Trauma Monthly
Volume:25 Issue: 3, May-Jun 2020

COVID-19 is a viral disease caused by SARS-CoV-2 that quickly became a global pandemic during 2020. Considering the recent outbreak, the lack of adequate data regarding SARS-CoV-2, and consequently the risk of dental practice and potential cross-infection, this article attempted to address the information collected so far in accordance with the internationally valid guidelines and to suggest a relatively safe protocol for the management of o patients. In other words, this study describes the essentials that need to be considered for the dental office reopening.

Managing sports injuries is clinically challenging. Although new techniques can delay musculoskeletal deterioration and promote tissue restoration, they are not widely used. Thus, there is a critical need to promulgate these new methods. In recent years, “tissue engineering” approaches have been developed for improving the regeneration of cartilage by transplanting cells or engineered constructs into injured tissue. The mechanical environment affects the biology of a tissue and is necessary for the development and maintenance of load-bearing tissues. Platelets can be combined with other healing factors as a new therapeutic modality. Platelet-rich plasma (PRP) can be introduced as an autologous blood product that may improve wound healing. In this regard, stem cell therapy that focuses on mesenchymal stem cells (MSCs) has been proposed as a new treatment method in sports medicine. MSCs are multipotent; they have the ability to differentiate into other cells, notably osteoblasts, chondrocytes, adipocytes, myoblasts, and fibroblasts, depending on a variety of factors. In summary, recent advances in tissue regeneration have provided new perspectives for the use of tissue engineering to enhance tissue healing after sports injuries namely the microfracture method, the mechanical stimuli method, PRP therapy, and stem cell therapy

Ossification of the Achilles tendon is a rare disease and seen more frequently in men than in women. Most patients present with pain caused by local inflammation. It is a disease of physically active people, and   management of these patients is important. Many pathologic and molecular studies have been conducted to determine the cause of this disease. Minor trauma and microdamages may be the most important factors related to Achilles tendinopathy or Achilles tears. Sometimes, in cases without significant symptoms, no treatment is need; in symptomatic ones, however, relief of pain is the main treatment objective. Treatment of this disease varies from conservative treatment, including NSAIDs or physiotherapy, to electrotherapy, ionotherapy, and surgical strategies. Herein we report of a patient with Achilles tendon ossification, diagnosed by physical and radiographic evaluation treated with a foot brace without any drugs or surgery. The relation between radiographic changes and patient symptoms was important and helpful in choosing the mode of treatment.

Natural disasters may lead to personal and social dysfunction in children.
The present study was conducted to determine the prevalence of behavioral problems and their relationship with demographic characteristics in children surviving the 2017 earthquake in western Iran.
This was a cross-sectional-analytical study. The statistical population included all children surviving the 2017 earthquake in western Iran. The sample size included 335 subjects selected by convenience sampling. The Achenbach Child Behavior Checklist (Parent Form) was the tool used to collect data and chi-square and Fisher’s exact tests were used to analyze the data.
The rule breaking (5.3%) and somatic complaints (2.4%) were the most and least prevalent behavioral problems in children, respectively. General behavior problems (8.3%), internalizing behavior problems (7.4%), and externalizing behavior problems (7.1%) were the most prevalent, respectively. Gender had a significant statistical relationship with somatic complaints and attention problems; loss of home with rule breaking, internalizing behavior problems, and general behavior problems; the number of children in a family with anxiety; age of the father with social problems, aggression, internalizing and externalizing behavior problems; the father’s educational level with withdrawal; mother’s educational level with attention problems, aggression, externalizing behavior problems and general behavior problems; and economic status with aggression (p<0.05) were apparent.
Given the significant prevalence of behavioral and psychiatric disorders in children who survived the earthquake, identifying children at risk is important for the prevention, early diagnosis, and treatment of aforementioned problems in these children.

There are many methods for evaluating a traumatized metacarp.

