Archives of Trauma Research Archives of Trauma Research Arch Trauma Res http://www.archtrauma.com 2251-953X 2251-9599 10.5812/atr. en jalali 2017 7 21 gregorian 2017 7 21 5 1
en 27148502 10.5812/atr.32915 Risk Factors for Deep Venous Thrombosis Following Orthopaedic Trauma Surgery: An Analysis of 56,000 patients Risk Factors for Deep Venous Thrombosis Following Orthopaedic Trauma Surgery: An Analysis of 56,000 patients research-article research-article Patients and Methods

Using current procedural terminology (CPT) codes for orthopaedic trauma procedures, we identified a prospective cohort of patients from the 2006 to 2013 ACS-NSQIP database. Using Wilcoxon-Mann-Whitney and chi-square tests where appropriate, patient demographics, comorbidities, and operative factors were compared between patients who developed a DVT within 30 days of surgery and those who did not. A multivariate logistic regression analysis was conducted to calculate odds ratios (ORs) and identify independent risk factors for DVT. Significance was set at P < 0.05.

Results

56,299 orthopaedic trauma patients were included in the analysis, of which 473 (0.84%) developed a DVT within 30 days. In univariate analysis, twenty-five variables were significantly associated with the development of a DVT, including age (P < 0.0001), BMI (P = 0.037), diabetes (P = 0.01), ASA score (P < 0.0001) and anatomic region injured (P < 0.0001). Multivariate analysis identified several independent risk factors for development of a DVT including use of a ventilator (OR = 43.67, P = 0.039), ascites (OR = 41.61, P = 0.0038), steroid use (OR = 4.00, P < 0.001), and alcohol use (OR = 2.98, P = 0.0370). Compared to patients with upper extremity trauma, those with lower extremity injuries had significantly increased odds of developing a DVT (OR = 7.55, P = 0.006). The trend toward increased odds of DVT among patients with injuries to the hip/pelvis did not reach statistical significance (OR = 4.51, P = 0.22). Smoking was not found to be an independent risk factor for developing a DVT (P = 0.1217).

Background

Deep venous thrombosis (DVT) and pulmonary embolism (PE) are recognized as major causes of morbidity and mortality in orthopaedic trauma patients. Despite the high incidence of these complications following orthopaedic trauma, there is a paucity of literature investigating the clinical risk factors for DVT in this specific population. As our healthcare system increasingly emphasizes quality measures, it is critical for orthopaedic surgeons to understand the clinical factors that increase the risk of DVT following orthopaedic trauma.

Conclusions

This is the largest study to date using the NSQIP database to identify risk factors for DVT in orthopaedic trauma patients. Although the incidence of DVT was low in our cohort, the presence of certain risk factors significantly increased the odds of developing a DVT following orthopaedic trauma. These findings will enable orthopaedic surgeons to target at-risk patients and implement post-operative care protocols aimed at reducing the morbidity and mortality associated with DVT in orthopaedic trauma patients.

Objectives

Utilizing the ACS-NSQIP database, we sought to determine the incidence and identify independent risk factors for DVT following orthopaedic trauma.

Patients and Methods

Using current procedural terminology (CPT) codes for orthopaedic trauma procedures, we identified a prospective cohort of patients from the 2006 to 2013 ACS-NSQIP database. Using Wilcoxon-Mann-Whitney and chi-square tests where appropriate, patient demographics, comorbidities, and operative factors were compared between patients who developed a DVT within 30 days of surgery and those who did not. A multivariate logistic regression analysis was conducted to calculate odds ratios (ORs) and identify independent risk factors for DVT. Significance was set at P < 0.05.

Results

56,299 orthopaedic trauma patients were included in the analysis, of which 473 (0.84%) developed a DVT within 30 days. In univariate analysis, twenty-five variables were significantly associated with the development of a DVT, including age (P < 0.0001), BMI (P = 0.037), diabetes (P = 0.01), ASA score (P < 0.0001) and anatomic region injured (P < 0.0001). Multivariate analysis identified several independent risk factors for development of a DVT including use of a ventilator (OR = 43.67, P = 0.039), ascites (OR = 41.61, P = 0.0038), steroid use (OR = 4.00, P < 0.001), and alcohol use (OR = 2.98, P = 0.0370). Compared to patients with upper extremity trauma, those with lower extremity injuries had significantly increased odds of developing a DVT (OR = 7.55, P = 0.006). The trend toward increased odds of DVT among patients with injuries to the hip/pelvis did not reach statistical significance (OR = 4.51, P = 0.22). Smoking was not found to be an independent risk factor for developing a DVT (P = 0.1217).

Background

Deep venous thrombosis (DVT) and pulmonary embolism (PE) are recognized as major causes of morbidity and mortality in orthopaedic trauma patients. Despite the high incidence of these complications following orthopaedic trauma, there is a paucity of literature investigating the clinical risk factors for DVT in this specific population. As our healthcare system increasingly emphasizes quality measures, it is critical for orthopaedic surgeons to understand the clinical factors that increase the risk of DVT following orthopaedic trauma.

Conclusions

This is the largest study to date using the NSQIP database to identify risk factors for DVT in orthopaedic trauma patients. Although the incidence of DVT was low in our cohort, the presence of certain risk factors significantly increased the odds of developing a DVT following orthopaedic trauma. These findings will enable orthopaedic surgeons to target at-risk patients and implement post-operative care protocols aimed at reducing the morbidity and mortality associated with DVT in orthopaedic trauma patients.

