Trauma Monthly
Volume:19 Issue: 2, Mar-Apr2014

Hook plates are used to treat acromioclavicular joint dislocations. Our study took into consideration the patients’ outcome following treatment with clavicular hook plates retained for more than five months.

Our aim was to assess the response to treatment of acromioclavicular joint dislocation by clavicular hook plate when retained for more than five months.

We treated 24 patients who had acromioclavicular joint dislocation with a clavicular hook plate between 2008 and 2012 at our hospital. We did not repair the coracoclavicular ligament. In all patients, the plate remained more than five months because they did not come back at the recommended time for removal of their plates. The follow-up period ranged from five to thirty three months with a mean of nineteen months.

The main complication was osteolysis that was seen in two patients. The mean constant score was 94.5 ± 8.77 out of 100 with a range between 70 and 100.

Our study showed that the use of clavicular hook plates was a good treatment option for acromioclavicular joint dislocation. However, scores were lower in case of prolonged presence of plates.

Many patients with severe traumatic injuries are admitted to intensive care units (ICU). These patients usually require prolonged mechanical ventilation. These interventions require oral intubation and leave the mouth open which consequently impairs the natural antimicrobial activity in the mouth and airways. These patients are also prone to ventilator-associated pneumonia (VAP). Evidence shows that paying attention to oral hygiene in patients under mechanical ventilation is important in helping to prevent VAP.

The present study was conducted to assess the viewpoints and performance of ICU nurses at Birjand hospitals towards oral care of patients under mechanical ventilation.

A cross-sectional study was conducted at ICUs of Imam-Reza and Vali-Asr hospitals, Birjand, Iran. Sampling was done through a census in which 53 ICU nurses participated. Descriptive statistics, Kolmogorov-Smirnov test, Mann-Whitney U tests and Kendall's correlation coefficient were used to analyze the data.

A total of 53 nurses participated in this study. Most of the nurses had been trained to provide oral care during their university education. According to the participants' opinions, oral care with an average score of 5.72 ranked second among the 10 nursing care domains. The most frequent oral care provided was oral suctioning, normal saline irrigation, and chlorhexidine rinse with 95%, 90%, and 81.3% frequency, respectively.

Nurses participating in this study considered oral care to be of prime importance. Most of the participants although trained in this area felt the need for continuing training courses.

Bisphosphonate-related osteonecrosis of the jaws (BRONJ) is a well-known challenging entity warranting management. Platelet-Rich Plasma (PRP) plays an important role in bone biology by enhancing bone repair and regeneration.

The aim of this animal study was to evaluate the effects of PRP on zoledronic acid-induced BRONJ.

Seven rats were given 0.04 mg Zoledronic acid intravenously once a week for five weeks. Two weeks later, the animals underwent extraction of their first lower molars, bilaterally. After clinical confirmation of the osteonecrosis, PRP was injected randomly into one of the extraction sockets of each rat. Three weeks later, all rats were sacrificed in order to obtain histological sections. The analysis of epithelialization was performed by McNamar’s test, and the analysis of osteogenesis and angiogenesis was performed by the Wilcoxon Sign Rank test. P value was set at 0.05.

We found no significant differences between the two groups regarding the amount of epithelialization, angiogenesis or sequestrum formation (P > 0.05), but a significant difference was seen between the two groups regarding the amount of existing vital bone (P < 0.05).

Our study demonstrates positive results (preservation or regeneration of bone) using PRP in treatment of BRONJ. Although PRP may enhance osseous regeneration, long-term follow-ups are required to confirm its benefits.

Bleaching of traumatized discolored teeth is considered an important issue in esthetic dentistry. Various methods have been introduced for bleaching, some of which may have adverse effects on soft or hard tissues of the tooth.

The objective of the study was to evaluate the effects of KTP laser bleaching on enamel of traumatized teeth.

A square of 36 mm2 was chosen on the labial surface of 32 extracted teeth. The corners were drilled in order to indicate the location precisely. The shade of each sample was recorded and the teeth were divided into four groups, each with eight teeth: group A (Smartbleach with KTP laser for 30 seconds), group B (Smartbleach with G-Light for 5 minutes), group C (only Smartbleach for 10 minutes) and group D (control group with no bleaching). After one session of bleaching, shade assessment was performed again. In another experiment on nine teeth, Smartbleach with KTP laser was used for 150 seconds to 1500 seconds. The samples were critically processed and observed by using scanning electron microscope (SEM) to assess enamel damage. Data was statistically analyzed using Kruskal-Wallis test (confidence interval level were set at 95%).

Smartbleach was highly effective when used with KTP laser (P = 0.0419). Enamel damage was observed after frequent KTP bleaching and 750 seconds of KTP bleaching was recognized as the limit by morphological evaluation via SEM, indicating a major difference between under and over 750 seconds of bleaching.

Application of KTP laser may increase the bleaching effect of Smartbleach, nevertheless it may cause some enamel damage.

There are two fundamental selections for the management of traumatic posterior urethral injury, delayed repair or early primary realignment.

The aim of this study was to assess the complications of primary realignment of posterior urethral disruption.

This retrospective descriptive cross-sectional study was done at the Shohada-ye Ashayer University Hospital in Khorramabad. All male patients admitted to the hospital with posterior urethral disruption and had undergone primary realignment of the urinary tract between 2003 and 2010 were included. Primary realignment of the urinary tract was done up to 24 hours after injury. The patients underwent open cystostomy and then a nelaton catheter was inserted from the bladder neck to the distal urethra anterogradely. Upon voiding from the catheter, another nelaton catheter was fixed to it and was pulled into the bladder. The catheter was removed if the urethra was intact in the retrograde urethrography after three weeks. The patients were followed for six months. The data were presented as mean and percentage.

A total of 24 patients were evaluated while seven, eleven, four, and two patients were aged under 20, 20 to 39, 40 to 59, and over 60 years old, respectively. Thirteen patients (54.16%) had urinary tract stenosis after the primary realignment. Erectile dysfunction was reported in three of them. Urinary incontinence did not occur in patients without stenosis.

Early primary realignment of posterior urethral disruption had significant complications. In this study we did not have a control group, thus we could not compare the complications of delayed repair and early primary realignment of the posterior urethra. We recommend further case-control studies with larger sample size.

Fishing is a leisure activity for some people around the world. Accidently the fish hook can get hooked in the hand. If the hook is barbed, removal becomes difficult. We report a case of such a injury in the hand and discuss the technique for its removal with a brief review of the literature.

A thirty-two year old male accidently suffered a fishhook injury to his hand. He came to the orthopaedic ward two hours after the incident with pain; the fish hook was hanging from the hand. Unsuccessful attempts to remove it were made by his relatives. A push-through and cut-off technique was used for removal of barbed hook.

Barbed hooks are to be removed atraumatically with controlled incision over properly anaesthetised skin. Proper wound management and prophylactic antibiotics suitable for treatment of Aeromonas species should be initiated to prevent complications.