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 20 gregorian 2018 1 20 5 4
en 28144609 10.5812/atr.41482 Commotio Cordis and Contusio Cordis: Possible Causes of Trauma-Related Cardiac Death Commotio Cordis and Contusio Cordis: Possible Causes of Trauma-Related Cardiac Death editorial editorial Commotio Cordis;Contusio Cordis;Death Commotio Cordis;Contusio Cordis;Death http://www.archtrauma.com/index.php?page=article&article_id=41482 Ali Reza Farrokhian Ali Reza Farrokhian Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran; Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran; Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
en 28144600 10.5812/atr.30796 Spatial Factors Affecting the Frequency of Pedestrian Traffic Crashes: A Systematic Review Spatial Factors Affecting the Frequency of Pedestrian Traffic Crashes: A Systematic Review review-article review-article Conclusions

It is proposed that the needed research be conducted at national and regional levels in coordination and cooperation with international organizations active in the field of traffic crashes in various parts of the world, especially in Asian, African and Latin American developing countries, where a greater proportion of pedestrian traffic crashes occur.

Results

A review of the studies showed significant correlations between a large number of spatial variables including student population and the number of schools, population density, traffic volume, roadway density, socio-economic status, number of intersections, and the pedestrian volume and the dependent variable of the frequency of pedestrian traffic crashes. In the studies, some spatial factors that play an important role in determining the frequency of pedestrian traffic crashes, such as facilities for increasing the pedestrians’ safety were ignored.

Context

Considering the importance of pedestrian traffic crashes and the role of environmental factors in the frequency of crashes, this paper aimed to review the published evidence and synthesize the results of related studies for the associations between environmental factors and distribution of pedestrian-vehicular traffic crashes.

Evidence Acquisition

We searched all epidemiological studies from 1966 to 2015 in electronic databases. We found 2,828 studies. Only 15 observational studies out of these studies met the inclusion criteria of the study. The quality of the included studies was assessed using the strengthening the reporting of observational studies in epidemiology (STROBE) checklist.

Conclusions

It is proposed that the needed research be conducted at national and regional levels in coordination and cooperation with international organizations active in the field of traffic crashes in various parts of the world, especially in Asian, African and Latin American developing countries, where a greater proportion of pedestrian traffic crashes occur.

Results

A review of the studies showed significant correlations between a large number of spatial variables including student population and the number of schools, population density, traffic volume, roadway density, socio-economic status, number of intersections, and the pedestrian volume and the dependent variable of the frequency of pedestrian traffic crashes. In the studies, some spatial factors that play an important role in determining the frequency of pedestrian traffic crashes, such as facilities for increasing the pedestrians’ safety were ignored.

Context

Considering the importance of pedestrian traffic crashes and the role of environmental factors in the frequency of crashes, this paper aimed to review the published evidence and synthesize the results of related studies for the associations between environmental factors and distribution of pedestrian-vehicular traffic crashes.

Evidence Acquisition

We searched all epidemiological studies from 1966 to 2015 in electronic databases. We found 2,828 studies. Only 15 observational studies out of these studies met the inclusion criteria of the study. The quality of the included studies was assessed using the strengthening the reporting of observational studies in epidemiology (STROBE) checklist.

Pedestrian;Road Crashes;Spatial Analysis;Spatial Factors;Systematic Review Pedestrian;Road Crashes;Spatial Analysis;Spatial Factors;Systematic Review http://www.archtrauma.com/index.php?page=article&article_id=30796 Ali Moradi Ali Moradi Department of Epidemiology, Faculty of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Department of Epidemiology, Faculty of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Hamid Soori Hamid Soori Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran; Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran. Tel: +98-2122439980 Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran; Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran. Tel: +98-2122439980 Amir Kavousi Amir Kavousi School of Health, Safety and Environment, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran School of Health, Safety and Environment, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Farshid Eshghabadi Farshid Eshghabadi Department of Human Geography/Urban Planning, Faculty of Geography, University of Tehran, Tehran, IR Iran Department of Human Geography/Urban Planning, Faculty of Geography, University of Tehran, Tehran, IR Iran Ensiyeh Jamshidi Ensiyeh Jamshidi Community Based Participatory Research Center, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, IR Iran Community Based Participatory Research Center, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, IR Iran
en 28144601 10.5812/atr.33298 Proximal Fifth Metatarsal Fractures: Anatomy, Classification, Treatment and Complications Proximal Fifth Metatarsal Fractures: Anatomy, Classification, Treatment and Complications review-article review-article Evidence Acquisition

A search of PubMed for studies on proximal fifth metatarsal fracture and Jones fracture focusing on the classification and management was performed. The reference list of the retrieved articles was searched for additional related studies.

Conclusions

Lawrence and Botte’s classification of proximal fifth metatarsal fractures is recommended by experts, due to its implication on prognosis and treatment strategy. Zone 1 fractures should be treated conservatively due to their excellent healing potential. Early operative treatment is advised for zone 2 and zone 3 fractures, especially in the athletic group. Complications of delayed union, non-union and refractures should be treated by revision fixation and bone grafting.

Results

The vascular supply and soft tissue anatomy of the fifth metatarsal explains the increased risk of delayed union and non-union in fractures at the metaphyseal-diaphyseal junction. Lawrence and Botte classify proximal fifth metatarsal fractures according to their location: tuberosity avulsion fractures (zone 1), fractures at metaphyseal-diaphyseal junction extending into the fourth-fifth intermetatarsal joint (zone 2) and proximal diaphyseal fractures (zone 3). Zone 1 fractures are treated conservatively with functional immobilization and early mobilization with excellent outcome. For zone 2 and zone 3 fractures, acute forms can be treated conservatively but with a risk of delayed union time and time for return to function. Therefore, early surgical fixation with intramedullary screw is advised in athletic individuals. For cases presented with signs of delayed union and non-union, surgical treatment with or without bone grafting is recommended. Complications of these fractures and their management are discussed in this report.

