Trauma Monthly
Volume:18 Issue: 3, Nov-Dec-2013

Groin injuries are among the most common injuries co-existing with sports. The aim of this review was to outline the epidemiology and identify risk factors, as well as examine preventative and interventional measures for reducing the occurrence of this form of injury among athletes. Evidence Acquisition: An electronic, systematic search for relevant keywords, either separately or in combination was sought in the academic scientific databases.

Groin injuries, acute or chronic, consist of a high percentage of injuries that manifest with pain. Despite the specific tendency for injury among some sports, such injuries make up 2-5% of sport-induced injuries. There are few available reports on lower limb injuries, especially groin injuries, in Iran. Numerous factors predispose to groin injuries. A lengthy list of preventive/ treatment measures, from preliminary to sophisticated, have been proposed.

Although using a programmed strategy designed to decrease the risk of groin injuries by taking a strategic approach to exercise may alleviate complications, in some cases the chronic nature of the injury may threaten the professional life of the athlete. More research is required to plan suitable programs for reducing the risk of this type of injury in athletes.

To survey genitourinary (GU) organ injury following general trauma, we performed an epidemiologic study of urogenital injuries in trauma patients referred to our hospital (a teaching hospital affiliated with the Zahedan University of Medical Sciences).

We aimed to assess the epidemiology of urogenital system injuries in southeastern Iran.

From April 2009 to November 2011, all patients with GU injuries referred to our hospital were studied. The data including age, sex, type of injury, mechanism of trauma, and prognosis of patients was collected and analyzed.

From a total of 3450 patients, 66 (1.91%) had injuries of the urogenital system; 49(74.24%) were male and 17(25.75%) female. The patients’ mean age was 23 ± 12 years (range 2 to 75 years). Of these 66 patients, 61 (94.24%) had blunt trauma, and 5 (7.57%) had penetrating trauma. Motor vehicle accidents were the most common cause of trauma (63.63%). The most common injured organs were kidneys in 41 (62.12%) and the bladder in 9 (13.6%); 47 patients (71.21%) had associated intra-abdominal injuries, and 42 (63.63%) had other accompanying injuries; 23(34.84%) patients required surgical intervention. Three patients (4.54%) died due to the severity of injuries (Injury Severity Score > 12).

In our assessment, blunt trauma including road traffic accidents were the main cause of urogenital injuries. Most patients with urogenital trauma had multiple injuries, and required a multidisciplinary approach for management.

Patients presenting with a mass require tissue biopsy for histological diagnosis and treatment. Fine needle aspiration (FNA) is offered as an atraumatic, well tolerated, and inexpensive method for obtaining a biopsy from these lesions.

In this study we evaluated the accuracy of FNA as an atraumatic method among patients with nonthyroidal masses for diagnosis of neoplastic masses compared to open surgery.

In a cross-sectional study, 65 patients with a head and neck masses (nonthyroidal) referred to us from 2004 to 2009. Those who had both FNA and open biopsy (the gold standard) were assessed for specificity, sensitivity, positive and negative predictive values of FNA in diagnoses.

Sixty-five cases with both definite diagnoses of open biopsy and FNA were assessed. The mean (± standard deviation) age of patients was 39.96 ± 19.69 years (range 10 to 82 years). Twenty-five (40.8%) subjects were categorized as malignant neoplasms, 16 (19.4%) as benign neoplasms, and 24 (39.8%) as non-neoplastic lesions. The sensitivity, specificity, positive and also negative predictive values of FNA in the diagnosis of neoplastic masses were 95%, 85%, 92.68%, and 91.66% respectively, and the diagnostic accuracy was 92.3%.

It seems that FNA is a useful atraumatic diagnostic technique with a high diagnostic accuracy which can provide a highly sensitive diagnosis with low false positive diagnoses in patients with nonthyroidal masses.

Natural disasters, both expected and unexpected, usually cause widespread injuries and destruction with a large number of survivors, including children. Several studies have shown that children may develop posttraumatic stress disorder after exposure to disasters such as an earthquake.

This study aimed to evaluate the screening abilities of the University of California at Los Angeles Posttraumatic Stress Disorder Index for DSM-IV (Revision 1) (UCLA PTSD for DSM-IV) among Iranian school-aged children.

Twenty months after the Qeshm Island 6.1-magnitude earthquake in 2008, we screened 50 students aged between 7 and 12 years for posttraumatic stress disorder using the UCLA PTSD INDEX for DSM-IV. A Structured Clinical Interview for DSM-IV criteria was used as the gold standard.

The internal consistency for all the scales was good and Cronbach’s coefficient for the overall items was 0.76. The sensitivity of this questionnaire was high (0.96), while its specificity was moderate (0.50).

The study findings showed that the Iranian version of UCLA PTSD Index for DS-MIV-R was appropriate for screening PTSD in children.

Limb loss occurs due to different causes and has been increased in many countries. It has without exception, great economic, psychological and social impacts.

This study assesses the demographics of amputees in one city of Iran.

This retrospective study was undertaken on all of the amputees between April 2002 and December 2011. Patients’ demographics including age, sex, the amputated limb, etiology of limb loss and level of amputation were recorded.

We had 216 patients in the study. The average number of amputations was 21.6 per year and varied from 14 to 32. The mean age of amputation was 39.26± 12.6 years. Of the patients, 172 were male (79.62%) and 44 female (20.37%); 119 of the amputations (55.09 %) were major and 97 minor (44.9 %). The most common cause of amputation was trauma and the most common was the toe. In trauma patients the mean age was 38.12± 10.25 years and 98 (83.7%) were male.

