Trauma Monthly
Volume:22 Issue: 4, Jul-Aug 2017

Foreign body aspiration is an emergency condition in children, which can lead to death. Most these foreign bodies are usually removed by bronchoscopy. Straight needle aspiration is a rare condition. Sometimes, there are some difficulties in diagnosis and management of this type of foreign body, especially in children.

We report a case of a needle aspiration.

For intraoperative localization of foreign body, the C-arm device may be used before broncheotomy to decrease morbidity of the patient.

The present study aimed at determining the incidence of deep venous thrombosis (DVT) in 2 groups of patients who underwent simultaneous bilateral total knee arthroplasty (BTKA) or staged bilateral TKA.

Patients with bilateral knee osteoarthritis, who were candidates for BTKA, were divided into 2 groups of patients undergoing either simultaneous bilateral or staged TKA. Incidence of DVT was measured during a 38- month follow- up period and compared between the 2 groups.

Finally, 120 patients with a mean age of 68.2 ± 2.3 years were enrolled (65% male). Baseline and demographic data of the 2 groups were not statistically significant (P > 0.05). During the 38- month follow- up, DVT occurred in 2 patients (3.3%) in the staged BTKA group. The incidence of DVT in the 2 studied groups was significantly different (P = 0.12).

It seems that performing same- day bilateral TKA does not have higher rates of DVT, when compared to those patients who underwent staged bilateral procedure. Simultaneous bilateral TKA can be a better choice for managing patients who need bilateral osteoarthritis surgery because of the significant reduction of hospital stay using this method.

Extra-articular distal tibia fractures have always been a challenge for orthopedic surgeons, and currently there is no consensus on whether to manage such fractures through the use of a plate or with an interlocking nail.

In this study, we compared the outcome of installing a medial distal tibial locking plate through minimally invasive percutaneous plate osteosynthesis (MIPPO) with closed intramedullary interlocking nailing in the treatment of extra-articular distal tibial fractures.

This prospective study was conducted on 60 patients with extra-articular distal tibial fractures. Thirty patients were treated with a distal tibial locking plate by MIPPO, and another thirty patients with closed intramedullary nailing. Patients were followed-up on every four weeks from time to full weight bearing and radiological union, alignment of the fracture, and the discovery of any complications. The final symptomatic and functional results were evaluated using the Teeny and Wiss clinical assessment criteria at nine months.

Though mean time to full weight bearing was early in the plating group, and mean time to radiological union was early in the interlocking group, these values were not significant (P = 0.244 and 0.246, respectively). Both techniques had their own set of complications. Primary valgus malalignment was more common among the nailing group (P = 0.001), but the majority of cases were in the acceptable range, so the occurrence of valgus mal-union was not clinically significant. The final Teeny and Wiss clinical and symptomatic scores at nine months were not statistically significant between the plating and nailing groups (P = 0.451).

Both treatment via medial distal tibial locking plate by MIPPO and closed intramedullary interlocking tibia nailing are viable options for management of extra-articular distal tibia fractures, with each method having its own merits and demerits. The final choice between the two depends on the surgeon’s experience and his or her familiarity with the respective technique

Osteomyelitis following ACL reconstruction occurs rarely and happens in 0.1% to 0.9% of the patients.

We report a distal femoral osteomyelitis and sinus formation following arthroscopic ACL reconstruction in a young nonimmunosuppressed patient, which was finally managed with antibiotic therapy and serial debridement.

Although infection followed by ACL reconstruction is a rare complication, it can seriously affect the outcome. It seems that we can manage such a case with debridement and intravenous antibiotic therapy

Burns are a major cause of stress, and afterwards, many patients suffer from anxiety, depression, and insomnia. Also, the levels of serum antioxidants increase after burns, which causes problems in patients. It has been observed that Melissa officinalis L. can increase serum antioxidant levels and improve mood and sleep quality.

Thirty-six patients who were admitted to Shahid Motahari Burn Hospital were selected. Patients in the control group consumed black tea, and those in the experimental group received Melissa tea. The serum levels of antioxidants were measured using spectrophotometry once before the intervention and at 20 days after the intervention. Depression, anxiety, and insomnia levels were each measured by the Beck, Kettles, and Petersburg questionnaires, respectively.

In the study group, the percentages of those experiencing anxiety (P value: 0.023) and depression (P value: 0.002) were significantly less than those of the control group. Also, sleep quality in the experimental group taking Melissa tea increased significantly (P value: 0.031). However, the mean serum antioxidant levels were not significantly different between the control and experimental groups (P value: 0.96).

Melissa officinalis L. can significantly reduce anxiety and depression and improve sleep quality. Therefore, its consumption may be useful for burn patients as a daily drink. However, the effects of Melissa on increasing serum antioxidants needs further investigation.

Pyoderma gangrenosum (PG) is a rare inflammatory skin disease, which is characterized by extensive ulcerative skin necrosis. The probable cause of PG is neutrophilic infiltration. In postoperative patients, the disease is often misdiagnosed as infection and the patient therefore undergoes improper treatment.

We report a case of PG following the external fixation of femoral and tibial fractures in a patient who underwent eight months of unsuccessful antibiotic therapy, as well as repeated wound irrigation and debridement.

When a histopathological study was at last performed, the diagnosis of PG was confirmed and the patient was successfully treated using corticosteroids.

