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 4
en 26848472 10.5812/atr.28466 Prevalence of Posttraumatic Stress Disorder and Related Factors Among Patients Discharged From Critical Care Units in Kashan, Iran Prevalence of Posttraumatic Stress Disorder and Related Factors Among Patients Discharged From Critical Care Units in Kashan, Iran research-article research-article Background

Posttraumatic Stress Disorder (PTSD) is a severe anxiety disorder occurred due to past adverse experiences. Several researches have demonstrated that PTSD is quite common among patients discharged from critical care unit.

Conclusions

Prevalence of PTSD is high among patients discharged from ICUs and some medical individual factors such as elderly, unemployed, being single, using mechanical ventilation and pre-existing diseases are risk factors. Therefore, it is recommended to perform appropriative educational plan for these patients to reduce the risk of PTSD.

Results

From a total of 332 patients, 160 cases (48.2%) had PTSD and the mean total PCL score in participants was 44.24 ± 19.89. There was a significant difference between the total score of PTSD and its domains in patients with and without PTSD. the univariate analysis showed a significant association between PTSD and increasing age, increased length of hospital stay, more children, having additional comorbidities, unemployed, use of mechanical ventilation (P < 0.001), drug abuse (P = 0.003) and single patients (P = 0.028). However, there was no significant association between PTSD and gender, type of the critical care unit, level of education and admission due to trauma. However, in multivariate analysis using logistic regression, factors associated with PTSD were older age of the participants, use of mechanical ventilation having additional comorbidities, unemployed (P<0.001) and being single (P=0.04)

Objectives

This study aimed to investigate the prevalence of PTSD and its related factors among patients discharged from critical care units in Kashan, Iran, during 2014.

Patients and Methods

A descriptive prospective study was performed on 332 patients admitted to critical care units of Kashan Shahid Beheshti Hospital using a convenience sampling method. Data were collected in wards during hospitalization and one month after their discharge from hospital using questionnaires on demographic, medical information and PTSD Checklist (PCL). The PCL scores of 45 or more were considered as PTSD. Data were analyzed using chi-square, t-test, Mann-Whitney U and logistic regression.

Background

Posttraumatic Stress Disorder (PTSD) is a severe anxiety disorder occurred due to past adverse experiences. Several researches have demonstrated that PTSD is quite common among patients discharged from critical care unit.

Conclusions

Prevalence of PTSD is high among patients discharged from ICUs and some medical individual factors such as elderly, unemployed, being single, using mechanical ventilation and pre-existing diseases are risk factors. Therefore, it is recommended to perform appropriative educational plan for these patients to reduce the risk of PTSD.

Results

From a total of 332 patients, 160 cases (48.2%) had PTSD and the mean total PCL score in participants was 44.24 ± 19.89. There was a significant difference between the total score of PTSD and its domains in patients with and without PTSD. the univariate analysis showed a significant association between PTSD and increasing age, increased length of hospital stay, more children, having additional comorbidities, unemployed, use of mechanical ventilation (P < 0.001), drug abuse (P = 0.003) and single patients (P = 0.028). However, there was no significant association between PTSD and gender, type of the critical care unit, level of education and admission due to trauma. However, in multivariate analysis using logistic regression, factors associated with PTSD were older age of the participants, use of mechanical ventilation having additional comorbidities, unemployed (P<0.001) and being single (P=0.04)

Objectives

This study aimed to investigate the prevalence of PTSD and its related factors among patients discharged from critical care units in Kashan, Iran, during 2014.

Patients and Methods

A descriptive prospective study was performed on 332 patients admitted to critical care units of Kashan Shahid Beheshti Hospital using a convenience sampling method. Data were collected in wards during hospitalization and one month after their discharge from hospital using questionnaires on demographic, medical information and PTSD Checklist (PCL). The PCL scores of 45 or more were considered as PTSD. Data were analyzed using chi-square, t-test, Mann-Whitney U and logistic regression.

Posttraumatic Stress Disorder;Critical Care Unit;Patient Posttraumatic Stress Disorder;Critical Care Unit;Patient http://www.archtrauma.com/index.php?page=article&article_id=28466 Zohreh Sadat Zohreh Sadat Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, IR Iran Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, IR Iran Mohammad Abdi Mohammad Abdi Department of Nursing, School of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, IR Iran; Department of Nursing, School of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, IR Iran. Tel: +98-36155540021, Fax: +98-36155546633 Department of Nursing, School of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, IR Iran; Department of Nursing, School of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, IR Iran. Tel: +98-36155540021, Fax: +98-36155546633 Mohammad Aghajani Mohammad Aghajani Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, IR Iran Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
en 26848471 10.5812/atr.28018 Rib Fracture Fixation Restores Inspiratory Volume and Peak Flow in a Full Thorax Human Cadaveric Breathing Model Rib Fracture Fixation Restores Inspiratory Volume and Peak Flow in a Full Thorax Human Cadaveric Breathing Model research-article research-article Conclusions

Negative pressure inspiration is significantly impaired by an unstable chest wall. Restoring mechanical stability of the fractured ribs improves respiratory outcomes similar to baseline values.

Results

A wide variation in the mean inspiratory volumes and peak flows were measured between specimens; however, the effect of a flail chest wall and the subsequent internal fixation of the unstable rib fractures was consistent across all samples. Compared to the intact chest wall, the inspiratory volume decreased by 40 ± 19% in the flail chest model (P = 0.04). Open reduction and internal fixation of the flail chest returned the inspiratory volume to 130 ± 71% of the intact chest volumes (P = 0.68). A similar 35 ± 19% decrease in peak flows was seen in the flail chest (P = 0.007) and this returned to 125 ± 71% of the intact chest following ORIF (P = 0.62).

Objectives

Using a novel full thorax human cadaveric breathing model, we sought to explore the effect of flail chest injury and subsequent rib fracture fixation on respiratory outcomes.

Patients and Methods

We used five fresh human cadavers to generate negative breathing models in the left thorax to mimic physiologic respiration. Inspiratory volumes and peak flows were measured using a flow meter for all three chest wall states: intact chest, left-sided flail chest (segmental fractures of ribs 3 - 7), and post-fracture open reduction and internal fixation (ORIF) of the chest wall with a pre-contoured rib specific plate fixation system.

