Trauma Monthly
Volume:27 Issue: 2, Mar-Apr 2022

After head trauma, pelvic fractures are the most common cause of death in patients with multiple trauma. The primary cause of death in patients with a pelvic fracture is uncontrollable bleeding, and in cases of delayed intervention, hemorrhagic shock is the principal cause of death. Bleeding from the external iliac artery following a Pelvic Ring and acetabulum fractures is an uncommon injury and an orthopedic emergency.A 48-year-old man who experienced an accident trauma was referred to the hospital, and an APC‎ II of the Pelvic Ring‏ ‏and Acetabulum fractures were diagnosed. The patient developed thrombosis in the external iliac artery 48 hours after admission with a diagnosis of a lack of femoral pulse. CT angiography was performed for further examination. Then, in surgery, the anterior column of the acetabulum on the left side and symphysis disruption, an open reduction, and internal fixation with a reconstruction of 3.5 plates via a modified Stoppa approach was used. Sacroiliac disruption on the right side was repaired by percutaneous sacroiliac screw fixation. In the same session, the vascular repair was conducted via interposition graft of PTFE. After the treatment interventions, the patient's general condition was satisfactory, and he was discharged without any particular complication.Due to the possibility of arterial injury in this trauma, the appropriate treatment can be done at the right time by checking pulses. While artery injuries are rare, they could be life-threatening.

Clival fracture is a rare traumatic injury that usually occurs in patients with high-energy trauma to the head and neck. Here, we present and discuss our experience with a patient with a transverse clival fracture associated with a significant vertical displacement.A 52 years-old comatose patient was admitted to our emergency department after a high-energy motor vehicle accident. The physical examination demonstrated a Glasgow coma scale (GCS) of 6 (with the motor scale of 4) associated with a left-sided six cranial nerve palsy, a left-sided fixed and dilated pupil; and quadriparesis that was more severe on the right side. The imaging tests revealed the brain contusions, pneumocephalus, and generalized brain edema without local mass effect and midline shift. Also, it showed TCF with a significant vertical displacement and a signal change within the medulla oblongata. The clival fracture was managed in a mild head flexion position without bracing, a routine ICU exchange body positioning program, and the minimum time of supine positioning. The follow-up imaging three months later showed complete bone fusion without any displacement. After 18 months of follow-up, he ambulated, and cranial nerve deficits improved except for mild diplopia due to a remnant of 6 nerve paresis.Transverse clival fracture, as most of the authors reported, does not need surgical treatment. Bracing can be used in conscious ambulated patients. A mild head-on-neck flexion position associated with suppurative care for bedsores can be a good option for unconscious patients.

The traditional method of treating patients with acute malignant colonic obstruction (AMCO) is emergency surgery, which is often accompanied by the development of severe complications and high mortality. Endoscopic colonic stenting with self-expandable metal stents (SEMS) is considered a promising way to treat such patients. However, its capabilities are not yet fully explored. This paper presents a cross-sectional study of the results of endoscopic colonic stenting using SEMS in AMCO patients, performed in 2016-2020 to clarify and identify the factors that influence its result.

The study included 218 patients with AMCO in whom surgeons attempted to eliminate the acute colonic obstruction using the method of endoscopic stenting. The capabilities of endoscopic stenting were assessed based on calculated technical and clinical efficacy, the incidence of complications, and mortality. All patients were divided into two groups clinical success group (182 patients) and clinical failure group (36 patients). The groups were subjected to comparative analysis.

The results showed that the technical efficiency of endoscopic stenting of the colon was 91.7%, and its clinical efficiency was 83.5%. Also, the incidence of intra-abdominal complications was 8.3%, the incidence of somatic complications was 11.9%, and the mortality was 5%. Comparative analysis of the groups revealed significant differences (with p<0.05) for the oncological process stage, the duration, and the severity of intestinal obstruction.

Endoscopic stenting of the colon with SEMS is an effective way to treat patients with AMCO. Its success can vary depending on the severity of trophic disorders in the intestinal wall.

After head trauma, pelvic fractures are the most common cause of death in patients with multiple trauma. The primary cause of death in patients with a pelvic fracture is uncontrollable bleeding, and in cases of delayed intervention, hemorrhagic shock is the principal cause of death. Bleeding from the external iliac artery following a Pelvic Ring and acetabulum fractures is an uncommon injury and an orthopedic emergency.A 48-year-old man who experienced an accident trauma was referred to the hospital, and an APC‎ II of the Pelvic Ring‏ ‏and Acetabulum fractures were diagnosed. The patient developed thrombosis in the external iliac artery 48 hours after admission with a diagnosis of a lack of femoral pulse. CT angiography was performed for further examination. Then, in surgery, the anterior column of the acetabulum on the left side and symphysis disruption, an open reduction, and internal fixation with a reconstruction of 3.5 plates via a modified Stoppa approach was used. Sacroiliac disruption on the right side was repaired by percutaneous sacroiliac screw fixation. In the same session, the vascular repair was conducted via interposition graft of PTFE. After the treatment interventions, the patient's general condition was satisfactory, and he was discharged without any particular complication.Due to the possibility of arterial injury in this trauma, the appropriate treatment can be done at the right time by checking pulses. While artery injuries are rare, they could be life-threatening.