Intraorbital penetration caused by foreign bodies can lead to blindness or even death following concomitant intracranial damage.

This study reports a three-year-old girl whose left orbit was penetrated by a long pencil. The penetration did not cause any ocular or neurological damage.

A computed tomography (CT) scan is the key imaging study for diagnosing the location and the extension of a foreign body. In this case, it indicated a hypodense object with a high-intensity core that is compatible with the wooden and carbon parts of a pencil, respectively. The pencil was removed easily under general anesthesia and without complications.

Since trauma is the leading cause of death, hospitalization, and disability among children under 15, this study aimed to evaluate the epidemiology and patterns of trauma in children.

All trauma patients under 15 years of age who were hospitalized for trauma from 1999 to 2011 were enrolled in this crosssectional study. After obtaining informed consent, demographic information, locations of the events, seasons of occurrence, times of arrival at the hospital, the transfer methods of the patients, types of trauma, anatomical locations of the trauma, hospitalization durations, and distances and times of the accidents before getting to a hospital were collected on a checklist. Then, SPSS software version 20 with a chi-squared test was used for statistical analysis.

The study population consisted of 1,686 children with trauma injuries, 71.9% of whom were male, and 28.1% of whom were female. There was a significant correlation between age, sex, and duration of hospitalization among those patients presenting with certain mechanisms of trauma. The most injuries, with 620 (63.8%) cases, were reported in the lower extremities. After examining the relationships between the ages of the injured patients and the location of the upper extremities, multiple traumas, and abdominal injuries, significant correlations were found.

The results of the present study suggested that boys over 10 years of age were more susceptible to trauma and falling and other accidents are the most important causes of trauma identified among the children. The upper and lower extremities were also the most affected areas.

The Hajj pilgrimage is one of the most important obligations of Muslims. Hajj is the 2nd largest annual gatherings in the world after the Arbaeen pilgrimage to Karbala. Many of the health risk factors during the Hajj can be prevented or controlled. Evidence Acquisition: 17 available papers pertaining to the Hajj pilgrimage from 2000 to 2016 were aggregated, coded and used in the current study. The data were collected from the ISI web of knowledge, Scopus, Google Scholar, Lancet, PubMed, MEDLINE, Wiley, Highwire and EMBASE. The search strategy included the Hajj pilgrimage and trauma centers or Islamic ethics, Islamic rights, and accreditation.

On average 1,379,500 pilgrims from 188 different countries as well as 800,000 from Saudi Arabia visited Mecca every year. The health risk factors classified categories included communicable and noncommunicable diseases. A total 2,431 people died and 427 were missing from 42 countries according to latest reports of the Hajj stampede in 2015.

Recent studies pertaining to Hajj had emphasized standard reforms to prevent future incidents during the Hajj rituals.

Injuries inflicted by motorboat propellers are rare but often result in extensive soft tissue and osseous injuries and can have great impact on the functional outcome of the patient. Treatment is challenging and needs a multidisciplinary approach.

This study retrospectively analyzed 4 cases and performed a PubMed, Embase, Medline and Cochrane literature search. All articles presenting original patient data were included.

In all four cases, a multidisciplinary approach was used. Mean follow up was 15.8 months (range 6 to 35). All patients had some degree of functional impairment with lower Foot and Ankle Outcome Score (FAOS) concerning sport and recreation, and footand ankle-related quality of life. A review of the literature revealed 20 articles with 95 reported cases. The most common injury was to the lower extremities (63 limbs). The injury mechanism was available for 84 cases; 62% was water sport related. In 18 cases, the propeller injury resulted in an amputation of the affected extremity. Twenty fatalities could be identified.

Motorboat propeller injuries can be severe and even fatal. Lower extremities are particularly at risk, resulting inextensive soft tissue and osseous injuries with a significant risk of subsequent amputation. The impact on functional outcome can be significant. A patient-based and multidisciplinary approach is necessary to ensure an optimal outcome.

Pain management is an important issue in traumatic patients. The aim of this randomized clinical trial was to compare the analgesic effect of intravenous acetaminophen with intravenous morphine sulfate in patients with traumatic diaphyseal long bone fracture.

This double-blind randomized clinical trial was carried out in an academic trauma center in Mashhad, Iran, from February to October 2013. After primary modalities like limb elevation, ice and limb splinting, patients were allocated to receive either acetaminophen 15 mg/kg or morphine sulfate 0.1 mg/kg randomly. The pain severity was measured using a visual analogue scale before drug administration and 5 and 30 minutes after drug administration. Then, the results were compared.

Of the 50 patients recruited over 9 months 26 patients received intravenous morphine sulfate and 24 patients received intravenous acetaminophen. A significant difference was observed between the two groups at 5 minutes after drug administration; the morphine sulfate group showed more reduction in pain severity after 5 minutes (P < 0.0001). However, there was no significant difference in pain severity at 30 minutes after drug administration between the two groups (P = 0.85).

It seems that after 30 minutes, intravenous acetaminophen is as effective as intravenous morphine sulfate in pain management of isolated diaphyseal long bone fracture. However, it should be noted that the analgesic effect of acetaminophen begins with a delay. Thus, we suggest using intravenous acetaminophen when morphine administration is contraindicated.