Archives of Trauma Research Archives of Trauma Research Arch Trauma Res http://www.archtrauma.com 2251-953X 2251-9599 10.5812/atr. en jalali 2018 1 24 gregorian 2018 1 24 4 3
en 26566509 10.5812/atr.27898 Bilateral Proximal Tibial Sleeve Fractures in a Child: A Case Report Bilateral Proximal Tibial Sleeve Fractures in a Child: A Case Report case-report case-report Conclusions

We feel this rare, currently unclassified variant of a tibial tubercle avulsion fracture should be recognised and consideration taken to adding it to existing classification systems.

Introduction

A sleeve fracture classically describes an avulsion of cartilage or periosteum with or without osseous fragments and usually occurs at the inferior margin of the patella. Tibial tubercle sleeve fractures in the skeletally immature are extremely rare.

Case Presentation

In this report the authors describe a 12-year-old boy with no systemic disease and no steroid use who sustained bilateral proximal tibial sleeve fractures whilst playing football. Both ruptures were associated with rupture of the medial patellofemoral ligament and tear of the medial retinaculum. Treatment was performed with primary end-to-end repair, reinforcement with bone anchors and cerclage wires with an excellent outcome.

Conclusions

We feel this rare, currently unclassified variant of a tibial tubercle avulsion fracture should be recognised and consideration taken to adding it to existing classification systems.

Introduction

A sleeve fracture classically describes an avulsion of cartilage or periosteum with or without osseous fragments and usually occurs at the inferior margin of the patella. Tibial tubercle sleeve fractures in the skeletally immature are extremely rare.

Case Presentation

In this report the authors describe a 12-year-old boy with no systemic disease and no steroid use who sustained bilateral proximal tibial sleeve fractures whilst playing football. Both ruptures were associated with rupture of the medial patellofemoral ligament and tear of the medial retinaculum. Treatment was performed with primary end-to-end repair, reinforcement with bone anchors and cerclage wires with an excellent outcome.

Cartilage Fracture;Patella Tendon;Adolescent Cartilage Fracture;Patella Tendon;Adolescent http://www.archtrauma.com/index.php?page=article&article_id=27898 Daniel Williams Daniel Williams Department of Trauma and Orthopaedics, Queen’s Hospital Romford, Rom Valley Way, Romford, Essex RM7 0AG, UK; Department of Trauma and Orthopaedics, Queen’s Hospital Romford, Rom Valley Way, Romford, Essex RM7 0AG, UK. Fax: +44-1689850915 Department of Trauma and Orthopaedics, Queen’s Hospital Romford, Rom Valley Way, Romford, Essex RM7 0AG, UK; Department of Trauma and Orthopaedics, Queen’s Hospital Romford, Rom Valley Way, Romford, Essex RM7 0AG, UK. Fax: +44-1689850915 Steven Kahane Steven Kahane Department of Trauma and Orthopaedics, Queen’s Hospital Romford, Rom Valley Way, Romford, Essex RM7 0AG, UK Department of Trauma and Orthopaedics, Queen’s Hospital Romford, Rom Valley Way, Romford, Essex RM7 0AG, UK Daud Chou Daud Chou Department of Trauma and Orthopaedics, Queen’s Hospital Romford, Rom Valley Way, Romford, Essex RM7 0AG, UK Department of Trauma and Orthopaedics, Queen’s Hospital Romford, Rom Valley Way, Romford, Essex RM7 0AG, UK Krishna Vemulapalli Krishna Vemulapalli Department of Trauma and Orthopaedics, Queen’s Hospital Romford, Rom Valley Way, Romford, Essex RM7 0AG, UK Department of Trauma and Orthopaedics, Queen’s Hospital Romford, Rom Valley Way, Romford, Essex RM7 0AG, UK
en 26566506 10.5812/atr.22602 Theoretical Analysis of the Relative Impact of Obesity on Hemodynamic Stability During Acute Hemorrhagic Shock Theoretical Analysis of the Relative Impact of Obesity on Hemodynamic Stability During Acute Hemorrhagic Shock research-article research-article Conclusions

This study suggests that obese patients in HS may have a higher risk of hemodynamic instability compared to their nonobese counterparts primarily due to obesity-induced increases in intra-abdominal pressure resulting in reduced venous return.

Results

In hemorrhage simulation, moderate increases in BMI were found to produce greater decreases in MAP and CO compared to the normal subject. During HS, the virtual obese subject had 42% and 44% greater falls in CO and MAP, respectively, compared to the nonobese subject. Systems analysis of the model revealed that an increase in resistance to venous return due to changes in intra-abdominal pressure resulting from obesity was the critical mechanism responsible for the differences.

Background

Evidence suggests that morbid obesity may be an independent risk factor for adverse outcomes in patients with traumatic injuries.

Objectives

In this study, a theoretic analysis using a derivation of the Guyton model of cardiovascular physiology examines the expected impact of obesity on hemodynamic changes in Mean Arterial Pressure (MAP) and Cardiac Output (CO) during Hemorrhagic Shock (HS).

Patients and Methods

Computer simulation studies were used to predict the relative impact of increasing Body Mass Index (BMI) on global hemodynamic parameters during HS. The analytic procedure involved recreating physiologic conditions associated with changing BMI for a virtual subject in an In Silico environment. The model was validated for the known effect of a BMI of 30 on iliofemoral venous pressures. Then, the relative effect of changing BMI on the outcome of target cardiovascular parameters was examined during simulated acute loss of blood volume in class II hemorrhage. The percent changes in these parameters were compared between the virtual nonobese and obese subjects. Model parameter values are derived from known population distributions, producing simulation outputs that can be used in a deductive systems analysis assessment rather than traditional frequentist statistical methodologies.