Objectives

Utilizing the ACS-NSQIP database, we sought to determine the incidence and identify independent risk factors for DVT following orthopaedic trauma.

Pulmonary Embolism;Venous Thromboembolism;Orthopaedic Trauma;Thromboprophylaxis;Deep Venous Thrombosis Pulmonary Embolism;Venous Thromboembolism;Orthopaedic Trauma;Thromboprophylaxis;Deep Venous Thrombosis http://www.archtrauma.com/index.php?page=article&article_id=32915 Paul S. Whiting Paul S. Whiting University of Wisconsin, Madison, WI, United States; University of Wisconsin, Madison, WI, United States. University of Wisconsin, Madison, WI, United States; University of Wisconsin, Madison, WI, United States. Gabrielle A. White-Dzuro Gabrielle A. White-Dzuro Vanderbilt University, Nashville, TN, United States Vanderbilt University, Nashville, TN, United States Sarah E. Greenberg Sarah E. Greenberg Vanderbilt University, Nashville, TN, United States Vanderbilt University, Nashville, TN, United States Jacob P. VanHouten Jacob P. VanHouten Vanderbilt University, Nashville, TN, United States Vanderbilt University, Nashville, TN, United States Frank R. Avilucea Frank R. Avilucea University of Cincinnati, Cincinnati, OH, United States University of Cincinnati, Cincinnati, OH, United States William T. Obremskey William T. Obremskey Vanderbilt University, Nashville, TN, United States Vanderbilt University, Nashville, TN, United States Manish K. Sethi Manish K. Sethi Vanderbilt University, Nashville, TN, United States Vanderbilt University, Nashville, TN, United States
en 27148501 10.5812/atr.32872 Avulsion Fractures at the Base of the 2nd Metacarpal Due to the Extensor Carpi Radialis Longus Tendon: A Case Report and Review of the Literature Avulsion Fractures at the Base of the 2<sup>nd</sup> Metacarpal Due to the Extensor Carpi Radialis Longus Tendon: A Case Report and Review of the Literature case-report case-report Conclusions

Of the open reductions and internal fixations, 11 (92%) were successful and patients made a full recovery. Conservative management was unsuccessful in 4 cases; one patient required surgery for metacarpal boss, one patient had retraction of the tendon at one week follow up and another had weak flexion of the wrist. We recommend open reduction and internal fixation for these injuries. It may allow a faster recovery and therefore allow an earlier return to work and activity.

Introduction

Simultaneous contraction of the extensor carpi radialis longus (ECRL) with forced hyperflexion of the wrist can result in avulsion of the tendon and its bony attachment at its insertion at the dorsum of the base of the second metacarpal. This is a rare and often unreported fracture pattern.

Case Presentation

We present a 31- year- old male who sustained a hyperflexion injury. He was managed surgically and had good post-operative outcomes. A literature search revealed 16 papers covering 18 cases of similar injuries. 12 were initially managed surgically and 6 were managed conservatively.

Conclusions

Of the open reductions and internal fixations, 11 (92%) were successful and patients made a full recovery. Conservative management was unsuccessful in 4 cases; one patient required surgery for metacarpal boss, one patient had retraction of the tendon at one week follow up and another had weak flexion of the wrist. We recommend open reduction and internal fixation for these injuries. It may allow a faster recovery and therefore allow an earlier return to work and activity.

Introduction

Simultaneous contraction of the extensor carpi radialis longus (ECRL) with forced hyperflexion of the wrist can result in avulsion of the tendon and its bony attachment at its insertion at the dorsum of the base of the second metacarpal. This is a rare and often unreported fracture pattern.

Case Presentation

We present a 31- year- old male who sustained a hyperflexion injury. He was managed surgically and had good post-operative outcomes. A literature search revealed 16 papers covering 18 cases of similar injuries. 12 were initially managed surgically and 6 were managed conservatively.

Ecrl;Extensor Carpi Radialis Longus;Avulsion;Metacarpal;Tendon Ecrl;Extensor Carpi Radialis Longus;Avulsion;Metacarpal;Tendon http://www.archtrauma.com/index.php?page=article&article_id=32872 Ali Najefi Ali Najefi Trauma and Orthopaedic Department, Queen’s Hospital, Romford, United Kingdom; Trauma and Orthopaedic Department, Queen’s Hospital, Romford, United Kingdom. Tel: +44-1708435000, Fax: +44-7956071227 Trauma and Orthopaedic Department, Queen’s Hospital, Romford, United Kingdom; Trauma and Orthopaedic Department, Queen’s Hospital, Romford, United Kingdom. Tel: +44-1708435000, Fax: +44-7956071227 Lucksmana Jeyaseelan Lucksmana Jeyaseelan Trauma and Orthopaedic Department, Queen’s Hospital, Romford, United Kingdom Trauma and Orthopaedic Department, Queen’s Hospital, Romford, United Kingdom Anand Patel Anand Patel Trauma and Orthopaedic Department, Queen’s Hospital, Romford, United Kingdom Trauma and Orthopaedic Department, Queen’s Hospital, Romford, United Kingdom Akhil Kapoor Akhil Kapoor Trauma and Orthopaedic Department, Queen’s Hospital, Romford, United Kingdom Trauma and Orthopaedic Department, Queen’s Hospital, Romford, United Kingdom Sunil Auplish Sunil Auplish Trauma and Orthopaedic Department, Queen’s Hospital, Romford, United Kingdom Trauma and Orthopaedic Department, Queen’s Hospital, Romford, United Kingdom
en 27148498 10.5812/atr.30672 The Mid-Term Changes of Pulmonary Function Tests After Phrenic Nerve Transfer The Mid-Term Changes of Pulmonary Function Tests After Phrenic Nerve Transfer brief-report brief-report Conclusions

This study highlights the close link between the role of the phrenic nerve and pulmonary function, such that the use of this nerve as a transfer donor leads to spirometric impairments.

