Trauma Monthly
Volume:17 Issue: 3, Jul-Aug2012

One of the most important goals of health care organizations is measuring and improving the quality of health care and reduction of adverse events.

The aim of this study was to evaluate the degree of observance of the WHO surgical safety checklist at two hospitals in Tehran.

During this analytic cross-sectional study the degree of observance and the effects of the checklist on patient outcomes were studied. The checklist was implemented at two teaching hospitals in Tehran, Iran.

One hundred patients (40 ± 15 years, 44 (44%) male and 56 (56%) female) were enrolled in our study. Determination of patients ‘ diagnoses, anesthesia safety check before anesthesia, patient connection to pulse oximetry, allergic airway disturbance check and aspiration risk, confirmation of patient identity, location of surgery and surgical method by surgeon and nurse, correct numbering of materials by nurse and correct ticketing by nurse were carried out in more than 90% of cases.

In conclusion, our study demonstrated that surgery team members comply moderately to the WHO surgery safety checklist in Iran. Iranian health care providers need to show more adherence to some items of the checklist compared to their previous routine.

Trauma still stands atop of the list of emergencies. Transfer of these patients via Emergency Medical Services (EMS) dispatch is critical with regard to importance of timing. This aspect has achieved greater importance due to population increase and telephone triage .

We aimed to decrease unnecessary Emergency Medical Services (EMS) missions via a computer program designed for an algorithmic approach for trauma care by nurses involved in EMS, to help them evaluate the case more accurately. We named our program "Trauma Dispatch Algorithm".

First, the most common chief complaints regarding traumatic events were chosen from searching all the calls in December 2008 recorded in Tehran, Iran’s EMS center; and then an algorithm approach was written for them. These algorithms were revised by three traumatologists and emergency medicine specialists, after their approval the algorithms were evaluated by EMS dispatch center for their practicality. Finally all data were turned into computer software. The program was used at the Tehran EMS center; 100 recorded calls assessed with each system were selected randomly. They were evaluated by another traumatologist whether it was necessary to send a team to the site or not.

The age average was 26 years in both groups. The "trauma dispatch algorithm" was significantly effective in reducing the unnecessary missions of EMS by 16% (from 42% to 26%) (P = 0.005).

This program was effective in reducing unnecessary missions. We propose the usage of this system in all EMS centers.

Inguinal hernia is one of the most common male diseases all over the world with an incidence rate of 18-24% throughout life. Chronic inguinal pain is one of the complications that prolong return to work time.

The main aim of this study was to determine the effect of ilioinguinal neurectomy on postoperative chronic pain (PCP) in patients that underwent open inguinal hernia repair via the Lichtenstein method.

In this randomised controlled clinical trial, male patients with unilateral inguinal hernia were randomized into two groups: 74 cases in the preserved-nerve group and 66 cases in the nerve-excised group. The method of herniorrhaphy was the classic Lichtenstein method. Pain and numbness were evaluated at 1 day, 1 week, 1 month, 6 months and 1 year after surgery via visual analogue scale (VAS) system. We used SPSS ver.16 for analysis.

All patients were male with mean age of 39.1 years (with a range of 18 to 68 years). The follow-up rate was 100% after 1 year. Pain severity was significantly lower in nerve-excised patients at 1 day, 1week, 1 month and 6 months after surgery; but it was not significant after one year, although overall pain severity was low. Numbness was significantly higher in excised patients at all endpoints (1 day, 1month, 3 months, 6 months and one year after surgery).

Ilioinguinal nerve excision at the time of inguinal hernia repair decreased post-surgical inguinal pain, and it can be used as a routine method in herniorrhaphy.

Nephrolithiasis is a relatively common problem and a frequent Emergency Department (ED) diagnosis in patients who present with acute flank/abdominal pain. The pain management in these patients is often challenging.

To investigate the most effective dose of morphine with the least side effects in emergency renal colic patients.

