Trauma Monthly
Volume:22 Issue: 3, May-Jun2017

The naso-orbito-ethmoid (NOE) area is an intricate structure composed of the nasal, lacrimal, maxillary, frontal, and ethmoid bones. The treatment of NOE fractures is one of the most challenging issues in the management of maxillofacial injuries. The management of these fractures requires a thorough knowledge of midfacial anatomy, surgical techniques, and the available implements in order to obtain optimal aesthetic and functional results. The aim of this study was to review current knowledge (i.e., from the past ten years) concerning NOE fractures and the related surgical techniques. Evidence Acquisition: An extensive electronic literature search was performed via international and national databases, including MEDLINE/PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), DOAJ, Iranian Science Information database (SID), Iranmedex, and Irandoc. Literature published between October 2004 and October 2014 was searched for using specific keywords. The references from each study were also searched. Finally, all articles relevant to the selected keywords and the topic of the study were reviewed.

High-energy blunt or penetrating traumas are themost common cause of NOE fractures. NOE fractures account for some 5% and 15% of adult and pediatric facial fractures, respectively. These fractures are characterized by three major post-injury symptoms, namely increased intercanthal distance, diminished nasal projection, and impaired nasofrontal and lacrimal drainage. The prompt management of NOE fractures is of the utmost importance in avoiding secondary deformities. Surgical treatment is guided by the pattern and classification of the injury. The surgical approach also varies according to the fracture type and other concomitant facial injuries. If the fractured fragment cannot be reduced satisfactorily by closed reduction, the operation should be converted into an open reduction and internal fixation. The most common method for medial canthopexy is transnasal wiring.

Nowadays, advances in radiographic imaging along with the evolution in minimally invasive surgical techniques have led to more conservative treatment modalities that may minimize post-injury complications and improve aesthetic outcomes

Accidents are the most frequent reason for admission to hospitals and the second most common cause of mortality. Accident-related injuries can cause severe financial loss in communities. Understanding the causes and prevalence of accidents is necessary to prevent such losses.

The objective of the present study was to reveal the causes of accidents leading to admission to the emergency ward of Shahid Beheshti hospital, the referral and educational hospital of the Kohkilooyeh and Boyerahmad provinces in Yasuj.

The present research was a cross-sectional study of the information of 583 patients who were admitted to the emergency ward of Shahid Beheshti hospital due to accidents. Data were extracted from the medical records of patients admitted to the emergency ward of the hospital during the calendar year March, 2011 to March, 2012. The data were then analyzed using SPSS 19.

Among the 583 patients admitted to the emergency ward due to accidents, 396 (68%) were male and 187 (32%) were female, with a mean age of 28 years (25 - 55 years). 257 patients (44.1%) were admitted to the emergency ward from 6 pm to 12 pm and Wednesday with 97 cases (17.7%). Only 176 patients (31.2%) used insurance services during hospitalization. The most common causes of accidents leading to admission were traffic accidents (66.4%), falls and collisions (29.06%), and fights (2.17%). The average hospital fee was 630,253 rails.

The findings of the present study show that patients 24 - 44 years of age were the most likely to experience accidents such as traffic accidents, falls, and fights which inflict irreversible damage on communities and families and cause financial and mental suffering due to the loss of man power. Most of these accidents could be prevented by improvements in public training, driver’s education, modification of areas where accidents frequently occur, and enforcement of safety measures.

Home health care (HHC) as a part of the health care delivery continuum has continued to be developed over the past decade. The number of patients receiving home mechanical ventilation (HMV) is increasing. The continuity of care from the hospital to the home is very important. However, these patients have various special care needs, and different conditions may affect the quality of care delivered to them.

This study was conducted to assess the barriers against service provided to the patients receiving HMV in the distinctive cultural, financial, spiritual, and emotional context of Iran.

The present study was performed using the method of qualitative content analysis with purposive sampling. In general, 18 participants, including seven nurses, three physicians, and two physiotherapists working in homes, and six family members who each had a patient receiving mechanical ventilation at home, were interviewed during 2013 to 2014. Semi-structured interviews were conducted in quiet places offered by the study participants.

