Trauma Monthly
Volume:27 Issue: 3, May-Jun 2022

Treatment of traumatic vascular lesions requires accurate and rapid diagnosis. Improper treatment and waste of time will lead to loss of limbs, lives, or injuries caused by ischemia. Therefore, this study aimed to evaluate various surgical methods and complications of vascular injuries.

 This Cross-sectional study were included all trauma patients referred to Shohada-e-Ashayer hospital, Khorramabad, Iran, and Shaheed Chamran hospital, Boroujerd, Iran, with the possibility of vascular injury from 2015 to 2019. Demographic characteristics, duration of surgery, complications of vascular injury, mechanism of vascular injury, type of vascular injury, location of vascular injury, clinical symptoms, comorbidities, and vital signs upon entry were extracted and recorded in the checklist.

Overall, 233 patients were included with a mean age of 29.15 ± 11.8 years (maximum 78 years and a minimum two years) and a male to female ratio of 20: 1. Six patients (25.8%) via venous graft and 11 cases (4.7%) by arterial ligation procedures were treated. Six cases (2.6%) with minor arterial injury were treated without surgical intervention. The artery was completely amputated in 135 patients (9.57%) and partial amputation in 83 cases (6.35%). The arterial thrombosis in 70 cases (30%), intimal flap in 14 patients (6%), vascular spasm in 4 cases (7.1%), crush injury in 4 cases (7.1%), arterial fistula in 1 patient (4.0%), and deep vein thrombosis in 3 cases (1/3 %) were observed.

Vascular injury following penetrating trauma occurs typically at young ages. However, the rate of vascular damage in the arteries was much higher than in the veins. The type of surgical treatment and side effects of treating vascular injuries vary depending on the type, severity, and other parameters associated with the trauma.

Decreased tissue perfusion predicts mortality in trauma patients, measured by serum lactic acid, but this isn’t possible in all centers. The reduction of Base Deficiency (BD) in trauma patients is mainly due to lactic acidosis. This variable was used to predict the need for surgery in trauma patients in the present study.

 In this study, 88 trauma patients were referred to the emergency department with a positive abdomen for surgery, free intra-abdominal fluid on fast ultrasound, an abdominal injury on a CT scan test, and candidates for surgery or non-operative management with all measures, were entered the study and their data were statistically analyzed.

Out of 88 participants, eight patients (9.1%) died, and 24 of them (27.3%) required surgical intervention. Mortality rate and hospitalization days increased with increasing BD, which was statistically significant (P = 0.001), but the increase in mortality rate and BD increase did not show a meaningful relationship. The area under the ROC curve for BD and the need for surgery was 0.769, indicating a good BD prediction for the need for surgery. The best BD cut-off point for predicting the need for surgery in patients was BD> 4.45 (sensitivity 79.2% and specificity 65.6%).

BD predicts the need for surgery and the length of hospital stay. Due to a low number of deaths in our study, it is suggested that studies be repeated with a larger statistical population to achieve higher accuracy in the assessments.

Pain management in diagnostic and therapeutic procedures and their complications is critical. The study aimed to assess the incidence and procedures type of pain control in patients admitted to Intensive Care Units (ICU).

This observational study was conducted on 400 trauma patients in ICU. The tool used in this study had three sections: In the first part, demographic variables, information related to trauma, and the type of painful procedures performed on the patient, were recorded.  The second part was the measurement of the pain severity with the Critical-Care Pain Observation Tool (CPOT). The third part recorded the time of the pain assessment, methods of controlling pain in local anesthesia, and the pharmacological and non-pharmacological interventions.

The prevalence of patients was male (78.2%), with a mean age of 33.1 years. The most common procedure was tracheal suctioning (38.8%). The patients showed mild pain intensity according to CPOT before the processes. Also, according to the Friedman test results, they experienced a significant increase in pain intensity during the procedure for all procedures. A total of 160 patients received pain relief interventions, of which 157 cases received pharmacy and three received non-pharmacological interventions. Patients who treated their pain with the interventions experienced additional pain according to the CPOT criteria immediately after the procedure.

Health services must be more active in pain management strategies since procedures potentially produce pain. Before any procedure for treatment, an accurate assessment of pain intensity is crucially important by proper tools to manage procedural pain appropriately.

Surveying serum markers can be valuable in predicting the outcome of patients with head trauma. The current study examined the diagnostic value of the serum level of brain natriuretic peptide (BNP) to determine the hospital outcome of patients with head trauma.

 This descriptive-analytical study was conducted on 40 pure head trauma patients who had indications for brain CT scans and required hospitalization from July 2017 to May 2019 in Trauma Medical-Educational Center. The variables were age, gender, initial consciousness level based on Glasgow Coma Score (GCS), trauma mechanism, the time-lapse between trauma and admission to hospital, mortality, Glasgow Outcome Scale (GOS) during discharge, GOS in one and six months after discharge, initial serum level of NT-pro BNP (N Terminal-pro BNP), and results of brain CT scan.

Concerning the reports of brain CT scans, from 40 patients, 26 patients had normal brain CT scans, and 14 patients had abnormal brain CT scans. Mean ± SD value of NT-pro BNP for normal group was 407.7 ± 190.25 pg/ml and for abnormal group was 631.43 ± 219.25 pg/ml (p = 0.009). Only five patients with abnormal CT scans died during the study. In predicting mortality of patients, the initial serum level of NT-pro BNP was 693 pg/ml with 80%sensitivity and 74% specificity.

Examining the serum values of NT-pro BNP can help predict the mortality of patients with head trauma. Higher values of NT-pro BNP during hospitalization were a good indicator of a low survival rate in patients.

