Archives of Trauma Research Archives of Trauma Research Arch Trauma Res http://www.archtrauma.com 2251-953X 2251-9599 10.5812/atr. en jalali 2017 11 22 gregorian 2017 11 22 2 1
en 10.5812/atr.11288 Towards an Integrative Approach to Trauma Study Towards an Integrative Approach to Trauma Study editorial editorial Health;Clinical Psychology;Injury Health;Clinical Psychology;Injury 1 2 http://www.archtrauma.com/index.php?page=article&article_id=11288 Abdollah Omidi Abdollah Omidi Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran; Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran. Tel.: +98-3615550026, Fax: +98-3615551112 Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran; Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran. Tel.: +98-3615550026, Fax: +98-3615551112
en 10.5812/atr.10894 The “Coagulation Box” and a New Hemoglobin-Driven Algorithm for Bleeding Control in Patients with Severe Multiple Traumas The “Coagulation Box” and a New Hemoglobin-Driven Algorithm for Bleeding Control in Patients with Severe Multiple Traumas research-article research-article Conclusions

An Hb-driven algorithm, in combination with the “coagulation box” and the early use of clotting factors, could be a simple and effective tool for improving coagulopathy in multiple trauma patients.

Results

Over a 12-month investigation period, 123 severe multiple trauma patients needing intensive care therapy were admitted to our trauma center (mean age 48 years, mean ISS (injury severity score) 30). Fourteen (11%) patients died; 25 (mean age 51.5 years, mean ISS 53) of the 123 patients were treated using the “coagulation box,” and 17 patients required massive transfusions. Patients treated with the “coagulation box” required an average dose of 16.3 RBC and 12.9 FFP, whereas 17 of the 25 patients required an average dose of 3.6 platelet packs. According to the algorithm, 25 patients received fibrinogen (average dose of 8.25 g), 24 (96%) received PCC (3000 IU.), 14 (56%) received desmopressin (36.6 µg), 13 (52%) received tranexamic acid (2.88 g), and 11 (44%) received factor VIIa (3.7 mg). The clotting parameters markedly improved between SR admission and ICU admission. Of the 25 patients, 16 (64%) survived. The revised injury severity classification (RISC) predicted a survival rate of 41%, which corresponds to a standardized mortality ratio (SMR) of 0.62, which implies a higher survival rate than predicted.

Background

Extensive hemorrhage is the leading cause of death in the first few hours following multiple traumas. Therefore, early and aggressive treatment of clotting disorders could reduce mortality. Unfortunately, the availability of results from commonly performed blood coagulation studies are often delayed whereas hemoglobin (Hb) levels are quickly available.

Objectives

In this study, we evaluated the use of initial hemoglobin (Hb) levels as a guide line for the initial treatment of clotting disorders in multiple trauma patients.

Patients and Methods

We have developed an Hb-driven algorithm to initiate the initial clotting therapy. The algorithm contains three different steps for aggressive clotting therapy depending on the first Hb value measured in the shock trauma room, (SR) and utilizes fibrinogen, prothrombin complex concentrate (PCC), factor VIIa, tranexamic acid and desmopressin. The above-mentioned drugs were stored in a special “coagulation box” in the hospital pharmacy, and this box could be immediately brought to the SR or operating room (OR) upon request. Despite the use of clotting factors, transfusions using red blood cells (RBC) and fresh frozen plasma (FFP) were performed at an RBC-to-FFP ratio of 2:1 to 1:1.

Conclusions

An Hb-driven algorithm, in combination with the “coagulation box” and the early use of clotting factors, could be a simple and effective tool for improving coagulopathy in multiple trauma patients.

Results

Over a 12-month investigation period, 123 severe multiple trauma patients needing intensive care therapy were admitted to our trauma center (mean age 48 years, mean ISS (injury severity score) 30). Fourteen (11%) patients died; 25 (mean age 51.5 years, mean ISS 53) of the 123 patients were treated using the “coagulation box,” and 17 patients required massive transfusions. Patients treated with the “coagulation box” required an average dose of 16.3 RBC and 12.9 FFP, whereas 17 of the 25 patients required an average dose of 3.6 platelet packs. According to the algorithm, 25 patients received fibrinogen (average dose of 8.25 g), 24 (96%) received PCC (3000 IU.), 14 (56%) received desmopressin (36.6 µg), 13 (52%) received tranexamic acid (2.88 g), and 11 (44%) received factor VIIa (3.7 mg). The clotting parameters markedly improved between SR admission and ICU admission. Of the 25 patients, 16 (64%) survived. The revised injury severity classification (RISC) predicted a survival rate of 41%, which corresponds to a standardized mortality ratio (SMR) of 0.62, which implies a higher survival rate than predicted.

Background

Extensive hemorrhage is the leading cause of death in the first few hours following multiple traumas. Therefore, early and aggressive treatment of clotting disorders could reduce mortality. Unfortunately, the availability of results from commonly performed blood coagulation studies are often delayed whereas hemoglobin (Hb) levels are quickly available.

Objectives

In this study, we evaluated the use of initial hemoglobin (Hb) levels as a guide line for the initial treatment of clotting disorders in multiple trauma patients.

Patients and Methods

We have developed an Hb-driven algorithm to initiate the initial clotting therapy. The algorithm contains three different steps for aggressive clotting therapy depending on the first Hb value measured in the shock trauma room, (SR) and utilizes fibrinogen, prothrombin complex concentrate (PCC), factor VIIa, tranexamic acid and desmopressin. The above-mentioned drugs were stored in a special “coagulation box” in the hospital pharmacy, and this box could be immediately brought to the SR or operating room (OR) upon request. Despite the use of clotting factors, transfusions using red blood cells (RBC) and fresh frozen plasma (FFP) were performed at an RBC-to-FFP ratio of 2:1 to 1:1.