The barriers against home care for patients depending upon mechanical ventilation in this study are classified into three main categories, including policy-based barriers, agency-based barriers, and family-based barriers. The main policy-based barriers were the legal framework restrictions, insurance limitations, and an inefficient social support network. Lack of a professional team, lack of an independent home care organization, and problems related to physician visits were considered as agency-based barriers. Family-based barriers included fatigue and distress of the families and financial drainage.

It seems that providing quality HHC is one of themost important challenges faced by our country’s health system, but the relevant infrastructure and policies have not been adequately considered. The results of this study could be used for improving the current challenges in delivering quality care to ventilator-dependent patients at home

Improving the quality of work life (QWL) is a comprehensive process essential to attracting and retaining employees, especially in health care.

The purpose of the present study was to determine quality of nursing work life and its related factors at nurses Kashan city hospitals in 2014.

This cross-sectional study was conducted on 157 ICU nurses from September to November, 2014 at 4 educational hospitals of Kashan, Iran. A three part questionnaire was used in this study: demographic and professional characteristics, quality of nursing work life (QNWL), and the national aeronautics and space administration task load index (NASA-TLX). Data were analyzed using the t-test, the Mann-Whitney U test, and the chi square and Fisher’s exact test with SPSS software, version 16.

The majority of the participants (N = 112) were female (83.3%), and the mean age of the subjects was 33 ± 6.98 years. Age, education, job position, job location, and a second nursing job in another hospital were found to predict QNWL. Among the six subscales of NASA-TLX, frustration and mental demand had the lowest and highest rating score, respectively. Temporal demand, frustration, and effort levels were significantly correlated with QNWL.

It is necessary to pay more attention to the QNWL and its related factors, especially nursing workload, to improve quality of care.

A multiple long-bone shaft fracture is associated with developing systemic complications and increased morbidity and mortality. Optimal timing for surgery of polytrauma patients according to damage control orthopedics principles is crucial.

We present a 5-year-old boy referred after a pedestrian car accident with right femoral shaft fractures, a left distal femur fracture, and a left tibial fracture. The patient was classified as a borderline state according to the orthopedic trauma team and was managed accordingly.

An article review is presented that signifies the potential benefits of delays in operativemultitrauma fracture fixation, particularly for patients in a borderline state.

Craniofacial injuries are a major cause of trauma-related disability and damage. Knowledge of the common causes of injuries to the head and facial areas and the resulting effects on the bone structures or brain tissue will be useful for healthcare personnel.

The aim was to investigate the common causes of injuries in patients with craniofacial trauma, and to describe the resulting bone and soft tissue injuries.

In this one-year cross-sectional study (2013 - 14) which was carried out in a tertiary referral hospital, 416 patients who suffered from various forms of craniofacial traumatic injuries (resulting from traffic accidents, assaults, falls, etc.) were enrolled in the study on a consecutive basis. Their medical records and radiographs were examined, and interviews were conducted with the patients and their family members to determine the exact causes of the injuries.

Of the 416 cases, 356 were males (85.6%). Mean (SD) age was 33.1 (21.1) years. The most common cause of injury was falls (137 cases, 32.9%) followed by motorcycle accidents (86 cases, 20.7%). Of the 206 patients with skull fractures (49.5% of the sample), 125 (58.4% of the group) were in non-motor vehicle accidents versus 81 patients (40.1%) who were in the motor vehicle accident group (P < 0.0001). Facial bone fractures were more common among those with non-motor vehicle accident injuries (28.5%) versus those who had been in motor vehicle accidents (12.4%, P < 0.0001). Conversely, intracranial hemorrhage (74.3% vs. 58.9%, P = 0.001) and brain tissue injuries including a contusion, edema, herniation, or burst lobe (44.6% vs. 24.8%, P < 0.0001) were respectively more prevalent in motor vehicle accident traumas than in non-vehicle motor accident injuries. At follow-up, 34 patients had died during hospitalization, 69 patients had undergone cranial surgery, and 67 required facial surgery.