Results

All patients regained Biceps power to M3 strength or above. None of our patients experienced pulmonary problems or respiratory complaints, but a significant reduction of spirometric parameters occurred after surgery.

Patients and Methods

We reviewed the results of serial spirometry tests, which were performed before and after phrenic nerve transfer surgery.

Objectives

In the current study, we reviewed the results of pulmonary function tests (PFT) in four patients who underwent phrenic nerve transfer.

Background

In the restoration of elbow flexion, the phrenic nerve has proven to be a good donor, but considering the role of the phrenic nerve in respiratory function, we cannot disregard the potential dangers of this method.

Conclusions

This study highlights the close link between the role of the phrenic nerve and pulmonary function, such that the use of this nerve as a transfer donor leads to spirometric impairments.

Results

All patients regained Biceps power to M3 strength or above. None of our patients experienced pulmonary problems or respiratory complaints, but a significant reduction of spirometric parameters occurred after surgery.

Patients and Methods

We reviewed the results of serial spirometry tests, which were performed before and after phrenic nerve transfer surgery.

Objectives

In the current study, we reviewed the results of pulmonary function tests (PFT) in four patients who underwent phrenic nerve transfer.

Background

In the restoration of elbow flexion, the phrenic nerve has proven to be a good donor, but considering the role of the phrenic nerve in respiratory function, we cannot disregard the potential dangers of this method.

Phrenic Nerve Transfer;Pulmonary Function Tests;Elbow Phrenic Nerve Transfer;Pulmonary Function Tests;Elbow http://www.archtrauma.com/index.php?page=article&article_id=30672 Masoud Yavari Masoud Yavari Department of Reconstructive Surgery, Shahid Behesti University of Medical Sciences, Tehran, IR Iran Department of Reconstructive Surgery, Shahid Behesti University of Medical Sciences, Tehran, IR Iran Seyed Esmail Hassanpour Seyed Esmail Hassanpour Department of Plastic and Reconstructive Surgery, Shahid Behesti University of Medical Sciences, Tehran, IR Iran Department of Plastic and Reconstructive Surgery, Shahid Behesti University of Medical Sciences, Tehran, IR Iran Mohammad Khodayari Mohammad Khodayari Department of Reconstructive Surgery, Shahid Behesti University of Medical Sciences, Tehran, IR Iran; Department of Reconstructive Surgery, Shahid Behesti University of Medical Sciences, Tehran, IR Iran. Tel: +98-2188901108, Fax: +98-2188909193 Department of Reconstructive Surgery, Shahid Behesti University of Medical Sciences, Tehran, IR Iran; Department of Reconstructive Surgery, Shahid Behesti University of Medical Sciences, Tehran, IR Iran. Tel: +98-2188901108, Fax: +98-2188909193
en 27148500 10.5812/atr.32221 Treatment of a Complex Distal Triceps Tendon Rupture With a New Technique: A Case Report Treatment of a Complex Distal Triceps Tendon Rupture With a New Technique: A Case Report case-report case-report Conclusions

The use of an Achilles tendon allograft provides excellent results in complex distal triceps tendon ruptures. We report the use of a new technique to anchor a distal Achilles allograft.

Introduction

The distal triceps tendon rupture is an uncommon injury. The acute treatment is well-defined, but when a delayed diagnosis is made or when a tendon retraction is present the alternatives or reconstruction are limited and sometimes complex.

Case Presentation

In this case, we report on a 28-year-old man who presented with a chronic disruption of the distal triceps tendon with a gap of approximately 15 cm. The patient was diagnosed in another center with an inveterate breakage of the distal triceps tendon and was initially treated with an Achilles allograft that was complicated by a wound infection and required more than ten surgeries. Nearly 22 months after the initial trauma, and 12 months after the first surgery, we performed a reconstruction with an Achilles tendon allograft using the new technique of distal attachment. At the 12-month follow-up the patient presented a joint balance from -5º to 110º and presented with no pain.

Conclusions

The use of an Achilles tendon allograft provides excellent results in complex distal triceps tendon ruptures. We report the use of a new technique to anchor a distal Achilles allograft.

Introduction

The distal triceps tendon rupture is an uncommon injury. The acute treatment is well-defined, but when a delayed diagnosis is made or when a tendon retraction is present the alternatives or reconstruction are limited and sometimes complex.

Case Presentation

In this case, we report on a 28-year-old man who presented with a chronic disruption of the distal triceps tendon with a gap of approximately 15 cm. The patient was diagnosed in another center with an inveterate breakage of the distal triceps tendon and was initially treated with an Achilles allograft that was complicated by a wound infection and required more than ten surgeries. Nearly 22 months after the initial trauma, and 12 months after the first surgery, we performed a reconstruction with an Achilles tendon allograft using the new technique of distal attachment. At the 12-month follow-up the patient presented a joint balance from -5º to 110º and presented with no pain.