Trauma;Hemorrhage;Coagulation Disorder;Bleeding Control;Blood Coagulation Factors Trauma;Hemorrhage;Coagulation Disorder;Bleeding Control;Blood Coagulation Factors 3 10 http://www.archtrauma.com/index.php?page=article&article_id=10894 Peter Hilbert Peter Hilbert Department of Anesthesiology, Intensive Care and Emergency Medicine, BG-Kliniken Bergmannstrost, Halle, Germany; Department of Anesthesiology, Intensive Care and Emergency Medicine, BG-Kliniken Bergmannstrost, Merseburger Str. 165, 06112 Halle (Saale) / Germany. Tel: +49-3451327716, Fax: +49-3451326344 Department of Anesthesiology, Intensive Care and Emergency Medicine, BG-Kliniken Bergmannstrost, Halle, Germany; Department of Anesthesiology, Intensive Care and Emergency Medicine, BG-Kliniken Bergmannstrost, Merseburger Str. 165, 06112 Halle (Saale) / Germany. Tel: +49-3451327716, Fax: +49-3451326344 Gunther Olaf Hofmann Gunther Olaf Hofmann Department of Trauma and Reconstructive Surgery, Friedrich-Schiller-University Jena, BG-Kliniken Bergmannstrost, Halle, Germany Department of Trauma and Reconstructive Surgery, Friedrich-Schiller-University Jena, BG-Kliniken Bergmannstrost, Halle, Germany Jörg Teichmann Jörg Teichmann Department of Pharmacy, BG-Kliniken Bergmannstrost, Halle, Germany Department of Pharmacy, BG-Kliniken Bergmannstrost, Halle, Germany Manuel F. Struck Manuel F. Struck Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, Leipzig, Germany Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, Leipzig, Germany Ralph Stuttmann Ralph Stuttmann Department of Anesthesiology, Intensive Care and Emergency Medicine, BG-Kliniken Bergmannstrost, Halle, Germany Department of Anesthesiology, Intensive Care and Emergency Medicine, BG-Kliniken Bergmannstrost, Halle, Germany
en 10.5812/atr.10687 Utility of the Cortical Thickness of the Distal Radius as a Predictor of Distal-Radius Bone Density Utility of the Cortical Thickness of the Distal Radius as a Predictor of Distal-Radius Bone Density research-article research-article Conclusions

The outside diameter/inside diameter ratio at the metaphyseal/diaphyseal junction of the distal radius on AP radiographs is suitable for use as a predictor of distal-radius bone density. Further studies should be performed, and clinical utility evaluated.

Results

The mean BMD was 0.559 (SD = 0.236) g / cm2. The mean outside diameter/inside diameter ratio was 1.24 (SD = 0.013); the ratio significantly correlated with the total BMD (P = 0.001; R2 = 0.710). In the BMD subregions, the correlation was also significant.

Patients and Methods

Six pairs of human cadaveric radii were harvested. The mean donor age was 74 years. Standardized AP radiographs were taken of the radii. The outside diameter and the inside diameter of the cortical shell at the metaphyseal / diaphyseal junction were measured and their ratio was calculated. Dual-energy x-ray absorptiometry (DXA) was used to obtain the bone mineral density (BMD) of the distal parts of the radii. The correlation of the BMD values with these ratios was studied.

Background

Bone density is an important factor in the management of fractures of the distal radius.

Objectives

The aim of this study was to establish whether standard anteroposterior (AP) radiographs would provide the attending physician with a prediction of bone density.

Conclusions

The outside diameter/inside diameter ratio at the metaphyseal/diaphyseal junction of the distal radius on AP radiographs is suitable for use as a predictor of distal-radius bone density. Further studies should be performed, and clinical utility evaluated.

Results

The mean BMD was 0.559 (SD = 0.236) g / cm2. The mean outside diameter/inside diameter ratio was 1.24 (SD = 0.013); the ratio significantly correlated with the total BMD (P = 0.001; R2 = 0.710). In the BMD subregions, the correlation was also significant.

Patients and Methods

Six pairs of human cadaveric radii were harvested. The mean donor age was 74 years. Standardized AP radiographs were taken of the radii. The outside diameter and the inside diameter of the cortical shell at the metaphyseal / diaphyseal junction were measured and their ratio was calculated. Dual-energy x-ray absorptiometry (DXA) was used to obtain the bone mineral density (BMD) of the distal parts of the radii. The correlation of the BMD values with these ratios was studied.

Background

Bone density is an important factor in the management of fractures of the distal radius.

Objectives

The aim of this study was to establish whether standard anteroposterior (AP) radiographs would provide the attending physician with a prediction of bone density.

Distal Radius;Bone Density;Cortical Thickness;Bone Fractures Distal Radius;Bone Density;Cortical Thickness;Bone Fractures 11 15 http://www.archtrauma.com/index.php?page=article&article_id=10687 Sascha Rausch Sascha Rausch Department of Traumatology, Hand and Reconstructive Surgery, Friedrich-Schiller-Universität Jena, Germany +49-3641322889, sascha.rausch@med.uni-jena.de; Department of Traumatology, Hand and Reconstructive Surgery. Friedrich-Schiller-Universität Jena, Jena, Germany. Tel.: +49-3641322889, Fax: +49-36419322802 Department of Traumatology, Hand and Reconstructive Surgery, Friedrich-Schiller-Universität Jena, Germany +49-3641322889, sascha.rausch@med.uni-jena.de; Department of Traumatology, Hand and Reconstructive Surgery. Friedrich-Schiller-Universität Jena, Jena, Germany. Tel.: +49-3641322889, Fax: +49-36419322802 Kajetan Klos Kajetan Klos Department of Traumatology, Hand and Reconstructive Surgery, Friedrich-Schiller-Universität Jena, Germany +49-3641322889, sascha.rausch@med.uni-jena.de Department of Traumatology, Hand and Reconstructive Surgery, Friedrich-Schiller-Universität Jena, Germany +49-3641322889, sascha.rausch@med.uni-jena.de Florian Gras Florian Gras Department of Traumatology, Hand and Reconstructive Surgery, Friedrich-Schiller-Universität Jena, Germany +49-3641322889, sascha.rausch@med.uni-jena.de Department of Traumatology, Hand and Reconstructive Surgery, Friedrich-Schiller-Universität Jena, Germany +49-3641322889, sascha.rausch@med.uni-jena.de Hristo Kostov Skulev Hristo Kostov Skulev Arbeitsgemeinschaft für Osteosynthesefragen, Switzerland Arbeitsgemeinschaft für Osteosynthesefragen, Switzerland Albrecht Popp Albrecht Popp Technical University of Varna, Bulgaria Technical University of Varna, Bulgaria Gunther Olaf Hofmann Gunther Olaf Hofmann Department of Traumatology, Hand and Reconstructive Surgery, Friedrich-Schiller-Universität Jena, Germany +49-3641322889, sascha.rausch@med.uni-jena.de Department of Traumatology, Hand and Reconstructive Surgery, Friedrich-Schiller-Universität Jena, Germany +49-3641322889, sascha.rausch@med.uni-jena.de Thomas Mückley Thomas Mückley Department of Traumatology and Orthopaedic Surgery Helios Klinikum Erfurt, Germany Department of Traumatology and Orthopaedic Surgery Helios Klinikum Erfurt, Germany
en 10.5812/atr.10638 Is a Magnetic-Manual Targeting Device an Appealing Alternative for Distal Locking of Tibial Intramedullary Nails? Is a Magnetic-Manual Targeting Device an Appealing Alternative for Distal Locking of Tibial Intramedullary Nails? research-article research-article Conclusions

Due to our satisfactory test results, the brief training, the steep learning curve and the radiation-free technique the new device has to be considered an appealing alternative for distal locking.