Background

Multiple rib fractures cause significant pain and potential for chest wall instability. Despite an emerging trend of surgical management of flail chest injuries, there are no studies examining the effect of rib fracture fixation on respiratory function.

Conclusions

Negative pressure inspiration is significantly impaired by an unstable chest wall. Restoring mechanical stability of the fractured ribs improves respiratory outcomes similar to baseline values.

Results

A wide variation in the mean inspiratory volumes and peak flows were measured between specimens; however, the effect of a flail chest wall and the subsequent internal fixation of the unstable rib fractures was consistent across all samples. Compared to the intact chest wall, the inspiratory volume decreased by 40 ± 19% in the flail chest model (P = 0.04). Open reduction and internal fixation of the flail chest returned the inspiratory volume to 130 ± 71% of the intact chest volumes (P = 0.68). A similar 35 ± 19% decrease in peak flows was seen in the flail chest (P = 0.007) and this returned to 125 ± 71% of the intact chest following ORIF (P = 0.62).

Objectives

Using a novel full thorax human cadaveric breathing model, we sought to explore the effect of flail chest injury and subsequent rib fracture fixation on respiratory outcomes.

Patients and Methods

We used five fresh human cadavers to generate negative breathing models in the left thorax to mimic physiologic respiration. Inspiratory volumes and peak flows were measured using a flow meter for all three chest wall states: intact chest, left-sided flail chest (segmental fractures of ribs 3 - 7), and post-fracture open reduction and internal fixation (ORIF) of the chest wall with a pre-contoured rib specific plate fixation system.

Background

Multiple rib fractures cause significant pain and potential for chest wall instability. Despite an emerging trend of surgical management of flail chest injuries, there are no studies examining the effect of rib fracture fixation on respiratory function.

Flail Chest;Inspiratory Volume;Operative Stabilization;Peak Flow;Rib Fixation Flail Chest;Inspiratory Volume;Operative Stabilization;Peak Flow;Rib Fixation http://www.archtrauma.com/index.php?page=article&article_id=28018 Gerard P. Slobogean Gerard P. Slobogean Department of Orthopaedics, University of Maryland School of Medicine, R. Adams Cowley Shock Trauma Center, Baltimore, Maryland, USA; Department of Orthopaedics, University of Maryland School of Medicine, R. Adams Cowley Shock Trauma Center, Baltimore, Maryland, USA. Tel: +1-4103286280, Fax: +1-4103282893 Department of Orthopaedics, University of Maryland School of Medicine, R. Adams Cowley Shock Trauma Center, Baltimore, Maryland, USA; Department of Orthopaedics, University of Maryland School of Medicine, R. Adams Cowley Shock Trauma Center, Baltimore, Maryland, USA. Tel: +1-4103286280, Fax: +1-4103282893 Hyunchul Kim Hyunchul Kim Fischell Department of Bioengineering, Orthopaedic Mechanobiology Laboratory, University of Maryland, College Park, Maryland, USA Fischell Department of Bioengineering, Orthopaedic Mechanobiology Laboratory, University of Maryland, College Park, Maryland, USA Joseph P. Russell Joseph P. Russell Fischell Department of Bioengineering, Orthopaedic Mechanobiology Laboratory, University of Maryland, College Park, Maryland, USA Fischell Department of Bioengineering, Orthopaedic Mechanobiology Laboratory, University of Maryland, College Park, Maryland, USA David J. Stockton David J. Stockton Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada Adam H. Hsieh Adam H. Hsieh Fischell Department of Bioengineering, Orthopaedic Mechanobiology Laboratory, University of Maryland, College Park, Maryland, USA Fischell Department of Bioengineering, Orthopaedic Mechanobiology Laboratory, University of Maryland, College Park, Maryland, USA Robert V. O’Toole Robert V. O’Toole Department of Orthopaedics, University of Maryland School of Medicine, R. Adams Cowley Shock Trauma Center, Baltimore, Maryland, USA Department of Orthopaedics, University of Maryland School of Medicine, R. Adams Cowley Shock Trauma Center, Baltimore, Maryland, USA
en 26848470 10.5812/atr.27183 Open Repair Versus Thoracic Endovascular Aortic Repair in Multiple-Injured Patients: Observations From a Level-1 Trauma Center Open Repair Versus Thoracic Endovascular Aortic Repair in Multiple-Injured Patients: Observations From a Level-1 Trauma Center research-article research-article Conclusions

Due to more sophisticated diagnostic tools and surgical approaches, mortality and morbidity of blunt aortic injuries were significantly reduced over the years compared to thoracic endovascular aortic repair and OR over two different time periods.

Objectives

The aim of the present study was to retrospectively evaluate the mortality and morbidity with either treatment option. Therefore, a retrospective observational study was performed to compare two different treatment methods at two different time periods at one trauma center.

Patients and Methods

Between 1977 and 2012, all severely injured patients referred to our level 1 trauma center were screened for blunt aortic injuries. We compared baseline characteristics, 30-day and overall mortality, morbidity, duration of intensive care treatment, procedure time, and transfusion of packed red blood between patients who underwent open surgical or stent repair.

Results

During the observation period, 45 blunt aortic injuries were recorded. The average Injury Severity Score (ISS) was 41.8 (range 29 - 68). Twenty-five patients underwent Open Repair (OR), and another 20 patients were scheduled to emergency stent grafting. The 30-day mortality in the surgical and stent groups were 5/25 (20%) and 2/20 (10%), respectively. The average time for open surgery was 151 minutes; the mean time for stent grafting was 67 minutes (P = 0.001). Postoperative stay on the intensive care unit was between one and 59 days (median 10) in group one and between four and 50 days in group two (median 26)(P = 0.03). Patients undergoing OR required transfusion of 6.0 units of packed red cells in median; patients undergoing stent grafting required a median of 2.0 units of packed red cells (P < 0.001). In the stent grafting group, 30-day mortality was 10% (2/20).

