC. Finally, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were also calculated for NEXUS chest and TIRC.

In this study, 1925 patients with a mean age of 43.7 ± 9.16 years were evaluated (55% male). The sensitivity, specificity, PPV, NPV of TIRC in the diagnosis of traumatic chest injury were 93.6%, 84.9%, 24.03%, and 99.6%, respectively, and those of NEXUS in the diagnosis of traumatic chest injuries were 97.84%, 51.80%, 93.43%, and 99.79%, respectively. There was no significant difference in diagnostic accuracy between TIRC and NEXUS chest models.

This study showed that NEXUS chest and TIRC have equal values in predicting traumatized chest injuries. Parameters of TIRC are easily measurable in ED and do not require subjective assessments, such as mechanisms and velocity of trauma or fall height. Therefore, the TIRC model seems to be a better tool than NEXUS in detecting injury to the chest and reducing the risk of radiation exposure.