Conclusions

This study suggests that obese patients in HS may have a higher risk of hemodynamic instability compared to their nonobese counterparts primarily due to obesity-induced increases in intra-abdominal pressure resulting in reduced venous return.

Results

In hemorrhage simulation, moderate increases in BMI were found to produce greater decreases in MAP and CO compared to the normal subject. During HS, the virtual obese subject had 42% and 44% greater falls in CO and MAP, respectively, compared to the nonobese subject. Systems analysis of the model revealed that an increase in resistance to venous return due to changes in intra-abdominal pressure resulting from obesity was the critical mechanism responsible for the differences.

Background

Evidence suggests that morbid obesity may be an independent risk factor for adverse outcomes in patients with traumatic injuries.

Objectives

In this study, a theoretic analysis using a derivation of the Guyton model of cardiovascular physiology examines the expected impact of obesity on hemodynamic changes in Mean Arterial Pressure (MAP) and Cardiac Output (CO) during Hemorrhagic Shock (HS).

Patients and Methods

Computer simulation studies were used to predict the relative impact of increasing Body Mass Index (BMI) on global hemodynamic parameters during HS. The analytic procedure involved recreating physiologic conditions associated with changing BMI for a virtual subject in an In Silico environment. The model was validated for the known effect of a BMI of 30 on iliofemoral venous pressures. Then, the relative effect of changing BMI on the outcome of target cardiovascular parameters was examined during simulated acute loss of blood volume in class II hemorrhage. The percent changes in these parameters were compared between the virtual nonobese and obese subjects. Model parameter values are derived from known population distributions, producing simulation outputs that can be used in a deductive systems analysis assessment rather than traditional frequentist statistical methodologies.

Shock;Hemorrhagic;Obesity;Trauma;Hemodynamics Shock;Hemorrhagic;Obesity;Trauma;Hemodynamics http://www.archtrauma.com/index.php?page=article&article_id=22602 Sarah A. Sterling Sarah A. Sterling Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA Alan E. Jones Alan E. Jones Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA Thomas G. Coleman Thomas G. Coleman Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA Richard L. Summers Richard L. Summers Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA; Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA. Tel: +1601-8158245; +1601-9845583 Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA; Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA. Tel: +1601-8158245; +1601-9845583
en 26566508 10.5812/atr.25439 Intrapelvic Lumbosacral Fracture Dislocation in a Neurologically Intact Patient: A Case Report Intrapelvic Lumbosacral Fracture Dislocation in a Neurologically Intact Patient: A Case Report case-report case-report Conclusions

Although spinopelvic fracture dislocation injuries are severe high-energy entities, in cases with traumatic spondylolytic spondylolisthesis due to widening of the vertebral canal, neurologic deficit may not be seen at all.

Case Presentation

We described a 16-year-old girl with extremely severe axial trauma to the lumbosacral spine who presented with fracture dislocation of the lumbosacral spine and its intrusion to the pelvic space. Despite violent lumbosacral joint dissociation on imaging studies, the patient was neurologically intact. She was treated with spinopelvic fusion and instrumentation.

Introduction

Lumbosacral fracture dislocation is a rare entity mainly occurred in high-energy trauma accidents. In this unstable injury, anatomical separation of the spinal column from pelvis is usually associated with severe neurological deficits.

Conclusions

Although spinopelvic fracture dislocation injuries are severe high-energy entities, in cases with traumatic spondylolytic spondylolisthesis due to widening of the vertebral canal, neurologic deficit may not be seen at all.

Case Presentation

We described a 16-year-old girl with extremely severe axial trauma to the lumbosacral spine who presented with fracture dislocation of the lumbosacral spine and its intrusion to the pelvic space. Despite violent lumbosacral joint dissociation on imaging studies, the patient was neurologically intact. She was treated with spinopelvic fusion and instrumentation.

Introduction

Lumbosacral fracture dislocation is a rare entity mainly occurred in high-energy trauma accidents. In this unstable injury, anatomical separation of the spinal column from pelvis is usually associated with severe neurological deficits.

Lumbosacral Region;Fractures;Dislocation;Injuries Lumbosacral Region;Fractures;Dislocation;Injuries http://www.archtrauma.com/index.php?page=article&article_id=25439 Ahmad Safaie Yazdi Ahmad Safaie Yazdi Department of Neurosurgery, Farabi Hospital, Islamic Azad University, Mashhad, IR Iran Department of Neurosurgery, Farabi Hospital, Islamic Azad University, Mashhad, IR Iran Farzad Omidi-Kashani Farzad Omidi-Kashani Orthopedic Research Center, Orthopedic Department, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran; Orthopedic Research Center, Orthopedic Department, Imam Reza Hospital,Mashhad University of Medical Sciences, Mashhad,IR Iran. P.O.Box: 9137913316. Tel: +98-5137646500, Fax: +98-5138595023 Orthopedic Research Center, Orthopedic Department, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran; Orthopedic Research Center, Orthopedic Department, Imam Reza Hospital,Mashhad University of Medical Sciences, Mashhad,IR Iran. P.O.Box: 9137913316. Tel: +98-5137646500, Fax: +98-5138595023 Aslan Baradaran Aslan Baradaran Orthopedic Research Center, Orthopedic Department, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran Orthopedic Research Center, Orthopedic Department, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran
en 26566513 10.5812/atr.29393 Measurement of Disability and Its Predictors Among Trauma Patients: A Follow-up Study Measurement of Disability and Its Predictors Among Trauma Patients: A Follow-up Study research-article research-article Conclusions

More than half of the patients were disabled after 3 months of trauma. Elderly patients, patient with severe trauma, and long hospitalization and patients with extremity injuries were high risk for disability.