Craniofacial injuries were more common in males in their thirties, with falls and motorcycle accidents as the most common causes. In motor vehicle accidents, we observed a significantly higher proportion of intracranial hemorrhages and brain tissue injuries. In non-motor vehicle accidents (including falls, assaults, accidentally hitting the head/face with a sharp/hard object, etc.), skull/facial bone fractures were more common. These findings can be considered by clinicians as well as forensic medicine specialists

Impending gangrene of the thumb in infants is rare.

A two-month-old baby was brought to our hospital with swelling and redness in the thumb of the left hand for one day. The child was irritable and febrile, but a systemic examination of the child was unremarkable. The thumb was swollen, with considerable redness and a small concentric band at the base of the thumb. A pulse oximetry probe could not detect oxygen saturation in the thumb. An intraoperative examination revealed a hair as the cause of the constriction band. All hair was meticulously removed. Oxygen saturation improved to 98% immediately after surgery, and the postoperative period was uneventful. A complete healing of the ulcer was seen after three weeks.

Impending gangrene secondary to the mother’s hair is extremely rare. Fortunately, the prompt use of measures and the timely removal of the hair causing constriction in our case prevented established gangrene that would have led further to amputation.

Spinal cord injury (SCI) is a life-altering experience that affects sexuality as well as other aspects of an individual’s life. However, sexuality of women with SCI has received less attention than that of men.

This study focused on the sexual understanding of a sample of Iranian women with SCI.

This qualitative study was conducted with 24 semi-structured interviews. Women with SCI were recruited from the brain and spinal injury research center (BASIR) registry system at the Imam Khomeini hospital in Tehran, Iran. Barun and Clarke’s thematic analysis approach was adapted to analyze the narrative data.

According to participation viewpoints, the following three main themes were explored: the dilemma that lead to limited sexual activity, seeking positive sexual adjustment, and the lack of client-based sexuality education in the rehabilitation process.

Our findings revealed that women with SCI expressed a need to be recognized as capable sexual beings regardless of their disability. The narratives highlighted their desire to seek help in order to prevent the adverse impact of SCI on their sexuality and marital life. These women could seek an active and pleasurable sexual life if they are informed about sexuality changes postinjury, accept sexual behavior changes, and apply various sexual skills to their post-injury lives. Therefore, sexuality education and counseling soon after SCI is recommended. These services would be delivered by a rehabilitation team to women and their spouses during initial caregiving and be ongoing as long as needed.

Early diagnosis of major trauma and rapid transmission of patients to appropriate therapeutic centers have always been issues of concern. Several prognostic models for rapid clinical decision-making and estimating the mortality rate of multipletrauma patients have been presented previously.

The current study aimed to evaluate the GCS, Age, and systolic blood pressure (GAP) and mechanism, GCS, age, and systolic blood pressure (MGAP) scores of patients with multiple trauma and determine the cut-off points of these scores for predicting mortality rates. Patients and

This cross-sectional descriptive study was included 374 patients with multiple trauma. Data regarding age, mechanism of injury, systolic blood pressure, and Glasgow coma score were collected. GAP and MGAP scores were calculated, and their relationship with the need for surgery, mortality in the ED, and mortality in the hospital ward were investigated.

Mean±SD of the MGAP and GAP scores of patients were 24.36±5.04 and 20.53±5.08, respectively. For no need for surgery, survival in the ED, and survival in the hospital ward, areas under the Roc curves for MGAP were 0.75, 0.93, and 0.99, respectively, and for GAP, were 0.74, 0.80, and 0.99.

MGAP and GAP scores were used to accurately predict outcomes for patients with multiple traumas. We recommend these simple triage tools for use by emergency medical technicians in pre-hospital settings to refer patients to appropriate trauma centers.

Immediate identification of vascular injury requiring embolization in patients with pelvic bone fracture is not an easy task. There have been many trials of indicators of embolization in patients with pelvic bone fracture. Although the Young and Burgess classification is useful inmaking decisions about treatment, it is reported to have little value as an indicator of embolization in major trauma patients.