Objectives

Our cadaver study was performed to evaluate the accuracy and efficiency of this device.

Materials and Methods

In two runs, 30 probands (group 1: 10 students; group 2: 10 residents; group 3: 10 attendings), none of who being familiar with the device, tested the radiation-free system using 60 intact cadaver tibias. Each proband performed the surgical procedure twice in succession.

Results

Referring to the first attempts, 9.6, 7.2 and 7.1 minutes were the time periods required to insert the four distal screws and the relevant values for the second attempts were 8.6, 6.3 and 6.2 minutes; in both cases revealing a significant difference between group 1 and 2 and group 1 and 3. Furthermore, the mean values within each group indicated a significant decrease of the test duration. Out of the 240 drillings, only one failure (group 1) occurred, representing an accuracy of 99.58 %. Of the probands, 90 % rated the targeting device better than the free-hand technique and 77 % at least attested a high user-friendliness.

Background

In order to enable a radiation-free, accurate and simple positioning of distal locking screws, a combined magnetic and manual targeting system has been developed by Sanatmetal®. Where a low-frequency magnetic field is initially used to detect the position of the first drill hole and three more holes can be found with a mechanical template.

Conclusions

Due to our satisfactory test results, the brief training, the steep learning curve and the radiation-free technique the new device has to be considered an appealing alternative for distal locking.

Objectives

Our cadaver study was performed to evaluate the accuracy and efficiency of this device.

Materials and Methods

In two runs, 30 probands (group 1: 10 students; group 2: 10 residents; group 3: 10 attendings), none of who being familiar with the device, tested the radiation-free system using 60 intact cadaver tibias. Each proband performed the surgical procedure twice in succession.

Results

Referring to the first attempts, 9.6, 7.2 and 7.1 minutes were the time periods required to insert the four distal screws and the relevant values for the second attempts were 8.6, 6.3 and 6.2 minutes; in both cases revealing a significant difference between group 1 and 2 and group 1 and 3. Furthermore, the mean values within each group indicated a significant decrease of the test duration. Out of the 240 drillings, only one failure (group 1) occurred, representing an accuracy of 99.58 %. Of the probands, 90 % rated the targeting device better than the free-hand technique and 77 % at least attested a high user-friendliness.

Background

In order to enable a radiation-free, accurate and simple positioning of distal locking screws, a combined magnetic and manual targeting system has been developed by Sanatmetal®. Where a low-frequency magnetic field is initially used to detect the position of the first drill hole and three more holes can be found with a mechanical template.

Orthopedic Procedure, Fracture Fixation, Intramedullary Nailing Orthopedic Procedure, Fracture Fixation, Intramedullary Nailing 16 20 http://www.archtrauma.com/index.php?page=article&article_id=10638 Lukas L. Negrin Lukas L. Negrin Department of Trauma Surgery, Medical University of Vienna, Vienna, Austria; Department of Trauma Surgery, Medical University of Vienna, Vienna, Austria. Tel: +43-1404005901, Fax: +43-1404005939 Department of Trauma Surgery, Medical University of Vienna, Vienna, Austria; Department of Trauma Surgery, Medical University of Vienna, Vienna, Austria. Tel: +43-1404005901, Fax: +43-1404005939 Vilmos Vécsei Vilmos Vécsei Department of Trauma Surgery, Medical University of Vienna, Vienna, Austria Department of Trauma Surgery, Medical University of Vienna, Vienna, Austria
en 10.5812/atr.6617 Do Patients with Penetrating Abdominal Stab Wounds Require Laparotomy? Do Patients with Penetrating Abdominal Stab Wounds Require Laparotomy? research-article research-article Background

The optimal management of hemodynamically stable asymptomatic patients with anterior abdominal stab wounds (AASWs) remains controversial. The goal is to identify and treat injuries in a safe cost-effective manner. Common evaluation strategies are local wound exploration (LWE), diagnostic peritoneal lavage (DPL), serial clinical assessment (SCAs) and computed tomography (CT) imaging. Making a decision about the right time to operate on a patient with a penetrating abdominal stab wound, especially those who have visceral evisceration, is a continuing challenge.

Objectives

Until the year 2010, our strategy was emergency laparotomy in patients with penetrating anterior fascia and those with visceral evisceration. This survey was conducted towards evaluating the results of emergency laparotomy. So, better management can be done in patients with penetrating abdominal stab wounds.

Patients and Methods

This retrospective cross-sectional study was performed on patients with abdominal penetrating trauma who referred to Al- Zahra hospital in Isfahan, Iran from October 2000 to October 2010. It should be noted that patients with abdominal blunt trauma, patients under 14 years old, those with lateral abdomen penetrating trauma and patients who had unstable hemodynamic status were excluded from the study. Medical records of patients were reviewed and demographic and clinical data were collected for all patients including: age, sex, mechanism of trauma and the results of LWE and laparotomy. Data were analyzed with PASW v.20 software. All data were expressed as mean ± SD. The distribution of nominal variables was compared using the Chi-squared test. Also diagnostic index for LWE were calculated. A two-sided P value less than 0.05 was considered to be statistically significant.

Results

During the 10 year period of the study, 1100 consecutive patients with stab wounds were admitted to Al-Zahra hospital Isfahan, Iran. In total, about 150 cases had penetrating traumas in the anterior abdomen area. Sixty-three (42%) patients were operated immediately due to shock, visceral evisceration or aspiration of blood via a nasogastric tube on admission. Organ injury was seen in 78% of patients with visceral evisceration. Among these 87 cases, 29 patients’ (33.3%) anterior fascia was not penetrated in LWE. So, they were observed for several hours and discharged from the hospital without surgery. While for the remaining 58 patients (66.6%), whose LWE detected penetration of anterior abdominal fascia, laparotomy was performed which showed visceral injuries in 11 (18%) cases.

Conclusions

All in all, 82 percent of laparotomies in patients with penetrated anterior abdominal fascia without visceral evisceration, who had no signs of peritoneal irritation, were negative. So, we recommended further evaluation in these patients. However, visceral evisceration is an indication for exploratory laparotomy, since in our study; the majority of patients had organ damages.