Context

Fractures of proximal fifth metatarsal are one of the most common fractures of the foot.

Evidence Acquisition

A search of PubMed for studies on proximal fifth metatarsal fracture and Jones fracture focusing on the classification and management was performed. The reference list of the retrieved articles was searched for additional related studies.

Conclusions

Lawrence and Botte’s classification of proximal fifth metatarsal fractures is recommended by experts, due to its implication on prognosis and treatment strategy. Zone 1 fractures should be treated conservatively due to their excellent healing potential. Early operative treatment is advised for zone 2 and zone 3 fractures, especially in the athletic group. Complications of delayed union, non-union and refractures should be treated by revision fixation and bone grafting.

Results

The vascular supply and soft tissue anatomy of the fifth metatarsal explains the increased risk of delayed union and non-union in fractures at the metaphyseal-diaphyseal junction. Lawrence and Botte classify proximal fifth metatarsal fractures according to their location: tuberosity avulsion fractures (zone 1), fractures at metaphyseal-diaphyseal junction extending into the fourth-fifth intermetatarsal joint (zone 2) and proximal diaphyseal fractures (zone 3). Zone 1 fractures are treated conservatively with functional immobilization and early mobilization with excellent outcome. For zone 2 and zone 3 fractures, acute forms can be treated conservatively but with a risk of delayed union time and time for return to function. Therefore, early surgical fixation with intramedullary screw is advised in athletic individuals. For cases presented with signs of delayed union and non-union, surgical treatment with or without bone grafting is recommended. Complications of these fractures and their management are discussed in this report.

Context

Fractures of proximal fifth metatarsal are one of the most common fractures of the foot.

Metatarsal Bones;Fractures;Bone;Evidence-Based Medicine;Classification;Anatomy;Fracture Fixation Metatarsal Bones;Fractures;Bone;Evidence-Based Medicine;Classification;Anatomy;Fracture Fixation http://www.archtrauma.com/index.php?page=article&article_id=33298 Chi Nok Cheung Chi Nok Cheung Department of Orthopedics and Traumatology, North District Hospital, Hong Kong SAR, China Department of Orthopedics and Traumatology, North District Hospital, Hong Kong SAR, China Tun Hing Lui Tun Hing Lui Department of Orthopedics and Traumatology, North District Hospital, Hong Kong SAR, China; Department of Orthopedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong SAR, China. Tel: +852-26837588, Fax: +852-26837576 Department of Orthopedics and Traumatology, North District Hospital, Hong Kong SAR, China; Department of Orthopedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong SAR, China. Tel: +852-26837588, Fax: +852-26837576
en 28144608 10.5812/atr.37976 The Current Perspectives of Stem Cell Therapy in Orthopedic Surgery The Current Perspectives of Stem Cell Therapy in Orthopedic Surgery review-article review-article Conclusions

Large amounts of preclinical studies have been made of stem cells and there is an increasing interest to perform these studies within the human population but preclinical studies are insufficient; therefore, much more and efficient studies should be conducted to evaluate the efficacy and safety of stem cells.

Context

Musculoskeletal injuries may be painful, troublesome, life limiting and also one of the global health problems. There has been considerable amount of interest during the past two decades to stem cells and tissue engineering techniques in orthopedic surgery, especially to manage special and compulsive injuries within the musculoskeletal system.

Evidence Acquisition

The aim of this study was to present a literature review regarding the most recent progress in stem cell procedures and current indications in orthopedics clinical care practice. The Medline and PubMed library databases were searched for the articles related with stem cell procedures in the field of orthopedic surgery and additionally the reference list of each article was also included to provide a comprehensive evaluation.

Results

Various sources of stem cells have been studied for orthopedics clinical care practice. Stem cell therapy has successfully used for major orthopedic procedures in terms of bone-joint injuries (fractures-bone defects, nonunion, and spinal injuries), osteoarthritis-cartilage defects, ligament-tendon injuries, femoral head osteonecrosis and osteogenesis imperfecta. Stem cells have also used in bone tissue engineering in combining with the scaffolds and provided faster and better healing of tissues.

Conclusions

Large amounts of preclinical studies have been made of stem cells and there is an increasing interest to perform these studies within the human population but preclinical studies are insufficient; therefore, much more and efficient studies should be conducted to evaluate the efficacy and safety of stem cells.

Context

Musculoskeletal injuries may be painful, troublesome, life limiting and also one of the global health problems. There has been considerable amount of interest during the past two decades to stem cells and tissue engineering techniques in orthopedic surgery, especially to manage special and compulsive injuries within the musculoskeletal system.

Evidence Acquisition

The aim of this study was to present a literature review regarding the most recent progress in stem cell procedures and current indications in orthopedics clinical care practice. The Medline and PubMed library databases were searched for the articles related with stem cell procedures in the field of orthopedic surgery and additionally the reference list of each article was also included to provide a comprehensive evaluation.

Results

Various sources of stem cells have been studied for orthopedics clinical care practice. Stem cell therapy has successfully used for major orthopedic procedures in terms of bone-joint injuries (fractures-bone defects, nonunion, and spinal injuries), osteoarthritis-cartilage defects, ligament-tendon injuries, femoral head osteonecrosis and osteogenesis imperfecta. Stem cells have also used in bone tissue engineering in combining with the scaffolds and provided faster and better healing of tissues.