In contrast to similar studies in developed countries, trauma was found to be the major cause of all types of amputations. Results of this study may be used in prevention planning

Anterior cruciate ligament (ACL) injury is the most common sports injury in both athletes and nonathletes; it can cause disability if not treated correctly. In cases with minor injuries, conservative treatments suffice. But, in cases with ACL tear, surgery by different methods and autografts are indicated. The most prevalent method for ACL reconstruction is the use of hamstring tendon autograft; this requires tendon removal and results in subsequent weakness in patient’s knee flexion strength which can cause dissatisfaction.

In this study we evaluate a common procedure used for treating ACL injuries.

This study was performed at a hospital in Tehran on 30 patients with ACL tears. Patients’ knee flexion strengths before and 2, 4, 6, and 12 months after reconstruction were measured separately at 20, 45, 90, and 110˚ knee flexion angles, and their means were analyzed using paired t-test.

In this study, knee flexion strength decreased after ACL reconstruction. The greatest decrease in knee flexion strength was observed at 90 and 110˚ knee flexion angles.

Some previous studies have confirmed reduced knee flexion strength following ACL reconstruction at high knee flexion angles. However, some others have denied it. The present study confirmed the reduction in knee flexion strength one year after ACL reconstruction at 90 and 110˚ flexion angles (P = 0.000). Furthermore, the need for physiotherapy, as a process for rehabilitating these patients was also confirmed

Since the time of Paul Harrington numerous implants have been introduced for correction of scoliosis, but none are ideal. Newer devices are very expensive, and in our country some patients cannot afford them.

The aim of this study was to compare the results of the Harrington rod (HR) device and the newer Cotrel-Dubousset (CD) device in treatment of adolescent idiopathic scoliosis (AIS).

A retrospective review assessed patients with AIS admitted for spinal curve correction treated with HR (n = 120) and CD devices (n = 138) between October 1988 to April 2001 at the Shafa Yahyaeian Hospital, Tehran, Iran. We extracted information from the patient’s file and radiographs before, after and two years post-operation.

The mean age of patients was 16.7 ± 2.5 years. There was no statistically significant difference between the two groups regarding gender, age, curve before surgery, and percentage of flexibility. The mean curvature was 70 ± 20.7 in the HR and 64.81 ± 19.4 in the CD group before surgery (P = 0.09); and the mean curvature was 40 ± 16.3 and 26.58 ± 15.37 in HR and CD groups respectively after surgery (P = 0.156). The mean curvature was 47.2 ± 15.9 in HR and 31.2 ± 15.4 in CD groups at two years follow-up (P = 0.156).

Results of many studies have shown no significant impairment in long-term quality of life and function in patients treated with Harrington rods. According to previously performed studies and the current study, surgical correction with Harrington rods seem to be comparable with the newer more expensive CD device. Although there is no doubt that the preference is to use newer devices in view of some disadvantages of HR, but this does not preclude using it for patients that cannot afford the newer devices.

Extra-hepatic bile duct injuries in children following blunt abdominal trauma are rare; early diagnosis and treatment are imperative for a good outcome. The purpose of this report is to describe the management of problems encountered in children with bile duct injuries following blunt abdominal trauma.

A three year-old girl presented with obstructive jaundice and vomiting following blunt abdominal trauma one month prior to referral. The child was sitting in her father’s lap when the accident occurred. She was then examined by an emergency physician to assess the cause of vomiting. An abdominal ultrasonography was performed and revealed dilatation of the common bile duct.

To the best of our knowledge, this is the first report of bile duct injury following blunt trauma and its emergency management.

A sudden loss of consciousness followed by abnormal movements can be ictal or syncopal in origin. Transient response by the brain to sudden decrease of blood flow may cause sudden loss of consciousness followed by abnormal movements that mimic seizure. Dysrhythmia is one of the important and critical reasons of such events that should be differentiated from seizure.

In this case report we describe a 55 year-old woman admitted to our emergency department first with the impression of seizure. Eventually, it was realized that she had suffered from brain hypo-perfusion secondary to hypokalemia induced arrhythmia. Her arrhythmia was managed by unsynchronized biphasic shock in acute phase and also potassium replacement. She was then admitted to the CCU (Coronary Care Unit) where she received further care for medical management and drug dose adjustment and was discharged 4 days later.

Syncope from arrhythmia most commonly results from ventricular tachycardia, which accounts for 11% of all cases of syncope. Torsades de point is a unique type of ventricular tachycardia, characterized by QRS complexes of changing amplitude proceeded by prolonged QT intervals and almost often followed by loss of consciousness and also seizure like movements. Prolonged QT interval which is an important provocative factor for torsades de point commonly results from interactions between drug therapy, myocardial ischemia, and electrolyte disturbances such as hypokalemia or hypomagnesaemia. Changes in the extracellular potassium level have predominant and profound influences on the function of the cardiovascular system that may provoke fatal demonstrations such as QT prolongation, ventricular arrhythmia and even cardiac arrest. Electrolyte assessment is particularly important in certain patient populations, such as the elderly in whom a variety of pathological states or conditions like dehydration or renal failure are more common. Early identification and correction of these disturbances are necessary to control either seizures or seizure-like movements and prevent permanent brain damage, as anticonvulsants alone are generally ineffective