Results

The mean disability scores at 1 and 3 months post-injury was 30.3 (9.2) and 18.8 (8.3), respectively and there was a statistical significant difference between disability status at 1 and 3 months after trauma (P < 0.0001). The rates of return to work in 262 employed patients at 1 and 3 months after injury were 29% and 55.4%, respectively. The disability score showed a statistically significant correlation with Injury Severity Score (ISS) (P < 0.0001), work return (P = 0.033), intensive care unit transfer (P < 0.0001), trauma type (P = 0.001) and age (P = 0.004). Also, age, ISS, duration of hospital stay and injury to extremities were predictors of disability.

Patients and Methods

In this longitudinal follow-up study, 400 injured patients 15 - 65 years referred to Shahid Beheshti hospital in Kashan and hospitalized more than 24 hours were assessed for disability status with the WHODAS II 12-item instrument at 1 and 3-months post-injury. Patients based on their disability scores were divided into 5 groups: none, mild, moderate, severe and very severe. Work status was assessed at the 3-month follow-up with one question “Are you back at work following your injury”. Also, demographic characteristics and information about injury were gathered by a checklist. Data were analyzed using chi-square, Mann-Whitney U, Kruskal Wallis, Pearson correlation coefficient and logistic regression by SPSS software. The significance level was set at P < 0.05.

Objectives

The aim of this study was to describe the prevalence of disability and its predictors at 1 and 3 months post-injury in Kashan City during 2014 - 2015.

Background

Globally more than a billion people, 15% of the population, lives with disability and most of disabilities are caused by injuries.

Conclusions

More than half of the patients were disabled after 3 months of trauma. Elderly patients, patient with severe trauma, and long hospitalization and patients with extremity injuries were high risk for disability.

Results

The mean disability scores at 1 and 3 months post-injury was 30.3 (9.2) and 18.8 (8.3), respectively and there was a statistical significant difference between disability status at 1 and 3 months after trauma (P < 0.0001). The rates of return to work in 262 employed patients at 1 and 3 months after injury were 29% and 55.4%, respectively. The disability score showed a statistically significant correlation with Injury Severity Score (ISS) (P < 0.0001), work return (P = 0.033), intensive care unit transfer (P < 0.0001), trauma type (P = 0.001) and age (P = 0.004). Also, age, ISS, duration of hospital stay and injury to extremities were predictors of disability.

Patients and Methods

In this longitudinal follow-up study, 400 injured patients 15 - 65 years referred to Shahid Beheshti hospital in Kashan and hospitalized more than 24 hours were assessed for disability status with the WHODAS II 12-item instrument at 1 and 3-months post-injury. Patients based on their disability scores were divided into 5 groups: none, mild, moderate, severe and very severe. Work status was assessed at the 3-month follow-up with one question “Are you back at work following your injury”. Also, demographic characteristics and information about injury were gathered by a checklist. Data were analyzed using chi-square, Mann-Whitney U, Kruskal Wallis, Pearson correlation coefficient and logistic regression by SPSS software. The significance level was set at P < 0.05.

Objectives

The aim of this study was to describe the prevalence of disability and its predictors at 1 and 3 months post-injury in Kashan City during 2014 - 2015.

Background

Globally more than a billion people, 15% of the population, lives with disability and most of disabilities are caused by injuries.

Injury;Return to Work;Disability Evaluation;Injury Severity Score Injury;Return to Work;Disability Evaluation;Injury Severity Score http://www.archtrauma.com/index.php?page=article&article_id=29393 Masoumeh Abedzadeh-Kalahroudi Masoumeh Abedzadeh-Kalahroudi Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran Ebrahim Razi Ebrahim Razi Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran Mojtaba Sehat Mojtaba Sehat Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran; Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran. Tel: +98-3155620634 Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran; Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran. Tel: +98-3155620634 Mohsen Asadi Lari Mohsen Asadi Lari School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran
en 26566512 10.5812/atr.29301 Current Concepts for Patellar Dislocation Current Concepts for Patellar Dislocation review-article review-article Conclusions

Surgical treatment for patellar dislocation is indicated primarily in case of relevant concomitant injuries such as osteochondral fractures, and secondarily for recurrent dislocations.

Evidence Acquisition

Authors searched the Medline library for studies on both surgical and conservative treatment for patellar dislocation and patellofemoral instability. Additionally, the reference list of each article was searched for additional studies.

Results

A thorough analysis of the anatomical risk factors with a particular focus on patella alta, increased Tibial Tuberosity-Trochlear Groove (TT-TG) distance, trochlear dysplasia as well as torsional abnormalities should be performed early after the first dislocation to allow adequate patient counseling. Summarizing the results of all published randomized clinical trials and comparing surgical and conservative treatment after the first-time patellar dislocation until today indicated no significant evident difference for children, adolescents, and adults. Therefore, nonoperative treatment was indicated after a first-time patellar dislocation in the vast majority of patients.

