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Archives of Trauma Research - Volume:6 Issue: 2, Apr-May 2017

Archives of Trauma Research
Volume:6 Issue: 2, Apr-May 2017

  • تاریخ انتشار: 1396/08/15
  • تعداد عناوین: 10
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  • Maurice Balke* Page 1
    Context: Acute acromioclavicular joint (ACJ) dislocations are very common in young and active adults. Despite the high incidence of this injury, there is still some controversy on its diagnosis and treatment..
    Evidence Acquisition: This review was based on the knowledge of the current literature listed in PubMed. It summarizes the current strategies for acute AC joint injuries..
    Results
    Acute injuries of the AC joint are very common among active individuals. Most authors recommend panorama- (stress-) view radiographs and additional radiographs for the horizontal instability. Low-grade injuries (Rockwood I-II) should be treated conservatively whereas high-grade injuries (Rockwood IV-VI) are best treated surgically. The most appropriate treatment for Rockwood III injuries is still a matter of debate and should be recommended based on the individual needs of the patient..
    Conclusions
    Based on the current literature, there still is no gold standard for the diagnosis of acute AC joint injuries. As surgical techniques, the hook plate as well as the arthroscopic button techniques are commonly used leading to good and reproducible results. However, evidence of the superiority of these techniques over alternative methods is lacking.
    Keywords: Rockwood, Tossy, Acromio-Clavicular Joint, ACJ, Hook Plate, TightRope
  • Serkan Akpancar*, Mehmet Murat Seven, Harun Yasin Tuzun, Levent Gurer, Safak Ekinci Page 2
    Context: Prolotherapy is a popular injection-based complementary treatment, which has shown promising results in the treatment of sprained and degenerated ligaments, and damaged dense connective tissues’ structures. More research was conducted in this area and many authors declared successful results for different indications.
    Evidence Acquisition: The purpose of this study was to present a literature review regarding the current concepts of prolotherapy injections and improvements in the orthopedic clinical care practice. The Medline and PubMed databases were searched for the articles related to prolotherapy injections in the field of orthopedic surgery and additionally the reference list of each article was also included to provide a comprehensive evaluation.
    Results
    Numerous studies have been conducted on prolotherapy injections for different indications for orthopedics clinical care practice. Prolotherapy injections have successfully used for major orthopedic procedures in terms of rotator cuff lesions, knee ligamentous lesions, osteoarthritis-cartilage defects, and ligament-tendon injuries. Most of the studies showed that prolotherapy provided faster and better healing of tissues.
    Conclusions
    There is a great interest to prolotherapy in orthopedic clinics, especially to manage musculoskeletal lesions. More research conducted in this area and many authors declared successful results in their studies. In spite of this increasing trend for prolotherapy injections, there were only one or two clinical studies investigated prolotherapy injections for different indications and most of them have limited participants, short-term follow-up or poor quality studies. There is still need for further high-quality studies investigated optimal strategy of the injections of prolotherapy.
    Keywords: Prolotherapy Injections, Preparation Protocols of Prolotherapy, Current Indications of Prolotherapy
  • Enayatollah Homaie Rad, Maryam Tavakkoli* Page 3
    Background
    Studies have shown that the number of road fatalities has been decreasing in developed regions and increasing in less and middle developed regions. Iran has one of the highest road fatalities in the world. Controlling road fatalities is vital for less and middle developed countries like Iran.
    Objectives
    The aim of this study was to find factors affecting road fatalities in Iran using macro provincial data.
    Materials And Methods
    Panel data of provinces of Iran between 2008 and 2012 were used for this study. Panel data Poisson estimator was used for estimating the model. Hausman test and Breusch-pagan test were used for finding between pooled or panel and fixed or random effects.
    Results
    No significant relationships were found regarding the percentage of emergency sites and percentage of cars with road fatalities. Increase in the percentage of motorcycles, rain, highways and freeways increased the risk of road fatalities. The effect of highways in road fatalities was higher than freeways. Increase in the percentage of traffic police sites and people living in urban regions decreased the risk of accident fatalities.
    Conclusions
    The government, ministry of health and policy makers must develop strategies for controling high levels of road fatalities in Iran.
    Keywords: Accident Prevention, Cause of Death, Accidents, Motor Vehicles, Poisson Distribution, Econometric Model, Panel Data, Iran
  • Golnar Sabetian, Shahram Paydar, Ali Rasti, Zahra Ghahramani* Page 4
    Background
    Being aware of trauma patients’ conditions and predicting their outcome has always been of a great interest. To determine the state and prognosis of these patients, we should find ways to enable the timely identification of those with poor health and allow the physicians to treat them before the situation gets out of hand.