Tendon;Tendon Injuries;Achilles Tendon Tendon;Tendon Injuries;Achilles Tendon http://www.archtrauma.com/index.php?page=article&article_id=32221 Ismael Aunon-Martin Ismael Aunon-Martin Orthopedic Trauma Section, Orthopedic Surgery Department, October 12 Hospital, Madrid, Spain; Orthopedic Trauma Section, Orthopedic Surgery Department, October 12 Hospital, Madrid, Spain. Tel: +35-913908227 Orthopedic Trauma Section, Orthopedic Surgery Department, October 12 Hospital, Madrid, Spain; Orthopedic Trauma Section, Orthopedic Surgery Department, October 12 Hospital, Madrid, Spain. Tel: +35-913908227 Alfonso Prada-Canizares Alfonso Prada-Canizares Orthopedic Trauma Section, Orthopedic Surgery Department, October 12 Hospital, Madrid, Spain Orthopedic Trauma Section, Orthopedic Surgery Department, October 12 Hospital, Madrid, Spain Veronica Jimenez-Diaz Veronica Jimenez-Diaz Orthopedic Trauma Section, Orthopedic Surgery Department, October 12 Hospital, Madrid, Spain Orthopedic Trauma Section, Orthopedic Surgery Department, October 12 Hospital, Madrid, Spain Carlos Vidal-Bujanda Carlos Vidal-Bujanda Orthopedic Trauma Section, Orthopedic Surgery Department, October 12 Hospital, Madrid, Spain Orthopedic Trauma Section, Orthopedic Surgery Department, October 12 Hospital, Madrid, Spain Jose Luis Leon-Baltasar Jose Luis Leon-Baltasar Orthopedic Trauma Section, Orthopedic Surgery Department, October 12 Hospital, Madrid, Spain Orthopedic Trauma Section, Orthopedic Surgery Department, October 12 Hospital, Madrid, Spain
en 27148503 10.5812/atr.33464 Cross-Cultural Adaptations of the MacArthur Competence Assessment Tool for Treatment in Iran Cross-Cultural Adaptations of the MacArthur Competence Assessment Tool for Treatment in Iran research-article research-article Objectives

Due to the lack of a standard tool for assessing patients’ capacity to consent to medical treatment in Iran, the present study was carried out aiming to devise a Persian version of a cross-cultural adaptation of the MacArthur competence assessment tool.

Conclusions

In the present study, we are able to focus on and prove the efficacy and benefits of this measurement tool.

Results

The MacArthur assessment tool is not dependent on any specific culture and language. As a result, if translation and its scientific adaptation are done based on an integrated and detailed model, the tool can be used for every culture and language. In other words, this tool is not culture-specific; so, it is applicable in cases where a translation is needed, and it can be culturally adapted to suit different societies.

Patients and Methods

By reviewing different methods of cultural translation and adaptation for assessment tools, and due to the lack of consensus on its processes, we selected Wild’s model as one of the most comprehensive methods in this regard. Wild’s (2005) 10-stage model includes preparation, forward translation, reconciliation of the forward translation, back translation of reconciliation, back translation review, cognitive debriefing and cognitive review, and finalization, proofreading and final reporting. Using this model, we translated the MacArthur assessment tool and made it adaptable to Iranian patients.

Background

According to general ethical and legal principles, valid consent must be obtained before starting any procedure.

Objectives

Due to the lack of a standard tool for assessing patients’ capacity to consent to medical treatment in Iran, the present study was carried out aiming to devise a Persian version of a cross-cultural adaptation of the MacArthur competence assessment tool.

Conclusions

In the present study, we are able to focus on and prove the efficacy and benefits of this measurement tool.

Results

The MacArthur assessment tool is not dependent on any specific culture and language. As a result, if translation and its scientific adaptation are done based on an integrated and detailed model, the tool can be used for every culture and language. In other words, this tool is not culture-specific; so, it is applicable in cases where a translation is needed, and it can be culturally adapted to suit different societies.

Patients and Methods

By reviewing different methods of cultural translation and adaptation for assessment tools, and due to the lack of consensus on its processes, we selected Wild’s model as one of the most comprehensive methods in this regard. Wild’s (2005) 10-stage model includes preparation, forward translation, reconciliation of the forward translation, back translation of reconciliation, back translation review, cognitive debriefing and cognitive review, and finalization, proofreading and final reporting. Using this model, we translated the MacArthur assessment tool and made it adaptable to Iranian patients.

Background

According to general ethical and legal principles, valid consent must be obtained before starting any procedure.

Decision-Making Capacity;Competency;Assessment Tools for Treatment;Translation and Cross-Cultural Adaptation;Macarthur Assessment Tool Decision-Making Capacity;Competency;Assessment Tools for Treatment;Translation and Cross-Cultural Adaptation;Macarthur Assessment Tool http://www.archtrauma.com/index.php?page=article&article_id=33464 Ali Saber Ali Saber Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, Tehran, IR Iran Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, Tehran, IR Iran Seyed Mahmoud Tabatabaei Seyed Mahmoud Tabatabaei Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, Tehran, IR Iran Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, Tehran, IR Iran Goodarz Akasheh Goodarz Akasheh Department of Psychiatry, Kashan University of Medical Sciences, Kashan, IR Iran Department of Psychiatry, 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 Zahra Zanjani Zahra Zanjani Department of Psychology, Kashan University of Medical Sciences, Kashan, IR Iran Department of Psychology, Kashan University of Medical Sciences, Kashan, IR Iran Bagher Larijani Bagher Larijani Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, Tehran, IR Iran; Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, IR Iran; Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, Tehran, IR Iran. Tel: +98-2166419661, Fax: +98-2166953832 Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, Tehran, IR Iran; Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, IR Iran; Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, Tehran, IR Iran. Tel: +98-2166419661, Fax: +98-2166953832
en 27148495 10.5812/atr.18330 Impalement Thoracoabdominal Trauma Secondary to Falling on Metallic (Iron) Bars: An Extremely Rare and Unique Case Impalement Thoracoabdominal Trauma Secondary to Falling on Metallic (Iron) Bars: An Extremely Rare and Unique Case case-report case-report Conclusions

Anesthetic and surgical management was difficult due to the inability to position in supine and rapidly progressing hemorrhagic shock. Surgical management for extraction of this iron bar and intensive monitoring and resuscitation resulted in an uneventful successful outcome.

