Archives of Trauma Research
Volume:11 Issue: 4, Oct-Dec 2022

Early assessment of the severity and prognosis of multiple trauma injuries is crucial for the improvement of prognosis. Therefore, defining the parameters related to mortality and severity of multiple trauma injuries needs to be considered. The current study aims to investigate the serum lactate level and prognosis of these patients.

This is a cross‑sectional study conducted on 150 motor‑vehicle‑induced multiple trauma patients who were admitted to the Babol Trauma Center for 15 months. The serum lactate level was measured at the time of admission, 24 h, and 72 h after admission. The outcome of the patients was evaluated as death, hospitalization, or discharge.

Overall, 150 motor vehicle‑induced trauma patients were enrolled in the study. Hyperlactatemia was seen in 33 (22%) patients in 24 h and 78 (52%) patients in 72 h after admission (P < 0.001). There was a clinically significant correlation between lactate level at the time of admission and the outcome of the patients (5.22 ± 3.41 expired, 2.69 ± 1.67 hospitalized, and 1.83 ± 1.09 discharged, P < 0.00). There was a clinically significant correlation between the serum lactate level at 24 h after admission and the outcome of the patients (6.81 ± 3.51 expired, 1.35 ± 0.79 hospitalized, and 0.83 ± 0.23 discharged, P < 0.001). There was also a clinically significant correlation between the outcome of the patients (discharge or hospitalization, or death) and the serum lactate level at the time of the admission and 24 h after the admission (P = 0.035).

The baseline lactate, the lactate level at 24 h after admission, and the difference between these two can be used as a prognostic factor in the evaluation of multiple trauma patients. It is suggested to check the difference between the serum lactate level at the time of admission and 24 h later in trauma centers.

Scaphoid fractures are common fractures of the upper extremity and more than 5% of them progress to nonunion. Nonvascularized bone grafting (NVBG) and vascularized bone grafting (VBG) are used to treat this fracture and the best option for the treatment of scaphoid nonunion (SN) is controversial. Hence, this study aimed to compare the clinical outcomes of VBG and NVBG in treatment of SN.

This quasi‑experimental study was conducted on 30 patients with SN. The patients were divided into two groups of NVBG (n = 15) and VBG (n = 13) and were followed up at 2, 4, 8 weeks, and at least 10 months after surgery. Patients’ functional abilities in both groups were compared using the Quick Disabilities of the Arm, Shoulder, and Hand (DASH) Questionnaire and the Mayo modified wrist score. Severity of pain was also compared using the Visual Analog Scale (VAS) before and after the surgery.

Union rates between the VBG (92.3%) and NVBG (73.3%) groups were not significantly different (P = 0.1). There was a significant difference in the VAS score (P = 0.03) and grip strength (P = 0.010) between the two groups. However, no significant difference was found regarding the active range of motion between the groups (P = 0.2). The postoperative Quick DASH scores of the VBG and of NVBG groups were 5.6 ± 1.1 and 8.4 ± 2.3, respectively, and the difference was significant (P = 0.001). The functional improvement based on the postoperative Mayo score was significantly higher in the VBG group compared with the NVBG group (85.9 ± 3.04 vs. 80.4 ± 6.6; P = 0.006).

Vascularized bone grafting seems to be a preferable treatment option for SN because of its higher union rate and better functional outcomes.

The bone defects involving both humeral and glenoid following traumatic dislocation of the shoulder are referred to as bipolar bone lesions. It is essential to identify bipolar bone lesions when considering standard stabilization procedures such as Bankart’s repair. We aim to correlate the radiological and arthroscopic assessment of bipolar lesions in predicting “on‑track” and “off‑track” lesions using three‑dimensional‑computed tomography (3D‑CT).

A prospective observational study was conducted between September 2019 and August 2021. Seventy‑four patients with anterior shoulder dislocation were evaluated; of which 45 patients having both radiological imaging and arthroscopic follow‑up were included in the study. The radiological and arthroscopic assessment for various parameters such as glenoid diameter (D), defect (d), glenoid track (GT), bone loss (BL), Hill‑Sachs (HS) defect, and Hill‑Sachs index (HSI) were tabulated and evaluated. 