Stem Cells;Orthopedic Surgery;Mesenchymal Stem Cells;Adipose Derived Stem Cells;Bone Marrow Derived Stem Cells Stem Cells;Orthopedic Surgery;Mesenchymal Stem Cells;Adipose Derived Stem Cells;Bone Marrow Derived Stem Cells http://www.archtrauma.com/index.php?page=article&article_id=37976 Serkan Akpancar Serkan Akpancar Department of Orthopedic Surgery, Gulhane Military Hospital, Ankara, Turkey; Department of Orthopedic Surgery, Gulhane Military Medicine Academy, Ankara, Turkey. Tel: +90-5443229700, Fax: +90-3124045500 Department of Orthopedic Surgery, Gulhane Military Hospital, Ankara, Turkey; Department of Orthopedic Surgery, Gulhane Military Medicine Academy, Ankara, Turkey. Tel: +90-5443229700, Fax: +90-3124045500 Oner Tatar Oner Tatar Department of Orthopedic Surgery, Air Force Academy Kasımpaşa Military Hospital, Istanbul, Turkey Department of Orthopedic Surgery, Air Force Academy Kasımpaşa Military Hospital, Istanbul, Turkey Hasan Turgut Hasan Turgut Department of Orthopedic Surgery, Bursa Military Hospital, Bursa, Turkey Department of Orthopedic Surgery, Bursa Military Hospital, Bursa, Turkey Faruk Akyildiz Faruk Akyildiz Department of Orthopedic Surgery, Gulhane Military Hospital, Ankara, Turkey Department of Orthopedic Surgery, Gulhane Military Hospital, Ankara, Turkey Safak Ekinci Safak Ekinci Department of Orthopedic Surgery, Agri Military Hospital, Agri, Turkey Department of Orthopedic Surgery, Agri Military Hospital, Agri, Turkey
en 28144599 10.5812/atr.30574 Mandibular Fractures and Associated Factors at a Tertiary Care Hospital Mandibular Fractures and Associated Factors at a Tertiary Care Hospital research-article research-article Conclusions

Mandibular fractures can be complicated and demanding, and have a compelling impact on patients’ quality of life. Our study reported that parasymphysis was the most common region involved in mandible fractures.

Results

A total of 653 subjects had mandibular fractures, out of which 574 were males. The mean age of the participants was 31.54 ± 13.07. The majority of the subjects were between 21-40 years of age, in both males (61.7%) and females (54.4%). The major cause of fractures was road traffic accidents (87.4%) followed by fall (6.9%) and assault (4%), with the least frequent being gunshot injuries (0.3%). Almost half of the patients had parasymphysis fractures (50.2%), followed by angle (24.3%), condyle (20.4%), ramus (2.3%) and coronoid (2%). A total of 115 patients had bilateral fractures out of which 29 had parasymphysis, 12 had body fractures and 74 had bilateral condylar fractures. Double mandibular fractures were reported in 193 subjects; out of which 151 subjects had double contralateral and 42 had double unilateral fractures. Triple unilateral fracture was reported in only one subject. A total of 338 subjects had multiple fractures among the study population.

Objectives

The aim of this study was to evaluate the distribution, etiology and type of mandibular fractures in subjects referred to our institution.

Methods

A retrospective study of 689 subjects, during the period from May 2010 to September 2013 with mandibular fractures was conducted. Information on age, gender, mechanism of injury and sites of trauma was obtained from the trauma registry. Data were tabulated and analyzed statistically.

Conclusions

Mandibular fractures can be complicated and demanding, and have a compelling impact on patients’ quality of life. Our study reported that parasymphysis was the most common region involved in mandible fractures.

Results

A total of 653 subjects had mandibular fractures, out of which 574 were males. The mean age of the participants was 31.54 ± 13.07. The majority of the subjects were between 21-40 years of age, in both males (61.7%) and females (54.4%). The major cause of fractures was road traffic accidents (87.4%) followed by fall (6.9%) and assault (4%), with the least frequent being gunshot injuries (0.3%). Almost half of the patients had parasymphysis fractures (50.2%), followed by angle (24.3%), condyle (20.4%), ramus (2.3%) and coronoid (2%). A total of 115 patients had bilateral fractures out of which 29 had parasymphysis, 12 had body fractures and 74 had bilateral condylar fractures. Double mandibular fractures were reported in 193 subjects; out of which 151 subjects had double contralateral and 42 had double unilateral fractures. Triple unilateral fracture was reported in only one subject. A total of 338 subjects had multiple fractures among the study population.

Objectives

The aim of this study was to evaluate the distribution, etiology and type of mandibular fractures in subjects referred to our institution.

Methods

A retrospective study of 689 subjects, during the period from May 2010 to September 2013 with mandibular fractures was conducted. Information on age, gender, mechanism of injury and sites of trauma was obtained from the trauma registry. Data were tabulated and analyzed statistically.