Background

The optimal management of hemodynamically stable asymptomatic patients with anterior abdominal stab wounds (AASWs) remains controversial. The goal is to identify and treat injuries in a safe cost-effective manner. Common evaluation strategies are local wound exploration (LWE), diagnostic peritoneal lavage (DPL), serial clinical assessment (SCAs) and computed tomography (CT) imaging. Making a decision about the right time to operate on a patient with a penetrating abdominal stab wound, especially those who have visceral evisceration, is a continuing challenge.

Objectives

Until the year 2010, our strategy was emergency laparotomy in patients with penetrating anterior fascia and those with visceral evisceration. This survey was conducted towards evaluating the results of emergency laparotomy. So, better management can be done in patients with penetrating abdominal stab wounds.

Patients and Methods

This retrospective cross-sectional study was performed on patients with abdominal penetrating trauma who referred to Al- Zahra hospital in Isfahan, Iran from October 2000 to October 2010. It should be noted that patients with abdominal blunt trauma, patients under 14 years old, those with lateral abdomen penetrating trauma and patients who had unstable hemodynamic status were excluded from the study. Medical records of patients were reviewed and demographic and clinical data were collected for all patients including: age, sex, mechanism of trauma and the results of LWE and laparotomy. Data were analyzed with PASW v.20 software. All data were expressed as mean ± SD. The distribution of nominal variables was compared using the Chi-squared test. Also diagnostic index for LWE were calculated. A two-sided P value less than 0.05 was considered to be statistically significant.

Results

During the 10 year period of the study, 1100 consecutive patients with stab wounds were admitted to Al-Zahra hospital Isfahan, Iran. In total, about 150 cases had penetrating traumas in the anterior abdomen area. Sixty-three (42%) patients were operated immediately due to shock, visceral evisceration or aspiration of blood via a nasogastric tube on admission. Organ injury was seen in 78% of patients with visceral evisceration. Among these 87 cases, 29 patients’ (33.3%) anterior fascia was not penetrated in LWE. So, they were observed for several hours and discharged from the hospital without surgery. While for the remaining 58 patients (66.6%), whose LWE detected penetration of anterior abdominal fascia, laparotomy was performed which showed visceral injuries in 11 (18%) cases.

Conclusions

All in all, 82 percent of laparotomies in patients with penetrated anterior abdominal fascia without visceral evisceration, who had no signs of peritoneal irritation, were negative. So, we recommended further evaluation in these patients. However, visceral evisceration is an indication for exploratory laparotomy, since in our study; the majority of patients had organ damages.

Anterior Abdominal Stab Wound;Patients;Urgent Laparotomy Anterior Abdominal Stab Wound;Patients;Urgent Laparotomy 21 25 http://www.archtrauma.com/index.php?page=article&article_id=6617 Behnam Sanei Behnam Sanei Department of Surgery, Isfahan University of Medical Sciences, Isfahan, IR Iran Department of Surgery, Isfahan University of Medical Sciences, Isfahan, IR Iran Mohsen Mahmoudieh Mohsen Mahmoudieh Department of Surgery, Isfahan University of Medical Sciences, Isfahan, IR Iran Department of Surgery, Isfahan University of Medical Sciences, Isfahan, IR Iran Hamid Talebzadeh Hamid Talebzadeh Department of Surgery, Isfahan University of Medical Sciences, Isfahan, IR Iran; Department of Surgery, Isfahan University of Medical Sciences, Isfahan, IR Iran Department of Surgery, Isfahan University of Medical Sciences, Isfahan, IR Iran; Department of Surgery, Isfahan University of Medical Sciences, Isfahan, IR Iran Shahab Shahabi Shahmiri Shahab Shahabi Shahmiri Department of Surgery, Isfahan University of Medical Sciences, Isfahan, IR Iran Department of Surgery, Isfahan University of Medical Sciences, Isfahan, IR Iran Zahra Aghaei Zahra Aghaei Department of Surgery, Isfahan University of Medical Sciences, Isfahan, IR Iran Department of Surgery, Isfahan University of Medical Sciences, Isfahan, IR Iran
en 10.5812/atr.10570 Effect of Supination Versus Pronation in the Non-Operative Treatment of Pediatric Supracondylar Humerus Fractures Effect of Supination Versus Pronation in the Non-Operative Treatment of Pediatric Supracondylar Humerus Fractures research-article research-article Background

Supracondylar fracture of the humerus is the most common elbow injury that requires reduction and immobilization in the proper position to union. There are a few reports regarding the position of the forearm immobilization on elbow cosmetic outcome.

Objectives

This study aimed to compare two modes of the forearm, supination and pronation in elbow deformity incidence after closed reduction and casting of this fracture.

Patients and Methods

This prospective and descriptive study was carried out on children with supracondylar fracture of the humerus treated with closed reduction and cast immobilization in one of the two modes of either supination or pronation for a period of three weeks. Twenty-nine patients were immobilized in supination and 35 in pronation. Follow-up lasted for 8 months. Re-displacement was defined as the criteria and subsequent deformities of the elbow in patients, were assessed by clinical and radiographic examination.

Results

A total of 64 patients, 50 boys and 14 girls, with the mean age of 4.8 years (3.1 to 8.5 years) participated. All fractures were closed and of the extension type. Forty-five cases had Gartland type II and 19 had type III fracture. Deformity of the elbow had occurred in seven cases (10.94%). Four cases of cubitus varus (CA 5 º - 16º) were observed in the supination group, of these, three patients had type III and one other had a type II fracture. In the pronation group, two cases of cubitus varus (CA 6 º - 14º) and one case of cubitus valgus (CA 17º) were observed, with type III initial fracture in all 3 cases.

Conclusions

In regard to elbow malunion deformity, no obvious difference was observed between the two methods of supination and pronation in the closed treatment of supracondylar humerus fracture. However, as cubitus varus and valgus had occurred in both groups with unstable type III fractures, to prevent this complication, operative fixation is advised rather than closed reduction and position of the forearm immobilization.

Background

Supracondylar fracture of the humerus is the most common elbow injury that requires reduction and immobilization in the proper position to union. There are a few reports regarding the position of the forearm immobilization on elbow cosmetic outcome.

Objectives

This study aimed to compare two modes of the forearm, supination and pronation in elbow deformity incidence after closed reduction and casting of this fracture.

Patients and Methods

This prospective and descriptive study was carried out on children with supracondylar fracture of the humerus treated with closed reduction and cast immobilization in one of the two modes of either supination or pronation for a period of three weeks. Twenty-nine patients were immobilized in supination and 35 in pronation. Follow-up lasted for 8 months. Re-displacement was defined as the criteria and subsequent deformities of the elbow in patients, were assessed by clinical and radiographic examination.