Context

Patellar dislocation usually occurs to the lateral side, leading to ruptures of the Medial Patellofemoral Ligament (MPFL) in about 90% of the cases. Even though several prognostic factors are identified for patellofemoral instability after patellar dislocation so far, the appropriate therapy remains a controversial issue.

Conclusions

Surgical treatment for patellar dislocation is indicated primarily in case of relevant concomitant injuries such as osteochondral fractures, and secondarily for recurrent dislocations.

Evidence Acquisition

Authors searched the Medline library for studies on both surgical and conservative treatment for patellar dislocation and patellofemoral instability. Additionally, the reference list of each article was searched for additional studies.

Results

A thorough analysis of the anatomical risk factors with a particular focus on patella alta, increased Tibial Tuberosity-Trochlear Groove (TT-TG) distance, trochlear dysplasia as well as torsional abnormalities should be performed early after the first dislocation to allow adequate patient counseling. Summarizing the results of all published randomized clinical trials and comparing surgical and conservative treatment after the first-time patellar dislocation until today indicated no significant evident difference for children, adolescents, and adults. Therefore, nonoperative treatment was indicated after a first-time patellar dislocation in the vast majority of patients.

Context

Patellar dislocation usually occurs to the lateral side, leading to ruptures of the Medial Patellofemoral Ligament (MPFL) in about 90% of the cases. Even though several prognostic factors are identified for patellofemoral instability after patellar dislocation so far, the appropriate therapy remains a controversial issue.

Knee;Patella;Patellar Dislocation;Evidence-Based Medicine;Medial Patellofemoral Ligament;Patellofemoral Instability Knee;Patella;Patellar Dislocation;Evidence-Based Medicine;Medial Patellofemoral Ligament;Patellofemoral Instability http://www.archtrauma.com/index.php?page=article&article_id=29301 Maximilian Petri Maximilian Petri Department of Trauma, Hannover Medical School, Hannover, Germany; Department of Trauma, Hannover Medical School, Hannover, Germany. Tel: +49-5115322050, Fax: +49-5115325877 Department of Trauma, Hannover Medical School, Hannover, Germany; Department of Trauma, Hannover Medical School, Hannover, Germany. Tel: +49-5115322050, Fax: +49-5115325877 Max Ettinger Max Ettinger Department of Orthopaedic Surgery, Hannover Medical School, Hannover, Germany Department of Orthopaedic Surgery, Hannover Medical School, Hannover, Germany Timo Stuebig Timo Stuebig Department of Trauma, Hannover Medical School, Hannover, Germany Department of Trauma, Hannover Medical School, Hannover, Germany Stephan Brand Stephan Brand Department of Trauma, Hannover Medical School, Hannover, Germany Department of Trauma, Hannover Medical School, Hannover, Germany Christian Krettek Christian Krettek Department of Trauma, Hannover Medical School, Hannover, Germany Department of Trauma, Hannover Medical School, Hannover, Germany Michael Jagodzinski Michael Jagodzinski Department of Orthopaedic Surgery, Agaplesion Ev. Hospital Bethel, Buckeburg, Germany Department of Orthopaedic Surgery, Agaplesion Ev. Hospital Bethel, Buckeburg, Germany Mohamed Omar Mohamed Omar Department of Trauma, Hannover Medical School, Hannover, Germany Department of Trauma, Hannover Medical School, Hannover, Germany
en 26566507 10.5812/atr.23167 Biomechanical Study Using the Finite Element Method of Internal Fixation in Pauwels Type III Vertical Femoral Neck Fractures Biomechanical Study Using the Finite Element Method of Internal Fixation in Pauwels Type III Vertical Femoral Neck Fractures research-article research-article Conclusions

The most relevant finding was that hook pinning in Pauwels type III fracture may result in delayed union or nonunion due to significantly increased stress of a traction force at the fracture site that works to displace the fracture. However, in a Pauwels type I fracture, increased compression stress contributes to stabilize it. Surgeons are recommended not to treat Pauwels type III femoral neck fractures by pinning.

Results

The peak Von Mises stresses at the medial femoral neck of the fracture site were 35, 50 and 130 MPa in Pauwels type I, II, and III fractures, respectively. Additionally, the peak Von Mises stresses along with the fracture site at the lateral femoral neck were 140, 16, and 8 MPa in Pauwels type I, II, and III fractures, respectively. The principal stress on the medial femoral neck in Pauwels type III fracture was identified as a traction stress, whereas the principal stress on the lateral femoral neck in Pauwels type I fracture was a compression stress.

Patients and Methods

The finite element models were constructed from computed tomography data of the femur. Three fracture models, treated with pinning, were constructed based on Pauwels classification: Type I, 30° between the fracture line and a horizontal line; Type II, 50°; and Type III, 70°. All other factors were matched between the models. The Von Mises stress and principal stress distribution were examined along with the fracture line in each model.

Objectives

To analyze the influence of one designated factor, authors believe that a computerized fracture model, using a finite element Finite Element Method (FEM), may be essential to negate the influence of other factors. The current study aimed to investigate a single factor, i.e. orientation of the fracture line toward a horizontal line, represented by Pauwels classification. It was hypothesized that a model with a vertically oriented fracture line maintaining parity of all other related factors has a higher stress at the fracture site, which would delay fracture healing. This result can be applicable to other types of pinning.

