Trauma Monthly
Volume:25 Issue: 4, Jul-Aug 2020

The finite element method is a used computational technique in obtaining detailed displacement of the fractured mandible with a fixation system. The aim of the study was the evaluation of the biomechanical performance of different rigid fixation methods in mandibular angle fractures. Computed Tomography (CT) scans applied to prepare a model of the mandible with a mandibular fracture angle. The fracture line was fixed with 7 different fixation plates. The CT scans were transferred and converted to the finite element model. The commercial ANSYS software was applied to analyze the Von Mises stresses and the amount of displacement on bones, plates, and screws. 150-newton vertical force was applied to central incisors in order to simulate the most critical loading. The maximum Von Mises stress values were found in the Champy technique with 474 Mpa in bones and 579 Mpa in screws, whereas the lowest Von Mises stress values observed in the square plate which was 180 Mpa. The minimum displacement observed in the Reconstructive plate & mini-plate which was 0.25 millimeters. The application of Reconstructive Plate & Mini-Plate, Dual straight mini-plates, Square Mini-Plate led to lower stress and displacement than other techniques in the bone, Plate, and screw.  Reconstructive Plate & Mini-Plate, Dual straight mini-plates, Square mini-plate offers more resistance and stability at the fracture site than other techniques used in the current study. This study was done based on the analysis of computer data. Clinical evidence showed that other procedures were used for many years with success. There are many other factors in the clinical application that have a critical role in stability.

The pelvic ring, sacral fractures and sacroiliac dislocations are managed with different methods. The preferred treatment in sacral fractures or SIjoint dislocations is iliosacral screw fixation. The upper sacral segment dysplasia increases the risk of perforation of the osseous cortex during Iliosacral fixation with a screw. The dysmorphic sacra have a narrow and angular osseous corridor. To date, no study has been conducted on the sacral dysmorphism and quantitative and qualitative criteria for fixation with iliosacral screw in sacral dysmorphism among the Iranian population. We analyzed 100 CT scan and Outlet CT reformation forms of traumatic patients without pelvic trauma to determine 5 qualitative criteria of sacral dysmorphism (i.e., mammillary bodies, misshapen sacral foramen, upper sacral segment not recessed in the pelvis, residual disc between S1 and S2 vertebra and acute alar slope). Upper sacral surface area and angulation were determined based on the CT scan reformatted. Five qualitative criteria from the 3D pelvic CT outlet view and sixth characteristic (tongue-in-groove) from the axial pelvic CT section were obtained by an orthopedic surgeon. Coronal reconstruction was used to divide the patients into dysmorphic and non-dysmorphic groups by drawing a line along the axis of the osseous corridor from one side of iliosacral to its other side. The results showed that 37% of the patients were in the dysmorphic group and 63% in non-dysmorphic. Qualitative criteria were in the range 24% -71% in the dysmorphic group and 14%-34% in the non-dysmorphic group. The sacral dysmorphism score was calculated in all patients. The sacral dysmorphism score = (first sacral segment coronal angle) + 2(first sacral segment axial angle). The obtained mean angle in the dysmorphic and non-dysmorphic group was 84° and 72°, respectively. As the score increased, the safety of the osseous corridor decreased. The dysmorphic score ranged between 70 and 84 in one-third of the patients and none of them was less than 70°. In this study, sacral dysmorphism was detected in 37% of the patients. Axial angulation and coronal angulation were the most important quantitative criteria for determining the sacral dysmorphism. Detecting sacral dysmorphism can be useful for preoperative planning of iliosacral screw placement.

Adherence of emergency medical technicians (EMTs) to a professional code of ethics is one of the most important aspects of their occupation. The purpose of this study was to determine the degree of adherence to the professional code of ethics from the perspective of EMTs and their patients. This was a cross-sectional study. The inclusion criteria for patients were age between 18-65 years, willingness to participate in the study, normal mental status, being medically stable and absence of any chronic mental or psychiatric disorder. The inclusion criteria for EMTs were willingness to participate in the study, having an associate or bachelor’s degree in the medical emergency, working at medical emergency departments and management centers. The exclusion criteria were refusal to continue the study and the necessity of therapeutic intervention while completing the questionnaire. The patients were recruited by cluster sampling. For this reason, first, two hospitals were randomly selected among six hospitals in Arak, Markazi province (Arak, Iran). Then, the list of missions at each shift was extracted by referring to the emergency departments of these hospitals. Afterward, one of the missions in each shift was randomly selected. In this study, a two-part questionnaire was used for data gathering. In this first part, the demographic information of the participants was collected. In the second part, a professional code of ethics for EMTs' questionnaire, including 26 statements in 5 dimensions was used. Finally, the questionnaires were given and completed by the pre-hospital emergency personnel and the transferred patients. A total of 105 EMTs and 109 patients were randomly selected as they transported patients to the studied hospitals. From the viewpoint of patients, adherence to the professional code of ethics was rated 2% as highly desirable, 39% as desirable, 58% as moderate, and 1% as undesirable. On the other hand, the EMTs rated themselves as 59.8% highly desirable, 37.1% as desirable, and 3.1% as moderate. There was a statistically significant difference between the average score of adherence to a professional code of ethics from the viewpoint of patients versus that of the EMTs (p <0.001). There was a statistically significant difference between the degrees of adherence to the professional code of ethics by EMTs from their own viewpoint versus that of the patients.