150 renal colic patients who experienced a pain level of 4 or greater, based on visual analog scale (VAS) at admission time were included. Pain was scored on a 100 mm VAS (0 = no pain, 100 = the worst pain imagined). When patients arrived at ED, a physician would examine the patients and assessed initial pain score, then filled a questionnaire according to the patient information. Patients were assigned to receive 2.5 mg morphine sulfate intravenously. We monitored patients’ visual analog scale (VAS), and adverse events at different time points (every 15 minutes) for 90 minutes. Additional doses of intravenous morphine (2.5 mg) were administered if the patient still had pain. (Max dose: 10 mg). The cumulative dose of morphine, defined as the total amount of morphine prescribed to each patient during the 90 minutes of the study, was recorded. Patients were not permitted to use any nonsteroidal anti-inflammatory drugs as coadjuvant analgesics during the study period. Subjects with inadequate pain relief at 90 minutes received rescue morphine and were excluded from the study. The primary end point in this study was pain relief at 90 minutes, defined as either VAS 0.05). Older patients responded sooner to morphine than the young. Most of the patients had a pain score of 90 -100 (77.3 %) at the beginning that was reduced to 29.4% during the 30 minutes follow up. During the first hour, we found that 94.7% of the patients had no pain or significant pain reduction and only 2.1% of the patients still had pain.

We conclude that there were no significant differences among the gender, time of admission and side - effects in renal colic patients in response to morphine.

An appropriate and well-timed surgery has great impact on a patient’s treatment and can prevent further damage to partially injured structures which if untreated will be lost leading to severe disability. In the present study we report our experience with early coverage of electrically injured upper extremity vital structures with encouraging results.

The aim of this study was to evaluate the results of early flap coverage (less than two weeks) after electrical injury in the induced wounds of upper extremity.

The records of electrically injured patients referred during a 10- year period to Firuzgar Medical Center were evaluated. After one or two sessions of debridement, the wounds were covered by distant or pedicled flaps and the results were evaluated according to the number of surgeries, complications and return to work time.

Thirty patients were registered in this study, mean age at the time of injury was 26.43 (SD = 10.41) years; 40% of patients had right upper extremity injury, 23.3% had left and 36.7% had bilateral injury. 43.4% of patients had no complications, amputation rate was 23.3% and nerve injury was seen in 13.3% of patients. Mean days of return to work was 132.57 (SD = 64.99). In 11 patients distant flaps were used, 9 patients with graft only and 7 patients had a combination of graft and regional flaps.The dominant hand involvement in electrical injury is very high.

We suggest that the routine treatment protocols of serial debridement until all the wound acquires a bed of granulation tissue should be revised, because the vital structures such as tendons and nerves will have undergone dessication necrosis and a young worker will be crippled for life. Early coverage of partially injured vital structures is gaining acceptance and this paper confirms the above mentioned treatment protocol.

There is significant prevalence of physical injuries sustained by civilian recruits at military training garrisons. Civilian recruits sustain these injuries mostly during the intensive and rigorous military combat-training period.

We sought to determine the prevalence and causes of oral and maxillofacial injuries as the first step in reducing and preventing them in civilian recruits (males aged over18 years) during their 2-year mandatory military service.

In this 2-year study, we referred to 11major military training garrisons in 8 provinces and collected data from available medical records of military clinics at each garrison. Injuries occurring in civilian recruits during the intense 2-month military combat training period were documented. Data regarding the number of civilian trainees, percentage of those injured, site where the injury was sustained, type of injury and its causes, etc. as well as demographic data were collected.

The number of civilians called to military service was 153, 886. The ratio of those injured was 4419/153,886. The percentage of maxillofacial injuries was 20.4% (903/4419). The majorities of maxillofacial injuries occurred during the first month (38%) and were due to nonmilitary (86%) rather than military (14%) causes. From among the military causes, bullets (66%) were the most common cause of injury, while falls (73%) were the major cause of nonmilitary injuries. Mountainous terrain was the main cause of falls (51%). The most common military incidents which led to injury were related to artillery fire and explosions (33%). Nasal bone fracture was the most common maxillofacial fracture (49%), and lacerations were the most common soft tissue injury (54%). Among dental injuries, tooth fracture was most common (66%).