Background

Several factors are known to influence osseous union of femoral neck fractures. Numerous clinical studies have reported different results, hence with different recommendations regarding treatment of Pauwels III fractures: femoral neck fractures with a more vertically oriented fracture line. The current study aimed to analyze biomechanically whether this fracture poses a higher risk of nonunion.

Conclusions

The most relevant finding was that hook pinning in Pauwels type III fracture may result in delayed union or nonunion due to significantly increased stress of a traction force at the fracture site that works to displace the fracture. However, in a Pauwels type I fracture, increased compression stress contributes to stabilize it. Surgeons are recommended not to treat Pauwels type III femoral neck fractures by pinning.

Results

The peak Von Mises stresses at the medial femoral neck of the fracture site were 35, 50 and 130 MPa in Pauwels type I, II, and III fractures, respectively. Additionally, the peak Von Mises stresses along with the fracture site at the lateral femoral neck were 140, 16, and 8 MPa in Pauwels type I, II, and III fractures, respectively. The principal stress on the medial femoral neck in Pauwels type III fracture was identified as a traction stress, whereas the principal stress on the lateral femoral neck in Pauwels type I fracture was a compression stress.

Patients and Methods

The finite element models were constructed from computed tomography data of the femur. Three fracture models, treated with pinning, were constructed based on Pauwels classification: Type I, 30° between the fracture line and a horizontal line; Type II, 50°; and Type III, 70°. All other factors were matched between the models. The Von Mises stress and principal stress distribution were examined along with the fracture line in each model.

Objectives

To analyze the influence of one designated factor, authors believe that a computerized fracture model, using a finite element Finite Element Method (FEM), may be essential to negate the influence of other factors. The current study aimed to investigate a single factor, i.e. orientation of the fracture line toward a horizontal line, represented by Pauwels classification. It was hypothesized that a model with a vertically oriented fracture line maintaining parity of all other related factors has a higher stress at the fracture site, which would delay fracture healing. This result can be applicable to other types of pinning.

Background

Several factors are known to influence osseous union of femoral neck fractures. Numerous clinical studies have reported different results, hence with different recommendations regarding treatment of Pauwels III fractures: femoral neck fractures with a more vertically oriented fracture line. The current study aimed to analyze biomechanically whether this fracture poses a higher risk of nonunion.

Femoral Neck Fractures;Finite Element Analysis;Vertical Femoral Neck Fractures;Finite Element Analysis;Vertical http://www.archtrauma.com/index.php?page=article&article_id=23167 Mitsuaki Noda Mitsuaki Noda Department of Orthopedics, Konan Hospital, Kobe, Japan; Department of Orthopedics, Konan hospital, Kobe, Japan. Tel: +81-788512161, Fax: +81-788210962 Department of Orthopedics, Konan Hospital, Kobe, Japan; Department of Orthopedics, Konan hospital, Kobe, Japan. Tel: +81-788512161, Fax: +81-788210962 Yasuhiro Saegusa Yasuhiro Saegusa Department of Orthopedics, Konan Hospital, Kobe, Japan Department of Orthopedics, Konan Hospital, Kobe, Japan Masayasu Takahashi Masayasu Takahashi Department of Orthopedics, Konan Hospital, Kobe, Japan Department of Orthopedics, Konan Hospital, Kobe, Japan Daichi Tezuka Daichi Tezuka Department of Mechanical Engineering, Graduate School of Engineering, Kobe University, Kobe, Japan Department of Mechanical Engineering, Graduate School of Engineering, Kobe University, Kobe, Japan Kazuhiko Adachi Kazuhiko Adachi Department of Mechanical Engineering, Graduate School of Engineering, Kobe University, Kobe, Japan Department of Mechanical Engineering, Graduate School of Engineering, Kobe University, Kobe, Japan Kazuya Naoi Kazuya Naoi Department of Mechanical Engineering, Graduate School of Engineering, Kobe University, Kobe, Japan Department of Mechanical Engineering, Graduate School of Engineering, Kobe University, Kobe, Japan
en 26566511 10.5812/atr.29184 Correlation Between Intra-Abdominal Free Fluid and Solid Organ Injury in Blunt Abdominal Trauma Correlation Between Intra-Abdominal Free Fluid and Solid Organ Injury in Blunt Abdominal Trauma research-article research-article Conclusions

It seems that FAST examination for intra-abdominal fluid in blunt trauma patients can predict intra-abdominal injuries with very high sensitivity and specificity. Using the scoring system can more accurately determine the probability of the presence of abdominal injuries with a cut-off point of three.

Results

The mean age of the patients was 29.6 ± 18.3 years and FAST was positive in 67% of the subjects. A significant correlation was seen between the FAST score and the presence of organ injury on CT scan (P < 0.001). Considering the cut-off point of 3 for the free fluid score (with a range of 0-8), sensitivity, specificity, positive predictive value and negative predictive value were calculated to be 0.83, 0.98, 0.93, and 0.95, respectively. Age and GCS showed no significant correlation with intra-abdominal injuries.

Patients and Methods

This study was performed on 200 patients with severe blunt abdominal trauma who had stable vital signs. For all patients, FAST-ultrasound was performed by a radiologist and the free fluid score in the abdomen was calculated according to the Huang score. Immediately, an intravenous contrast-enhanced abdominal CT scan was performed in all patients and abdominal solid organ injuries were assessed. Results were analyzed using Kruskal-Wallis test, Mann-Whitney test and ROC curves. The correlation between age and GCS and the presence of intra-abdominal injuries on CT-scan was also evaluated.