Epidemiology;Fractures;Mandible;Trauma Epidemiology;Fractures;Mandible;Trauma http://www.archtrauma.com/index.php?page=article&article_id=30574 Srikanth Gadicherla Srikanth Gadicherla Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal University, Karnataka, India Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal University, Karnataka, India Prem Sasikumar Prem Sasikumar Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal University, Karnataka, India Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal University, Karnataka, India Satpal Singh Gill Satpal Singh Gill Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal University, Karnataka, India Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal University, Karnataka, India Manish Bhagania Manish Bhagania Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal University, Karnataka, India Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal University, Karnataka, India Abhay Taranath Kamath Abhay Taranath Kamath Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal University, Karnataka, India Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal University, Karnataka, India Kalyana Chakravarthy Pentapati Kalyana Chakravarthy Pentapati Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal University, Karnataka, India; Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal University, Karnataka, India. Tel: +91-9916036303 Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal University, Karnataka, India; Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal University, Karnataka, India. Tel: +91-9916036303
en 28144604 10.5812/atr.34343 Evaluation of Metallo-β-Lactamase-Production and Carriage of bla-VIM Genes in Pseudomonas aeruginosa Isolated from Burn Wound Infections in Isfahan Evaluation of Metallo-β-Lactamase-Production and Carriage of <italic>bla-</italic><sub>VIM</sub> Genes in <italic>Pseudomonas aeruginosa</italic> Isolated from Burn Wound Infections in Isfahan research-article research-article Conclusions

Our findings showed a high occurrence of metallo-β-lactamase production among P. aeruginosa isolates in burn patient infections in our region. Also, there are P. aeruginosa isolates carrying the bla-VIM-1 and bla-VIM-2 genes in Isfahan province.

Background

Metallo-β-lactamase-production among Gram-negative bacteria, including Pseudomonas aeruginosa, has become a challenge for treatment of infections due to these resistant bacteria.

Objectives

The aim of the current study was to evaluate the metallo-β-lactamase-production and carriage of bla-VIM genes among carbapenem-resistant P. aeruginosa isolated from burn wound infections.

Patients and Methods

A cross-sectional study was conducted from September 2014 to July 2015. One hundred and fifty P. aeruginosa isolates were recovered from 600 patients with burn wound infections treated at Imam-Musa-Kazem Hospital in Isfahan city, Iran. Carbapenem-resistant P. aeruginosa isolates were screened by disk diffusion using CLSI guidelines. Metallo-β-lactamase-producing P. aeruginosa isolates were identified using an imipenem-EDTA double disk synergy test (EDTA-IMP DDST). For detection of MBL genes including bla-VIM-1 and bla-VIM-2, polymerase chain reaction (PCR) methods and sequencing were used.

Results

Among the 150 P. aeruginosa isolates, 144 (96%) were resistant to imipenem by the disk diffusion method, all of which were identified as metallo-β-lactamase-producing P. aeruginosa isolates by EDTA-IMP DDST. Twenty-seven (18%) and 8 (5.5%) MBL-producing P. aeruginosa isolates harbored bla-VIM-1 and bla-VIM-2 genes, respectively.

Conclusions

Our findings showed a high occurrence of metallo-β-lactamase production among P. aeruginosa isolates in burn patient infections in our region. Also, there are P. aeruginosa isolates carrying the bla-VIM-1 and bla-VIM-2 genes in Isfahan province.

Background

Metallo-β-lactamase-production among Gram-negative bacteria, including Pseudomonas aeruginosa, has become a challenge for treatment of infections due to these resistant bacteria.

Objectives

The aim of the current study was to evaluate the metallo-β-lactamase-production and carriage of bla-VIM genes among carbapenem-resistant P. aeruginosa isolated from burn wound infections.

Patients and Methods

A cross-sectional study was conducted from September 2014 to July 2015. One hundred and fifty P. aeruginosa isolates were recovered from 600 patients with burn wound infections treated at Imam-Musa-Kazem Hospital in Isfahan city, Iran. Carbapenem-resistant P. aeruginosa isolates were screened by disk diffusion using CLSI guidelines. Metallo-β-lactamase-producing P. aeruginosa isolates were identified using an imipenem-EDTA double disk synergy test (EDTA-IMP DDST). For detection of MBL genes including bla-VIM-1 and bla-VIM-2, polymerase chain reaction (PCR) methods and sequencing were used.

Results

Among the 150 P. aeruginosa isolates, 144 (96%) were resistant to imipenem by the disk diffusion method, all of which were identified as metallo-β-lactamase-producing P. aeruginosa isolates by EDTA-IMP DDST. Twenty-seven (18%) and 8 (5.5%) MBL-producing P. aeruginosa isolates harbored bla-VIM-1 and bla-VIM-2 genes, respectively.

Burn Patients;Metallo-β-Lactamase;bla VIM-1;bla VIM-1;Pseudomonas aeruginosa Burn Patients;Metallo-β-Lactamase;bla VIM-1;bla VIM-1;Pseudomonas aeruginosa http://www.archtrauma.com/index.php?page=article&article_id=34343 Mahmood Saffari Mahmood Saffari Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran Farzaneh Firoozeh Farzaneh Firoozeh Department of Microbiology and Immunology, School of Medicine, Kashan University of Medical Sciences, Kashan, IR Iran; Department of Microbiology and Immunology, P. O. Box: 87159-88141, Kashan, IR Iran. Tel/Fax: +98-3155540021 Department of Microbiology and Immunology, School of Medicine, Kashan University of Medical Sciences, Kashan, IR Iran; Department of Microbiology and Immunology, P. O. Box: 87159-88141, Kashan, IR Iran. Tel/Fax: +98-3155540021 Mohammad Pourbabaee Mohammad Pourbabaee Department of Microbiology and Immunology, School of Medicine, Kashan University of Medical Sciences, Kashan, IR Iran Department of Microbiology and Immunology, School of Medicine, Kashan University of Medical Sciences, Kashan, IR Iran Mohammad Zibaei Mohammad Zibaei Department of Parasitology and Mycology, School of Medicine, Alborz University of Medical Sciences, Karaj, IR Iran Department of Parasitology and Mycology, School of Medicine, Alborz University of Medical Sciences, Karaj, IR Iran
en 28144605 10.5812/atr.36273 Limb Lengthening Using the PRECICETM Nail System: Complications and Results Limb Lengthening Using the PRECICE<sup>TM</sup> Nail System: Complications and Results research-article research-article Conclusions

We report of loss of achieved length after lengthening with a telescopic nail. Weight bearing before complete consolidation of the regenerate might be a risk factor for that. Thorough examination of the limb length and careful evaluation of the radiographs are required in the follow-up period. The PRECICE nail system requires the same vigilance like the other intramedullary systems too.

