Bulletin of Emergency And Trauma
Volume:5 Issue: 4, Oct 2017

Le Fort fractures constitute a pattern of complex facial injury that occurs secondary to blunt facial trauma. The most common mechanisms of injury for these fractures, which are frequently associated with drug and alcohol use, include motor vehicle collisions, assault, and falls. A thorough search of the world’s literature following PRISMA guidelines was conducted through PubMed and EBSCO databases. Search terms included “Le Fort fracture”, “facial”, “craniofacial”, and “intracranial.” Articles were selected based on relevance and examined regarding etiology, epidemiology, diagnosis, treatment, complications, and outcomes in adults. The analyzed studies were published between 1980 and 2016. Initial data search yielded 186 results. The search was narrowed to exclude articles lacking in specificity for Le Fort fractures. Fifty-one articles were selected, the majority of which were large case studies, and collectively reported that Le Fort fractures are most commonly due to high-velocity MVC and that the severity of fracture type sustained occurred with increasing frequency. It was also found that there is a general lack of published Level I, Level II, and Level III studies regarding Le Fort fracture management, surgical management, and outcomes. The limitation of this study, similar to all PRISMA-guided review articles, is the dependence on previously published research and availability of references as outlined in our methodology. While mortality rates for Le Fort fractures are low, these complex injuries seldom occur in isolation and are associated with other severe injuries to the head and neck. Quick and accurate diagnosis of Le Fort fractures and associated injuries is crucial to the successful management of blunt head trauma.

To determine the effects of methylprednisolone-laden hydrogel loaded into a chitosan conduit on the functional recovery of peripheral nerve using a rat sciatic nerve regeneration model was assessed.
10-mm sciatic nerve defect was bridged using a chitosan conduit (CHIT/CGP-Hydrogel) filled with CGP-hydrogel. In authograft group (AUTO) a segment of sciatic nerve was transected and reimplanted reversely. In methylprednisolone treated group (CHIT/MP) the conduit was filled with methylprednisolone-laden CGP-hydrogel. The regenerated fibers were studied within 16 weeks after surgery.
The behavioral, functional and electrophysiological studies confirmed faster recovery of the regenerated axons in methylprednisolone treated group compared to CHIT/Hydrogel group (p Methylprednisolone-laden hydrogel when loaded in a chitosan conduit resulted in improvement of functional recovery and quantitative morphometric indices of sciatic nerve.

To determine the effects of chitosan-zinc oxide nanocomposite conduit on transected sciatic nerve in animal model of rat.
Sixty male White Wistar rats were used in this study. A 10-mm sciatic nerve defect was bridged using a chitosan-zinc oxide nanocomposite conduit (CZON) filled with phosphate buffered saline. In chitosan group (CHIT) the chitosan conduit was filled with phosphate buffered saline solution. In sham-operated group (SHAM), sciatic nerve was exposed and manipulated. In transected group (TC), left sciatic nerve was transected and nerve cut ends were fixed in the adjacent muscle. The regenerated fibers were studied within 12 weeks after surgery.
The behavioral and functional tests confirmed faster recovery of the regenerated axons in CZON group compared to Chitosan group (p Chitosan-zinc oxide nanocomposite conduit resulted in acceleration of functional recovery and quantitative morphometric indices of sciatic nerve.

To compare the healing process of pressure ulcers treated with cryopreserved human amniotic membrane allograft and routine pressure ulcer care in our hospital.
From January 2012 to December 2013, in a prospective randomized clinical trial (IRCT201612041335N2), 24 patients with second and third stage of pressure ulcers were enrolled in this study. All patients needed split-thickness skin grafts for pressure ulcer-wound coverage. Selected patients had symmetric ulcers on both upper and lower extremities. The patients were randomly divided into two groups: amnion and control. In the amnion group, the ulcer was covered with cryopreserved amniotic membrane and in the control group it was treated with local Dilantin powder application. The duration and success rate of complete healing was compared between the two groups.
The study group was composed of 24 pressure ulcers in 24 patients (19 males and 5 females) with a mean age of 44±12.70 years. The demographic characteristics, ulcer area, and underlying diseases were similar in both groups. The early sign of response, such as decrease in wound discharge, was detected 12-14 days after biological dressing. Complete pressure ulcer healing occurred only in the amnion group (p Cryopreserved amniotic membrane is an effective biologic dressing that promotes re-epithelialization in pressure ulcers.

To assess the outcome long standing ulno-humeral dislocation managed by open reduction and stabilization with V-Y plasty.
This cross-sections study included 14 patients with elbow dislocation that was more than 3 months without joint ankylosis, myositis ossificans or nerve injury. The surgical management not only included open reduction of the elbow joint, but also elongation of the triceps aponeurosis, collateral ligament repair along with the stabilization of the elbow joint. The results were analyzed using the Mayo Elbow score and the range of motion at 3 months and results were compared with the function of the patients elbows before surgery.
Among the 14 included patients, there were 9 (64.3%) men and 5 (35.7%) women. The mean age of the patients was 27.8 ± 8.3 (ranging from 21 to 34) years. The average ROM at the time of admission was found to be 37.0° ± 25.8° (10° to 65°) in flexion and 15.5° ± 14.6° (0° to 30°) in extension lag. Patients’ preoperative Mayo clinic elbow performance assessment showed an index score of 47.3 ± 10.3 (range of 35 to 53).
This results of the current study demonstrates that relative good function with a pretty low risk can be obtained when comparing the functional results after 3 months with preoperative status. Based on these results we recommend that neglected elbow dislocation should be managed by surgical intervention even if the dislocations are old.