Objectives

The aim of this study was to determine the prognostic value of FAST according to the Huang scoring system and to propose a cut-off point for predicting the presence of intra-abdominal injuries on the Computed Tomography (CT) scan. The correlation between age and Glasgow Coma Scale (GCS) and the presence of intra-abdominal injuries on the CT scan was also assessed.

Background

In previous studies, the diagnostic value of Focused Assessment with Sonography for Trauma (FAST) has been evaluated but few studies have been performed on the relationship between the amount of free intra-abdominal fluid and organ injury in blunt abdominal trauma. To select patients with a higher probability of intra-abdominal injuries, several scoring systems have been proposed based on the results of FAST.

Conclusions

It seems that FAST examination for intra-abdominal fluid in blunt trauma patients can predict intra-abdominal injuries with very high sensitivity and specificity. Using the scoring system can more accurately determine the probability of the presence of abdominal injuries with a cut-off point of three.

Results

The mean age of the patients was 29.6 ± 18.3 years and FAST was positive in 67% of the subjects. A significant correlation was seen between the FAST score and the presence of organ injury on CT scan (P < 0.001). Considering the cut-off point of 3 for the free fluid score (with a range of 0-8), sensitivity, specificity, positive predictive value and negative predictive value were calculated to be 0.83, 0.98, 0.93, and 0.95, respectively. Age and GCS showed no significant correlation with intra-abdominal injuries.

Patients and Methods

This study was performed on 200 patients with severe blunt abdominal trauma who had stable vital signs. For all patients, FAST-ultrasound was performed by a radiologist and the free fluid score in the abdomen was calculated according to the Huang score. Immediately, an intravenous contrast-enhanced abdominal CT scan was performed in all patients and abdominal solid organ injuries were assessed. Results were analyzed using Kruskal-Wallis test, Mann-Whitney test and ROC curves. The correlation between age and GCS and the presence of intra-abdominal injuries on CT-scan was also evaluated.

Objectives

The aim of this study was to determine the prognostic value of FAST according to the Huang scoring system and to propose a cut-off point for predicting the presence of intra-abdominal injuries on the Computed Tomography (CT) scan. The correlation between age and Glasgow Coma Scale (GCS) and the presence of intra-abdominal injuries on the CT scan was also assessed.

Background

In previous studies, the diagnostic value of Focused Assessment with Sonography for Trauma (FAST) has been evaluated but few studies have been performed on the relationship between the amount of free intra-abdominal fluid and organ injury in blunt abdominal trauma. To select patients with a higher probability of intra-abdominal injuries, several scoring systems have been proposed based on the results of FAST.

Blunt Trauma;Ultrasound;FAST;Free Fluid Blunt Trauma;Ultrasound;FAST;Free Fluid http://www.archtrauma.com/index.php?page=article&article_id=29184 Hamidreza Talari Hamidreza Talari Department of Radiology, Kashan University of Medical Sciences, Kashan, IR Iran Department of Radiology, Kashan University of Medical Sciences, Kashan, IR Iran Nushin Moussavi Nushin Moussavi Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran; Department of Surgery, Kashan University of Medical Sciences, Kashan, IR Iran. Tel: +98-3155540026, Fax: +98-3155548900 Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran; Department of Surgery, Kashan University of Medical Sciences, Kashan, IR Iran. Tel: +98-3155540026, Fax: +98-3155548900 Masoumeh Abedzadeh-Kalahroudi Masoumeh Abedzadeh-Kalahroudi Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran Fatemeh Atoof Fatemeh Atoof Department of Biostatistics and Epidemiology, Tehran University of Medical Sciences, Tehran, IR Iran Department of Biostatistics and Epidemiology, Tehran University of Medical Sciences, Tehran, IR Iran Arezoo Abedini Arezoo Abedini Department of Radiology, Kashan University of Medical Sciences, Kashan, IR Iran Department of Radiology, Kashan University of Medical Sciences, Kashan, IR Iran
en 26557639 10.5812/atr.19280 Quality of Life and Related Factors Among People With Spinal Cord Injuries in Tehran, Iran Quality of Life and Related Factors Among People With Spinal Cord Injuries in Tehran, Iran research-article research-article Results

The mean QOL in these patients was 37.1 ± 1.7 years (21 - 65 years) and mean disease duration was 7.3±6 years. The most common injury was paraplegia. Most of the patients have moderate QOL (54.7 %). The results showed a significant relationship between QOL and marital status and employment status (P < 0.05). Also, results showed a significant relationship between QOL and education levels (P = 0.002), age (P = 0.001), and duration of illness (P = 0.001).The highest and lowest scores were 64 ± 7.1 and 36 ± 5.3 for understanding General Health (GH) and role physical, respectively.

Conclusions

The results show that patients with SCI have a moderate health-related QOL Determining the QOL is needed to focus on the strengths and weaknesses of patients with spinal cord injuries. Planning principles is recommended in order to reform the disability.

Objectives

The purpose of this study was to determine the QOL and related factors among people with SCIs.

Patients and Methods

In this cross-sectional descriptive study, 106 patients with SCI were selected through sampling based on census. Data were collected using a demographic questionnaire and a Short-Form 36 (SF-36) health survey questionnaire for measuring the QOL among patients. Data were analyzed using SPSS 14 software and descriptive and inferential statistics. P < 0.05 was considered statistically significant.