Objectives

The aim of the current study was to describe and analyze the complications associated with lengthening with the PRECICETM nail. Are the problems preventable when using the PRECICE, related to the distraction rate control, the lengthening goals and technique and handling?

Methods

We retrospectively reviewed the charts of 9 patients operated between 2012 and 2013 with a PRECICETM nail for a leg length discrepancy (LLD). The mean age of the patients was 32 years (range, 17 - 48 years). There were 5 femoral and 4 tibial procedures. The causes of LLD were posttraumatic (n = 5) and congenital (n = 4). The mean LLD was 36.4 ± 11.4 mm. The minimum follow-ups were 2 months (average, 5 months; range, 2 - 9 months).

Results

The mean distraction rate was 0.5 ± 0.1 mm/day. We observed in 7 patients differences in achieving the lengthening goals (average, 1.6 mm; range, -20.0 - 5.0 mm). Average lengthening was 34.7 ± 10.7 mm. All patients reached normal alignment and normal joint orientation. An unintentional loss of the achieved length during the consolidation phase was noticed in patients with delayed bone healing in two cases. In the first case (loss of 20mm distraction) the nail could be redistracted and the goal length was achieved. In the second case (loss of 10mm distraction) the nail broke shortly after the diagnosis and the nail was exchanged.

Background

Three types of telescopic nails are mainly used for intramedullary limb lengthening nowadays. Despite some important advantages of this new technology (e.g. controlled distraction rate, not restricted availability, possibility to perform accordion maneuvers), few articles exist on clinical results and complications after lengthening with the PRECICETM nail (Ellipse, USA).

Conclusions

We report of loss of achieved length after lengthening with a telescopic nail. Weight bearing before complete consolidation of the regenerate might be a risk factor for that. Thorough examination of the limb length and careful evaluation of the radiographs are required in the follow-up period. The PRECICE nail system requires the same vigilance like the other intramedullary systems too.

Objectives

The aim of the current study was to describe and analyze the complications associated with lengthening with the PRECICETM nail. Are the problems preventable when using the PRECICE, related to the distraction rate control, the lengthening goals and technique and handling?

Methods

We retrospectively reviewed the charts of 9 patients operated between 2012 and 2013 with a PRECICETM nail for a leg length discrepancy (LLD). The mean age of the patients was 32 years (range, 17 - 48 years). There were 5 femoral and 4 tibial procedures. The causes of LLD were posttraumatic (n = 5) and congenital (n = 4). The mean LLD was 36.4 ± 11.4 mm. The minimum follow-ups were 2 months (average, 5 months; range, 2 - 9 months).

Results

The mean distraction rate was 0.5 ± 0.1 mm/day. We observed in 7 patients differences in achieving the lengthening goals (average, 1.6 mm; range, -20.0 - 5.0 mm). Average lengthening was 34.7 ± 10.7 mm. All patients reached normal alignment and normal joint orientation. An unintentional loss of the achieved length during the consolidation phase was noticed in patients with delayed bone healing in two cases. In the first case (loss of 20mm distraction) the nail could be redistracted and the goal length was achieved. In the second case (loss of 10mm distraction) the nail broke shortly after the diagnosis and the nail was exchanged.

Background

Three types of telescopic nails are mainly used for intramedullary limb lengthening nowadays. Despite some important advantages of this new technology (e.g. controlled distraction rate, not restricted availability, possibility to perform accordion maneuvers), few articles exist on clinical results and complications after lengthening with the PRECICETM nail (Ellipse, USA).

Leg Length Discrepancy;Femur;Intramedullary Limb Lengthening;Complication Leg Length Discrepancy;Femur;Intramedullary Limb Lengthening;Complication http://www.archtrauma.com/index.php?page=article&article_id=36273 Ulrich Wiebking Ulrich Wiebking Department of Trauma, Medical School Hannover, Hannover, Germany; Department of Trauma, Medical School Hannover, Hannover, Germany. Tel: +49-5115322050, Fax: +49-5115325877 Department of Trauma, Medical School Hannover, Hannover, Germany; Department of Trauma, Medical School Hannover, Hannover, Germany. Tel: +49-5115322050, Fax: +49-5115325877 Emmanouil Liodakis Emmanouil Liodakis Department of Trauma, Medical School Hannover, Hannover, Germany Department of Trauma, Medical School Hannover, Hannover, Germany Mohamed Kenawey Mohamed Kenawey Department of Orthopedic Surgery, Sohag University, Sohag, Egypt Department of Orthopedic Surgery, Sohag University, Sohag, Egypt Christian Krettek Christian Krettek Department of Trauma, Medical School Hannover, Hannover, Germany Department of Trauma, Medical School Hannover, Hannover, Germany
en 28144606 10.5812/atr.36406 Outcome Analysis of Intra-Articular Scapula Fracture Fixation with Distal Radius Plate: A Multicenter Prospective Study Outcome Analysis of Intra-Articular Scapula Fracture Fixation with Distal Radius Plate: A Multicenter Prospective Study research-article research-article Background

Scapula fractures occur in approximately 1% of all fractures and constitute about 3% - 5% of all injuries of the shoulder joint.