Introduction

Penetrating thoracoabdominal injuries are potentially life threatening due to the associated hemorrhagic shock and visceral injury. Through and through penetrating injury with polytrauma is rarely encountered.

Case Presentation

Here we report on a 25-year-old male with penetrating thoracoabdominal injury caused by a metallic (iron) bar projecting from a pillar of a construction site after he fell down from a height.

Conclusions

Anesthetic and surgical management was difficult due to the inability to position in supine and rapidly progressing hemorrhagic shock. Surgical management for extraction of this iron bar and intensive monitoring and resuscitation resulted in an uneventful successful outcome.

Introduction

Penetrating thoracoabdominal injuries are potentially life threatening due to the associated hemorrhagic shock and visceral injury. Through and through penetrating injury with polytrauma is rarely encountered.

Case Presentation

Here we report on a 25-year-old male with penetrating thoracoabdominal injury caused by a metallic (iron) bar projecting from a pillar of a construction site after he fell down from a height.

Thoracoabdominal;Metallic;Penetrating Traum Thoracoabdominal;Metallic;Penetrating Traum http://www.archtrauma.com/index.php?page=article&article_id=18330 Mohsen Kolahdouzan Mohsen Kolahdouzan Department of Surgery, Isfahan University of Medical Sciences and Health Services, Isfahan, IR Iran Department of Surgery, Isfahan University of Medical Sciences and Health Services, Isfahan, IR Iran Mohammad Taqhi Rezaee Mohammad Taqhi Rezaee Department of Surgery, Isfahan University of Medical Sciences and Health Services, Isfahan, IR Iran Department of Surgery, Isfahan University of Medical Sciences and Health Services, Isfahan, IR Iran Shahab Shahabi Shahab Shahabi Department of Surgery, Isfahan University of Medical Sciences and Health Services, Isfahan, IR Iran; Department of Surgery, Isfahan University of Medical Sciences and Health Services, Isfahan, IR Iran. Tel: +98-9111137105, Fax: +98-3116684510 Department of Surgery, Isfahan University of Medical Sciences and Health Services, Isfahan, IR Iran; Department of Surgery, Isfahan University of Medical Sciences and Health Services, Isfahan, IR Iran. Tel: +98-9111137105, Fax: +98-3116684510
en 27148496 10.5812/atr.24596 Prevalence of Traumatic Dental Injuries to Anterior Teeth of 12-Year-Old School Children in Kashmir, India Prevalence of Traumatic Dental Injuries to Anterior Teeth of 12-Year-Old School Children in Kashmir, India research-article research-article Conclusions

It was concluded that the prevalence of traumatic dental injuries was 9.3%. Traumatic dental injuries among children exhibit complex interaction between the victims’ oral conditions and their behavior. Therefore, prevention should consider a number of characteristics such as oral predisposing factors, environmental determinants and human behavior. It is recommended that specific and proper public places for leisure and sports activities, with impact-absorbing surfaces around the items on which children are most likely to fall, should be provided.

Results

The overall prevalence of TDI to anterior teeth was found to be 9.3%. The TDI to anterior teeth in male was more than female, but the difference was statistically nonsignificant (P < 0.01). Falls and sports were the most common causes of trauma in the present study. The highest potential risk factor for the occurrence of trauma was over jet. Academic performance was found to be significantly associated to TDI to anterior teeth, when analyzed in a multiple regression model.

Background

Traumatic dental injuries to anterior teeth are a significant public health problem, not only because their prevalence is relatively high, but also because they have considerable impact on children’s daily lives. Traumatic dental injuries (TDIs) cause physical and psychological discomfort, pain and other negative impacts, such as tendency to avoid laughing or smiling, which can affect social relationships.

Objectives

This study aimed to assess the prevalence of traumatic dental injuries to anterior teeth among 12-year-old school children in Kashmir, India.

Patients and Methods

A cross-sectional study was conducted in private and government schools of India among 1600 schoolchildren aged 12 years. In addition to recording of the type of trauma (using Ellis and Davey classification of fractures, 1970), over jet, Angle’s molar relation and lip competence were also recorded. The socioeconomic status and academic performance of the study subjects were registered. The data obtained were compiled systematically and then statistically analyzed. The statistical significance for the association between the traumatic injury and the variables was analyzed using the chi-square test. Logistic regression was used to identify potential risk predictors of TDIs.

Conclusions

It was concluded that the prevalence of traumatic dental injuries was 9.3%. Traumatic dental injuries among children exhibit complex interaction between the victims’ oral conditions and their behavior. Therefore, prevention should consider a number of characteristics such as oral predisposing factors, environmental determinants and human behavior. It is recommended that specific and proper public places for leisure and sports activities, with impact-absorbing surfaces around the items on which children are most likely to fall, should be provided.

Results

The overall prevalence of TDI to anterior teeth was found to be 9.3%. The TDI to anterior teeth in male was more than female, but the difference was statistically nonsignificant (P < 0.01). Falls and sports were the most common causes of trauma in the present study. The highest potential risk factor for the occurrence of trauma was over jet. Academic performance was found to be significantly associated to TDI to anterior teeth, when analyzed in a multiple regression model.