Trauma is one of the major non-communicable diseases of this century and one of the main problems threatening public health. Trauma injuries are the leading cause of disability and mortality in all countries. This study aimed to explore and understand the challenges of early rehabilitation care in multiple trauma patients from the experience of a multidisciplinary care team using a qualitative research method.  This study was conducted with the qualitative research approach using qualitative content analysis. Participants were seven nurses, two doctors, three physiotherapies, and two occupational therapists in inpatient wards and outpatient trauma were interviewed. Data were collected through semi-structured interviews with a purposive sampling continued until data saturation. Analysis of data collected concurrently with data for comparison was done. First, for depth descriptions of the participant statements, 800 codes were extracted and finally, for the analysis, and constant comparison, two main themes of the lack of holistic care and support structure were extracted. The results showed that comprehensive and rehabilitation-based care was essential to achieve important care goals in this group of patients. Understanding the challenges of early rehabilitation care in multiple trauma patients will help health policymakers that solve these problems and help improve the health of this group.

The most common method for burn wound dressing is silver sulfadiazine (SSD); however, its side effects on wound healing and the need for repeated use for healing are often painful. This study aimed to compare two different dressings, namely Bilva and SSD ointments, on wound healing, pain, itching, and scarring of the burn wounds. This clinical trial study was performed on 35 patients with superficial second-degree burns hospitalized in the Burn Ward of Sina Hospital in Tabriz, Iran, from 2019 to 20. After irrigation of the wound, Bilva ointment was applied randomly on one side and SSD ointment on the other side to repair patients' burns. Patients were followed up on days 1, 7, 14, 21, and the first, second, and third months after burns; data related to the wound healing process, pain, itching, and scar status of patients were collected with a checklist.  There was no statistically significant difference between the two groups of variables related to the wound healing process on all days. The amount of burn wound scar did not differ between the two groups on day 21 and the first, second, and third months. Patients' pain and itching were significantly better in the Bilva group on the 7th (p<0.01), 14th (p<0.01), 21st day (p<0.01), and the first month (p<0.01) after burns relative to the SSD group. Bilva ointment had a similar effect in healing the burn wounds of patients compared to SSD, and it was more effective in controlling pain and itching of burn wounds than SSD. Further studies are needed to evaluate the cost-effectiveness of this dressing method on superficial burn wounds.

The humerus shaft fracture (HSF) is a typical long bone fracture. Following non-surgical therapy, some patients experience delayed or non-union of the HSF. The most common treatment is open reduction and internal fixation (ORIF) with plate and bone graft. However, substantial tissue dissection increases radial nerve damage and delays union. Because of its minimally invasive nature, the minimally invasive plate osteosynthesis (MIPO) method may be a suitable replacement technique. MIPO helps in the protection of soft tissue and nerves in the area of the fracture. A better and faster union achieve with less tissue dissection and vascular disturbance. All patients were treated with the MIPO method using bone graft implantation. A specific six-hole locking plate was used during surgeries. Physical examinations and radiological studies were used to monitor the patients' progress. UCLA and the MEPS scoring system assessed shoulder and elbow function. The average follow-up period was six months. The mean age of patients was 39.8 years (19-73 years). The mean fracture site distance from the elbow joint was 12.1 cm. The mean maximal final rotation was 3.3 degrees. The last rotation alignment was within normal limits. No shortening was detected. Average scores were 35 for UCLA and 100 for MEPS. Radial nerve damage was not reported. Malunion delayed union, or nonunion did not occur. Mean union time was 2.8 months. MIPO technique combined with bone transplant causes micromotion at the fracture site, resulting in a better and faster union. Its minimally invasive nature also helps prevent iatrogenic injury to nerves and soft tissue. Less tissue manipulation and dissection help shoulder and elbow function progress more quickly and reduce the rate of malunion. We recommend using this method in delayed union and nonunion of the HSF patients to reach better outcomes and lesser complications.

This study aimed to review the articles comparing orthodontic first (OFA) and surgery first approaches (SFA) orthognathic approaches from various treatment aspects of patients with class III skeletal malocclusion.

Electronic databases were systematically searched, including PubMed, Scopus, and Web of Science. We included experimental cohort and retrospective studies that compared the orthodontics first (conventional method) and surgery first approaches in the management of patients with skeletal class III malocclusion in various aspects.

Overall, 294 records were found through database searching and after removing duplicates, 131 papers were investigated. Finally, 17 studies were included in this study. The included studies have evaluated vast spectroum of outcome measures ranging from quality of life and duration of treatment to cephalometric measures. The amount of surgical movement, post-surgical change, and the relapse rate was the most prevalent assessed outcome measure in 10 out of 17 included studies, followed by total treatment time, which was evaluated in 8 studies. Other less common outcome measures were temporomandibular joint (TMJ) disorders and the oral health-related quality of life (OQLQ) questionnaire.

Two OFA and SFA orthognathic surgery approaches are not different in terms of the final amounts of surgical change in the mandible and maxilla. Also, these two approaches can remarkably improve the quality of life with no intergroup differences. It was realized that there are no united agreements on the effects of two OF and SF approaches on the outcomes the patients with class III skeletal malocclusions.