Trauma Monthly
Volume:27 Issue: 1, Jan-Feb 2022

An aneurysm is defined as a permanent dilation of an artery diameter more than 50% of its typical diameter. The aneurysm of the finger artery is a sporadic disease that divides into true and false types. A Pseudo-aneurysm of the finger artery is more prevalent than a true aneurysm; caused by penetrating trauma. A patient with a true aneurysm of the finger's artery without trauma history is reported. It was removed after proximal and distal control and heparin IV injection. The finger artery was micro-surgically repaired to maintain distal blood flow and prevent finger ischemia and adverse consequences in future trauma.

The isolated trochlea fracture is a rare condition that has been previously reported in different settings and times. However, there is still a lack of data regarding the diagnosis and treatment of this condition. Hence, we sought to clarify various aspects of isolated trochlea fracture. The case presented was a young man referred to our hospital following a high-energy motor-car accident. The diagnosis was made via anteroposterior and lateral X-ray and   with 3-dimensional computed tomography. Following diagnosis, open reduction and internal fixation with medial approach were selected for the patient. Finally, the patient’s follow-up revealed that the range of motion of the affected elbow reached its normal range six months after the operation.

Aspiration-induced pneumonia is responsible for 15-20% of hospital infections and a 39% increase in   costs. Besides, it is one of the ten leading causes of death in   the USA. It can be prevented by choosing the feeding method. This study aimed to assess the incidence of respiratory aspiration using the tube feeding method of intermittent drip bag. This one group only post-test study was conducted on 36 ICU   trauma patients. The patients were fed using the tube feeding method of intermittent drip bag for three days, each time with 150 to 300 cc liquid nourishing solution for 30 to 60 minutes with three-hour intervals. To detect respiratory aspiration, 0.5 cc of methylene blue 1% was added to 500 cc of the liquid. In case the patients needed suction, whenever the blue color of methylene blue was observed in the lung secretions during suction of the respiratory tube, incidence of respiratory aspiration was ascertained. The data were collected using Demographic information registration form and Clinical Information Registration Questionnaire. Then, the data were analyzed using SPSS V19 and descriptive and analytic statistics. The results revealed no incidence of respiratory aspiration via the tube feeding method of intermittent drip bag during   three consecutive days. The present study indicated no respiratory aspiration   observed using the tube feeding method of intermittent drip bag, this method can be utilized in the centers that are not equipped with feeding pump. Moreover, using feeding bags instead of feeding pumps plays a key role in reducing related costs.

Knowledge of effective imaging methods to determine the metallic foreign bodies is essential to better manage patients with trauma injuries. The study aimed to evaluate of visibility of jaw bone particles adjacent to metallic foreign bodies related to the explosion in the maxillofacial region by panoramic imaging, Computed Tomography (CT), Cone-Beam Computed Tomography (CBCT), and Ultrasonography (US).
Ten fresh sheep’s head was used in this in vitro study. Metal foreign objects with dimensions of 1×10×10 mm, 1×5×5 mm, and 1×3×3 mm were placed in the infraorbital area on the right were used. In each imaging, just one of the iron bodies is applied at the center. Then nine parts of the mandibular bone with dimensions of 1×10×10 mm, 1×5×5 mm, and 1×3×3 mm (3 sets, containing all sizes) were placed 5, 10, 20 mm upper (cephalic), inferior (caudal), and posterior to a metallic foreign body, respectively. The same procedure was repeated for all three sizes of metals. Panoramic imaging, computed tomography, cone-beam computed tomography, and Ultrasonography were obtained by were observed by an oral and maxillofacial radiologist and a general radiologist. 
CBCT and CT had good visibility in detections of bone particles adjacent to metallic foreign bodies. There were no significant differences between CBCT and CT regarding detections of bone particles adjacent to metallic foreign bodies (8.56±1.54 and 8.46±2.15 and P=0.56). Panoramic view and US poor visibility in detections of bone particles adjacent to metallic foreign bodies. The mean of number bone detection in the panoramic view was 3.47±1.41 and in the US was 4.06±1.74 (P=0.23). There were significant differences between panoramic view and the US with CBCT and CT regarding detections of bone particles adjacent to metallic foreign bodies (P<0.001). The results were the same regarding distances of bones to metallic foreign bodies.
The results showed that CBCT and CT are effective methods as the first option in detecting bone particles adjacent to metallic foreign bodies in the infraorbital area of the Maxillofacial Region.