Background

Traumatic dental injuries to anterior teeth are a significant public health problem, not only because their prevalence is relatively high, but also because they have considerable impact on children’s daily lives. Traumatic dental injuries (TDIs) cause physical and psychological discomfort, pain and other negative impacts, such as tendency to avoid laughing or smiling, which can affect social relationships.

Objectives

This study aimed to assess the prevalence of traumatic dental injuries to anterior teeth among 12-year-old school children in Kashmir, India.

Patients and Methods

A cross-sectional study was conducted in private and government schools of India among 1600 schoolchildren aged 12 years. In addition to recording of the type of trauma (using Ellis and Davey classification of fractures, 1970), over jet, Angle’s molar relation and lip competence were also recorded. The socioeconomic status and academic performance of the study subjects were registered. The data obtained were compiled systematically and then statistically analyzed. The statistical significance for the association between the traumatic injury and the variables was analyzed using the chi-square test. Logistic regression was used to identify potential risk predictors of TDIs.

Traumatic Dental Injuries;Schools;Risks Traumatic Dental Injuries;Schools;Risks http://www.archtrauma.com/index.php?page=article&article_id=24596 Tasneem S. Ain Tasneem S. Ain Department of Public Health Dentistry, Mahatma Jyotiba Phule Rohilkhand University, Bareilly, India; Department of Public Health Dentistry, Kothiwal Dental College & Research Centre, Moradabad, India; Department of Public Health Dentistry, Mahatma Jyotiba Phule Rohilkhand University, Bareilly, India. Tel: +91-8494044261, Fax: +59-12452996 Department of Public Health Dentistry, Mahatma Jyotiba Phule Rohilkhand University, Bareilly, India; Department of Public Health Dentistry, Kothiwal Dental College & Research Centre, Moradabad, India; Department of Public Health Dentistry, Mahatma Jyotiba Phule Rohilkhand University, Bareilly, India. Tel: +91-8494044261, Fax: +59-12452996 Ravishankar Lingesha Telgi Ravishankar Lingesha Telgi Department of Public Health Dentistry, Mahatma Jyotiba Phule Rohilkhand University, Bareilly, India Department of Public Health Dentistry, Mahatma Jyotiba Phule Rohilkhand University, Bareilly, India Saima Sultan Saima Sultan Departments of Pedodontics, Mahatma Jyotiba Phule Rohilkhand University, Bareilly, India Departments of Pedodontics, Mahatma Jyotiba Phule Rohilkhand University, Bareilly, India Pradeep Tangade Pradeep Tangade Department of Public Health Dentistry, Mahatma Jyotiba Phule Rohilkhand University, Bareilly, India Department of Public Health Dentistry, Mahatma Jyotiba Phule Rohilkhand University, Bareilly, India Chaitra Ravishankar Telgi Chaitra Ravishankar Telgi Departments of Pedodontics, Mahatma Jyotiba Phule Rohilkhand University, Bareilly, India Departments of Pedodontics, Mahatma Jyotiba Phule Rohilkhand University, Bareilly, India Amit Tirth Amit Tirth Department of Public Health Dentistry, Mahatma Jyotiba Phule Rohilkhand University, Bareilly, India Department of Public Health Dentistry, Mahatma Jyotiba Phule Rohilkhand University, Bareilly, India Sumit Kumar Pal Sumit Kumar Pal Department of Public Health Dentistry, Mahatma Jyotiba Phule Rohilkhand University, Bareilly, India Department of Public Health Dentistry, Mahatma Jyotiba Phule Rohilkhand University, Bareilly, India Owais Gowhar Owais Gowhar Departments of Oral and Maxillofacial Pathology, Mahatma Jyotiba Phule Rohilkhand University, Bareilly, India Departments of Oral and Maxillofacial Pathology, Mahatma Jyotiba Phule Rohilkhand University, Bareilly, India Vaibhav Tandon Vaibhav Tandon Department of Public Health Dentistry, Mahatma Jyotiba Phule Rohilkhand University, Bareilly, India Department of Public Health Dentistry, Mahatma Jyotiba Phule Rohilkhand University, Bareilly, India
en 27148497 10.5812/atr.29555 Nasolabial Flap in Maxillofacial Gunshot Trauma: A Case Series Nasolabial Flap in Maxillofacial Gunshot Trauma: A Case Series case-report case-report Introduction

The nasolabial flap (NLF) has many advantages in oromaxillary reconstruction, but the majority of cases are reconstructions after pathologic resections. Its usage in trauma surgery, especially in the management of gunshot wounds, is rarely mentioned.

Case Presentation

Three cases involving gunshot injuries to the face are presented: one for reconstruction of the nasal ala, another for bone graft coverage in mandibular reconstruction, and the third for the repair of premaxillary hard and soft tissue avulsive defects.

Conclusions

The NLF is a thin, pliable flap and is useful for intraoral and facial reconstruction of trauma patients with small to moderate soft tissue loss.

Introduction

The nasolabial flap (NLF) has many advantages in oromaxillary reconstruction, but the majority of cases are reconstructions after pathologic resections. Its usage in trauma surgery, especially in the management of gunshot wounds, is rarely mentioned.

Case Presentation

Three cases involving gunshot injuries to the face are presented: one for reconstruction of the nasal ala, another for bone graft coverage in mandibular reconstruction, and the third for the repair of premaxillary hard and soft tissue avulsive defects.

Conclusions

The NLF is a thin, pliable flap and is useful for intraoral and facial reconstruction of trauma patients with small to moderate soft tissue loss.