Background

Spinal Cord Injury (SCI) is one of the biggest health problems. Disabilities resulting from injuries such as spinal disability requires special attention because of their potential reduced to cause adverse effects in different systems of the body. Today, improving the Quality of Life (QOL) in patients with SCIs is an important goal of treatment.

Results

The mean QOL in these patients was 37.1 ± 1.7 years (21 - 65 years) and mean disease duration was 7.3±6 years. The most common injury was paraplegia. Most of the patients have moderate QOL (54.7 %). The results showed a significant relationship between QOL and marital status and employment status (P < 0.05). Also, results showed a significant relationship between QOL and education levels (P = 0.002), age (P = 0.001), and duration of illness (P = 0.001).The highest and lowest scores were 64 ± 7.1 and 36 ± 5.3 for understanding General Health (GH) and role physical, respectively.

Conclusions

The results show that patients with SCI have a moderate health-related QOL Determining the QOL is needed to focus on the strengths and weaknesses of patients with spinal cord injuries. Planning principles is recommended in order to reform the disability.

Objectives

The purpose of this study was to determine the QOL and related factors among people with SCIs.

Patients and Methods

In this cross-sectional descriptive study, 106 patients with SCI were selected through sampling based on census. Data were collected using a demographic questionnaire and a Short-Form 36 (SF-36) health survey questionnaire for measuring the QOL among patients. Data were analyzed using SPSS 14 software and descriptive and inferential statistics. P < 0.05 was considered statistically significant.

Background

Spinal Cord Injury (SCI) is one of the biggest health problems. Disabilities resulting from injuries such as spinal disability requires special attention because of their potential reduced to cause adverse effects in different systems of the body. Today, improving the Quality of Life (QOL) in patients with SCIs is an important goal of treatment.

Spinal Cord Injuries;Quality of Life;Questionnaire;Iran Spinal Cord Injuries;Quality of Life;Questionnaire;Iran http://www.archtrauma.com/index.php?page=article&article_id=19280 Maryam Moghimian Maryam Moghimian Department of Nursing, Faculty of Nursing and Midwifery, Najafabad Branch, Islamic Azad University, Najafabad, Isfahan, IR Iran Department of Nursing, Faculty of Nursing and Midwifery, Najafabad Branch, Islamic Azad University, Najafabad, Isfahan, IR Iran Fahimeh Kashani Fahimeh Kashani Department of Medical Surgical Nursing, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, IR Iran Department of Medical Surgical Nursing, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, IR Iran Mohammad Ali Cheraghi Mohammad Ali Cheraghi Department of Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, IR Iran Department of Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, IR Iran Esmaeil Mohammadnejad Esmaeil Mohammadnejad Department of Nursing, Students’ Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran; Department of Nursing, Students’ Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran. Tel: +98-2166936626, Fax: +98-2166936626 Department of Nursing, Students’ Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran; Department of Nursing, Students’ Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran. Tel: +98-2166936626, Fax: +98-2166936626
en 26566510 10.5812/atr.28381 Infrapatellar Fat Pad Para-Articular Osteochondroma: A Ten-Year Follow-up and Review Infrapatellar Fat Pad Para-Articular Osteochondroma: A Ten-Year Follow-up and Review case-report case-report Conclusions

Tumor-like lesions within the infrapatellar fat pad should remind the para-articular osteochondroma. Although its etiology has not yet been elicited, operative removal of the mass is the preferred treatment of choice and also curative in long-term follow-up.

Introduction

Para-articular masses are not clear enough in terms of their etiology and nomenclature. Although surgical removal of the mass is the preferred treatment, long term follow-up after surgical treatment has not been reported yet. The current study presents a patient with the osteo-cartilaginous mass of infrapatellar region, diagnosed after a trauma. This case has the longest follow-up period in the literature.

Case Presentation

A 52-year-old female patient referred after falling down on her right knee. Lateral radiographs of the knee revealed a mass in the infrapatellar area. The case was treated surgically by total excision of the mass. The mass was extra-capsular with lobular and irregular shape. After mass removal the clinical course was uneventful and at the 10-year follow-up, no signs of recurrence were evident clinically or radiologically.

Conclusions

Tumor-like lesions within the infrapatellar fat pad should remind the para-articular osteochondroma. Although its etiology has not yet been elicited, operative removal of the mass is the preferred treatment of choice and also curative in long-term follow-up.

Introduction

Para-articular masses are not clear enough in terms of their etiology and nomenclature. Although surgical removal of the mass is the preferred treatment, long term follow-up after surgical treatment has not been reported yet. The current study presents a patient with the osteo-cartilaginous mass of infrapatellar region, diagnosed after a trauma. This case has the longest follow-up period in the literature.

Case Presentation

A 52-year-old female patient referred after falling down on her right knee. Lateral radiographs of the knee revealed a mass in the infrapatellar area. The case was treated surgically by total excision of the mass. The mass was extra-capsular with lobular and irregular shape. After mass removal the clinical course was uneventful and at the 10-year follow-up, no signs of recurrence were evident clinically or radiologically.