Background

Blunt trauma of the thoracic aorta is a rare but potentially life-threatening entity. Intimal tears are a domain of non-operative management, whereas all other types of lesions should be repaired urgently. There is now a clear trend favoring minimally invasive stent grafting over open surgical repair.

Conclusions

Due to more sophisticated diagnostic tools and surgical approaches, mortality and morbidity of blunt aortic injuries were significantly reduced over the years compared to thoracic endovascular aortic repair and OR over two different time periods.

Objectives

The aim of the present study was to retrospectively evaluate the mortality and morbidity with either treatment option. Therefore, a retrospective observational study was performed to compare two different treatment methods at two different time periods at one trauma center.

Patients and Methods

Between 1977 and 2012, all severely injured patients referred to our level 1 trauma center were screened for blunt aortic injuries. We compared baseline characteristics, 30-day and overall mortality, morbidity, duration of intensive care treatment, procedure time, and transfusion of packed red blood between patients who underwent open surgical or stent repair.

Results

During the observation period, 45 blunt aortic injuries were recorded. The average Injury Severity Score (ISS) was 41.8 (range 29 - 68). Twenty-five patients underwent Open Repair (OR), and another 20 patients were scheduled to emergency stent grafting. The 30-day mortality in the surgical and stent groups were 5/25 (20%) and 2/20 (10%), respectively. The average time for open surgery was 151 minutes; the mean time for stent grafting was 67 minutes (P = 0.001). Postoperative stay on the intensive care unit was between one and 59 days (median 10) in group one and between four and 50 days in group two (median 26)(P = 0.03). Patients undergoing OR required transfusion of 6.0 units of packed red cells in median; patients undergoing stent grafting required a median of 2.0 units of packed red cells (P < 0.001). In the stent grafting group, 30-day mortality was 10% (2/20).

Background

Blunt trauma of the thoracic aorta is a rare but potentially life-threatening entity. Intimal tears are a domain of non-operative management, whereas all other types of lesions should be repaired urgently. There is now a clear trend favoring minimally invasive stent grafting over open surgical repair.

Aortic Rupture;Traffic Accident;Injury Severity Score;In-Hospital Mortality;Multiple Injuries Aortic Rupture;Traffic Accident;Injury Severity Score;In-Hospital Mortality;Multiple Injuries http://www.archtrauma.com/index.php?page=article&article_id=27183 Stephan Brand Stephan Brand Trauma Department, Hannover Medical School (MHH), Hannover, Germany; Trauma Department, Hannover Medical School (MHH), Hannover, Germany. Tel: +49-5115322026, Fax: +49-5115325877 Trauma Department, Hannover Medical School (MHH), Hannover, Germany; Trauma Department, Hannover Medical School (MHH), Hannover, Germany. Tel: +49-5115322026, Fax: +49-5115325877 Ingo Breitenbach Ingo Breitenbach Department of Cardiothoracic and Vascular Surgery, Public Hospital Braunschweig, Braunschweig, Germany Department of Cardiothoracic and Vascular Surgery, Public Hospital Braunschweig, Braunschweig, Germany Philipp Bolzen Philipp Bolzen Department of Diagnostic Radiology, Hannover Medical School, Hannover, Germany Department of Diagnostic Radiology, Hannover Medical School, Hannover, Germany Maximilian Petri Maximilian Petri Trauma Department, Hannover Medical School (MHH), Hannover, Germany Trauma Department, Hannover Medical School (MHH), Hannover, Germany Christian Krettek Christian Krettek Trauma Department, Hannover Medical School (MHH), Hannover, Germany Trauma Department, Hannover Medical School (MHH), Hannover, Germany Omke Teebken Omke Teebken Division of Vascular Surgery, Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany Division of Vascular Surgery, Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
en 26848475 10.5812/atr.29923 Operative Treatment of an Atypical Segmental Bipolar Fracture of the Clavicle Operative Treatment of an Atypical Segmental Bipolar Fracture of the Clavicle case-report case-report Conclusions

Stability of the clavicle is crucial for shoulder function and care should be taken not to miss or underestimate segmental bipolar fractures even with a low energy mechanism. Authors believe that operative treatment should be taken into consideration for displaced fractures.

Introduction

Clavicle fractures are very common, accounting for approximately 4% of all adult fractures. Segmental bipolar fractures involving the lateral and the medial ends of the clavicle are extremely rare, with only isolated cases reported in the literature. The injury mechanism is often unclear and the management of these fractures remains controversial.

Case presentation

Here is to report a case of a segmental bipolar fracture of the clavicle with a lateral fracture and a displaced medial fracture without dislocation of the sternoclavicular joint following a low energy fall to the outstretched hand, and discuss its management.

Conclusions

Stability of the clavicle is crucial for shoulder function and care should be taken not to miss or underestimate segmental bipolar fractures even with a low energy mechanism. Authors believe that operative treatment should be taken into consideration for displaced fractures.

Introduction

Clavicle fractures are very common, accounting for approximately 4% of all adult fractures. Segmental bipolar fractures involving the lateral and the medial ends of the clavicle are extremely rare, with only isolated cases reported in the literature. The injury mechanism is often unclear and the management of these fractures remains controversial.

Case presentation

Here is to report a case of a segmental bipolar fracture of the clavicle with a lateral fracture and a displaced medial fracture without dislocation of the sternoclavicular joint following a low energy fall to the outstretched hand, and discuss its management.

