Trauma Monthly
Volume:23 Issue: 3, May-Jun 2018

Peripheral nerve injury (PNI), due to upper extremity and cervical trauma can impair hand function, as well as affect quality of life.

In this study we aimed to evaluate clinical symptoms and electrodiagnostic findings in traumatic upper extremity PNI.

A total of 106 traumatic patients with upper extremity peripheral nerve injuries were recruited and completed a physical examination. In addition, an electrodiagnostic study was performed to investigate detailed pattern of nerve lesions.

Of 106 patients, 88 were males with a mean age of 36.6 ± 14.91. Thirty-three patients had an involvement in the forearm area and 20 of them had an injury of the shoulder girdle. Twenty-one had ulnar nerve injury, 8 had median, and 8 had radial nerve involvement. Furthermore, the ulnar nerve was the most common nerve injury among other nerve involvements. Only 10 patients had plexopathy and 10 other had radiculopathy.

Ulnar nerve lesions were highly prevalent in upper limb trauma followed with brachial plexopathy and radiculopathy. The forearm and shoulder girdle are more susceptible to nerve injury.

Triage of trauma patients is particularly important. Correct triage can reduce the rate of mortality and prevent disability in trauma patients.

The current study aimed at comparing the frequency of miss triage using the two methods namely emergency severity index (ESI) and shock index, in patients with abdominal trauma.

Trauma patients referring to Shahid Rajaee hospital, were included as the study population. A census survey was conducted for three months. Data were collected by a demographic questionnaire, a five-level triage system checklist, and triage form based on the shock index. Content validity of the questionnaire was confirmed by experts and Patients were simultaneously evaluated by both ESI and shock index methods. The triage level in each method was compared with the triage level approved by an emergency clinician. Data were analyzed with SPSS version 18.

Based on ESI, 6.3% of patients were under-triaged and 2.7% over-triaged; but based on the shock index, 36.2% of the patients were under-triaged and 19.2% over-triaged. There was a positive correlation between each of the two methods and the final score of triage. Moreover, the correlation coefficient of the final score in the five-level triage system was higher than that of the shock index (r = 0.834 vs. r = 0.162).

According to the results, the shock index can be used as an auxiliary tool in the triage of traumatic patients in emergency departments.

Several operative techniques have been described for operative treatment of posterior cruciate ligament (PCL) avulsion injuries. Here we introduce a new arthroscopic suture technique for the treatment of PCL avulsion fracture using Scorpion suture passer. Three standard portals of anteromedial, anterolateral, and posteromedial are established along with the central trans-patellar tendon portal, if necessary. A Scorpion suture passer and No. 2 FiberWire were used to put two sutures at the base of the PCL-bone interface. After reducing the fragment, a tibial target guide for PCL was used to make a tunnel at the center of the fracture site and the fragment, if possible. An Endotack is used to fix the sutures at the anterior border of the tibia. This is a practical technique with a short learning curve and biomechanically stable fixation.

In many countries, disease registries are the main source of information necessary for planning and monitoring health-improving programs. In Iran, there is no unified registry system for deaths due to traffic accidents, so organizations that are involved in traffic accidents report different statistics. This study aimed to assess traffic accident mortality rate and completeness of death registries in Northern provinces of Iran from March 21, 2010 to March 20, 2011 using capture-recapture method.

Data of all traffic accident victims including last name, age, sex, and time of death confirmed by traffic police legal forensics organization, and hospitals were used to collect. Then, different log-linear models proposed in the context of capture-recapture method were fitted to predict the number of cases missed by the sources. Akaike information criterion (AIC) and Bayesian information criterion (BIC) were used as goodness of fit indices to identify preferred fitted models.

According to the prediction of the most fitted model, the total number of traffic accident deaths was 3857 of which, 727 cases were not documented by any of the responsible organizations. Mortality rate due to traffic accidents was estimated as 53.73 with 95% confidence interval (52.41 - 55.15) per 100000 population of the three provinces. The rates of legal medicine organization, hospitals, and traffic police department were 65.95%, 36.06%, and 16.85%, respectively.

Incidence rate of fatal traffic accidents in Northern provinces of Iran is higher in comparison with other provinces. It seems that statistics reported by responsible organizations are underestimated, hence the need for application of methods like the capture-recapture method.

The shoulder is considered to be an important flexible and movable part in the human body. However, it is a wobble joint as its range of motion (ROM) is high. This unstable status increases the rate of joint injury. The processes leading to shoulder joint dysfunction are arthritis, hemiarthroplasty failure, and pseudoparalysis; in turn, one of the main factors contributing to these problems is rotator cuff tear (RCT). Reverse shoulder arthroplasty (RSA)may be a proper treatment for shoulder dysfunction and pain. This treatment elevates shoulder movement and has been augmented by recent advances in the development of the reverse shoulder prosthesis (RSP) design. This current review highlights the recent developments, revisions, and complications. A review of the published literature has been done to determine the overall rates of problems, complications, reoperations, and revisions after RSA. Furthermore, this review discusses the problems concerning RSP, shoulderjoint replacement, and improvement in shoulderjointmovement after arthroplasty

Isolated fractures of the capitate account for only 0.3% of carpal bones fractures.

We report a motorbike rider, aged 27 years, who was involved in a motorcycle accident. He complained of right wrist pain, and wrist motion was considerably impaired. In the right wrist radiograph and CT scan, we diagnosed an isolated displaced capitate fracture. Open reduction was done under regional anaesthesia. After confirming the guide-wire’s position and reduction of the fracture by imaging, we applied a headless compression screw (HCS, Synthes, Paoli, USA). After 24 months, the patient regained pain-free activity level with 90% of grip strength (in comparison with the contralateral wrist), with extension, flexion, radial deviation, ulnar deviation, supination, and pronation of 75°, 75°, 15°, 30°, 80°, and 80°, respectively.

