Trauma Monthly
Volume:19 Issue: 3, Ju-Aug-2014

Injuries are a major cause of mortality and disability worldwide and are estimated to become the third leading cause of death by 2020. Most traffic deaths occur during the prehospital phase; consequently, prehospital trauma care has received considerable attention during the past decade. However, there is no study on the prehospital immobilization of spine and limbs in patients with multiple trauma in Iran.

This study aimed to investigate the epidemiology of trauma and the quality of limb and spine immobilization in patients with multiple trauma transferred to Shahid Beheshti Medical Center via emergency medical services (EMS).

This cross-sectional study was conducted in 2013. The study population consisted of all patients with multiple trauma who had been transferred by EMS to the Central Trauma Department of the Shahid Beheshti Medical Center, Kashan, Iran. The study used a checklist and we recruited a convenience sample of 400 patients with multiple trauma. Data were described by using frequency tables, central tendency measures, and variability indices. Moreover, we analyzed data using SPSS.

The study sample consisted of 301 (75.2%) males and 99 (24.8%) females. The most common mechanism of trauma was traffic injuries (87.25%). Motorcyclists constituted 52.25% of the road traffic injuries victims. Overall, the quality of immobilization was at an undesirable level in 95.8% of patients with spine and limbs injuries. A significant association was observed between the quality of spine and limbs immobilization and the EMS workers’ education level (P = 0.005).

The quality of spine and limb immobilizations was undesirable in more than 90% of cases. Due to the importance of good spine and limb immobilization in patients with multiple trauma, prehospital EMS technicians should be retrained for proper immobilization in patients suspected of spine or limb injuries. Developing evidence-based protocols and strengthening the regulatory and supervisory system to improve quality of prehospital emergency care in patients with multiple trauma is recommended.

One of the modern techniques for the treatment of clavicle fracture (Fx) is elastic titanium intramedullary nailing. But, there are different opinions about this technique. We studied this technique in 12 patients with clavicle Fx and assessed its outcome.

We aimed to study the prognosis of midshaft clavicular Fx treated via minimally invasive stable elastic intramedullary nailing.

We operated on 13 clavicle Fx in 12 patients from 2008 through 2012. We used a new technique called minimally invasive titanium elastic intramedullary nailing for operating patients with midshaft clavicular Fx.

Clinical union was achieved 3-5 weeks after the operation with no pain over Fx sites upon physical examination. Radiologic union appeared at 6 to 12 weeks .We did not encounter nonunion or infection, but one of the comminuted Fx united 1 cm shorter; however, it had a solid union with a good score. All but two patients had good scores.

Although controversy exist regarding intramedullary nailing of clavicle Fx, our results using this technique for minimally comminuted midshaft clavicular Fx were very good.

Facial soft tissue injury can be one of the most challenging cases presenting to the plastic surgeon. The life quality and selfesteem of the patients with facial injury may be compromised temporarily or permanently. Immediate reconstruction of most defects leads to better restoration of form and function as well as early rehabilitation.

The aim of this study was to present our experience in management of facial soft tissue injuries from different causes.

We prospectively studied patients treated by plastic surgeons from 2010 to 2012 suffering from different types of blunt or sharp (penetrating) facial soft tissue injuries to the different areas of the face. All soft tissue injuries were treated primarily. Photography from all patients before, during, and after surgical reconstruction was performed and the results were collected. We used early pulsed dye laser (PDL) post-operatively.

In our study, 63 patients including 18 (28.5%) women and 45 (71.5%) men aged 8-70 years (mean 47 years) underwent facial reconstruction due to soft tissue trauma in different parts of the face. Sharp wounds were seen in 15 (23%) patients and blunt trauma lacerations were seen in 52 (77%) patients. Overall, 65% of facial injuries were repaired primary and the remainder were reconstructed with local flaps or skin graft from adjacent tissues. Postoperative PDL therapy done two weeks following surgery for all scars yielded good results in our cases.

Analysis of the injury including location, size, and depth of penetration as well as presence of associated injuries can aid in the formulation of a proper surgical plan. We recommend PDL in the early post operation period (two weeks) after suture removal for better aesthetic results.

Unalleviated complications related to hospitalization, including stress, anxiety, and pain, can easily influence different structures, like the neural system, by enhancing the stimulation of sympathetic nervous pathways and causing unstable vital signs and deterioration in the level of consciousness.

The purpose of this study was to determine the effects of massage therapy by family members on vital signs and Glasgow Coma Scale Score (GCS) of patients hospitalized in the Intensive Care Unit (ICU).

This randomized controlled clinical trial was conducted at the ICU of the Shariati Hospital during 2012; 45 ICU patients and 45 family members in the experimental group and the same number of patients and family members in the control group were consecutively selected . The data collection instrument consisted of two parts. The first part included demographic data (age, marital status and Body Mass Index) and the second part included a checklist to record the patient’s vital signs (systolic blood pressure (SBP), diastolic blood pressure (DBP), respiratory rate (RR), pulse rate (PR)) and GCS. All measurements were done at the same time in both groups before the intervention (full body massage therapy), and 1 hour, 2 hours, 3 hours, and 4 hours after intervention. The patients were provided with a 60-minute full body massage The massage protocol included static, surface tension, stretching, superficial lymph unload, transverse friction, and myofacial releasing techniques.

Significant differences were observed between experimental and control groups in the SBP at 1 hour, SBP 2 hours, and SBP 3 hours, and also in GCS at 1 hour to GCS at 4 hours (P < 0.05). Multivariate analysis revealed a significant difference between experimental and control groups in SBP at all time points (P < 0.05).