Objectives

This study aimed to evaluate the clinical outcomes of 20 surgically treated patients with displaced glenoid fractures after stabilization with distal radius plate.

Methods

Between 2012 and 2015, at 2 centers (HMCH & SHCE) of Bhubaneswar Odisha, we stabilized 20 scapular intra-articular fractures surgically with distal radius locking plate and studied the outcome of the surgeries. The outcome of the 20 fractures was determined using the Constant and Murley score. Both shoulders were assessed and the score on the injured side was given as a percentage of that on the uninjured side.

Results

The median score was 88% (mean 65%, range 30 to 100). The median score for strength was 21/25 (mean 19, range 0 to 25) and that for pain 11/15 (mean 11, range 5 to 15). The median functional score was 16/20 (mean 15, range 0 to 20). The mean range of active abduction of the shoulder was 135° (20 to 180), the mean range of flexion 138° (20 to 180) and the mean range of external rotation 38° (0 to 100). Five patients showed excellent result; 11 patients showed good result; three patients showed fair result and one patient had poor outcome according to the Constant-Murley score. A superficial infection settled with antibiotics after operation in one patient whose score at final follow-up was 96%. In one patient, delayed healing was reported because of infection. One patient with stiffness of the shoulder at six weeks underwent manipulation under anesthesia with a follow-up score of 81%.

Conclusions

Various fixation modalities have been described in the literature, however fixation of intra-articular fracture of glenoid with distal radius locking plate for articular reconstruction in the presented series provides good functional outcome with early restoration of the range of motion of the shoulder.

Background

Scapula fractures occur in approximately 1% of all fractures and constitute about 3% - 5% of all injuries of the shoulder joint.

Objectives

This study aimed to evaluate the clinical outcomes of 20 surgically treated patients with displaced glenoid fractures after stabilization with distal radius plate.

Methods

Between 2012 and 2015, at 2 centers (HMCH & SHCE) of Bhubaneswar Odisha, we stabilized 20 scapular intra-articular fractures surgically with distal radius locking plate and studied the outcome of the surgeries. The outcome of the 20 fractures was determined using the Constant and Murley score. Both shoulders were assessed and the score on the injured side was given as a percentage of that on the uninjured side.

Results

The median score was 88% (mean 65%, range 30 to 100). The median score for strength was 21/25 (mean 19, range 0 to 25) and that for pain 11/15 (mean 11, range 5 to 15). The median functional score was 16/20 (mean 15, range 0 to 20). The mean range of active abduction of the shoulder was 135° (20 to 180), the mean range of flexion 138° (20 to 180) and the mean range of external rotation 38° (0 to 100). Five patients showed excellent result; 11 patients showed good result; three patients showed fair result and one patient had poor outcome according to the Constant-Murley score. A superficial infection settled with antibiotics after operation in one patient whose score at final follow-up was 96%. In one patient, delayed healing was reported because of infection. One patient with stiffness of the shoulder at six weeks underwent manipulation under anesthesia with a follow-up score of 81%.

Conclusions

Various fixation modalities have been described in the literature, however fixation of intra-articular fracture of glenoid with distal radius locking plate for articular reconstruction in the presented series provides good functional outcome with early restoration of the range of motion of the shoulder.

Scapula Fracture;Distal Radius Plate;Trauma Glenoid;Intra Articular Glenoid;Intra Articular Scapula;Fall From Height Scapula Fracture;Distal Radius Plate;Trauma Glenoid;Intra Articular Glenoid;Intra Articular Scapula;Fall From Height http://www.archtrauma.com/index.php?page=article&article_id=36406 Ranajit Panigrahi Ranajit Panigrahi Department of Orthopedics, Hi-Tech Medical College & Hospital, Bhubaneswar, India; Department of Orthopedics, Hi-Tech Medical College & Hospital, Bhubaneswar, India. Tel: +91-9777037435 Department of Orthopedics, Hi-Tech Medical College & Hospital, Bhubaneswar, India; Department of Orthopedics, Hi-Tech Medical College & Hospital, Bhubaneswar, India. Tel: +91-9777037435 Divya Madharia Divya Madharia Department of Orthopedics, Hi-Tech Medical College & Hospital, Bhubaneswar, India Department of Orthopedics, Hi-Tech Medical College & Hospital, Bhubaneswar, India Dibya Singha Das Dibya Singha Das Department of Orthopedics, Hi-Tech Medical College & Hospital, Bhubaneswar, India Department of Orthopedics, Hi-Tech Medical College & Hospital, Bhubaneswar, India Saswat Samant Saswat Samant Department of Orthopedics, Hi-Tech Medical College & Hospital, Bhubaneswar, India Department of Orthopedics, Hi-Tech Medical College & Hospital, Bhubaneswar, India Manas Ranjan Biswal Manas Ranjan Biswal Department of Orthopedics, Hi-Tech Medical College & Hospital, Bhubaneswar, India Department of Orthopedics, Hi-Tech Medical College & Hospital, Bhubaneswar, India
en 28144607 10.5812/atr.37070 Clinical Utility of Chest Computed Tomography in Patients with Rib Fractures CT Chest and Rib Fractures Clinical Utility of Chest Computed Tomography in Patients with Rib Fractures CT Chest and Rib Fractures research-article research-article Methods

Retrospective cohort study of blunt trauma patients with rib fractures at a level I trauma center that had both a CXR and a CT chest. The CT finding of ≥ 3 additional fractures in patients with ≤ 3 rib fractures on CXR was considered clinically meaningful. Student’s t-test and chi-square analysis were used for comparison.