Results and Analysis: 

Inter‑observer correlation was calculated using intraclass correlation coefficient (ICC) ranging from 0.61 to 0.80 for most variables (D, d, BL%, GT, and HSI) suggesting a substantial agreement. Almost perfect agreement (0.93) was observed in predicting on‑ and Off‑track lesions and moderate agreement (ICC = 0.56) was observed in calculating HS angle. There was a positive strong correlation between glenoid defect (d) and BL percentage (BL%) among both modalities.

3D‑CT proves an essential tool in the preoperative evaluation of the shoulder in patients with recurrent anterior shoulder dislocation; based on the glenoid BL and characterization of the bipolar lesions through the glenoid track concept.

Inflammatory factors are indicators of complications such as infection following trauma fracture healing that is necessary to identify the process of changes after surgery and the factors affecting it. Therefore, this study aimed to evaluate the extent of inflammatory factors before and after surgery in patients with fractures following trauma.

This prospective study was performed on 200 patients with fractures requiring surgery. After obtaining patient satisfaction and recording demographic information, the white blood cells (WBC) count, erythrocyte sedimentation rate (ESR), and serum levels of C‑reactive protein (CRP) changes before and during the first 6 weeks of the postoperative period were recorded. Repeated measure ANOVA and mixed ANOVA tests were used to compare the data.

According to our results, the day after surgery all inflammatory factors including WBC, ESR, and CRP increased significantly, and 2 weeks after surgery serum levels of WBC and CRP decreased, while ESR serum levels were still high and decreased from the 4th week.

The results of this study showed the deviation of inflammation factors from the normal ranges and increase and decrease after surgery can indicate the presence of complications such as infection after surgery. Since CRP changes were more sensitive than ESR, it is recommended to check WBC and CRP changes to evaluate infection because ESR was elevated for a longer duration.

The preparedness of petrochemical industries against disasters is important to control risks, reduce losses and possible damages. Studies have shown that preparedness is an important factor in the disaster response phase. This study aimed to explore the factors influencing industry preparedness in fire.

This study was conducted from July 2020 to December 2021, with a qualitative case study design. The population included 22 people including 12 crisis managers, three Health, Safety, and Environment chief officers, two operational commanders in the fire department, two policymakers and three university professors. The data were collected through semi‑structured interviews and purposeful sampling, which continued until saturating the data. The strategies recommended by Guba and Lincoln were used for evaluating the trustworthiness of the data. The data were analyzed using the conventional content analysis method according to the method suggested by Graneheim and Lundman.

The effective components of the petrochemical industry preparedness for fire were classified into six main categories and 16 subcategories. Categories and subcategories covered fire characteristics (nature and chain of fire), policy‑making (regulations, incident information documentation, and incident insurance incentives), and management factors (commitment and leadership, incident command, communication and information, and planning). The others involved support factors (equipment supply, coordination and cooperation, and training and awareness), safety culture (risk management, monitoring and auditing, inherently safe design), and sanction consequence (software and hardware).

Many factors affect the petrochemical industry’s preparedness for fire. Adopting effective management and appropriate policy regarding preparedness with strategies for promoting and developing a safety culture can improve the preparedness of petrochemical industries in disasters.

Trauma is a prominent reason for morbidity and death in Iran. The objective of this study was to provide epidemiological and clinical features of the injured patients admitted to one of the collaborating centers of the national trauma registry of Iran (NTRI).

The study was carried out at the one NTRI center from March 25, 2017, to November 20, 2020. Patients who had the NTRI criteria were included in the study. Data comprised demographics, injury information, prehospital and in‑hospital information, procedures, International Classification of Diseases 10 codes, diagnoses, injury severity, and outcomes.

Overall, 4043 trauma patients were included in the trauma. Of whom, 3036 (75.0%) were men. There was a statistically significant association between the cause of trauma and the severity of the injury. The post hoc test results demonstrated that the percentage of the injury severity score (ISS) ≥9 in patients with falls was higher than in patients with road traffic injuries (RTI) (26.9% vs. 16.8%, P = 0.01). The univariable and multiple logistic regression analyses showed statistically significant associations between age ≥65, cause of trauma, years of school, and ISS ≥9 with intensive care units (ICU) admission. After adjusting for age and cause of trauma, the odds of ICU admission in patients with ISS ≥9 were 6.23 times more than in patients with ISS <9 (odds ratio = 6.23, 95% confidence interval [4.92–7.88]).