Flap;Trauma;Reconstruction Flap;Trauma;Reconstruction http://www.archtrauma.com/index.php?page=article&article_id=29555 Amin Rahpeyma Amin Rahpeyma Oral and Maxillofacial Diseases Research Center, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, IR Iran Oral and Maxillofacial Diseases Research Center, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, IR Iran Saeedeh Khajehahmadi Saeedeh Khajehahmadi Dental Research Center, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, IR Iran; Dental Research Center, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, IR Iran. Tel: + 98-5138829501, Fax: + 98-5138829500 Dental Research Center, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, IR Iran; Dental Research Center, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, IR Iran. Tel: + 98-5138829501, Fax: + 98-5138829500
en 27148499 10.5812/atr.31888 Clinical Presentation and Time-Based Mortality in Patients With Chest Injuries Associated With Road Traffic Accidents Clinical Presentation and Time-Based Mortality in Patients With Chest Injuries Associated With Road Traffic Accidents research-article research-article Conclusions

Blunt chest trauma from RTA represents one-fifth of the total trauma admissions in Qatar, with a high overall mortality. Pedestrians are likely to have more severe injuries and higher fatality rates than MVC victims. Specific injury prevention programs focusing on road safety should be implemented to minimize the incidence of such preventable injuries.

Background

Blunt chest trauma (BCT) poses significant morbidity and mortality worldwide.

Objectives

We investigated the clinical presentation and outcome of BCT related to road traffic accidents (RTA).

Patients and Methods

A retrospective observational analysis for patients who sustained BCT secondary to RTA in terms of motor vehicle crash (MVC) and pedestrian-motor vehicle accidents (PMVA) who were admitted to the trauma center at Hamad general hospital, Doha, Qatar, between 2008 and 2011.

Results

Of 5118 traumatic injury cases, 1004 (20%) were found to have BCT secondary to RTA (77% MVC and 23% PMVA). The majority were males (92%), and expatriates (72%). Among MVCs, 84% reported they did not use protective devices. There was a correlation between chest abbreviated injury score (AIS) and injury severity scoring (ISS) (r = 0.35, r2 = 0.12, P < 0.001). Regardless of mechanism of injury (MOI), multivariate analysis showed that the head injury associated with chest AIS and ISS was a predictor of mortality in BCT. Overall mortality was 15%, and the highest rate was observed within the first 24 hours post-trauma.

Conclusions

Blunt chest trauma from RTA represents one-fifth of the total trauma admissions in Qatar, with a high overall mortality. Pedestrians are likely to have more severe injuries and higher fatality rates than MVC victims. Specific injury prevention programs focusing on road safety should be implemented to minimize the incidence of such preventable injuries.

Background

Blunt chest trauma (BCT) poses significant morbidity and mortality worldwide.

Objectives

We investigated the clinical presentation and outcome of BCT related to road traffic accidents (RTA).

Patients and Methods

A retrospective observational analysis for patients who sustained BCT secondary to RTA in terms of motor vehicle crash (MVC) and pedestrian-motor vehicle accidents (PMVA) who were admitted to the trauma center at Hamad general hospital, Doha, Qatar, between 2008 and 2011.

Results

Of 5118 traumatic injury cases, 1004 (20%) were found to have BCT secondary to RTA (77% MVC and 23% PMVA). The majority were males (92%), and expatriates (72%). Among MVCs, 84% reported they did not use protective devices. There was a correlation between chest abbreviated injury score (AIS) and injury severity scoring (ISS) (r = 0.35, r2 = 0.12, P < 0.001). Regardless of mechanism of injury (MOI), multivariate analysis showed that the head injury associated with chest AIS and ISS was a predictor of mortality in BCT. Overall mortality was 15%, and the highest rate was observed within the first 24 hours post-trauma.

Chest Trauma;Road Traffic Accidents;Injury;Pedestrians;Motor Vehicle Crashes Chest Trauma;Road Traffic Accidents;Injury;Pedestrians;Motor Vehicle Crashes http://www.archtrauma.com/index.php?page=article&article_id=31888 Ayman El-Menyar Ayman El-Menyar Clinical Research, Trauma Surgery Section, Hamad General Hospital, Doha, Qatar; Clinical Medicine, Weill Cornell Medical College, Doha, Qatar; Clinical Medicine, Weill Cornell Medical College, Doha, Qatar. Tel: +974-44394029 Clinical Research, Trauma Surgery Section, Hamad General Hospital, Doha, Qatar; Clinical Medicine, Weill Cornell Medical College, Doha, Qatar; Clinical Medicine, Weill Cornell Medical College, Doha, Qatar. Tel: +974-44394029 Husham Abdelrahman Husham Abdelrahman Trauma Surgery Section, Hamad General Hospital, Doha, Qatar Trauma Surgery Section, Hamad General Hospital, Doha, Qatar Ammar Al-Hassani Ammar Al-Hassani Trauma Surgery Section, Hamad General Hospital, Doha, Qatar Trauma Surgery Section, Hamad General Hospital, Doha, Qatar Mohammad Ellabib Mohammad Ellabib Trauma Surgery Section, Hamad General Hospital, Doha, Qatar Trauma Surgery Section, Hamad General Hospital, Doha, Qatar Mohammad Asim Mohammad Asim Clinical Research, Trauma Surgery Section, Hamad General Hospital, Doha, Qatar Clinical Research, Trauma Surgery Section, Hamad General Hospital, Doha, Qatar Ahmad Zarour Ahmad Zarour Trauma Surgery Section, Hamad General Hospital, Doha, Qatar Trauma Surgery Section, Hamad General Hospital, Doha, Qatar Hassan Al-Thani Hassan Al-Thani Trauma Surgery Section, Hamad General Hospital, Doha, Qatar Trauma Surgery Section, Hamad General Hospital, Doha, Qatar
en 27169096 10.5812/atr.28734 A Systematic Literature Review: Workplace Violence Against Emergency Medical Services Personnel A Systematic Literature Review: Workplace Violence Against Emergency Medical Services Personnel review-article review-article Objectives

The research question addressed by this paper is, “What are the characteristics and findings of studies on workplace violence against emergency medical services personnel”?