Results

We identified 499 patients with rib fractures: 93 (18.6%) had CXR only, 7 (1.4%) had chest CT only, and 399 (79.9%) had both CXR and chest CT. Among these 399 patients, a total of 1,969 rib fractures were identified: 1,467 (74.5%) were missed by CXR. The median number of additional fractures identified by CT was 3 (range, 4 - 15). Of 212 (53.1%) patients with a clinically meaningful increase in the number of fractures, 68 patients underwent one or more clinical interventions: 36 SICU admissions, 20 pain catheter placements, 23 epidural placements, and 3 SSRF. Additionally, 70 patients had a chest tube placed for retained hemothorax or occult pneumothorax. Overall, 138 patients (34.5%) had a change in clinical management based upon CT chest.

Objectives

The purpose of this study was to determine the added diagnostic use of chest CT performed after CXR in patients with either known or suspected rib fractures secondary to blunt trauma.

Conclusions

The chest X-ray missed ~75% of rib fractures seen on chest CT. Although patients with a clinical meaningful increase in the number of rib fractures were more likely to be admitted to the intensive care unit, there was no associated improvement in pulmonary outcomes.

Background

Chest CT is more sensitive than a chest X-ray (CXR) in diagnosing rib fractures; however, the clinical significance of these fractures remains unclear.

Methods

Retrospective cohort study of blunt trauma patients with rib fractures at a level I trauma center that had both a CXR and a CT chest. The CT finding of ≥ 3 additional fractures in patients with ≤ 3 rib fractures on CXR was considered clinically meaningful. Student’s t-test and chi-square analysis were used for comparison.

Results

We identified 499 patients with rib fractures: 93 (18.6%) had CXR only, 7 (1.4%) had chest CT only, and 399 (79.9%) had both CXR and chest CT. Among these 399 patients, a total of 1,969 rib fractures were identified: 1,467 (74.5%) were missed by CXR. The median number of additional fractures identified by CT was 3 (range, 4 - 15). Of 212 (53.1%) patients with a clinically meaningful increase in the number of fractures, 68 patients underwent one or more clinical interventions: 36 SICU admissions, 20 pain catheter placements, 23 epidural placements, and 3 SSRF. Additionally, 70 patients had a chest tube placed for retained hemothorax or occult pneumothorax. Overall, 138 patients (34.5%) had a change in clinical management based upon CT chest.

Objectives

The purpose of this study was to determine the added diagnostic use of chest CT performed after CXR in patients with either known or suspected rib fractures secondary to blunt trauma.

Conclusions

The chest X-ray missed ~75% of rib fractures seen on chest CT. Although patients with a clinical meaningful increase in the number of rib fractures were more likely to be admitted to the intensive care unit, there was no associated improvement in pulmonary outcomes.

Background

Chest CT is more sensitive than a chest X-ray (CXR) in diagnosing rib fractures; however, the clinical significance of these fractures remains unclear.

Rib Fractures;Tomography X-Ray Compute;X-rays;Thoracic Injuries. Rib Fractures;Tomography X-Ray Compute;X-rays;Thoracic Injuries. http://www.archtrauma.com/index.php?page=article&article_id=37070 Brandon C. Chapman Brandon C. Chapman Department of Surgery, University of Colorado School of Medicine, Colorado, United States; Department of Surgery, University of Colorado School of Medicine, Colorado, United States. Tel: +1-7207373858 Department of Surgery, University of Colorado School of Medicine, Colorado, United States; Department of Surgery, University of Colorado School of Medicine, Colorado, United States. Tel: +1-7207373858 Douglas M. Overbey Douglas M. Overbey Department of Surgery, University of Colorado School of Medicine, Colorado, United States Department of Surgery, University of Colorado School of Medicine, Colorado, United States Feven Tesfalidet Feven Tesfalidet School of Medicine, University of Colorado, Colorado, United States School of Medicine, University of Colorado, Colorado, United States Kristofer Schramm Kristofer Schramm Department of Radiology, School of Medicine, University of Colorado, Colorado, United States Department of Radiology, School of Medicine, University of Colorado, Colorado, United States Robert T. Stovall Robert T. Stovall Department of Surgery, Denver Health Medical Center, Colorado, United States Department of Surgery, Denver Health Medical Center, Colorado, United States Andrew French Andrew French Department of Emergency Medicine, Denver Health Medical Center, Denver, CO, United States Department of Emergency Medicine, Denver Health Medical Center, Denver, CO, United States Jeffrey L. Johnson Jeffrey L. Johnson Department of Surgery, Denver Health Medical Center, Colorado, United States Department of Surgery, Denver Health Medical Center, Colorado, United States Clay C. Burlew Clay C. Burlew Department of Surgery, Denver Health Medical Center, Colorado, United States Department of Surgery, Denver Health Medical Center, Colorado, United States Carlton Barnett Carlton Barnett Department of Surgery, Denver Health Medical Center, Colorado, United States Department of Surgery, Denver Health Medical Center, Colorado, United States Ernest E. Moore Ernest E. Moore Department of Surgery, Denver Health Medical Center, Colorado, United States Department of Surgery, Denver Health Medical Center, Colorado, United States Fredric M. Pieracci Fredric M. Pieracci Department of Surgery, Denver Health Medical Center, Colorado, United States Department of Surgery, Denver Health Medical Center, Colorado, United States
en 28144603 10.5812/atr.33377 Early Prediction of Ongoing Hemorrhage in Severe Trauma: Presentation of the Existing Scoring Systems Early Prediction of Ongoing Hemorrhage in Severe Trauma: Presentation of the Existing Scoring Systems brief-report brief-report

Early prediction of ongoing hemorrhage may reduce mortality via the earlier delivery of blood products, adequate orientation of the patient in a dedicated highly specialized and trained infrastructure, and by earlier correction of acute traumatic coagulopathy. We identified 14 scores or algorithms developed for the prediction of ongoing hemorrhage and the need for massive transfusion in severe trauma patients.