Para-Articular Osteochondroma;Chondroma;Knee;Infrapatellar Para-Articular Osteochondroma;Chondroma;Knee;Infrapatellar http://www.archtrauma.com/index.php?page=article&article_id=28381 Hasan Bombaci Hasan Bombaci Department of Orthopaedics and Traumatology, Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey; Department of Orthopaedics and Traumatology, Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey. Tel: +90-2164144502 Department of Orthopaedics and Traumatology, Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey; Department of Orthopaedics and Traumatology, Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey. Tel: +90-2164144502 Emre Bilgin Emre Bilgin Department of Orthopaedics and Traumatology, Igdir State Hospital, Igdir, Turkey Department of Orthopaedics and Traumatology, Igdir State Hospital, Igdir, Turkey
en 26566514 10.5812/atr.30687 Determination of Tetanus Antibody Levels in Trauma Patients Referred To Shahid Beheshti Hospital in Kashan, Iran, 2014 Determination of Tetanus Antibody Levels in Trauma Patients Referred To Shahid Beheshti Hospital in Kashan, Iran, 2014 research-article research-article Conclusions

The findings of the present study show a high level of tetanus antibody among trauma patients in this hospital; so, taking the tetanus vaccine history can be misleading. It is suggested that further studies be performed in different regions of our country and with larger sample sizes and detection of the immunization status of patients by measuring anti-tetanus antibody levels among trauma patients is recommended to make suitable policy for a national vaccine protocol in the future.

Results

From a total of 204 patients, 35 cases (16.7%) were females and 169 (83.2%) were males with the mean age of 40.9 ± 3.7 years. There was no statistically significant difference in the tetanus antibody levels between both sexes (P = 0.09). Moreover, there was no significant difference in immunization status between the patients who had a history of tetanus vaccination and those who had not received the vaccine before (P = 0.67). The antibody levels were significantly reduced with the passage of time since the last vaccination (P < 0.001). Also, 87.3% of the patients had the high protective level of immunity to tetanus.

Patients and Methods

This cross-sectional study was performed on 204 trauma patients referred to the trauma emergency ward of Shahid Beheshti hospital in Kashan City, Iran, in 2014. After obtaining a written informed consent from the patients, a questionnaire consisted of demographic information and tetanus vaccination record was completed by the patients. Afterwards, a 4 - 5 mL venous blood sample was taken from each patient and the tetanus antibody level (IgG) was measured using the enzyme-linked immunosorbent assay method. The tetanus antibody levels equal or more than 0.1 IU/mL were considered protective. Data were analyzed using chi-square test, independent t-test and one-way ANOVA with SPSS software version 16.

Background

There is a noticeable difference in serologic immune status against tetanus among different age and social groups in various countries due to different national vaccination policies and methods.

Objectives

Considering that the immunization status of trauma patients against tetanus is not-known or uncertain and they may need to receive the vaccine and tetabulin, this study was conducted to determine the tetanus antibody levels in patients referred to the trauma emergency ward of Shahid Beheshti Hospital in Kashan City, Iran.

Conclusions

The findings of the present study show a high level of tetanus antibody among trauma patients in this hospital; so, taking the tetanus vaccine history can be misleading. It is suggested that further studies be performed in different regions of our country and with larger sample sizes and detection of the immunization status of patients by measuring anti-tetanus antibody levels among trauma patients is recommended to make suitable policy for a national vaccine protocol in the future.

Results

From a total of 204 patients, 35 cases (16.7%) were females and 169 (83.2%) were males with the mean age of 40.9 ± 3.7 years. There was no statistically significant difference in the tetanus antibody levels between both sexes (P = 0.09). Moreover, there was no significant difference in immunization status between the patients who had a history of tetanus vaccination and those who had not received the vaccine before (P = 0.67). The antibody levels were significantly reduced with the passage of time since the last vaccination (P < 0.001). Also, 87.3% of the patients had the high protective level of immunity to tetanus.

Patients and Methods

This cross-sectional study was performed on 204 trauma patients referred to the trauma emergency ward of Shahid Beheshti hospital in Kashan City, Iran, in 2014. After obtaining a written informed consent from the patients, a questionnaire consisted of demographic information and tetanus vaccination record was completed by the patients. Afterwards, a 4 - 5 mL venous blood sample was taken from each patient and the tetanus antibody level (IgG) was measured using the enzyme-linked immunosorbent assay method. The tetanus antibody levels equal or more than 0.1 IU/mL were considered protective. Data were analyzed using chi-square test, independent t-test and one-way ANOVA with SPSS software version 16.

Background

There is a noticeable difference in serologic immune status against tetanus among different age and social groups in various countries due to different national vaccination policies and methods.

Objectives

Considering that the immunization status of trauma patients against tetanus is not-known or uncertain and they may need to receive the vaccine and tetabulin, this study was conducted to determine the tetanus antibody levels in patients referred to the trauma emergency ward of Shahid Beheshti Hospital in Kashan City, Iran.

Tetanus;Vaccination;Tetabulin;Trauma Tetanus;Vaccination;Tetabulin;Trauma http://www.archtrauma.com/index.php?page=article&article_id=30687 Hasan Afzali Hasan Afzali Department of Infectious Diseases, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, IR Iran Department of Infectious Diseases, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, IR Iran Mohammad Reza Sharif Mohammad Reza Sharif Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran; Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran. Tel/Fax: +98-3155620634 Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran; Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran. Tel/Fax: +98-3155620634 Shamsaddin Mousavi Shamsaddin Mousavi Student Research Committee, Kashan University of Medical Sciences, Kashan, IR Iran Student Research Committee, Kashan University of Medical Sciences, Kashan, IR Iran