Results

A total of 64 patients, 50 boys and 14 girls, with the mean age of 4.8 years (3.1 to 8.5 years) participated. All fractures were closed and of the extension type. Forty-five cases had Gartland type II and 19 had type III fracture. Deformity of the elbow had occurred in seven cases (10.94%). Four cases of cubitus varus (CA 5 º - 16º) were observed in the supination group, of these, three patients had type III and one other had a type II fracture. In the pronation group, two cases of cubitus varus (CA 6 º - 14º) and one case of cubitus valgus (CA 17º) were observed, with type III initial fracture in all 3 cases.

Conclusions

In regard to elbow malunion deformity, no obvious difference was observed between the two methods of supination and pronation in the closed treatment of supracondylar humerus fracture. However, as cubitus varus and valgus had occurred in both groups with unstable type III fractures, to prevent this complication, operative fixation is advised rather than closed reduction and position of the forearm immobilization.

Fractures;Supracondylar Humerus Fracture;Supination;Pronation Fractures;Supracondylar Humerus Fracture;Supination;Pronation 26 29 http://www.archtrauma.com/index.php?page=article&article_id=10570 Seyed Ali Marashi Nejad Seyed Ali Marashi Nejad Department of Orthopedics, Musculoskeletal and Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran Department of Orthopedics, Musculoskeletal and Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran Seyed Abdolhossein Mehdi Nasab Seyed Abdolhossein Mehdi Nasab Department of Orthopedics, Musculoskeletal and Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran; Department of Orthopedics, Musculoskeletal and Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran. Tel./Fax: +98-6112921836 Department of Orthopedics, Musculoskeletal and Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran; Department of Orthopedics, Musculoskeletal and Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran. Tel./Fax: +98-6112921836 Mohammad Baianfar Mohammad Baianfar Department of Orthopedics, Nikan Hospital, Tehran, IR Iran Department of Orthopedics, Nikan Hospital, Tehran, IR Iran
en 10.5812/atr.9411 Calculation of the Probability of Survival for Trauma Patients Based on Trauma Score and the Injury Severity Score Model in Fatemi Hospital in Ardabil Calculation of the Probability of Survival for Trauma Patients Based on Trauma Score and the Injury Severity Score Model in Fatemi Hospital in Ardabil research-article research-article Conclusions

We can conclude that the surveillance presented to our injured group probably had some defects that need to be revised in therapeutic services to enhance survival requirements.

Objectives

The aim of this study was to evaluate the outcome of trauma cases using the trauma score and the injury severity score (TRISS) model and then comparing this with the results of a major trauma outcome study (MTOS) carried out in the US.

Patients and Methods

This study is a retrospective, descriptive and analytical study on 1000 patients aged 2 - 82 years old with closed or penetrating traumas staying at Ardebil Fatemi hospital. In this study, injury severity score (ISS), revised trauma score (RTS), and TRISS were calculated and patients\' viability ratios were obtained.

Results

The results showed that 714 patients (71.4%) were male and 286 patients (28.6%) female with the mean age of 35.68 years. In this study 45 (4.5%) and 955 patients (95.5%) had penetrating and blunt traumas, respectively, whereby the head and neck were the most prevalent (74%) areas of injury. The most common reason for these traumas was, accident with vehicles with 670 cases (67%), which resulted in hospitalization. From this group, ninety-seven cases (9.7%) died in the hospital. From these results, calculations of ISS and RTS were 15.50 ± 11.31 and 7.49 ± 0.79, respectively. According to the calculation of the TRISS model, 91.5% of trauma victims should be survived, while only 90.3% survived practically.

Background

Trauma, in addition to economic and social costs, is the fourth cause of death in the world and in the year 2000 alone, it led to the death of more than 6000000 people. In Iran, Trauma has the first burden of disease and also needs a long medical surveillance.

Conclusions

We can conclude that the surveillance presented to our injured group probably had some defects that need to be revised in therapeutic services to enhance survival requirements.

Objectives

The aim of this study was to evaluate the outcome of trauma cases using the trauma score and the injury severity score (TRISS) model and then comparing this with the results of a major trauma outcome study (MTOS) carried out in the US.

Patients and Methods

This study is a retrospective, descriptive and analytical study on 1000 patients aged 2 - 82 years old with closed or penetrating traumas staying at Ardebil Fatemi hospital. In this study, injury severity score (ISS), revised trauma score (RTS), and TRISS were calculated and patients\' viability ratios were obtained.

Results

The results showed that 714 patients (71.4%) were male and 286 patients (28.6%) female with the mean age of 35.68 years. In this study 45 (4.5%) and 955 patients (95.5%) had penetrating and blunt traumas, respectively, whereby the head and neck were the most prevalent (74%) areas of injury. The most common reason for these traumas was, accident with vehicles with 670 cases (67%), which resulted in hospitalization. From this group, ninety-seven cases (9.7%) died in the hospital. From these results, calculations of ISS and RTS were 15.50 ± 11.31 and 7.49 ± 0.79, respectively. According to the calculation of the TRISS model, 91.5% of trauma victims should be survived, while only 90.3% survived practically.

Background

Trauma, in addition to economic and social costs, is the fourth cause of death in the world and in the year 2000 alone, it led to the death of more than 6000000 people. In Iran, Trauma has the first burden of disease and also needs a long medical surveillance.

Wounds and Injuries;Survival;Mortality Wounds and Injuries;Survival;Mortality 30 35 http://www.archtrauma.com/index.php?page=article&article_id=9411 Vadood Norouzi Vadood Norouzi Department of Anesthesia, Ardabil University of Medical Sciences, Ardabil, IR Iran Department of Anesthesia, Ardabil University of Medical Sciences, Ardabil, IR Iran Iraj Feizi Iraj Feizi Department of Surgery, Ardabil University of Medical Sciences, Ardabil, IR Iran Department of Surgery, Ardabil University of Medical Sciences, Ardabil, IR Iran Soodabe Vatankhah Soodabe Vatankhah Department of Health Care Services Management, Tehran University of Medical Sciences, Tehran, IR Iran Department of Health Care Services Management, Tehran University of Medical Sciences, Tehran, IR Iran Majid Pourshaikhian Majid Pourshaikhian Department of Health Care Services Management, Tehran University of Medical Sciences, Tehran, IR Iran; Department of Health Care Services Management, Tehran University of Medical Sciences, IR Iran +98-2188793805, pourshaikhian@razi.tums.ac.ir Department of Health Care Services Management, Tehran University of Medical Sciences, Tehran, IR Iran; Department of Health Care Services Management, Tehran University of Medical Sciences, IR Iran +98-2188793805, pourshaikhian@razi.tums.ac.ir
en 10.5812/atr.10338 Acromioclavicular Joint Fixation Using an Acroplate Combined With a Coracoclavicular Screw Acromioclavicular Joint Fixation Using an Acroplate Combined With a Coracoclavicular Screw research-article research-article Background

Appropriate treatment of acromioclavicular joint dislocation is controversial. Acroplate fixation is one of the most common treatment methods of acromioclavicular joint (ACJ) dislocation. Based on the risk of re-dislocation after Acroplate fixation, we assumed that combined fixation with an Acroplate and a coracoclavicular screw helps improve the outcome.