This study sought to evaluate the accuracy of the metacarpal compression test for the diagnosis of metacarpal fracture.

All patients with metacarpal trauma were tested via placement of axial load (compression) on the metacarpal; induction or exacerbation of pain on each metacarp was recorded upon applying axial pressure. Then, an X-Ray imaging system was used to identify and record the presence of fracture. All data were entered into a 2x2 table, and then negative predictive value (NPV), positive predictive value (PPV), sensitivity and specificity of the test were calculated.

After careful physical examination and application of the axial pressure on the metacarpal bone, 16(23.68%) patients did not experience any pain during axial loading (none had fracture). According to the statistical analyses of the data, the proposed method had a 69% specificity, 100% sensitivity, 86% PPV and 100% NPV.

Our findings showed that axial loading applied on the metacarpal bone, when it leads to pain, is a good marker for fracture. On the other hand, patients with negative test results had no fracture on radiography, which emphasized 100% NPV of the test.

Optimal management of proximal tibial fractures remains to be a clinical challenge. Most studies on this condition have been conducted on cadaver specimens, and few have compared the clinical outcomes of single and double plating methods in these fractures.
The current study aimed to compare the postoperative outcomes and complications of the single and double plating methods in the treatment of metaphysical proximal tibial fracture.
We treated 40 patients with metaphyseal tibial fracture with single or double plating methods (20 in each group). Patients were followed after 2 and 6 weeks, and 3 and 6 months; all were assessed for malunion, nonunion, and malalignment deformities.
In the double plating group, numerically better flexion and extension range was not significant (p >0.05). However, in the interpretation of the Lysholm Knee Score questionnaire, a significantly higher proportion of good and excellent postoperative outcomes were found in the double plating group (p=0.041). In the double plating group, 15%, 15%, 40%, and 30% of patients were categorized as having poor, fair, good, and excellent outcomes, respectively. These proportions were 30%, 45%, 15%, and 10% among the single plating group respectively. Moreover, we detected positive valgus stress test in the single plating method in 30% of the cases, compared with 5% in the double plating method (p=0.037). Similarly, we observed that 20% of the cases with positive varus stress test in the single plating method, compared with the double plating method that had no cases who tested positive (p=0.035). The observed significant differences survived after we controlled for the positive stress test using regression models. It should be noted that in the single plating group, one case of valgus malalignment with 10° and one case of varus malalignment with 5° were observed.
Our results highlight that the choice of the double plating method to be associated with significantly better outcomes and fewer complications in the treatment of proximal tibial metaphyseal fracture.

Zygomatic fractures are the second most common facial injury, knowledge of their management is important. However, fixations methods, which are of importance are variable. Therefore, for the first time ZMC fx, were  evaluated via (FEA)  and dynamics of the zygoma fixed using four 2- and 3-point resorbable plates and  our non-resorbable plates under normal and maximal masticatory loads. A maxillofacial CT scan of a man with linear fractures without severe displacements was used to model the zygoma and its adjacent bones. Seven combinations of resorbable and seven combinations of non-resorbable mini-plates 2mm thick were fixed on the zygoma (orbital rim, zygomaticomaxillary buttress [ZMB], and frontozygomatic [FZ]) suture using 6mm miniscrews. ZMB was fixed using an L-shaped 4-hole plate. The infraorbital rim was fixed with a curved 5-hole miniplate. The FZ suture area was fixed with a 4-hole miniplate. The model underwent 150N and 750N loads. Minimum and maximum and rotational displacements, stresses, and strains of the zygoma models were calculated. Non-resorbable fixation methods can yield much smaller stresses, strains, and displacements compared to resorbable fixations. Adittionally, the parameters were much smaller under the 150N load compared to the 750N load. The worst results belonged to the fixation of the rim and ZMB and the best results belonged to the fixation of ZMB-Rim, FZ-ZMB, Rim-FZ, and FZ-ZMB-Rim. In patients with heavy masticatory forces, use of resorbable plates are not recommended.