To compare the short-term functional outcome between resection and reconstruction in Mason Type II and Type III radial head fractures using Broberg and Morrey score.
A prospective cohort study was conducted in the Department of Orthopedic Surgery of SMS Medical College and attached Hospitals. A total of 29 patients (15 in resection group, 14 in reconstruction group) between the age group of 20-60 years with Mason Type II and Type III fresh closed radial head fractures were included in the study. The functional outcome including the range of motion, extension lag and Broberg Morrey score were determined and compared between two group.
The mean age of resection group was 44.5 ± 6.6 years and mean age of reconstruction group was 37.1 ± 6.2 years. The baseline characteristics . At 12-months follow-up, in Mason type II fracture, radial head reconstruction group with mean extension lag of 9.4 ± 4.1 and mean Broberg Morrey score of 94.9 ± 5.1 showed better results compared to radial head resection with mean extension lag of 15.7 ± 4.1 (p=0.022) mean Broberg Morrey score 88.3 ± 5.1 (p=0.045) respectively. In Mason type III fractures, radial head resection with mean supination of 79.4 ± 4.7, mean pronation of 74.4 ± 4.1 and mean Broberg Morrey score 89.8 ± 6 showed better results when compared with radial head reconstruction group with mean supination of 64.2 ± 4 (p The procedure suggested in Mason type II, is reconstruction of radial head. In Mason type III due to difficulty in achieving anatomical reduction results were not good with reconstruction when compared with resection. We recommend radial head excision in Mason type III fractures where anatomical and stable fixation is not possible.

To epidemiologically assess the accidents and incidents in the injured pedestrians referred to Shahid Rajaee Hospital, Shiraz in order to provide basic preventive strategies and reduce injuries and fatalities caused by traffic accidents in pedestrians.
This cross-sectional study was conducted on 5840 injured pedestrians referred to Shahid Rajaee Hospital, Shiraz from 2009 to 2014. The baseline characteristic including the demographic and clinical information, the mechanism of injury, injury severity score (ISS) and outcome determinants. We also recorded the outcome measures and the mortality. Multivariate logistic regression analysis was performed to investigate the factors related to mortality rate and Length of Stay (LOS) in hospital.
In our study, the history of 5840 injured pedestrians was analyzed. The mean age of the patients was 41.32±19.21 years. Multivariate logistic regression indicated that mortality increased with age. Moreover, the odds of mortality was more in patients with Injury Severity Score (ISS) between 16 and 24 [OR: 12.94, 95% CI (3.78-32.66), p=0.001] and injuries in the head and neck [OR: 7.92, 95% CI (4.18-14.99), p=0.020]. LOS in hospital was also higher in patients with ISS > 25 [OR: 16.65, 95%CI (10.68-25.96), p=0.001].
Pedestrians have always been one of the most vulnerable road users. Our study indicated that the adverse consequences and mortalities in pedestrians increased with age. Hence, approaches are required to improve primary prevention programs and reduce deaths and injuries due to this major public health problem.

To investigate epidemiological aspects of injuries among Iranian children under 7 years of age using obtained data from a national registry.
Injury data were derived from a national-based injury supervision system during 2000–2002. This registry involved all of home-related injuries for children less than 7 years of age that treated in health or emergency centers. The study population included 25% of Iranian people. The descriptive statistical methods were used for representing the distribution of the variables like age, sex, injury mechanisms, types of injuries, etc. Data were presented as mean ± SD and proportions as appropriate.
Of the total 307,064 domestic injuries registered during 2000–2002, 77,500 cases (25.2%) were children. 70% of these children (54581 cases) were in age group of 1-5 years.
The large fraction (58.8%) of injuries among children under 7 years of age went back to burn injuries. Cuts and lacerations were at the second level with 17.4%. 51% of injuries had contact with hot liquids. Of all children under 7 years of age injuries, 282 died, 86 were disabled, while the rest improved or being under treatment when recording data.
Injuries, particularly burns (especially those who had contact with hot liquids that led into scald), are major public health problem that children under 7 years of age encounter. Therefore, it seems necessary to provide adequate plans to promote children under 7 years of age safety issues.