Objectives

The main purpose of the current study was to compare the outcome of ACJ dislocation treated with an Acroplate alone and in combination with coracoclavicular screw.

Patients and Methods

This study was carried out on 40 patients with ACJ dislocation types III to VI who were divided randomly into two equal groups: Acroplate group (P) and Acroplate in combination with coracoclavicular screw group (P + S). The screws were extracted 3-6 months postoperatively. The patients were followed for 1 year and Imatani’s score was calculated. Finally, the data were compared between the groups.

Results

The mean Imatani’s score was significantly higher in P + S group (83.4 ± 14.1) than P group (81.2 ± 10.3) (P < 0.001). The mean duration of surgery was the same in the two groups (59.8 ± 9.4 minutes in group P V.s 64.3 ± 10.9 minutes in group P + S; P = 0.169). There were no cases of re-dislocation, degenerative changes and ossification and all patients returned to their previous jobs or sporting activities.

Conclusions

Using a coracoclavicular screw combined with an Acroplate can improve the patients’ function after ACJ disruption without any significant increase in surgical duration. Authors recommend this technique in the fixation of ACJ dislocation.

Background

Appropriate treatment of acromioclavicular joint dislocation is controversial. Acroplate fixation is one of the most common treatment methods of acromioclavicular joint (ACJ) dislocation. Based on the risk of re-dislocation after Acroplate fixation, we assumed that combined fixation with an Acroplate and a coracoclavicular screw helps improve the outcome.

Objectives

The main purpose of the current study was to compare the outcome of ACJ dislocation treated with an Acroplate alone and in combination with coracoclavicular screw.

Patients and Methods

This study was carried out on 40 patients with ACJ dislocation types III to VI who were divided randomly into two equal groups: Acroplate group (P) and Acroplate in combination with coracoclavicular screw group (P + S). The screws were extracted 3-6 months postoperatively. The patients were followed for 1 year and Imatani’s score was calculated. Finally, the data were compared between the groups.

Results

The mean Imatani’s score was significantly higher in P + S group (83.4 ± 14.1) than P group (81.2 ± 10.3) (P < 0.001). The mean duration of surgery was the same in the two groups (59.8 ± 9.4 minutes in group P V.s 64.3 ± 10.9 minutes in group P + S; P = 0.169). There were no cases of re-dislocation, degenerative changes and ossification and all patients returned to their previous jobs or sporting activities.

Conclusions

Using a coracoclavicular screw combined with an Acroplate can improve the patients’ function after ACJ disruption without any significant increase in surgical duration. Authors recommend this technique in the fixation of ACJ dislocation.

Acromioclavicular Joint;Acroplate;Bone Screw Acromioclavicular Joint;Acroplate;Bone Screw 36 39 http://www.archtrauma.com/index.php?page=article&article_id=10338 Reza Tavakoli Darestani Reza Tavakoli Darestani Orthopedics Surgery Department, Beheshti University of Medical Sciences, Tehran, IR Iran Orthopedics Surgery Department, Beheshti University of Medical Sciences, Tehran, IR Iran Arash Ghaffari Arash Ghaffari Orthopedics Surgery Department, Beheshti University of Medical Sciences, Tehran, IR Iran Orthopedics Surgery Department, Beheshti University of Medical Sciences, Tehran, IR Iran Mehrdad Hosseinpour Mehrdad Hosseinpour Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran; Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran. Tel: +98-3112335547, Fax: +98-3615620634 Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran; Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran. Tel: +98-3112335547, Fax: +98-3615620634
en 10.5812/atr.10862 Role of Endovascular Grafts in Combined Vascular and Skeletal Injuries of the Lower Extremity: a Preliminary Report Role of Endovascular Grafts in Combined Vascular and Skeletal Injuries of the Lower Extremity: a Preliminary Report case-report case-report Background

A gunshot wound to the lower extremity with combined skeletal and vascular injuries can be difficult to manage. In clinical practice, it is not always possible to assemble a multispecialty team to work seamlessly to attain this goal, and the end result may be unnecessary prolonged ischemic time. A covered endovascular stent (EVS) can be used initially to restore perfusion without need of a time-consuming temporary shunt in select cases.

Objectives

The objective of this study is to compare novel methods of repairing the superficial femoral artery to the traditional three-step operative approach in patients that have a concomitant femur fracture.

Patients and Methods

All patients with combined vascular and skeletal injuries to the lower extremity were reviewed retrospectively. Patients were divided into three groups: Group 1: EVS placed percutaneously. Group 2: EVS placed with a hybrid combination of open and endovascular technique. Group 3: Placement of temporary shunt followed by skeletal stabilization and definitive vascular repair.

Results

There were 16 patients identified. Group 1 = three, Group 2 = six, Group 3 = seven. EVS can shorten time to revascularization and prevents a second episode of vascular interruption at the time of the final vascular repair. The structural stability of the EVS was strong enough to withstand the skeletal manipulation without deformation of the stent.

Conclusions

EVS is comparable to open repair and has the strength to withstand orthopedic manipulation in the short term when used in combined vascular and skeletal injuries to the lower extremity. Ischemic time is reduced significantly if final revascularization is accomplished at the onset with an EVS and the process is more efficient if the trauma surgeon is able to repair the vascular injury. With increasing sophistication of endovascular devices, this offers an appealing approach to vascular injuries that will decrease ischemic and total operative times when compared to the more traditional three-stage repair.

Background

A gunshot wound to the lower extremity with combined skeletal and vascular injuries can be difficult to manage. In clinical practice, it is not always possible to assemble a multispecialty team to work seamlessly to attain this goal, and the end result may be unnecessary prolonged ischemic time. A covered endovascular stent (EVS) can be used initially to restore perfusion without need of a time-consuming temporary shunt in select cases.

Objectives

The objective of this study is to compare novel methods of repairing the superficial femoral artery to the traditional three-step operative approach in patients that have a concomitant femur fracture.