    Objectives
    The present study aimed at evaluating the efficiency of respiratory index (RI) in determining the short-term prognosis of multiple trauma patients in comparison with revised trauma score (RTS).
    Methods
    In this cross-sectional study, all multiple trauma patients who were admitted to emergency department (ED) of Shahid Rajaee hospital, Shiraz, Iran, during September and October 2013 were included. Demographic data and data regarding vital signs (blood pressure, heart rate, respiratory rate, GCS, and oxygen saturation), respiratory tract status, trauma type, blood gases, procedures performed in resuscitation room, and final outcome of the patients (discharge, disposition to general unit, intensive care unit, or operating room, and dying) were recorded using a predesigned checklist. Based on the collected data, RTS and RI were calculated for each patient and their correlation and the final outcome were evaluated.
    Results
    Evaluating 187 multiple trauma patients showed that 131 (70%) patients had head injury, 78 (42%) chest injury, 66 (35%) abdominal injury, 49 (26%) extremity injury, 27 (14%) neck injury, and 4 (2%) vascular injury. A significant correlation was seen between RI and RTS (P = 0.024). RTS differentiated patients with good and poor health (P
    Conclusions
    Based on the findings of this study, RI cannot properly estimate short-term prognosis of multiple trauma patients, but it can be used as an independent factor in evaluating the severity of injury.
    Keywords: Glasgow Coma Scale, Multiple Trauma, Patients, Prognosis, Respiratory Index
  • Zahra Ghodsi, Vafa Rahimi Movaghar, Mohammadreza Zafarghandi, Soheil Saadat, Mahdi Mohammadzadeh, Mohammadreza Fazel, Mojtaba Sehat, Mohammad Javad Fatemi, Hadi Khoshmohabat, Shahram Paydar, Hamid Pahlavanhosseini, Hamid Heydari, Ahmad Shafaeizadeh, Payman Salamati* Page 5
    Background
    Burden of injuries is an important public health problem, especially in developing countries. However, a national standard tool for data collection of trauma registry has not been developed in Iran yet.
    Objectives
    The present study aimed to describe the steps undertaken in the development of the minimum dataset (MDS) and define the inclusion and exclusion criteria for a case of trauma registry by the national trauma registry of Iran (NTRI).
    Methods
    The working group consists of sixteen elected expert representatives from seven established countrywide active trauma research centers. Following a structured extensive review of the literature, the working party identified the data variables that included key registry goals for pre-hospital and hospital, outcome and quality assurance information. We used data variables from three trauma registry centers: National trauma data standard questionnaire, European trauma care (UT stein version), and Sina trauma and surgery research center. Then, we performed two email surveys and three focus group discussions and adapted, modified and finally developed the optimized MDS in order to prepare the quality care registry for injured patients.
    Results
    The finalized MDS consisted of 109 data variables including demographic information (n = 24), injury information (n = 19), prehospital information (n = 26), emergency department information (n = 25), hospital procedures (n = 2), diagnosis (n = 2), injury severity (n = 3), outcomes (n = 5), financial (n = 2), and quality assurance (n = 1). For a patient sustained one or more traumatic injury in a defined diagnostic ICD-10 codes, the inclusion criteria considered as one of the followings: If the patient stayed > 24 hours in the hospital, any death after hospital arrival, any transfer from another hospital during the first 24 hours from injury.
    Conclusions
    This study presents how we developed the MDS in order to uniform data reporting in the NTRI and define our inclusion and exclusion criteria for trauma registry. Applying the MDS and the case definition in pilot studies are needed in next steps.
    Keywords: Focus Group Discussion, Iran, Patient Selection, Registries, System, Wound, Injuries
  • Abdolhossein Davoodabadi, Faramarz Marzban, Leila Ghafoor, Hamid Reza Talari, Esmaeil Abdolrahim-Kashi, Hossein Akbari*, Mehrdad Mahdian Page 6
    Background
    Ultrasound has widely been used to assess patients with blunt abdominal trauma and detect free fluid in the abdomen. Nevertheless, different studies reported different false negative for this imaging technique.
    Objectives
    The present study was conducted to evaluate the diagnostic value of the repetitive ultrasound in diagnosis of free intraperitoneal fluid.