Clavicle;Bone Fracture;Bipolar;Care Management Clavicle;Bone Fracture;Bipolar;Care Management http://www.archtrauma.com/index.php?page=article&article_id=29923 Nikolaos Varelas Nikolaos Varelas Department of Surgery, Division of Orthopaedic Surgery and Traumatology, Centre Hospitalier du Centre du Valais, Sion, Switzerland Department of Surgery, Division of Orthopaedic Surgery and Traumatology, Centre Hospitalier du Centre du Valais, Sion, Switzerland Pieter Joosse Pieter Joosse Department of Surgery, Medisch Centrum Alkmaar, Alkmaar, The Netherlands Department of Surgery, Medisch Centrum Alkmaar, Alkmaar, The Netherlands Philippe Zermatten Philippe Zermatten Department of Surgery, Division of Orthopaedic Surgery and Traumatology, Centre Hospitalier du Centre du Valais, Sion, Switzerland; Department of Surgery, Division of Orthopaedic Surgery and Traumatology, Centre Hospitalier du Centre du Valais, Sion, Switzerland. Tel: +41-276038885, Fax: +41-276034438 Department of Surgery, Division of Orthopaedic Surgery and Traumatology, Centre Hospitalier du Centre du Valais, Sion, Switzerland; Department of Surgery, Division of Orthopaedic Surgery and Traumatology, Centre Hospitalier du Centre du Valais, Sion, Switzerland. Tel: +41-276038885, Fax: +41-276034438
en 26848468 10.5812/atr.25313 Operative Treatment of Isolated Bicondylar Hoffa Fracture With a Modified Swashbuckler Approach Operative Treatment of Isolated Bicondylar Hoffa Fracture With a Modified Swashbuckler Approach case-report case-report Conclusions

In our study, we treated this rare fracture successfully using a modified swashbuckler approach and found it to be a good approach for such fractures as compared to the conventional approach.

Case Presentation

A 32-year-old male sustained a bicondylar Hoffa fracture of the right femur which was treated by open reduction and internal fixation using a modified swashbuckler approach. At two years of follow-up, the patient had excellent radiological and functional outcome.

Introduction

An isolated coronal fracture of either or both femoral condyles is a rare entity and is usually associated with high-energy injury trauma. Such fractures should be meticulously fixed for a good functional outcome as they involve the articular surface of a weight bearing joint. A modified swashbuckler approach provides adequate exposure for appropriate reduction and fixation of such fractures.

Conclusions

In our study, we treated this rare fracture successfully using a modified swashbuckler approach and found it to be a good approach for such fractures as compared to the conventional approach.

Case Presentation

A 32-year-old male sustained a bicondylar Hoffa fracture of the right femur which was treated by open reduction and internal fixation using a modified swashbuckler approach. At two years of follow-up, the patient had excellent radiological and functional outcome.

Introduction

An isolated coronal fracture of either or both femoral condyles is a rare entity and is usually associated with high-energy injury trauma. Such fractures should be meticulously fixed for a good functional outcome as they involve the articular surface of a weight bearing joint. A modified swashbuckler approach provides adequate exposure for appropriate reduction and fixation of such fractures.

Bicondylar;Hoffa Fracture;Swashbuckler Approach Bicondylar;Hoffa Fracture;Swashbuckler Approach http://www.archtrauma.com/index.php?page=article&article_id=25313 Ramanath K. Sharath Ramanath K. Sharath Department of Orthopaedics, MS Ramaiah Medical College, Bangalore, India; Department of Orthopaedics, MS Ramaiah Medical College, Bangalore, India. Tel: +91-9945815821 Department of Orthopaedics, MS Ramaiah Medical College, Bangalore, India; Department of Orthopaedics, MS Ramaiah Medical College, Bangalore, India. Tel: +91-9945815821 Daksh Gadi Daksh Gadi Department of Orthopaedics, MS Ramaiah Medical College, Bangalore, India Department of Orthopaedics, MS Ramaiah Medical College, Bangalore, India Amit Grover Amit Grover Department of Orthopaedics, MS Ramaiah Medical College, Bangalore, India Department of Orthopaedics, MS Ramaiah Medical College, Bangalore, India Sandeep Kumar Gour Sandeep Kumar Gour Department of Orthopaedics, MS Ramaiah Medical College, Bangalore, India Department of Orthopaedics, MS Ramaiah Medical College, Bangalore, India
en 26848476 10.5812/atr.30165 New Prognostic Biomarkers in Patients With Traumatic Brain Injury New Prognostic Biomarkers in Patients With Traumatic Brain Injury review-article review-article Context

Traumatic brain injury (TBI) is a leading cause of death, disability, and resource consumption per year. There are two kinds of brain injury in TBI, primary and secondary injuries. Primary injury refers to the initial physical forces applied to the brain at the moment of impact. Secondary injury occurs over a period of hours or days following the initial trauma and results from the activation of different pathways such as inflammation, coagulation, oxidation, and apoptosis.

Conclusions

Circulating levels of some biomarkers, such as SP, sCD40L, TIMP-1, MDA, and CK-18 fragmented, related to inflammation, coagulation, oxidation, and apoptosis have been recently associated with mortality in patients with TBI. These biomarkers could help in the prognostic classification of the patients and open new research lines in the treatment of patients with TBI.

Evidence Acquisition

This review focuses on new prognostic biomarkers of mortality in TBI patients related to inflammation, coagulation, oxidation, and apoptosis.

Results

Recently circulating levels of substance P (SP), soluble CD40 ligand (sCD40L), tissue inhibitor of matrix metalloproteinases (TIMP)-1, malondialdehyde (MDA), and cytokeratin (CK)-18 fragmented have been found to be associated with mortality in TBI patients. Substance P is a neuropeptide of the tachykinin family, mainly synthesized in the central and peripheral nervous system, with proinflammatory effects when binding to their neurokinin-1 receptor (NK1R). Soluble CD40 ligand, a member of the tumor necrosis factor (TNF) family that is released into circulation from activated platelets, exhibit proinflamatory, and procoagulant properties on binding to their cell surface receptor CD40. Matrix metalloproteinases (MMPs) are a family of zinc-containing endoproteinases involved neuroinflammation and TIMP-1 is the inhibitor of some of them. Malondialdehyde is an end-product formed during lipid peroxidation due to degradation of cellular membrane phospholipids, that is released into extracellular space and finally into the blood. Cytokeratin -18 is cleaved by the action of caspases during apoptosis, and CK-18 fragmented is released into the blood.

Context

Traumatic brain injury (TBI) is a leading cause of death, disability, and resource consumption per year. There are two kinds of brain injury in TBI, primary and secondary injuries. Primary injury refers to the initial physical forces applied to the brain at the moment of impact. Secondary injury occurs over a period of hours or days following the initial trauma and results from the activation of different pathways such as inflammation, coagulation, oxidation, and apoptosis.