To presents a survey investigating differences between driver's beliefs regarding utilizing cellphone when driving.
In this population-based survey, the participants who were studied in the North of Iran, Gorgan, were categorized as main urban and rural areas. A sample of 400 drivers, 92 women and 308 men, filled out the four sections questionnaire which was based on the Theory of Planned Behavior (TPB) used for measuring the differences between the driver's opinions (attitudinal beliefs, normative beliefs, and perceived control behavioral beliefs) about utilizing a cell phone when driving along with their age and driving purpose. Data were collected by distributing the 68- query questionnaire between the drivers.
The MANOVA analysis showed that important discrepancies were found between the normative, control and behavioral beliefs of cellular phone users while driving. As expected, frequent business and younger users with sturdy intention expressed more benefits of further concentration on family members and fewer obstacles that would prevent them from utilizing cellphone when driving than older and frequently personal users.
These results indicated that the benefits of utilizing cellphone while driving are greater than its dangers. To reduce cellphone utilization when driving and increase road safety, more effort is required to lower the perceived advantages of the behavior and to outstand the risks of this hazardous driving act.

To explore impact of emergency medicine residency program on patient waiting times in emergency department (ED) and determine the associated factors.
A two-phased sequential exploratory mixed-methods approach was used. The first phase was comprised of retrospective before-after design of ED encounters for a 3-month period, six months before and six months after the introduction of an emergency medicine residency program in an Iranian teaching hospital. The second phase included semi-structured interviews with five individuals which purposively selected to participate in qualitative design. Quantitative data were analysed descriptively and qualitative data were analysed using an iterative framework approach.
The most patients were admitted to the hospital in night shift, both before and after the resident EMS. No statistically significant differences were found among all of the waiting times during the two time periods except for the average time interval between admission and physician start time (p This study has shown that intradisciplinary conflict would affect the outcomes of emergency medicine residency program and ED process. These new findings enhance the understanding of the nature of conflicts and will persuade policy makers that design a set of clinical practice guidelines to clarify the duties and responsibilities of parties involved in ED.

To identify and prioritize factors affecting the location of road emergency bases in Iran using Analytical Hierarchy Process (AHP).
This was a mixed method (quantitative-qualitative) study conducted in 2016. The participants in this study included the professionals and experts in the field of pre-hospital and road emergency services issues working in the Health Deputy of Iran Ministry of Health and Medical Education, which were selected using purposive sampling method. In this study at first, the factors affecting the location of road emergency bases in Iran were identified using literature review and conducting interviews with the experts. Then, the identified factors were scored and prioritized using the studied professionals and expert's viewpoints through using the analytic hierarchy process (AHP) technique and its related pair-wise questionnaire. The collected data were analyzed using MAXQDA 10.0 software to analyze the answers given to the open question and Expert Choice 10.0 software to determine the weights and priorities of the identified factors.
The results showed that eight factors were effective in locating the road emergency bases in Iran from the viewpoints of the studied professionals and experts in the field of pre-hospital and road emergency services issues, including respectively distance from the next base, region population, topography and geographical situation of the region, the volume of road traffic, the existence of amenities such as water, electricity, gas, etc. and proximity to the village, accident-prone sites, University ownership of the base site, and proximity to toll-house.
Among the eight factors which were effective in locating the road emergency bases from the studied professionals and expert's perspectives, "distance from the next base" and "region population" were respectively the most important ones which had great differences with other factors.

Traumatic iliac vessels injuries secondary to gunshot wound can often be fatal at the scene. One of the intriguing complications of vascular injuries is arteriovenous fistula. If the patient survives, these lesions may often not be diagnosed on first evaluation and patients may present with clinical signs and symptoms years later. Open surgical repair can have prohibitive morbidity and mortality and endovascular techniques, an effective treatment alternative, can interrupt the abnormal vascular communication and preserve artery vein patency. We describe a unique case of iliac arteriovenous fistula (AVF), secondary to a bullet injury, identified by imaging studies and subsequently treated with endovascular surgery. In conclusion, traumatic AVF are rare. Traditional teaching mandates that zone III pelvic retroperitoneal hematomas secondary to penetrating trauma be explored.

Isolated traumatic brachialis muscle tears are uncommonly reported – leading to occasional misdiagnosis and misdirected treatment. The rarity of brachialis muscle tear may promote misdiagnosis or mistreatment of this injury. We report an isolated brachialis muscle tear in a young female, possibly caused by strenuous exercise in the gymnasium. The diagnosis was made clinically and confirmed by magnetic resonance imaging. The patient was subsequently managed adequately with conservative treatment. We herein present a 35-year-old woman who was diagnosed with an acute brachialis muscle tear being diagnosed with a combination of clinical signs and imaging and successfully managed non-operatively. A chronologically arranged review of literature is also presented.

Diabetes insipidus is a disease charaterised by increased urine production and thrist. Neurogenic diabetes insipidus following head trauma,autoimmune disease and infection is quite common but diabetes insipidus following thermal burn injury is a rare complication.We should know about this complication as its management need a comprehensive approach for satisfactory outcome. Thermal burn can cause different complications in early post burn period like electrolyte imbalance, dehydration, acute renal failure, but diabetes insipidus is a very rare and unusual complication that may come across in thermal burn. We should be aware about this condition to prevent and treat mortality and morbidity in burn patients. We have reported a case of transient diabetes insipidus in a patient of thermal burn in early post burn period. Patient was treated accordingly, leading to complete recovery.