In surgeries, when making a window in the bone cortex is necessary, a circular window is usually recommended. A review of the literature did not yield any positive evidence indicating the preference for the circular shape under bending and compression loading. In this study, we examined this issue using two methods, including software analysis and performing load tests in laboratory. Windows of different shapes with the same area were made in 40 femoral bones of the same-weight New Zealand rabbits, and then they were put under bending and compression force by a hydraulic device in the laboratory to measure the force required to fracture the bone by a computer. Simultaneously, ANSYS® software was used to simulate the test by the Biomechanics Research Team of the University of Technology. According to the results obtained from software analysis and simulation, under compression and bending loading conditions, the mean fracture force in a trapezoidal shape was more than that in circular, square, and triangular shapes. These results were also confirmed in the experiments. Based on the results, no significant difference was observed between these shapes under the bending force. Moreover, under compression loading, no significant difference was found between trapezoidal and circular shapes.

Antibiotics contribute to a lot of patients’ treatment. However, improper prescription and wasteful use of antibiotics may lead to various side effects or complications such as medicinal resistance and lack of treatment, resulting in an excessive financial burden. The present study aimed to compare antibiotics prescription pattern and their financial burden before and after intervention based on prophylactic antibiotics guidelines in traumatic surgical sections. This analytical and cross-sectional study was conducted in 2018 on patients undergoing surgery in 4 general, urology, neurosurgery, and orthopedics surgery sections. The sample consisted of 464 patients with traumatic injuries. A researcher-made questionnaire was used as a principal instrument for gathering data. The data was analysed using SPSS (version 21). The accordance of dose, method and kind of prescribed antibiotics with the instructions and guidelines after intervention increased to 29, 5.1 and 28.8%, respectively. There was a significant relationship between dose, method, and kind of prescribed antibiotic before and after the intervention (p <0.05). The financial burden of prescribed antibiotics before and after the intervention was 56400480 and 52789290 IRR, respectively. Based on the results, the intervention was effective in accordance with dose, method and kind of prescribed antibiotics. Also, financial burden reduced by 6.4% after the intervention. Continuous monitoring of antibiotic prescription based on instructions, training instructions of prophylaxis antibiotics to physicians, and infectious monitoring committee meetings can prevent irrational prescriptions and reduce the excessive financial burden on society, government and insurance organizations.

Mechanically ventilated patients are at risk of developing the iatrogenic infection ventilator-associated pneumonia (VAP). Inadequate knowledge of nurses is one of the obstacles to adherence to evidence-based guidelines to prevent VAP. This study aimed to estimate the knowledge of nurses about VAP prevention. In this systematic review and meta-analysis, national and international databases, including MagIran, Scientific Information Database (SID), Web of Sciences, PubMed, and Scopus were searched using the following keywords: “Ventilator-associated pneumonia”, “VAP”, “Nosocomial pneumonia”, “Knowledge”, and their possible combinations. The VAP prevention score was calculated according to the questionnaire introduced and validated by Labeau et al.  The analyses were performed using Stata (version 12). In the initial search, 1193 articles were found of which a total of 8 articles were included in the analysis. The nurses achieved 48.31% of the VAP prevention total score (Confidence Interval [CI]: 95%: 44.63-52). The lowest and highest VAP prevention scores were attributed to frequency of humidifier changes (15.13%, CI: 95%: 11.35-18.92) and patient positioning (81.03%, CI: 95%: 75.43-86.64), respectively. The percentage of nurses’ knowledge about VAP prevention in Asian studies was higher than that in the European studies (54.71% versus 44.92%). The nurses obtained less than half of the VAP prevention total score. Regular training courses and reviewing VAP prevention guidelines can keep nurses' knowledge up to date.

Many signs in relation to vascular events and consequent loss of consciousness could be easily incorrectly explained (unclear) in a setting of trauma, especially when these events are a result of the car accident. Third cranial nerve palsy widely occurs due to internal carotid and posterior communicating artery aneurysm. An anterior communicating(ACOM) aneurysm is a rare reason that could lead to oculomotor dysfunction. ACOM ruptured aneurysm may present with sub arachnoid hemorrhage (SAH) and intraventricular hemorrhage (IVH) but isolated IVH is a rare finding for ACOM ruptured aneurysm.

A 56-year-old male presented to the hospital emergency department because of trauma after a car accident. He was unconscious with left-sided dilated pupil and ptosis with a brain CT indicating IVH. Brain CT angiography that performed two weeks after the accident revealed ACOM aneurysm. The patient underwent craniotomy and clipping the aneurysm. He was discharged, after completing the period of the following treatmentA combination of neuropathic agents and opioids helped to control pain. These analgesic included amitriptyline, gabapentin, pregabalin, tramadol and morphine in various regimens. Paracetamol and ibuprofen were also used.

This report is a unique case of synchronization of third cranial nerve palsy and isolated IVH without SAH due to ACOM aneurysm. In addition, it could be interesting to re-emphasize the need for a comprehensive assessment of traumatic patients for finding some primary pathologies, which could result in an accident.