The odds of ICU admission were higher in older patients (age ≥65), lower educated patients, patients with falling, and severe injuries.

Enteral alimentation is the preferred modality of support in critical patients who have acceptable digestive function and are unable to eat orally, but the advantages of continuous versus bolus administration are surrounded by controversy. This study aimed to examine the effect of tube feeding using the bolus method and continuous infusion on the clinical indicators of trauma patients in intensive care units (ICUs).

A randomized clinical trial of the triple blind was conducted on 74 trauma patients admitted to special care units of a university hospital in 2022. The patients were randomly assigned to two equal groups (n = 36). Feeding in the continuous group was carried out through an infusion pump while feeding in the bolus group was carried out by the usual bolus method. In addition, clinical indicators (intestinal excretion, gavage’s residual volume, vomiting, and pulmonary aspiration) were monitored for a period of 7 days in the patients. Data were analyzed using descriptive statistics, t‑tests, Chi‑square, and Fisher’s exact test by the SPSS software version 16.

Results of the study showed that the number of times the gavage’s residual volume was greater in the bolus group than in the continuous group (P = 0.02). Other results showed no statistical significant difference between the two groups regarding vomiting, intestinal excretion, and respiratory aspiration (P < 0.05).

The gavage’s residual volume did not increase during continuous infusion enteral feeding; therefore, this method is suitable for use in the ICU as a supportive feeding method.

Casting is the most commonly used method of treating fractures and protecting injured limbs. Nevertheless, inappropriate casting can cause severe complications. This study investigated the frequency of cast‑related complications and some of the associated factors.

A cross‑sectional study was conducted on 289 patients with limb fractures requiring casting. The study was conducted from November 1, 2020, to December 31, 2021. Postcasting complications were assessed using a checklist. Patients were instructed to examine the cast at home and report any complications to the researcher by telephone. Frequency, percentage, Chi‑square, Fisher’s exact test, and univariate and multivariate logistic regression were used to analyze the data.

The mean age of the patients was 36.51 ± 1.72 years. Most patients (52.6%) had a short‑leg cast. The mean duration of the cast was 2.66 ± 1.23 weeks. Most casts (82%) were applied by nurses. Totally, 85.5% of patients experienced at least one complication. Pain, numbness, movement disorders, swelling, and burning under the cast were the most common complications in the 1st week and occurred in 69.9%, 50.5%, 45%, 43.3%, and 39.4% of patients, respectively. In the regression analysis, patients’ marital status, age, place of residence, mobility status, sex, and body mass index of patients as well as the person who applied the cast and his work experience, were associated with some of the complications (P < 0.05).

More than two‑thirds of the patients who participated in this study experienced at least a cast‑related complication, indicating a high frequency of complications and the need to develop an appropriate follow‑up program to prevent or timely diagnose and treat cast‑related complications.

Rectus sheath hematoma (RSH) mainly occurs due to anticoagulant therapy, and blunt traumas may also rarely cause RSH. However, there is no case report published on the follow‑up and treatment process of RSH after stabbing. A 60‑year‑old man was admitted after stabbing himself for suicide. The patient had a history of using clopidogrel and oral antidiabetic drugs. On physical examination, there were many entrance holes (more than 10) in the anterior abdominal wall, the largest of which was in the periumbilical region, approximately 30 mm in size and reaching toward the intra‑abdominal cavity. On computed tomography, there was a RSH of roughly 95 mm × 55 mm and a wound about 25 mm in diameter on the lateral side of the umbilicus, including hyperdense areas thought to belong to active extravasation. Due to a hemoglobin level decrease, hypotension, and tachycardia, he underwent an emergency laparotomy. On exploration, there was no need to intervene in the RSH. The patient was discharged without complications on the 7th postoperative day.

Traumatic acetabular and ipsilateral femoral neck fracture combined with posterior traumatic hip dislocation is a rare presentation. Here, we described such a difficult case treated with one stage total hip arthroplasty (THA) with open reduction and internal fixation. The patient returned to his previous job with good function after 5 months postoperatively. The plain radiograph showed a well‑seated prosthesis position with no evidence of subsidence. This present article shows our experience with good results, and makes a literature review.