    Methods
    In this study, 125 patients with abdominal blunt trauma were recruited prospectively for ultrasound evaluation. Ultrasound and CT- scan were performed for all recruited patients in the study. In case of positive ultrasound or CT-scan (free fluid in the peritoneal cavity), patients underwent surgical operation. In the presence of negative ultrasound and CT-scan, and if the patient was alert and had stable vital signs, then, he/she would undergo exact supervision. In such patients, ultrasound and CT-scan were repeated 12 and 24 hours after admission. If any of the tests were positive, the patient underwent laparotomy. Moreover, if ultrasound and CT-scan examinations were negative 24 hours after admission, the patients with normal laboratory tests were discharged according to the surgeon's decision. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated.
    Results
    Of the 125 patients with abdominal blunt trauma, 90 patients finally underwent laparotomy. Based on the surgical outcome as the gold standard, the initial, 12 hours, and 24 hours sensitivity were measured to be 19.8%, 75.2%, and 82.2%, respectively. These numbers for specificity were 91.7, 75, and 70.8, respectively; they were 90.9, 92.6, and 92.2 for PPV, and 21.3, 41.8, and 48.5 for NPV, respectively.
    Conclusions
    The sensitivity of ultrasound to detect intraperitoneal fluid in blunt abdominal trauma cases will be increased by repeated ultrasound examinations.
    Keywords: Abdominal Injuries, Ultrasonography, Hemoperitoneum
  • Paul K. Okeny*, Geoffrey Ndikaboona Page 7
    Traumatic injuries to the gallbladder are rare. This is attributed to its anatomical location and protection by the liver. Direct penetrating trauma is the commonest mechanism of injury. Here is the report of a 27-year-old otherwise healthy male who sustained gallbladder perforation following the penetration of abdominal injury in a domestic fight. A high index of suspicion is necessary for early diagnosis. He safely underwent an open cholecystectomy and his postoperative recovery was uneventful.
    Keywords: Gallbladder Perforation, Domestic Violence, Open Cholecystectomy
  • Mansooreh Jamshidian Tehrani, Shahbaz Nekoozadeh, Mohammad Soleimani, Seyed Ali Tabatabaei*, Bahram Eshraghi Page 8
    In this report we present a case of severe facial injury due to a donkey bite. Immediate repair with surgical flaps was performed. No significant complication was observed at the time of surgery or during follow up and the result was acceptable. Animal bites are relatively frequent and most often are done by dogs. Besides dogs, other animals such as cats, horses and donkeys may be responsible for this type of injuries. Although donkey bites to the facial area are very rare, they can cause severe and life-threatening injuries. Early management of facial injuries caused by animal bites is acceptable nowadays and guarantees satisfactory outcome.
    Keywords: Donkey Bite, Facial Laceration, Primary Repair
  • Ali Tabrizi*, Mir Bahram Safari, Hassan Taleb, Nasrin Navaeifar Page 9
    Introduction
    Posterior shoulder dislocation associated with fracture of the lesser tuberosity is considered as a rare shoulder trauma. It can lead to the locked shoulder with a very high possibility of unsuccessful closed reduction.
    Case Presentation
    In this case, the patient was a 30-year-old male motorcyclist with the right shoulder injury who had posterior shoulder dislocation with lesser tuberosity fracture. Early attempt for closed reduction was unsuccessful and led to iatrogenic brachial plexus injury. This patient is treated by open reduction and fracture fixation with screw. Subscapularis partial rupture was repaired. Finally, full stability was achieved.
    Conclusions
    Fracture fixation plays a crucial role in stability after reduction. Several techniques have been suggested for surgical treatment including fixation with screw and the modified McLaughlin technique. Similar to the previous case reports, according to our experience, careful attention to the fracture concomitant with posterior dislocation is of the utmost importance.
    Keywords: Posterior Fracture Dislocation, Lesser Tuberosity Fracture, Reverse Hill-Sachs Lesion
  • Behnam Sanei, Mohsen Kolahdouzan*, Hamid Reza Jafari Page 10
    Arterial pseudoaneurysm is an uncommon life-threatening complication in blunt trauma patients. Blunt liver injury may lead to hepatic artery pseudoaneurysm. Radiological intervention is the method of choice in diagnosis and treatment of hepatic artery pseudoaneurysm. However, surgical intervention is advised for unstable patients with large leaking defects. This study reports a case of 53-year-old female who was admitted with vague abdominal pain. She had experienced a blunt abdominal trauma a year ago and had gone under liver packing procedure. The CT-scan results showed hematoma in RUQ region and leaking pseudoaneurysm of right hepatic artery. Hematoma was drained and partial liver resection and hepatic arterioraphy were done through laparotomy.
    Keywords: Hepatic Artery, Pseudoaneurysm, Blunt Abdominal Trauma