Archives of Trauma Research
Volume:6 Issue: 1, Jan-Mar 2017

Context: Every government implements various policies to mitigate road traffic injuries (RTIs). Many of these interventions are performed by traffic police. To evaluate effectiveness and efficiency of police enforcement, numerous studies have been conducted. Potential capabilities of epidemiology could get opportunity to improve these studies. The aim of this study was to extract and discuss some related methodological points of traffic police effectiveness and efficiency from related studies, in view of epidemiology discipline..
Evidence Acquisition: Related articles were searched with “traffic police”, “effectiveness”, “efficiency” and “road safety” keywords in ScienceDirect, PubMed and Safetylit databases. Related papers were selected and read carefully to summarize and discuss the epidemiological points with aims of giving clues to improve quality of studies..
From a total of 797 articles, 20 were eligible which among them 17 articles were about effectiveness and 3 of them were about efficiency evaluations. Discussed points were the method of study, taking a holistic view to all positive and negative side effects, desired inputs and outputs, relation pattern between police enforcement and outcome and potential confounders..
Better understanding of the effectiveness and efficiency mechanism and having valid evaluation required considering specific theories and points in this field. Applying a dynamic approach with considering epidemiological concepts and sophisticated statistical models could improve quality of studies in this field..

Context: Complications of vehicular-related trauma contribute to the overall morbidity, and ultimately the costs, of road accidents. However, direct evidence on the burden of complications of vehicular-related trauma injuries is not directly explored. This scoping review aims to provide a summary of the relevant literature on the most significant acute complications and consequences of trauma caused by motor vehicle accidents or similar mechanisms..
Evidence Acquisition: Multiple electronic databases, as well as grey literature, were explored. Studies were included in this scoping review if they evaluated adult patients with acute complications of traumatic injury caused by motor vehicle trauma or similar mechanisms..
Trauma-related complications contribute to increasing mortality of patients. Complications of traumatic injuries are also the main cause of patients’ readmission to hospitals. Various studies report the rate of high-grade complications around 10%, but the overall rate of complications, ignoring severity, is approximately 60%. Depending on the surveyed population, different complications are identified as the most prevalent, but pneumonia is identified as the most prevalent complication in the majority of studies. The most important factors predicting the occurrence of complications in trauma patients are older age and poor Glasgow coma scale..
Complications of trauma-related injuries are significant factors affecting the outcome of patients. There has been limited research directly exploring this topic, possibly due to the difficulty of undertaking such studies. A particularly important research topic is the prevention and management of complications in elderly trauma patients with comorbidities. In conclusion, complications of trauma related injuries are significant considerations for clinical practice and research..

The aim of this study was to examine the correlation of the clinical examination, MRI and arthroscopic findings in cruciate ligaments and meniscal injuries of knee and to evaluate the accuracy of clinical examination and MRI with the gold standard arthroscopy..
A prospective diagnostic double-blind study was conducted on 104 consecutive patients admitted to the outdoor/casualty with trauma to the knee complaining of knee pain/locking/ instability, from August 2012 to June 2014. All the patients were subjected to clinical examination, MRI scanning and diagnostic arthroscopy. Variables like sensitivity, specificity, positive predictive value, negative predictive value and accuracy of clinical examination and MRI against arthroscopy were evaluated..
The sensitivity, specificity and accuracy of clinical examination for anterior cruciate ligament tears were 94.7%, 71.4% and 88.5% and for MRI were 94.7%, 78.6% and 90.4%, respectively; for posterior cruciate ligament tears 100%, 100% and 100% for clinical examination and for MRI 80%, 97.9% and 96.2%, respectively. These values for medial meniscus tears were 76.5%, 68.6% and 71.2% for clinical examination and 88.2%, 62.8% and 71.2% respectively for MRI. For lateral meniscus tears, 40%, 94.6% and 78.8% for clinical examination and 46.7%, 89.2% and 76.9% respectively for MRI..
A skillfully performed clinical examination establishes a diagnosis on which an arthroscopic procedure can be planned, reserving MRI scans for patients where the clinical examination fails to establish a diagnosis or cannot be performed. Decision to use MRI should be based on the criteria that it would confirm, expand the diagnosis or change diagnosis in such a way that alters the proposed treatment..