Conclusions

Circulating levels of some biomarkers, such as SP, sCD40L, TIMP-1, MDA, and CK-18 fragmented, related to inflammation, coagulation, oxidation, and apoptosis have been recently associated with mortality in patients with TBI. These biomarkers could help in the prognostic classification of the patients and open new research lines in the treatment of patients with TBI.

Evidence Acquisition

This review focuses on new prognostic biomarkers of mortality in TBI patients related to inflammation, coagulation, oxidation, and apoptosis.

Results

Recently circulating levels of substance P (SP), soluble CD40 ligand (sCD40L), tissue inhibitor of matrix metalloproteinases (TIMP)-1, malondialdehyde (MDA), and cytokeratin (CK)-18 fragmented have been found to be associated with mortality in TBI patients. Substance P is a neuropeptide of the tachykinin family, mainly synthesized in the central and peripheral nervous system, with proinflammatory effects when binding to their neurokinin-1 receptor (NK1R). Soluble CD40 ligand, a member of the tumor necrosis factor (TNF) family that is released into circulation from activated platelets, exhibit proinflamatory, and procoagulant properties on binding to their cell surface receptor CD40. Matrix metalloproteinases (MMPs) are a family of zinc-containing endoproteinases involved neuroinflammation and TIMP-1 is the inhibitor of some of them. Malondialdehyde is an end-product formed during lipid peroxidation due to degradation of cellular membrane phospholipids, that is released into extracellular space and finally into the blood. Cytokeratin -18 is cleaved by the action of caspases during apoptosis, and CK-18 fragmented is released into the blood.

Biomarkers;Substance P;sCD40L;TIMP-1;Malondialdehyde;Cytokeratin-8;Brain Trauma Biomarkers;Substance P;sCD40L;TIMP-1;Malondialdehyde;Cytokeratin-8;Brain Trauma http://www.archtrauma.com/index.php?page=article&article_id=30165 Leonardo Lorente Leonardo Lorente Intensive Care Unit, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain; Intensive Care Unit, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain. Tel: +34-686429703, Fax: +34-922662245 Intensive Care Unit, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain; Intensive Care Unit, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain. Tel: +34-686429703, Fax: +34-922662245
en 26848473 10.5812/atr.29214 Effectiveness of Five-Level Emergency Severity Index Triage System Compared With Three-Level Spot Check: An Iranian Experience Effectiveness of Five-Level Emergency Severity Index Triage System Compared With Three-Level Spot Check: An Iranian Experience research-article research-article Results

Increase from 6.46 to 8.92 minutes in the average time from patient arrival to being visited by a physician (P < 0.001) and increase in average time from physician visit to receive the first nursing care from 7.68 to 15.89 minutes were significant (P < 0.001). The average waiting time for laboratory services was significantly decreased from 112.3 to 84.1 (P = 0.033). Increase in the average waiting time for radiology, decrease in average waiting time for sonography, average length of stay in the emergency department, and number of patients per emergency bed were not significant.

Conclusions

Between the two systems of triage, ESI was more effective than the spot check and in the spatial and temporal domain of research, was a successful method in improving some indicators of emergency and improving the performance indices. Hospital managers by implementation of ESI system can take a step toward new health policies and improve the processes as key tools of continuous quality improvement system.

Patients and Methods

Data for this quasi-experimental study were extracted using a form to review 770 records of patients referred to emergency department of Imam Khomeini hospital (in Sari, north of Iran) during two separated periods each for four months; the first from 20th March to 19th July 2010 and the other from 21 March to 20 July 2011. The method used in the first time was spot check triage and the second one ESI triage. Data were processed with descriptive statistics and analyzed using independent samples t-test (CI = 95%).

Background

Triage for patients’ prioritization in the emergency department is a suitable solution to decrease overcrowding. Different methods are used for prioritization that needs effectiveness evaluation.

Objectives

The aim of this study was to assess the effectiveness of the emergency severity index (ESI) 5-level triage system in contrast with spot check triage.

Results

Increase from 6.46 to 8.92 minutes in the average time from patient arrival to being visited by a physician (P < 0.001) and increase in average time from physician visit to receive the first nursing care from 7.68 to 15.89 minutes were significant (P < 0.001). The average waiting time for laboratory services was significantly decreased from 112.3 to 84.1 (P = 0.033). Increase in the average waiting time for radiology, decrease in average waiting time for sonography, average length of stay in the emergency department, and number of patients per emergency bed were not significant.

Conclusions

Between the two systems of triage, ESI was more effective than the spot check and in the spatial and temporal domain of research, was a successful method in improving some indicators of emergency and improving the performance indices. Hospital managers by implementation of ESI system can take a step toward new health policies and improve the processes as key tools of continuous quality improvement system.

Patients and Methods

Data for this quasi-experimental study were extracted using a form to review 770 records of patients referred to emergency department of Imam Khomeini hospital (in Sari, north of Iran) during two separated periods each for four months; the first from 20th March to 19th July 2010 and the other from 21 March to 20 July 2011. The method used in the first time was spot check triage and the second one ESI triage. Data were processed with descriptive statistics and analyzed using independent samples t-test (CI = 95%).

Background

Triage for patients’ prioritization in the emergency department is a suitable solution to decrease overcrowding. Different methods are used for prioritization that needs effectiveness evaluation.

Objectives

The aim of this study was to assess the effectiveness of the emergency severity index (ESI) 5-level triage system in contrast with spot check triage.