Early prediction of ongoing hemorrhage may reduce mortality via the earlier delivery of blood products, adequate orientation of the patient in a dedicated highly specialized and trained infrastructure, and by earlier correction of acute traumatic coagulopathy. We identified 14 scores or algorithms developed for the prediction of ongoing hemorrhage and the need for massive transfusion in severe trauma patients.

Transfusion;Hemorrhage;Wounds and Injuries Transfusion;Hemorrhage;Wounds and Injuries http://www.archtrauma.com/index.php?page=article&article_id=33377 Martin L Tonglet Martin L Tonglet Emergency Department, Liege University Hospital, Domaine du Sart Tilman, Belgium; Emergency Department, Liege University Hospital, Domaine du Sart Tilman, Belgium Emergency Department, Liege University Hospital, Domaine du Sart Tilman, Belgium; Emergency Department, Liege University Hospital, Domaine du Sart Tilman, Belgium
en 28144602 10.5812/atr.33361 Hyperammonemia as a Marker of Subclinical Seizures After Traumatic Cardiac Arrest Hyperammonemia as a Marker of Subclinical Seizures After Traumatic Cardiac Arrest case-report case-report

This report details the presence of hyperammonemia in a patient who sustained cardiac arrest after a traumatic amputation. Serum ammonia levels may rise due to numerous etiologies; however, few reports detail its usefulness in diagnosing subclinical seizures. In this case, we successfully utilized persistently elevated serum ammonia levels as a marker of subclinical seizures in a patient who sustained traumatic cardiac arrest.

This report details the presence of hyperammonemia in a patient who sustained cardiac arrest after a traumatic amputation. Serum ammonia levels may rise due to numerous etiologies; however, few reports detail its usefulness in diagnosing subclinical seizures. In this case, we successfully utilized persistently elevated serum ammonia levels as a marker of subclinical seizures in a patient who sustained traumatic cardiac arrest.

Hyperammonemia;Seizure;Traumatic Cardiac Arrest Hyperammonemia;Seizure;Traumatic Cardiac Arrest http://www.archtrauma.com/index.php?page=article&article_id=33361 Patricia Aswani Patricia Aswani Department of Research, Staten Island University Hospital, New York, United States Department of Research, Staten Island University Hospital, New York, United States Michael Kalina Michael Kalina Department of Surgery, Staten Island University Hospital, New York, United States; Department of Surgery, Staten Island University Hospital, Director of Emergency Surgery, 256 Mason Avenue, Suite C Staten Island, New York, United States. Tel: +718-2256398, Fax: +718-2261247 Department of Surgery, Staten Island University Hospital, New York, United States; Department of Surgery, Staten Island University Hospital, Director of Emergency Surgery, 256 Mason Avenue, Suite C Staten Island, New York, United States. Tel: +718-2256398, Fax: +718-2261247
en 28138435 10.5812/atr.33705 Death as a Consequence of a Hip Fracture After a Fall; to Be Further Investigated? Death as a Consequence of a Hip Fracture After a Fall; to Be Further Investigated? case-report case-report

Although it is not often thought of, elderly abuse is a frequently occurring phenomenon. Especially when an older patient dies, maltreatment is low on the list of possible causes of death. There are, however, signs that may point in the direction of abuse. These can either be on the patient’s body, in the surroundings, or within the story as to how the patient died. Attention should be paid to these often subtle signs, and autopsies need to be performed more frequently to establish the exact cause of death.

Although it is not often thought of, elderly abuse is a frequently occurring phenomenon. Especially when an older patient dies, maltreatment is low on the list of possible causes of death. There are, however, signs that may point in the direction of abuse. These can either be on the patient’s body, in the surroundings, or within the story as to how the patient died. Attention should be paid to these often subtle signs, and autopsies need to be performed more frequently to establish the exact cause of death.

Trauma Patients;Missed Injuries;Abuse;Intentional Asphyxia Trauma Patients;Missed Injuries;Abuse;Intentional Asphyxia http://www.archtrauma.com/index.php?page=article&article_id=33705 Annelieke MK. Harmsen Annelieke MK. Harmsen Department of Trauma Surgery, VU University Medical Centre, Amsterdam, The Netherlands; Department of Trauma Surgery, VU University Medical Centre, Amsterdam, The Netherlands. Tel: +31-204443529, Fax: +31-204444512 Department of Trauma Surgery, VU University Medical Centre, Amsterdam, The Netherlands; Department of Trauma Surgery, VU University Medical Centre, Amsterdam, The Netherlands. Tel: +31-204443529, Fax: +31-204444512 Udo JL. Reijnders Udo JL. Reijnders Department of Forensic Medicine, Public Health Service, Amsterdam, The Netherlands Department of Forensic Medicine, Public Health Service, Amsterdam, The Netherlands Georgios F. Giannakopoulos Georgios F. Giannakopoulos Department of Trauma Surgery, VU University Medical Centre, Amsterdam, The Netherlands Department of Trauma Surgery, VU University Medical Centre, Amsterdam, The Netherlands