Carbapenemes are a good choice for treatment of infections caused by multidrug resistant Pseudomonads aeruginosa. The emergence of carbapenem resistance has become a major problem in treatment of this organism especially among immunocompromised patients including burn patients..
The aim of this study was to investigate carbapenem-resistance mechanisms among burn patients in Tehran, Iran, during 2014 - 2015..
The antibiotic resistance phenotypic test was accomplished by the Kirby Bauer disk diffusion method. The phenotypic investigation of metallo-beta-lactamase (MBL) producers was evaluated by the combined disk diffusion test (CDDT) method. The prevalence of MBL genes, including blaIMP-1 and blaVIM-1 was evaluated by polymerase chain reaction (PCR) and sequencing methods. Amplification of oprD was performed by PCR and the results of sequencing were aligned with wild-type P. aeruginosa strain PAO1.
A total of 100 P. aeruginosa were investigated, of which, 95 were resistance to imipenem. Out Of 95 imipenem resistant isolates,, 81 (85.2%) were MBL producers. Among all isolates, 13 strains carried the blaIMP-1 gene, whereas all of the strains were negative for the blaVIM-1 gene. Amplification of OprD porin was performed for all 100 P. aeruginosa strains. Two insertion sequences (ISs) including ISPpu21 and ISPa1328 were detected in PCR products of OprD gene, that were larger than expected..
The prevalence of β-lactamase-producing isolates and their isolation from life-threatening infections in burn patients is increasing at an alarming rate worldwide. Also, we have identified two novel IS elements, ISPa1328 and ISPpu21, in P. aeruginosa isolates from hospitals in Tehran, Iran. In most of the isolates, insertional inactivation of oprD by ISPa1328 and ISPpu21 were associated with carbapenem resistance..

Traffic accidents are the major cause of injuries that endanger the lives of many people annually. It seems that studying the factors and grounds of this type of event including risky driving contributes to the identification of groups at risk and development of preventive programs..
Given the importance of this issue, we decided to conduct a study to examine the social factors of risky driving..
The present study was implemented based on a case-cohort design. The target community was all the drivers who drove on the intercity roads of Tehran Province. Each driver with and without a history of being guilty in a car accident leading to injury or death during the last 5 years was assigned to the case and control groups, respectively. The questionnaires were completed through a review of documents and interview within the groups. In the analytical analysis, a chi-square test and, if necessary, the odds ratio and confidence intervals were used to determine the relationship between the variables. In each case, the necessary investigation of confounding or interacting variables was performed using regression models and the final model of the factors affecting a risky driving was extracted..
From a total of 990 drivers studied, 54 cases (5.5%) were females and 936 (94.5%) were males. The mean and SD of the drivers’ ages were 39.4 and 11.8 years, respectively. People with a driving job, chronic disease, poor socio-economic status, having only a family dispute, without a religious attitude, and under medical supervision (all with P This study showed that gender, education level, occupation, socioeconomic status, medical care, health condition, lifestyle, family conflict, drug abuse history, and religious attitudes are the major social factors of risky driving on the intercity roads of Tehran Province..

Management of displaced proximal humeral fractures is subject of ongoing debate..
We aimed to review our results of operative treatment of proximal humeral fractures compared to age-, sex, and fracture-type controlled conservative treatment. We hypothesized that there is no significant difference in upper-extremity specific disability between patients treated with operative fixation and patients treated nonoperatively after displaced proximal humeral fracture. Our secondary null hypotheses were that there were no differences in pain intensity, satisfaction and physical function..
Thirty-three patients treated with operative fixation were enrolled and randomly matched with 33 patients treated nonoperatively according to age (within 5 years), sex, ASA-score, Neer fracture type and mechanism of injury. The patients were evaluated using the disabilities of the arm, shoulder and hand (DASH) scale, the constant score, short form (SF)-36 health survey, CESD, the pain catastrophizing scale (PCS) and pain intensity and satisfaction questionnaires..
At follow-up, the nonoperatively treated patients had better functional outcomes than the operatively treated patients. Nonoperatively treated patients also scored better on pain intensity and satisfaction. There were no significant differences in CESD, PCS, and SF-36 physical- and mental health summary scores between cohorts..
The results of this study suggest that operative treatment might, on average, be detrimental to patients with proximal humeral fractures compared to natural healing. It will be a key to identify patients who will benefit from surgery..

Crushed fingers are one of the most common reasons that patients visit the emergency centers for hand surgery, and based on the level of injury, it can cause many disabilities for patients. It is difficult to decide the treatment strategies (amputation, aggressive revascularization, immediate or delayed complex reconstruction and immediate conservative treatment) for crushed fingers..
The current study aimed to compare the blood sugar (BS) levels measured by the glucometer in healthy and crushed fingers to predict gangrene in patients referred to 15 Khordad Hospital in Tehran, Iran..
This cohort study was conducted on 265 patients with crushed fingers referred to the emergency center of 15 Khordad hospital in Tehran, Iran, from March 2015 to March 2016. Blood glucose levels were measured by glucometer in the crushed fingers and in the finger of the opposite side at the same time and measurements were recorded. Data were analyzed using t-test and chi-square test with SPSS software version 22..
The results showed that 317 crushed fingers of 265 patients were ischemic based on the color, temperature, capillary refill time and pulse oximetry and accordingly the vascular reconstruction was not possible. Of 317 crushed fingers, 61 (19.24%) became gangrene (all with sugar levels lower than 37). The mean BS levels of the amputated and non-amputated fingers were 33.5 ± 1.52 and 111.04 ± 15.27 mg/dL, respectively. Therefore, there was a significant difference in the mean BS level between the patients with amputated and non-amputated fingers (P The lower levels of sugar in crushed fingers compared to healthy fingers can help to diagnose gangrene in crushed fingers..