Emergency Service;Triage;Comparative Effectiveness Research Emergency Service;Triage;Comparative Effectiveness Research http://www.archtrauma.com/index.php?page=article&article_id=29214 Mohammadreza Maleki Mohammadreza Maleki Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, IR Iran Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, IR Iran Razieh Fallah Razieh Fallah Amol Imam Reza Hospital, Mazandaran University of Medical Sciences, Sari, IR Iran; Amol Imam Reza Hospital, Mazandaran University of Medical Sciences, P. O. Box: 4614937597, Sari, IR Iran. Tel: +98-1143272016, Fax: +98-1143272011 Amol Imam Reza Hospital, Mazandaran University of Medical Sciences, Sari, IR Iran; Amol Imam Reza Hospital, Mazandaran University of Medical Sciences, P. O. Box: 4614937597, Sari, IR Iran. Tel: +98-1143272016, Fax: +98-1143272011 Leila Riahi Leila Riahi Department of Health Services Management, Faculty of Management and Economics, Science and Research Branch, Islamic Azad University, Tehran, IR Iran Department of Health Services Management, Faculty of Management and Economics, Science and Research Branch, Islamic Azad University, Tehran, IR Iran Sajad Delavari Sajad Delavari Health Human Resources Research Center, School of Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, IR Iran Health Human Resources Research Center, School of Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, IR Iran Satar Rezaei Satar Rezaei Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, IR Iran Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, IR Iran
en 26848478 10.5812/atr.30788 Intravenous Paracetamol Versus Patient-Controlled Analgesia With Morphine for the Pain Management Following Diagnostic Knee Arthroscopy in Trauma Patients: A Randomized Clinical Trial Intravenous Paracetamol Versus Patient-Controlled Analgesia With Morphine for the Pain Management Following Diagnostic Knee Arthroscopy in Trauma Patients: A Randomized Clinical Trial research-article research-article Conclusions

Intravenous administration of paracetamol immediately after knee arthroscopy improved postoperative pain, decreased analgesic administration, maintained stable hemodynamic parameters, had no complications related to opiates, no nausea and vomiting, and increased patient satisfaction and comfort in comparison to PCA with morphine.

Results

There was no significant difference regarding the pain level at different times after entering the recovery between the two groups. No one from the paracetamol group developed drug complications. However, 22.3% in the PCA morphine suffered from postoperative nausea; there was a statistically significant difference regarding the sedation level, nausea, and vomiting at various times between the two groups.

Objectives

The aim of this study was to compare intravenous paracetamol and patient-controlled analgesia (PCA) with morphine for the pain management following diagnostic knee arthroscopy in trauma patients.

Patients and Methods

Sixty trauma patients who were scheduled to undergo knee arthroscopy were randomly divided into two groups. Patients immediately received intravenous infusion of 1 g paracetamol within 15 minutes after surgery and every 6 hours to 24 hours in the paracetamol group. The patient-controlled analgesia group received morphine through PCA infusion pump at 2 mL/h base rate and 1mL bolus every 15 minutes. Pain level, nausea and vomiting, and sedation were measured and recorded during entering the recovery, 15 and 30 minutes after entering the recovery, 2, 6, and 24 hours after starting morphine pump infusion in the morphine and paracetamol in the paracetamol groups.

Background

Most patients undergoing outpatient surgeries have the unpleasant experience of high level pain after surgery. Compared with open surgeries, arthroscopic procedures are less painful; however, inadequate pain management could be associated with significant concerns. Opioids alone or in combination with local anesthetics are frequently used for diminishing postoperative pain using intravenous or epidural infusion pumps. Despite morphine various disadvantages, it is commonly used for controlling pain after surgery.

Conclusions

Intravenous administration of paracetamol immediately after knee arthroscopy improved postoperative pain, decreased analgesic administration, maintained stable hemodynamic parameters, had no complications related to opiates, no nausea and vomiting, and increased patient satisfaction and comfort in comparison to PCA with morphine.

Results

There was no significant difference regarding the pain level at different times after entering the recovery between the two groups. No one from the paracetamol group developed drug complications. However, 22.3% in the PCA morphine suffered from postoperative nausea; there was a statistically significant difference regarding the sedation level, nausea, and vomiting at various times between the two groups.

Objectives

The aim of this study was to compare intravenous paracetamol and patient-controlled analgesia (PCA) with morphine for the pain management following diagnostic knee arthroscopy in trauma patients.

Patients and Methods

Sixty trauma patients who were scheduled to undergo knee arthroscopy were randomly divided into two groups. Patients immediately received intravenous infusion of 1 g paracetamol within 15 minutes after surgery and every 6 hours to 24 hours in the paracetamol group. The patient-controlled analgesia group received morphine through PCA infusion pump at 2 mL/h base rate and 1mL bolus every 15 minutes. Pain level, nausea and vomiting, and sedation were measured and recorded during entering the recovery, 15 and 30 minutes after entering the recovery, 2, 6, and 24 hours after starting morphine pump infusion in the morphine and paracetamol in the paracetamol groups.

Background

Most patients undergoing outpatient surgeries have the unpleasant experience of high level pain after surgery. Compared with open surgeries, arthroscopic procedures are less painful; however, inadequate pain management could be associated with significant concerns. Opioids alone or in combination with local anesthetics are frequently used for diminishing postoperative pain using intravenous or epidural infusion pumps. Despite morphine various disadvantages, it is commonly used for controlling pain after surgery.

Analgesia;Patient-Controlled;Patient Safety;Pain Management;Arthroscopy;Acetaminophen;Morphine Analgesia;Patient-Controlled;Patient Safety;Pain Management;Arthroscopy;Acetaminophen;Morphine http://www.archtrauma.com/index.php?page=article&article_id=30788 Seyed Masoud Hashemi Seyed Masoud Hashemi Department of Pain Management, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Department of Pain Management, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Aliakbar Esmaeelijah Aliakbar Esmaeelijah Department of Orthopedics, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Department of Orthopedics, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Samad Golzari Samad Golzari Department of Anesthesiology, Tabriz University of Medical Sciences, Tabriz, IR Iran Department of Anesthesiology, Tabriz University of Medical Sciences, Tabriz, IR Iran Sohrab Keyhani Sohrab Keyhani Department of Orthopedics, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Department of Orthopedics, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Azita Maserrat Azita Maserrat Department of Anesthesiology, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Department of Anesthesiology, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Gholamreza Mohseni Gholamreza Mohseni Department of Anesthesiology, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran; Department of Anesthesiology, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran. Tel: +98-9375347941 Department of Anesthesiology, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran; Department of Anesthesiology, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran. Tel: +98-9375347941 Seyed Hosein Ardehali Seyed Hosein Ardehali Department of Anesthesiology, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Department of Anesthesiology, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
en 26848469 10.5812/atr.25363 Functional Independence Measure in Iran: A Confirmatory Factor Analysis and Evaluation of Ceiling and Floor Effects in Traumatic Brain Injury Patients Functional Independence Measure in Iran: A Confirmatory Factor Analysis and Evaluation of Ceiling and Floor Effects in Traumatic Brain Injury Patients research-article research-article Conclusions

Although ceiling effects should be considered for rehabilitation targets, the two-factor model of FIM (motor and cognitive independence) has an eligible fitness for Iranian patients with TBI.