Patients and Methods

All patients with combined vascular and skeletal injuries to the lower extremity were reviewed retrospectively. Patients were divided into three groups: Group 1: EVS placed percutaneously. Group 2: EVS placed with a hybrid combination of open and endovascular technique. Group 3: Placement of temporary shunt followed by skeletal stabilization and definitive vascular repair.

Results

There were 16 patients identified. Group 1 = three, Group 2 = six, Group 3 = seven. EVS can shorten time to revascularization and prevents a second episode of vascular interruption at the time of the final vascular repair. The structural stability of the EVS was strong enough to withstand the skeletal manipulation without deformation of the stent.

Conclusions

EVS is comparable to open repair and has the strength to withstand orthopedic manipulation in the short term when used in combined vascular and skeletal injuries to the lower extremity. Ischemic time is reduced significantly if final revascularization is accomplished at the onset with an EVS and the process is more efficient if the trauma surgeon is able to repair the vascular injury. With increasing sophistication of endovascular devices, this offers an appealing approach to vascular injuries that will decrease ischemic and total operative times when compared to the more traditional three-stage repair.

Endovascular Procedures;Stents;Bone Fractures;Wounds and Injuries Endovascular Procedures;Stents;Bone Fractures;Wounds and Injuries 40 45 http://www.archtrauma.com/index.php?page=article&article_id=10862 Jon David Simmons Jon David Simmons Division of Trauma and Surgical Critical Care, University of South Alabama, USA; Division of Trauma and Surgical Critical Care, University of South Alabama, USA +1-2514717971, jdsimmons@usouthal.edu Division of Trauma and Surgical Critical Care, University of South Alabama, USA; Division of Trauma and Surgical Critical Care, University of South Alabama, USA +1-2514717971, jdsimmons@usouthal.edu William Bryant Walker William Bryant Walker Section of Trauma and Surgical Critical Care, University of Mississippi Medical Center, Jackson, Mississippi, USA Section of Trauma and Surgical Critical Care, University of Mississippi Medical Center, Jackson, Mississippi, USA Joseph William Gunter III Joseph William Gunter III Section of Trauma and Surgical Critical Care, University of Mississippi Medical Center, Jackson, Mississippi, USA Section of Trauma and Surgical Critical Care, University of Mississippi Medical Center, Jackson, Mississippi, USA Naveed Ahmed Naveed Ahmed Section of Trauma and Surgical Critical Care, University of Mississippi Medical Center, Jackson, Mississippi, USA Section of Trauma and Surgical Critical Care, University of Mississippi Medical Center, Jackson, Mississippi, USA
en 10.5812/atr.9250 Firecracker Injuries During Chaharshanbeh Soori Festival In Iran: a Case Series Study Firecracker Injuries During Chaharshanbeh Soori Festival In Iran: a Case Series Study case-report case-report

On the last Wednesday of every year Iranians celebrate the sanctity of fire in the annual festival of Chaharshanbeh Soori. Each year many cases of firecracker-related injuries (FRI) are reported during this festival. The aim of this study was to assess the pattern of injuries and the frequency of disabilities during this period.

In 2011, a cross-sectional study was conducted at the emergency departments (EDs) of three educational hospitals in Tehran, to assess the extent and demographics of FRI. The age and sex of the patient, type of referral to the hospital, type of injury, its region and treatment process were recorded for each patient by the physicians. Data were analyzed by SPSS version 20. Thirty-five patients suffering from FRI were admitted to the hospitals during the festival. The majority of patients were under 30 years-old and most of them were male (83% male and 17% female). The injuries were mostly lacerations and cuts (n = 17, 49%) and scratches (n = 12, 34%). One patient suffered amputation. The most common site of the injuries were the hands (n = 13, 37%) followed by the face (n = 10, 29%). There were 10 patients (29%) with more than one site of injury. Twenty-one patients were hospitalized, 12 patients (34%) received outpatient treatment and two patients were referred to other hospitals. There are still many victims during Chaharshanbeh Soori festival despite efforts and legislations by the government. Education and raise of awareness among people especially for youth are the most important ways to prevent and reduce Red Wednesday injuries.

On the last Wednesday of every year Iranians celebrate the sanctity of fire in the annual festival of Chaharshanbeh Soori. Each year many cases of firecracker-related injuries (FRI) are reported during this festival. The aim of this study was to assess the pattern of injuries and the frequency of disabilities during this period.

In 2011, a cross-sectional study was conducted at the emergency departments (EDs) of three educational hospitals in Tehran, to assess the extent and demographics of FRI. The age and sex of the patient, type of referral to the hospital, type of injury, its region and treatment process were recorded for each patient by the physicians. Data were analyzed by SPSS version 20. Thirty-five patients suffering from FRI were admitted to the hospitals during the festival. The majority of patients were under 30 years-old and most of them were male (83% male and 17% female). The injuries were mostly lacerations and cuts (n = 17, 49%) and scratches (n = 12, 34%). One patient suffered amputation. The most common site of the injuries were the hands (n = 13, 37%) followed by the face (n = 10, 29%). There were 10 patients (29%) with more than one site of injury. Twenty-one patients were hospitalized, 12 patients (34%) received outpatient treatment and two patients were referred to other hospitals. There are still many victims during Chaharshanbeh Soori festival despite efforts and legislations by the government. Education and raise of awareness among people especially for youth are the most important ways to prevent and reduce Red Wednesday injuries.

Wounds and Injuries;Emergency Medicine;Prevention and Control Wounds and Injuries;Emergency Medicine;Prevention and Control 46 49 http://www.archtrauma.com/index.php?page=article&article_id=9250 Hamid Reza Hatamabadi Hamid Reza Hatamabadi Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran; Emergency Department, Shahid Beheshti University of Medical Sciences, IR Iran +98-2173432380, mkkhoramian@yahoo.com Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran; Emergency Department, Shahid Beheshti University of Medical Sciences, IR Iran +98-2173432380, mkkhoramian@yahoo.com Ali Tabatabaey Ali Tabatabaey Emergency Department, Shahid Beheshti University of Medical Sciences, IR Iran +98-2173432380, mkkhoramian@yahoo.com Emergency Department, Shahid Beheshti University of Medical Sciences, IR Iran +98-2173432380, mkkhoramian@yahoo.com Kamran Heidari Kamran Heidari Emergency Department, Shahid Beheshti University of Medical Sciences, IR Iran +98-2173432380, mkkhoramian@yahoo.com Emergency Department, Shahid Beheshti University of Medical Sciences, IR Iran +98-2173432380, mkkhoramian@yahoo.com Mohamad Karim Khoramian Mohamad Karim Khoramian Emergency Department, Shahid Beheshti University of Medical Sciences, IR Iran +98-2173432380, mkkhoramian@yahoo.com ; Emergency Department, Shahid Beheshti University of Medical Sciences, IR Iran +98-2173432380, mkkhoramian@yahoo.com Emergency Department, Shahid Beheshti University of Medical Sciences, IR Iran +98-2173432380, mkkhoramian@yahoo.com ; Emergency Department, Shahid Beheshti University of Medical Sciences, IR Iran +98-2173432380, mkkhoramian@yahoo.com
en 10.5812/atr.8633 Concomitant Ulecranon Fracture, Ipsilateral Segmental Humerus Fracture and Intercondylar Humerus Fracture in a 4-Year-Old Girl: an Extremely Rare Case Report and Literature Review Concomitant Ulecranon Fracture, Ipsilateral Segmental Humerus Fracture and Intercondylar Humerus Fracture in a 4-Year-Old Girl: an Extremely Rare Case Report and Literature Review case-report case-report