Many different surgical techniques have been described to stabilize the acromion-clavicular (AC) dislocations. So far many of these procedures are performed only in arthroscopy..
In this study, we describe a new technique that utilizes the tightrope with a mini-invasive open approach for the acute stabilization of the acromion-clavicular joint (ACJ) dislocation..
Patients and We set an prospective study aimed to verify the efficacy of this new surgical technique. We treated 28 patients with acute ACJ dislocation with ACJ TightRope ® System with dual mini access. We retrospectively reviewed the data of 34 patients treated with arthroscopic technique. They were considered as the control group..
At 6 month’s follow-up, all the 28 patients showed a stable joint during clinical examination and obtained an average Constant score of 98.62/100, with a complete recovery of ROM and strength in abduction. The mean operation time was of 33.7 minutes. The mean recovery duration was 102.8 days. No significant difference was found between the experimental and control groups (P > 0.05)..
Results of this trial suggest the effectiveness of this new mini-invasive surgical technique in producing clinical and functional recovery in patients with ACJ dislocations..

Late onset bipolar disorder is not common. In addition, bipolar disorder with a dominancy over sexual behaviors is very rare. Hence, traumatic and vigorous sexual behavior, such as masturbation and self-mutilation, are odd and rare occurrences..
An elderly woman in a manic phase of bipolar disorder without a previous history of psychiatric disorders was concomitant with problematic sexual over stimulation in the context of hyper sexuality. She had traumatized her genitals and underwent surgery for their repair. Following her admission and psychopharmacologic therapy, she recovered..
The presentation of bipolar disorder in the elderly can be seen in sexual behaviors and self-mutilation that can lead to the need for reparative surgery. In each case with trauma to the external genitalia, psychiatric problems should be considered..

In contrast with victims of major trauma, patients who suffer minor injuries receive little specialist input. In most cases, this causes no difficulty, but there are situations where minor trauma results in persistent disability affecting the quality of life..
A young man sustained a perineal puncture wound resulting from a fall onto a bush. Following an initial delay, he sought medical advice for a continual pain in his right leg, and a discharging perineal wound. A computed tomography (CT) scan and flexible sigmoidoscopy failed to identify the cause, and he was subsequently discharged from hospital. One year after his initial presentation, a magnetic resonance imaging (MRI) scan identified a retained foreign body consistent with a fragment of wood..
Penetrating trauma from wooden fragments provides a diagnostic challenge. A stubborn discharge from a wound must always raise the suspicion of retained fragment. Early and appropriate surgical exploration is imperative..

Criteria for starting weight-bearing on the heel with a symptomatic calcaneal insufficiency fracture have not yet been reported..
We describe a rare case of a 52-year-old woman with a calcaneal insufficiency fracture who sustained a second ipsilateral calcaneal insufficiency fracture within a short time span. The initial fracture was not evident radiographically, but was detected using magnetic resonance imaging (MRI). The patient rejected our advice to avoid weight-bearing on the heel, instead opting to use a silicone heel orthosis. Although there were no abnormal local findings, the stand on heel test was positive at each subsequent visit until 2 months after her first medical examination. At this time, radiographs showed a sclerotic line; however, a second round of MRI showed a new calcaneal insufficiency fracture anterior to the initial calcaneal insufficiency fracture. The patient then agreed to stop weight-bearing on the heel. Three months after the initial visit, radiographs showed two sclerotic lines, and the stand on heel test became negative for the first time; hence, weight-bearing was permitted. There was radiographic evidence of fracture healing and complete resolution of symptoms 4 months after the initial visit..
The callus formation seen on radiographs is helpful in determining when to start weight-bearing; however, fresh insufficiency fractures of the ipsilateral calcaneus may not be detected by radiography. Since local findings such as tenderness, swelling, and heat are subjective, the criteria for starting weight-bearing on the affected heel with an insufficiency fracture should be based on not only radiographs but also objective clinical findings such as the stand on heel test..

Five patients presented to the emergency department of a tertiary referral teaching hospital with atraumatic fractures of their humerus sustained during a recreational dodgeball tournament..
The patients were young healthy individuals that described the fracture occurring during the act of throwing..
The causes leading to fracture of the humerus during the act of a throw are discussed and the management strategies utilized..