Massage via family members had several positive effects on the patients’ clinical conditions, and therefore, it should be recognized as one of the most important clinical considerations in hospitalized patients.

Research on the association between testosterone and violent behavior has provided conflicting findings. The majority of studies on the association between testosterone and antisocial-violent behaviors has used a clinical sample of severely violent individuals. These studies have mostly assessed males.

To study sex differences in the association between testosterone and violent behaviors in a community sample of young adults in the United States.

A longitudinal study of an inner city population on subjects aged from adolescence to adulthood was undertaken. Testosterone and violent behaviors were measured among 257 young adults with an average age of 22 years (range 21 to 23 years). We used regression analysis to test the association between testosterone and violent behaviors in male and female samples.

There was a significant positive correlation between testosterone levels and violent behaviors among females, but not males. The association between testosterone levels and violent behaviors among females was significant, as it was above and beyond the effects of socio-economic status, age, education, and race.

Our findings provide more information about the biological mechanisms for violent behaviors among young female adults. The study also helps us better understand sex differences in factors associated with violent behaviors in the community

CT is increasingly used during the initial evaluation of blunt trauma patients. In this era of increasing cost-awareness, the pros and cons of CT have to be assessed.

This study was performed to evaluate cost-consequences of different diagnostic algorithms that use thoracoabdominal CT in primary evaluation of adult patients with high-energy blunt trauma.

We compared three different algorithms in which CT was applied as an immediate diagnostic tool (rush CT), a diagnostic tool after limited conventional work-up (routine CT), and a selective tool (selective CT). Probabilities of detecting and missing clinically relevant injuries were retrospectively derived. We collected data on radiation exposure and performed a micro-cost analysis on a reference case-based approach.

Both rush and routine CT detected all thoracoabdominal injuries in 99.1% of the patients during primary evaluation (n = 1040). Selective CT missed one or more diagnoses in 11% of the patients in which a change of treatment was necessary in 4.8%. Rush CT algorithm costed € 2676 (US$ 3660) per patient with a mean radiation dose of 26.40 mSv per patient. Routine CT costed € 2815 (US$ 3850) and resulted in the same radiation exposure. Selective CT resulted in less radiation dose (23.23 mSv) and costed € 2771 (US$ 3790).

Rush CT seems to result in the least costs and is comparable in terms of radiation dose exposure and diagnostic certainty with routine CT after a limited conventional work-up. However, selective CT results in less radiation dose exposure but a slightly higher cost and less certainty.

At present, the use of ventilator support is an important part of treatment in ICU patients. However, aside from its wellknown advantages, the use of these devices is also associated with complications, the most important of which is pulmonary infection (PI). PI has a high rate of morbidity and mortality.

This study aimed to evaluate the prevalence of PI in mechanically-ventilated patients and the role that factors, such as age, sex, and duration of intubation, play in this regard.

This descriptive cross-sectional study evaluated the prevalence of PI in mechanically ventilated patients, with no underlying condition which could compromise their immune system. Age, sex, and duration of intubation were assessed. Data were analyzed using SPSS (version 16) software.

A total of 37 ICU patients on ventilators were evaluated, including 21 males (56.8%) and 16 females (43.2%). The mean age of the patients was 54 ± 19 years (range 19 to 86 years), with a mean age of 52 ± 20 years in men, and 56 ± 18 years in women (P = 0.52). The mean duration of ventilation was 6 ± 4 days (range 2 to 20 days). The mean duration of ventilation was 5 ± 2 days in men, and 6 ± 5 days in women (P = 0.42). A total of 16 patients (43.2%) developed ventilator-associated pneumonia (VAP); of whom, 50% were male and 50% female (P = 0.46). Patients who developed a pulmonary infection had a significantly longer duration of ventilation. The mean duration of ventilation was 8 ± 4 days in patients who had developed VAP, while this duration was 4 ± 2 days in the non-affected patients (P = 0.005). Overall, 17 patients died, and 7 of these deaths were attributed to VAP.

The prevalence of VAP in this study was approximately 43%, which is relatively high. In total, the percentage of deaths due to VAP among the patients was 18.91%. Duration of ventilator support was significantly correlated with the prevalence of PI.

Cervical hyperlordosis is a rare pediatric deformity leading to gaze and postural disturbances. The cornerstone of treatment consists of spinal manipulative therapy (SMT) combined with positional traction.

We report a new surgical approach in a 7-year-old female patient suffering from stiff cervical hyperlordosis, desiring to correct forward head posture as well as gaze disturbance. The patient had a chief complaint of restricted range of motion of the neck for the past 4 years. Posture examination revealed several abnormalities, including apparent thoracic hump with shifting to right side, slight elevation of the right shoulder, with back pain. She also had difficulties performing her assignments. Radiological investigations revealed a 95˚ cervical lordosis and forward head posture (FHP) assessed by two separate measurements. There was no considerable response to conservative treatment, (which included 30 sessions of SMT combined with positional traction). Consequently, she underwent radical resection of cervical paraspinal muscles, followed by halo traction. She was discharged with a halo-vest. Specific instructions for home exercise were provided to the patient. Post-trial radiographs showed a reduction of cervical lordosis to 51˚ and a reduction in FHP of 73 mm. The symptoms were alleviated at the end of the treatment.

This new approach appeared to correct postural abnormalities, and had an obvious positive effect on the patient’s chief complaint.