Results

The results of this study showed that the floor effect was not observed; however, ceiling effects were observed for the FIM total score and its subscales. The confirmatory factor analysis showed that the chi-square/df ratio was 2.8 for the two-factor structure and the fit indices for this structural model including root mean square error of approximation (RMSEA) = 0.099, normed fit index (NFI) = 0.96, tucker lewis index (TLI) = 0.97, comparative fit index (CFI) = 0.97 were close to standard indices.

Objectives

The aim of this study was to evaluate a two-factor model (motor and cognitive independence as latent variables) and ceiling/floor effects for FIM in Iranian patients with traumatic brain injuries (TBI).

Patients and Methods

In this cross-sectional study, 185 subacute TBI patients were selected from emergency and neurosurgery departments of Poursina Hospital (the largest trauma hospital in northern Iran, Rasht) using the consecutive sampling method and were assessed for functional independence.

Background

The functional independence measure (FIM) is one of the most important assessment instruments for motor and cognitive dependence in rehabilitation medicine; however, there is little data about its confirmatory factor analysis (CFA) and ceiling/floor effects from other countries and also in Iranian patients.

Conclusions

Although ceiling effects should be considered for rehabilitation targets, the two-factor model of FIM (motor and cognitive independence) has an eligible fitness for Iranian patients with TBI.

Results

The results of this study showed that the floor effect was not observed; however, ceiling effects were observed for the FIM total score and its subscales. The confirmatory factor analysis showed that the chi-square/df ratio was 2.8 for the two-factor structure and the fit indices for this structural model including root mean square error of approximation (RMSEA) = 0.099, normed fit index (NFI) = 0.96, tucker lewis index (TLI) = 0.97, comparative fit index (CFI) = 0.97 were close to standard indices.

Objectives

The aim of this study was to evaluate a two-factor model (motor and cognitive independence as latent variables) and ceiling/floor effects for FIM in Iranian patients with traumatic brain injuries (TBI).

Patients and Methods

In this cross-sectional study, 185 subacute TBI patients were selected from emergency and neurosurgery departments of Poursina Hospital (the largest trauma hospital in northern Iran, Rasht) using the consecutive sampling method and were assessed for functional independence.

Background

The functional independence measure (FIM) is one of the most important assessment instruments for motor and cognitive dependence in rehabilitation medicine; however, there is little data about its confirmatory factor analysis (CFA) and ceiling/floor effects from other countries and also in Iranian patients.

Traumatic Brain Injury;Confirmatory Factor Analysis;Disability Evaluation Traumatic Brain Injury;Confirmatory Factor Analysis;Disability Evaluation http://www.archtrauma.com/index.php?page=article&article_id=25363 Sajjad Rezaei Sajjad Rezaei Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, IR Iran; Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, IR Iran. Tel: +98-9113390785, Fax: +98-1333338373 Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, IR Iran; Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, IR Iran. Tel: +98-9113390785, Fax: +98-1333338373 Anoush Dehnadi Moghadam Anoush Dehnadi Moghadam Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, IR Iran; Department of Anesthesiology and Intensive Care Unit, Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, IR Iran Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, IR Iran; Department of Anesthesiology and Intensive Care Unit, Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, IR Iran Naeima Khodadadi Naeima Khodadadi Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, IR Iran; Department of Nursing, Faculty of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, IR Iran Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, IR Iran; Department of Nursing, Faculty of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, IR Iran Pardis Rahmatpour Pardis Rahmatpour Department of Nursing, Faculty of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, IR Iran Department of Nursing, Faculty of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, IR Iran
en 26848477 10.5812/atr.30244 Evaluation of the Safe Ischemic Time of Clamping During Intermittent Pringles Maneuver in Rabbits Evaluation of the Safe Ischemic Time of Clamping During Intermittent Pringles Maneuver in Rabbits research-article research-article Conclusions

Continuous portal triade clamping (the Pringle maneuver) during liver ischemia (30 and 45 minutes) in rabbits resulted in no ischemic change. Increasing time of clamping to 30 minutes was safe in intermittent Pringle maneuver.

Materials and Methods

In an experimental study, 20 New-Zealand white rabbits were selected. In laparotomy, a blunt dissector was passed through the foramen of Winslow and the hepato-duodenal ligament encircled with an umbilical tape. En masse Pringle maneuver was performed using atraumatic flexible clamps. Rabbits were divided into four groups based on Pringle maneuver time (30 minutes, 45 minutes, 60 minutes, and 75 minutes). A hepatic biopsy was performed at the beginning of operation. The degree of tissue injury was evaluated using blood markers.

Background

The liver is the most commonly injured organ in blunt abdominal trauma. Although major hepatic bleeding may be partially controlled with portal triade clamping (the Pringle’s maneuver), continuous prolonged clamping results in liver ischemia.

Results

There were five rabbits in each group. At the end of 60 minutes ischemia, only minor alterations were observed in pathological specimens. At the end of 75 minutes, hepatocyte damage and necrosis were observed. The serum levels of alanine aminotransferase (Group A: P = 0.02; Group B: P = 0.01; Group C: P = 0.0002; Group D: P = 0.01) and Aspartate aminotransferase (Group A: P = 0.03; Group B: P = 0.002; Group C: P = 0.0004; Group D: P = 0.0003) were significantly increased post-operatively. The maximum level was in the first day after operation.

Objectives

The purpose of this study was to determine the safe time of Pringle maneuver based on pathologic changes of liver in rabbit models.

Conclusions

Continuous portal triade clamping (the Pringle maneuver) during liver ischemia (30 and 45 minutes) in rabbits resulted in no ischemic change. Increasing time of clamping to 30 minutes was safe in intermittent Pringle maneuver.