A heart injury is a genuine emergency that needs to be diagnosed and treated as soon as possible. Transport to a tertiary center with facilities such as a heart-lung pump and sternotomy can lead to loss of time. This study aimed to share the author's experiences as a solitary thoracic surgeon in a private hospital with limited facilities.  A retrospective study was conducted in a private hospital. Eleven penetrating cardiac injuries, which were treated surgically by the same thoracic surgeon in two small hospitals from 2005 to 2015, were evaluated retrospectively. Patients' age and sex, type of injury, damage position to the heart, duration between injury and surgery, presence of additional damage, and patient survival were all recorded. The most common form of injury was defined as the sharp object injury, while the most common place was the right ventricle. In the period from injury to surgery, the additional injuries were found to be statistically significant in terms of survival ratios. The probability of patients' survival with intervention times 30, 60, and 120 minutes was 90.9, 54.5, and 27.3%, respectively. Mortality in cardiac injuries can be reduced with early intervention. The risks of being transported to a developed structure and the risks of emergency surgery performed in a small facility should be well weighed. Successful surgeries may be performed even in a small, well-organized hospital.

In a mass casualty incident (MCI), when medical resources are overwhelmed by the number and severity of casualties, victims’ triage plays a crucial role in disaster management. This study aimed to assess the difference between two triage methods, Simple Triage and Rapid Treatment (START) and Sacco Triage Method (STM), in an MCI scenario and determine which way leads to more accurate and quick triage results.

 In this simulated prospective cohort study, observers were selected among 2nd-year medical students and newly graduated paramedics and presented with an imaginary disaster scenario. Half of the medical students and paramedics used the START method, and the other half prioritized patients with STM. The triage results accuracy, time to triage, and time to evacuation in the two methods were recorded and analyzed.

One-hundred-fifty observers were divided into four groups. All of them were male, and their mean age was 20.37±1.22 years. The overall accuracy for STM was 89.52% which showed a better and statistically significant performance than the START method (p<0.001). The mean time to triage for each patient in START and STM was 14.29+-2.95 and 16.84+-3.33 seconds, respectively. The mean time to evacuation for each triage method was 4.76+-.98 minutes for START and 5.61+-1.11 minutes for STM. In both STM and START groups, medical students performed better in triage than paramedics (p<0.001 for START and p=0.025 for STM). Medical students were also significantly faster than paramedics in the time to triage and evacuation categories in the STM group (p<0.001).

In conclusion, 2nd-year medical students and newly graduated paramedics performed a more accurate and quicker triage with STM than the START method.

Pediatric bone forearm fractures are commonly encountered in an orthopedic emergency. Treatment of them varies widely from simple sling and cast to operative fixation with nailing and plating, with no definitive consensus on one treatment modality. This study aimed to evaluate the functional outcome of pediatric bone forearm fractures managed by the titanium elastic nailing system and measure the difficulty.  The study was conducted at the department of orthopedics, SHKM Govt medical college Nuh, India, which included 30 patients, 18 males and 12 females from 6 to 15 years (with a mean age of ten years). Twenty patients had middle third fractures, six proximal 1/3rd, and three distal 1/3rd fractures. The transverse fractures were seen in 17, oblique fractures in six, communicated in four, and spiral fractures in three patients. Overall, 30 patients were included in this study, 18 were Male children, and 12 were females. The Right-sided Forearm was involved in 18 patients (60%), and the Left-sided in 12 patients (40%). Closed bone fractures were noted in 24 patients (80%), open Grade I in 4 patients, and Grade II in 2 patients. The Mean hospital stay was three days, ranging from 2-5 days. The Fracture site showed radiographic healing at six weeks in five patients, at nine weeks in 24 patients, and 12 weeks in all patients. The functional outcome was excellent in 28 patients and good in two patients. No patient showed poor function at the final follow-up at one year. The complications were eight patients with skin irritation at the nail insertion site, two cases who developed signs of infection like erythema and serous discharge, and two patients with ulnar nail back out. TENS (Titanium Elastic Nailing System) allows micromotion at the fracture site due to the elasticity of nails elastic deformation within the medullary canal creates a bending moment within the long bone that is not rigid but, that is stable enough to reduce and fix the fracture and favors callous formation and bone healing. The treatment of pediatric bone fractures with TENS continues to be the unparallel success and reliable treatment method with a predictable outcome and minimal complication. We recommend this type of treatment in angulated and unstable forearm fractures in children.

Arthroplasty is a better treatment for displaced fractures of the femoral neck in the elderly. The type of arthroplasty remains controversial as total hip replacements potentially have a higher dislocation rate. The study aimed to evaluate dual mobility cups to manage fractures of the femoral neck with the posterior approach in the elderly.  This prospective study was conducted in Amritsar (Punjab), India. All patients with displaced fractures of the femoral neck treated via arthroplasty were operated on with the insertion of a dual mobility cup with the posterior approach. All patients were fallow up by clinical and radiological assessment at immediate post-op, 3 and 6 months, and 1 and 3 years after surgery. Overall in the 240 patients, surgeries on the right hip of 121 (50.4%) and the left hip of 119 (49.6%) cases were performed. Male was the majority of patients, and all patients were followed-up. The mean Harris hip score improved from 16.62 ± 6.34 preoperatively to 92.86 ± 2.28 at one-year follow-up and 95.20 ± 1.82 at three years’ follow-up. Three dislocations occurred, and Open Reduction was performed through a posterior approach under regional anesthesia for two patients. Close Reduction was performed on one patient, and there was no recurrence of dislocation. The low dislocation rate after acute total hip replacement using dual mobility design cups is comparable with hemi arthroplasties. The dual mobility cups might be considered a valuable option to prevent postoperative dislocation when treating displaced intra-capsular fractures of the proximal femur in elderly patients. A dual mobility cup reduces the incidence of postoperative instability even after using the posterior approach.