This study suggested that an early diagnosis and open reduction of the displaced fragment in the treatment of such difficult fractures can lead to a successful outcome

Unicompartmental knee arthroplasty (UKA) is performed as an alternative to total knee arthroplasty (TKA) and high tibial osteotomy for unicompartmental osteoarthritis.

We examined whether the tolerable range of component malalignment is narrower in obese (BMI > 30) or in nonobese patients.

We performed 163 consecutive all-poly medial UKA from 01/01/1995 to 31/10/2003. We examined 83 patients (88 knees) with a minimal follow-up period of 10 years. We examined the correlation between limb- and component malalignment and clinical outcome separately in the obese (67 knees) and nonobese (21 knees) groups.

The 10-year prothesis survival was 92.8%, and 9 UKA were converted to total knee arthroplasty. The average time for revision was 84.44 (48 to 144) months. The 8 obese and 1 nonobese patients had slightly higher BMI (33.47) than the 83 long-term followed patients (31.72). In each of these 9 patients, knee score and functional score were poor. At every revision, we used stems and augments. In the obese group, the prosthetic joint space depression correlated with fair and poor knee and functional scores, the prosthetic joint space elevation correlated with degenerative changes in the lateral tibiofemoral joint.

In the obese group, we noted at least 2 mm of prosthetic joint space depression in all of the 8 failed knees, and 4 mm or more than 4 mm in 6 cases. We hypothesize that the reason fot the subsidence of the tibial component is the increased loading because of prosthetic joint space depression. The result of this study suggests that tibial component positioning which provides an optimal level of prosthetic joint space reduces the risk of failure in medial UKA, prevents degenerative changes in lateral tibiofemoral joint, and provides better long-term clinical outcome.

Lumbar spine laminectomy and spinal fixation are common procedures, associated with several recognized complications. Thromboembolic events have been reported during these types of procedures; although their incidence is low, the associated mortality is not.

We present a 53-year-old woman with no medical history or risk factors for thromboembolic events, who underwent lumbar spine laminectomy and posterior spinal fixation. The clinical findings indicated the risk of pulmonary embolism following surgery, which was confirmed via capnography, arterial blood gas, electrocardiography, and computed tomography angiography.

Pulmonary embolism may be diagnosed, based on clinical findings and simple data provided by the analysis of vital signs and monitoring in the operating room.

Injury to right hepatic artery (RHA) may occur during hepatobiliary operative procedures. Although it may not be detected and is clinically silent in most of the cases, liver abscess, bleeding, hemobilia, and right hepatic lobe ischemia needing surgical excision have been reported. The aim of this study was a more detailed evaluation of hepatic consequences following RHA injury in an animal model.

This study was conducted on 20 New Zealand rabbits 6 months of age. Blood samples for the measurement of hepatic enzymes was obtained from the rabbits before ligation of the hepatic artery. After 10 days, blood sampling was repeated and the animals were killed and 0.5 × 2 cm liver wedge biopsy was prepared from right lateral lobe, the distribution area of RHA. P values of < 0.05 were considered significant.

Laboratory data before and after surgical intervention showed serum bilirubin of 0.133 ± 0.044 and 0.135 ± 0.042, respectively (P value = 0.47). Serum alkaline phosphatase (ALP) was 122.4 ± 44.12 and 122.8 ± 44.43, (P value = 0.36) respectively. Serum glutamic-pyruvic transaminase (SGPT) was 31.2 ± 5.34 and 86.2 ± 33.9, (P value = 0.001) respectively. Serum glutamic oxaloacetic transaminase (SGOT) was 30.13±8.46 and 69.4±47.7, respectively (P value = 0.001). Laparotomy showed no considerable change in median lobe of livers, except mild necrosis in one (5%) rabbit. Severe necrosis was found in the right lateral lobe of 15 rabbits (75%), moderate necrosis in 3 (15%), and mild necrosis in 2 (10%) cases. No abscess or gangrene was found. The Gall bladder was intact in all animals.

The RHA obliteration causes an increase in liver enzymes and considerable right lateral hepatic lobe necrosis (75%) but no liver abscess, gangrene or gall bladder abnormality

In Iran, trauma is the second cause of mortality after cardiovascular diseases. Since children are known to belong to one of the high-risk age groups, the identification of the prevalent fractures in this age group could aid the identification of causes of fractures as well as damages observed in this group.

In this descriptive cross-sectional study, a total of 5187 patients under 12 years of age, with definitive diagnosis of fractures referred to the Taleghani hospital of Kermanshah, were evaluated and the information was extracted from the patients’ records according to a researcher-built checklist, the validity of which was confirmed by 2 faculty members. The data was analyzed using SPSS v.16 software.

The average age of patients was 6.4±5.32 and their hospitalization duration was 1.2±0.98 days. Herein, 3579 patients (67% of the total number of patients) were male and a significant difference was observed between the 2 genders (P < 0.001). Furthermore, 3498 subjects (65.4%) had upper-limb fractures, 1662 subjects (31.2%) had lower-limb fractures, and 182 cases (3.4%) had non-limbic fractures. The most common cause of fracture was falling from a height (77%).

The results demonstrate that a high percentage of fractures resulted from falling from a height, in males younger than 12 years old.