Materials and Methods

In an experimental study, 20 New-Zealand white rabbits were selected. In laparotomy, a blunt dissector was passed through the foramen of Winslow and the hepato-duodenal ligament encircled with an umbilical tape. En masse Pringle maneuver was performed using atraumatic flexible clamps. Rabbits were divided into four groups based on Pringle maneuver time (30 minutes, 45 minutes, 60 minutes, and 75 minutes). A hepatic biopsy was performed at the beginning of operation. The degree of tissue injury was evaluated using blood markers.

Background

The liver is the most commonly injured organ in blunt abdominal trauma. Although major hepatic bleeding may be partially controlled with portal triade clamping (the Pringle’s maneuver), continuous prolonged clamping results in liver ischemia.

Results

There were five rabbits in each group. At the end of 60 minutes ischemia, only minor alterations were observed in pathological specimens. At the end of 75 minutes, hepatocyte damage and necrosis were observed. The serum levels of alanine aminotransferase (Group A: P = 0.02; Group B: P = 0.01; Group C: P = 0.0002; Group D: P = 0.01) and Aspartate aminotransferase (Group A: P = 0.03; Group B: P = 0.002; Group C: P = 0.0004; Group D: P = 0.0003) were significantly increased post-operatively. The maximum level was in the first day after operation.

Objectives

The purpose of this study was to determine the safe time of Pringle maneuver based on pathologic changes of liver in rabbit models.

Liver;Pringle’s Maneuver;Ischemia Liver;Pringle’s Maneuver;Ischemia http://www.archtrauma.com/index.php?page=article&article_id=30244 Mohsen Kolahdoozan Mohsen Kolahdoozan Department of General Surgery, Isfahan University of Medical Sciences, Isfahan, IR Iran Department of General Surgery, Isfahan University of Medical Sciences, Isfahan, IR Iran Akbar Behdad Akbar Behdad Department of General Surgery, Isfahan University of Medical Sciences, Isfahan, IR Iran Department of General Surgery, Isfahan University of Medical Sciences, Isfahan, IR Iran Mehrdad Hosseinpour Mehrdad Hosseinpour Department of General Surgery, Isfahan University of Medical Sciences, Isfahan, IR Iran Department of General Surgery, Isfahan University of Medical Sciences, Isfahan, IR Iran Samin Behdad Samin Behdad Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran; Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran. Tel: +98-3155540026, Fax: +98-36262828 Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran; Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran. Tel: +98-3155540026, Fax: +98-36262828 Mohammad Taghi Rezaei Mohammad Taghi Rezaei Department of General Surgery, Isfahan University of Medical Sciences, Isfahan, IR Iran Department of General Surgery, Isfahan University of Medical Sciences, Isfahan, IR Iran
en PMC4733515 10.5812/atr.29903 Management and Prognostic Factors for Delayed Reconstruction of Neglected Posterior Shoulder Fracture-Dislocation Management and Prognostic Factors for Delayed Reconstruction of Neglected Posterior Shoulder Fracture-Dislocation case-report case-report Conclusions

Glenohumeral joint reduction with reconstruction of the humeral head seems to be possible even in a neglected locked posterior shoulder fracture-dislocation. If the depressed osteochondral fragment is still spheric, signs of the avascular necrosis are absent on CT, and malunion of the fragment has occurred, it is quite possible to reconstruct the head. Although results of the case are good, it is worthwhile to follow these patients for long-term complications.

Introduction

Posterior fracture-dislocations of the shoulder are rare conditions. Misdiagnosis can occur in 50% - 80% of the patients. Due to the size of the lesion, stability of the joint could not be achieved with transfer of subscapular tendon or tuberosity.

Case Presentation

A 54-year-old male patient was referred to our hospital with a neglected posterior shoulder fracture-dislocation. Functional results of the patient, and technical informations were explained in this case report. The reverse Hill-Sachs lesion involved 40% of the articular surface. Depressed and malunited fragment was elevated, and fixated to the humeral head.

Conclusions

Glenohumeral joint reduction with reconstruction of the humeral head seems to be possible even in a neglected locked posterior shoulder fracture-dislocation. If the depressed osteochondral fragment is still spheric, signs of the avascular necrosis are absent on CT, and malunion of the fragment has occurred, it is quite possible to reconstruct the head. Although results of the case are good, it is worthwhile to follow these patients for long-term complications.

Introduction

Posterior fracture-dislocations of the shoulder are rare conditions. Misdiagnosis can occur in 50% - 80% of the patients. Due to the size of the lesion, stability of the joint could not be achieved with transfer of subscapular tendon or tuberosity.

Case Presentation

A 54-year-old male patient was referred to our hospital with a neglected posterior shoulder fracture-dislocation. Functional results of the patient, and technical informations were explained in this case report. The reverse Hill-Sachs lesion involved 40% of the articular surface. Depressed and malunited fragment was elevated, and fixated to the humeral head.

Reverse Hill-Sachs;Posterior Instability;Shoulder Reverse Hill-Sachs;Posterior Instability;Shoulder http://www.archtrauma.com/index.php?page=article&article_id=29903 Taner Bekmezci Taner Bekmezci Department of Orthopaedics and Traumatology, Liv Hospital, Bahcesehir University, Istanbul, Turkey; Department of Orthopaedics and Traumatology, Liv Hospital, Bahcesehir University, Istanbul, Turkey. Tel: +90-5052123260, Fax: +90-2122734400 Department of Orthopaedics and Traumatology, Liv Hospital, Bahcesehir University, Istanbul, Turkey; Department of Orthopaedics and Traumatology, Liv Hospital, Bahcesehir University, Istanbul, Turkey. Tel: +90-5052123260, Fax: +90-2122734400 Egemen Altan Egemen Altan Orthopaedics and Traumatology, Selcuk University, Konya, Turkey Orthopaedics and Traumatology, Selcuk University, Konya, Turkey
en 10.5812/atr.35949 Happy New Year, Happy Yalda, Hope a Peaceful Year Happy New Year, Happy Yalda, Hope a Peaceful Year letter letter http://www.archtrauma.com/index.php?page=article&article_id=35949