The large number of general and maxillofacial injuries in civilian recruits during the 2-month combat-training period at military garrisons is disconcerting. This issue warrants further research to implement methods for identifying, decreasing, and preventing injuries in civilians at military-training garrisons.

Advances in the care of burn injuries have resulted from the efforts of regional patient-based specialist teams at burn care centers.

We conducted this study to assess the four-year epidemiology of burn injuries in Rasht, Iran.

In this cross-sectional study, medical records of 2274 burn patients, treated at Velayat hospital from January 2007 to December 2010 in Rasht, Iran, were assessed. Age, sex, level of education, occupation, severity and degree of burn, burn surface area, burn cause and outcome of patients were evaluated.

In our study the overall mortality rate was 8.7%; 65.7% of patients were men and 34.3% were women. Mean age of patients was 31.47 ± 22.67 years. Mean Total Burn Surface Area (TBSA) was 15.24 ± 18.4. Lowest TBSA was 0.5% and highest TBSA was 100%. Significant associations were observed between age (P = 0.0001), place of residence (P = 0.004), level of education (P = 0.0001), unemployment (P = 0.0001), marital status (P = 0.021), causes of burn (P = 0.0001), TBSA (P = 0.0001) and mortality rate. In our study, no significant difference was observed between age and sex (P = 0.071).

Due to high prevalence of burn injuries in Iran, increasing the level of awareness of the society as well as adhering to safety procedures both at home and workplace is recommended via implementing effective national safety policies.

Correction of digit deformities at or near the Joints is performed easily ; however, maintaining the result is often difficult either due to noncompliance of the patient to wear the postoperative splints or problems related to unequal growth of bones or normal tissues compared to the scarred or operated side.

The aim of this study was to overcome the above mentioned problems for which we propose the "Distal d Digit Syndactyly" technique.

This method is based on the concept of suturing the distal phalanx of the deformed digit to the normal adjoining finger to help prevent the recurrence of the anomaly during the child’s growth period or the very important three or four postoperative months of scar maturation in the adult. After the correction of deformity of the finger or toe, "Distal Syndactyly" is created by two flaps on the adjoining digits; one base is dorsally hinged and the other one volar and after elevating the flaps they are sutured together. During the three postoperative weeks care is taken that this attachment is not disrupted and after healing a "distal syndactyly" is created which is very durable and in children it stretches with growth and does not impede the digit’s growth.

Eleven patients with congenital and traumatic digit anomalies were treated. The recurrence of the problem was prevented in 9 patients; in 2 patients with intact Syndactyly the contracture recurred by stretching the Syndactyly skin. The period of the "Joining" ranged from 6 months to three years and cosmetic appearance was acceptable to the patient and parents.

This technique by joining a deformed digit to a normally growing adjacent digit prevents the postoperative recurrence of the contracture or growth-induced deviation in the digits of noncompliant patients especially children.

With the growing interest in long bone distraction several types of distractors have been introduced; all have the same principle of an outer structure which acts like a scaffold and the distracting mechanism is a separate device which is mounted on this outer structure. We have used a simple and very light weight external fixator we designed and discuss the results of distraction and advantages of this device . We applied our distractor to treat 14 men and four women, with a mean age of 39 years. There were three thumbs and 23 fingers; 26 digits (18 patients) lengthened by distraction callotasis and second stage bone grafting evaluated accordingly. All patients but one were satisfied with the results and a stable pinch and grip was obtained. After lengthening, all patients maintained sensation of the finger pulp, as assessed by the Semes - Weinstein test. The superiority of this device for manoplasty lies in its simplicity of construction in addition to being, lightweight and also eases of application.

Traumatic rupture of the distal biceps tendon is rare. Conservative treatment can result in reduced flexion and supination power with reduced function. This case report emphasizes the need for prompt surgical treatment and describes the possible complications of delayed surgical intervention.