T-condylar fracture of distal humerus in young children is very rare. Pure physeal fractures of the olecranon are also rare. We report on an extremely rare case of concomitant ulecranon fracture, ipsilateral segmental humerus and intercondylar humerus fracture (type III) in a skeletally immature patient.

T-condylar fracture of distal humerus in young children is very rare. Pure physeal fractures of the olecranon are also rare. We report on an extremely rare case of concomitant ulecranon fracture, ipsilateral segmental humerus and intercondylar humerus fracture (type III) in a skeletally immature patient.

Elbow Fractures;Upper Extremity;Humerus Fracture;Pediatric Trauma;Iran Elbow Fractures;Upper Extremity;Humerus Fracture;Pediatric Trauma;Iran 50 53 http://www.archtrauma.com/index.php?page=article&article_id=8633 Mohammad Hossein Ebrahimzadeh Mohammad Hossein Ebrahimzadeh Orthopedic and Trauma Research Center, Mashhad University of Medical Sciences, IR Iran +98-5118417453, ebrahimzadehmh@mums.ac.ir Orthopedic and Trauma Research Center, Mashhad University of Medical Sciences, IR Iran +98-5118417453, ebrahimzadehmh@mums.ac.ir Ali Birjandinejad Ali Birjandinejad Orthopedic and Trauma Research Center, Mashhad University of Medical Sciences, IR Iran +98-5118417453, ebrahimzadehmh@mums.ac.ir Orthopedic and Trauma Research Center, Mashhad University of Medical Sciences, IR Iran +98-5118417453, ebrahimzadehmh@mums.ac.ir Ali Sahebjami Ali Sahebjami Orthopedic and Trauma Research Center, Mashhad University of Medical Sciences, IR Iran +98-5118417453, ebrahimzadehmh@mums.ac.ir Orthopedic and Trauma Research Center, Mashhad University of Medical Sciences, IR Iran +98-5118417453, ebrahimzadehmh@mums.ac.ir Mohammad Hossein Taraz Jamshidi Mohammad Hossein Taraz Jamshidi Orthopedic and Trauma Research Center, Mashhad University of Medical Sciences, IR Iran +98-5118417453, ebrahimzadehmh@mums.ac.ir; Orthopedic and Trauma Research Center, Mashhad University of Medical Sciences, IR Iran +98-5118417453, ebrahimzadehmh@mums.ac.ir Orthopedic and Trauma Research Center, Mashhad University of Medical Sciences, IR Iran +98-5118417453, ebrahimzadehmh@mums.ac.ir; Orthopedic and Trauma Research Center, Mashhad University of Medical Sciences, IR Iran +98-5118417453, ebrahimzadehmh@mums.ac.ir
en 10.5812/atr.9859 Application of Queuing Analytic Theory to Decrease Waiting Times in Emergency Department: a review Application of Queuing Analytic Theory to Decrease Waiting Times in Emergency Department: a review letter letter Emergency Medicine;Waiting Time, Patients Emergency Medicine;Waiting Time, Patients 54 55 http://www.archtrauma.com/index.php?page=article&article_id=9859 Roger Edmund Thomas Roger Edmund Thomas Department of Family Medicine, Faculty of Medicine, University of Calgary, Canada +1-4032109255, rthomas@ucalgary.ca; Department of Family Medicine, Faculty of Medicine, University of Calgary, Canada +1-4032109255, rthomas@ucalgary.ca Department of Family Medicine, Faculty of Medicine, University of Calgary, Canada +1-4032109255, rthomas@ucalgary.ca; Department of Family Medicine, Faculty of Medicine, University of Calgary, Canada +1-4032109255, rthomas@ucalgary.ca
en 10.5812/atr.10224 Pain Relief in Patients Undergoing Tonsillectomy Pain Relief in Patients Undergoing Tonsillectomy letter letter Diclofenac;Gabapentin;Tonsillectomy Diclofenac;Gabapentin;Tonsillectomy 56 57 http://www.archtrauma.com/index.php?page=article&article_id=10224 Francesca G Iodice Francesca G Iodice Children's Hospital Bambino Gesù, Italy +39-3336545045, francesca_iodice@yahoo.it; Children's Hospital Bambino Gesù, Italy +39-3336545045, francesca_iodice@yahoo.it Children's Hospital Bambino Gesù, Italy +39-3336545045, francesca_iodice@yahoo.it; Children's Hospital Bambino Gesù, Italy +39-3336545045, francesca_iodice@yahoo.it Giuseppina Testa Giuseppina Testa Children's Hospital Bambino Gesù, Italy +39-3336545045, francesca_iodice@yahoo.it Children's Hospital Bambino Gesù, Italy +39-3336545045, francesca_iodice@yahoo.it
en 10.5812/atr.10032 The Influence of Administration Route in the Comparison of Dosage Forms The Influence of Administration Route in the Comparison of Dosage Forms letter letter Gabapentin;Diclofenac;Tonsillectomy Gabapentin;Diclofenac;Tonsillectomy 58 59 http://www.archtrauma.com/index.php?page=article&article_id=10032 Tansel Comoglu Tansel Comoglu Department of Pharmaceutical Technology, Faculty of Pharmacy, Ankara University, Ankara, Turkey; Faculty of Pharmacy, Ankara University, Ankara, Turkey. Tel.: +90-3122033164, Fax: +90-3122033164 Department of Pharmaceutical Technology, Faculty of Pharmacy, Ankara University, Ankara, Turkey; Faculty of Pharmacy, Ankara University, Ankara, Turkey. Tel.: +90-3122033164, Fax: +90-3122033164