Data Sources

A systematic literature review was conducted using online databases (PubMed, Scopus, Google Scholar, and Magiran) with the help of experienced librarians.

Study Selection

Inclusion criteria comprised studies in the English or Persian language and researcher’s access to the full text. There was no limit to the entry of the study design. Exclusion criteria included lack of access to the full text of the article, studies published in unreliable journals or conferences, and studies in which the results were shared with other medical or relief groups and there was no possibility of breaking down the results.

Data Extraction

A “Data extraction form” was designed by the researchers based on the goals of the study that included the title and author(s), study method (type, place of study, sample size, sampling method, and data collection/analysis tool), printing location, information related to the frequency of types of violence, characteristics of victims /perpetrators, and related factors.

Results

The papers reviewed utilized a variety of locations and environments, methods, and instrument samplings. The majority of the studies were performed using the quantitative method. No intervention study was found. Most studies focused on the prevalence of violence, and their results indicated that exposure to violence was high. The results are presented in six major themes.

Conclusions

Workplace violence and injuries incurred from it are extensive throughout the world. The important causes of violence include the shortage of training programs dealing with violence, lack of violence management protocols, and delays in response times. Therefore, afterthought and resolve are more crucial than ever. Workplace violence reduction strategies and suggestions for future studies are also discussed.

Context

In spite of the high prevalence and consequences of much workplace violence against emergency medical services personnel, this phenomenon has been given insufficient attention. A systematic review can aid the development of guidelines to reduce violence.

Objectives

The research question addressed by this paper is, “What are the characteristics and findings of studies on workplace violence against emergency medical services personnel”?

Data Sources

A systematic literature review was conducted using online databases (PubMed, Scopus, Google Scholar, and Magiran) with the help of experienced librarians.

Study Selection

Inclusion criteria comprised studies in the English or Persian language and researcher’s access to the full text. There was no limit to the entry of the study design. Exclusion criteria included lack of access to the full text of the article, studies published in unreliable journals or conferences, and studies in which the results were shared with other medical or relief groups and there was no possibility of breaking down the results.

Data Extraction

A “Data extraction form” was designed by the researchers based on the goals of the study that included the title and author(s), study method (type, place of study, sample size, sampling method, and data collection/analysis tool), printing location, information related to the frequency of types of violence, characteristics of victims /perpetrators, and related factors.

Results

The papers reviewed utilized a variety of locations and environments, methods, and instrument samplings. The majority of the studies were performed using the quantitative method. No intervention study was found. Most studies focused on the prevalence of violence, and their results indicated that exposure to violence was high. The results are presented in six major themes.

Conclusions

Workplace violence and injuries incurred from it are extensive throughout the world. The important causes of violence include the shortage of training programs dealing with violence, lack of violence management protocols, and delays in response times. Therefore, afterthought and resolve are more crucial than ever. Workplace violence reduction strategies and suggestions for future studies are also discussed.

Context

In spite of the high prevalence and consequences of much workplace violence against emergency medical services personnel, this phenomenon has been given insufficient attention. A systematic review can aid the development of guidelines to reduce violence.

Literature Review;Workplace Violence;Emergency Medical Services Literature Review;Workplace Violence;Emergency Medical Services http://www.archtrauma.com/index.php?page=article&article_id=28734 Majid Pourshaikhian Majid Pourshaikhian Department of Health Services Management, Iran University of Medical Sciences, Tehran, IR Iran Department of Health Services Management, Iran University of Medical Sciences, Tehran, IR Iran Hassan Abolghasem Gorji Hassan Abolghasem Gorji Department of Health Services Management, Iran University of Medical Sciences, Tehran, IR Iran; Department of Health Services Management, Iran University of Medical Sciences, Tehran, IR Iran. Tel: +98-9125267591, Fax: +98-88883334 Department of Health Services Management, Iran University of Medical Sciences, Tehran, IR Iran; Department of Health Services Management, Iran University of Medical Sciences, Tehran, IR Iran. Tel: +98-9125267591, Fax: +98-88883334 Aidin Aryankhesal Aidin Aryankhesal Department of Health Services Management, Iran University of Medical Sciences, Tehran, IR Iran; Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, IR Iran Department of Health Services Management, Iran University of Medical Sciences, Tehran, IR Iran; Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, IR Iran Davood Khorasani-Zavareh Davood Khorasani-Zavareh Department of Health in Disaster and Emergency, School of HSE, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran; Clinical Sciences and Education Department, Karolinska Institute, Stockholm, Sweden Department of Health in Disaster and Emergency, School of HSE, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran; Clinical Sciences and Education Department, Karolinska Institute, Stockholm, Sweden Ahmad Barati Ahmad Barati Department of Health Services Management, Iran University of Medical Sciences, Tehran, IR Iran Department of Health Services Management, Iran University of Medical Sciences, Tehran, IR Iran