The aim of this study is to find fracture patterns for predicting vessel injury by analyzing pelvic radiographs taken from major trauma patients with pelvic bone fracture. Patients and

Among major trauma patients with injury severity scores (ISS) higher than 15 who visited our emergency room from January 2011 to June 2014, 170 patients were found with pelvic bone fracture and thus pelvic computed tomography (CT) angiography was performed. Setting aside patients who met the exclusion criteria, 126 patients were enrolled in this study for analysis of the length of anterior pelvic ring displacement, fracture involving the greater sciatic notch, iliac bone fracture involving the sacroiliac joint and sacral fracture.

Anterior pelvic ring displacement in group I was shorter (3.8 mm) than that of Group II (18.0 mm), but without statistical signficance (P > 0.05). Although fracture involving the SI joint did not prove to be of statistical significance (P > 0.05), fracture involving the sciatic notch or sacrum was statistically significant (P < 0.05).

Analzying fracture sites involving the sciatic notch and sacrum may help predict the need for embolization of arterial injury concommitant with pelvic fracture.

Few studies have assessed the association between behavioral responses and burn pain intensity.

This study aimed to assess the afore mentioned association in an Iranian adult population.

A cross-sectional study was done on 100 eligible burn patients referring to one of the referral teaching hospitals in the north-west of Iran. A numerical rating scale was used to assess pain intensity during dressing change (procedural pain) and rest time (background pain). A self-administered validated and reliable questionnaire was used to determine behavioral responses.

The mean pain intensity related to dressing change was 8.5 ± 1.8 and the mean pain intensity during rest time was 5.6 ± 2.0. The most frequent behavioral responses to procedural pain (at dressing change) were grimacing (%93), moaning (%71) and restlessness (%52). The most frequent behavioral responses at the rest time was silence (%95), refusing to move (82%), and protecting the painful area (73%). The behavioral responses including moving away from painful stimuli, moaning, crying, grimacing, restlessness, protesting, and being silent were found to be significantly associated with burn pain intensity at the dressing change time (P < 0.05). In addition, refusing to move seemed to be the only behavioral response associated with burn pain intensity at rest (P < 0.05).

Burn patients experience severe and mild to moderate pain at the time of dressing change and during rest, respectively. Accurate multidisciplinary care plan including pain assessment scales and responses to pain is offered to provide effective treatment and care.

Diaphragmatic injuries due to penetrating trauma remain a diagnostic challenge. Inspection is the best approach in diagnosis as palpation may miss some injuries. The following approaches have been used, either alone or together, to recognize penterating trauma injuries: physical examination, chest x-ray, computed tomography scan, focused assessment with sonography for trauma, and diagnostic peritoneal lavage (DPL). These modalities have been reported to miss 10 to 30 percent of injuries. These diagnostic tools have a low sensitivity and specificity to detect morbidities associated with these injuries. Finding a suitable diagnostic modality is essential for patient care. In this study, we assessed the diagnostic value of video-assisted thoracoscopy as an approach to diagnose diaphragmatic injuries in patients with negative DPL.

This case series was conducted on 33 patients with penetrating thoracoabdominal trauma referred to the Loghman Hospital in Theran, Iran, from 2013 to 2014 (during an 18-month period). All negative DPL and hemodynamically stable hemopneumothorax patients with no indications for emergent surgical interventions were included in the study. All these patients underwent diagnostic thoracoscopy. Data were collected and analyzed by SPSS software version 20.

Thirty-three patients were eligible to participate in this study with a mean age of 23.79±6.42 years. The youngest participant was 17 years old and the oldest was 51. A penetrating wound was located in the right side in 11 patients (33.3%) and on the left side in 19 subjects (57.6%). Three patients (9.1%) had trauma on both sides of their thorax. During thoracoscopy, 6 subjects (18.2%) were found to have asymptomatic diaphragmatic injuries.

Diaphragmatic injuries can be missed based on negative DPL. Application of video- assisted thoracoscopy is a minimally invasive procedure that is a practical approach for the evaluation, and management of trauma patients with diaphragmatic injuries