Daily emergency department surges can cause crowding in facilities that do not have adequate physical and personnel resources to meet peak demands. The mismatch between surge and surge capacity results in ED crowding, thus indicating compromised daily ED capacity. This study aimed to analyze the daily ED visits and the relevance of this data in disaster preparedness at the Qassim hospital in Saudi Arabia.
This retrospective analytic study was conducted in the central hospitals of Buraidah City, including King Fahad Specialist Hospital (KFSH), Buraidah Central Hospital (BCH), and Maternity and Children’s Hospital (MCH) in Saudi Arabia. Data were collected from January 2017 to December 2018 using a specially designed data collection form. ED visit information such as visits per month, and per day, were collected.
During the study period, 311805 patients visited the King Fahad Specialist Hospital ED, 131071 patients visited the Maternity and Children’s Hospital ED, and 284693 patients visited the Buraida Central Hospital ED. The highest number of visits per month in 2017 was recorded at KFSH with 18,849 patients, while in 2018, it was at BCH with 11,983 patients. The mean number of ED visits per day and month was significantly different between the three hospitals in 2017 and 2018 (P <.001). A significant association was noted between visits per time of day and hospitals in 2018 (P <.0001).
This study suggests that overcrowding investigated during the selected period occurred less in 2018 compared to 2017 in KFSH due to a strict triage initiative. However, the problem of patient overcrowding in MCH and BCH still needs to be addressed.

Intra-articular fractures of the distal radius pose a surgical challenge as there is no consensus in the literature on the treatment for these fractures. Many treatment modalities have been described; however, the use of volar variable angle locking plates is currently being advocated for these fractures.
Overall, 28 patients with intra-articular fractures of the distal radius managed with a volar variable angle locking plate were included in this study. The mean age of the patients in our study was 33.24 ± 11.74 years (range 22-64), and the average follow-up period was 12.18 ±2.64 months (range 6-20). Radiological assessment was done by analyzing volar tilt, radial inclination, radial length, and ulnar variance from the radiographs taken at six weeks and six months’ post-surgery. Functional assessment was done at two weeks, six weeks, three months, and six months. The final functional outcome was calculated at six months   using the Gartland and Werley scoring system. 
There was a constant gain in functional parameters, and significant improvements occurred within 12 weeks. Radiological indices were also maintained after six months of final follow-up showed no significant change. According to the Gartland and Werley scoring system, results were   75% excellent, 14.28% good, 7.14% fair, and 3.57% poor.   One patient developed a superficial infection which was managed with oral antibiotics, one patient had screw impingement for which screw removal was done at eight months, and another developed complex regional pain syndrome that was managed conservatively but ultimately had a poor outcome.
The use of Volar VALCP in intraarticular distal radius fractures is associated with early rehabilitation and good functional and radiological outcomes.

Nerve root sedimentation sign is natural sedimentation of lumbar nerve roots to the dorsal part of the dural sac seen on transverse MRI scans. This phenomenon can be taken advantage of to distinguish symptomatic lumbar spinal stenosis from nonspecific low back pain. We aimed to evaluate the clinical validity of the nerve root sedimentation sign to diagnose patients with symptomatic lumbar spinal stenosis who need surgical intervention.

In this study, 100 patients were surveyed referring to an Orthopedic Clinic with a chief complaint of chronic low back pain (LBP) for three months or more. Demographic information, physical examination, and lumbar MRI scans were obtained, then the patients were assigned to two groups of 50 patients in each   namely Lumbar spinal stenosis (LSS) and LBP groups. The frequency of a positive sedimentation sign was compared between the two groups.

The mean age of patients was 57.95±9.81 years, 61 of them were male, and the rest of the 39 subjects were female. Nerve root sedimentation sign was positive in 48 pts of the LSS group (96% Sensitivity) but none in the LBP group (100% specificity).

A positive sedimentation sign exclusively and reliably occurs in patients with lumbar spinal stenosis, suggesting its usefulness in clinical practice. Future   studies are needed to address its sensitivity and specificity.

Total hip arthroplasty (THA) is a typical surgical procedure with uncommon and preventable complications. However, most adverse events following THA are unusual and preventable or easily treated as expected. This study examined the two common complications of the THA procedure namely: orthopedic and vascular complications and their management.

The primary search began with reviewing   citations from PubMed, and Scopus, between 1991 and 2020 using the keywords: (Hip arthroplasty) or (Arthroplasty AND Hip AND vascular Complications).

Overall, 117 articles were extracted with the initial search. Then 67 studies were selected and used in the present study according to inclusion criteria. The studies reputed thromboembolic disease as vascular complications. The management of vascular complications includes preoperative management, preoperative clinical investigation, intraoperative, and postoperative management.

In general, vascular injuries are rare in hip replacement surgeries. Vascular injuries can appear early in surgery, in the mid-term as postoperative bleeding, and later as pseudo-aneurysms.