Archives of Trauma Research Archives of Trauma Research Arch Trauma Res http://www.archtrauma.com 2251-953X 2251-9599 10.5812/atr. en jalali 2018 1 24 gregorian 2018 1 24 6 2
en 10.5812/atr.40081 Diagnosis and Treatment of Acute Acromioclavicular Joint Injuries Diagnosis and Treatment of Acute Acromioclavicular Joint Injuries review-article review-article Conclusions

Based on the current literature, there still is no gold standard for the diagnosis of acute AC joint injuries. As surgical techniques, the hook plate as well as the arthroscopic button techniques are commonly used leading to good and reproducible results. However, evidence of the superiority of these techniques over alternative methods is lacking.

Results

Acute injuries of the AC joint are very common among active individuals. Most authors recommend panorama- (stress-) view radiographs and additional radiographs for the horizontal instability. Low-grade injuries (Rockwood I-II) should be treated conservatively whereas high-grade injuries (Rockwood IV-VI) are best treated surgically. The most appropriate treatment for Rockwood III injuries is still a matter of debate and should be recommended based on the individual needs of the patient.

Evidence Acquisition

This review was based on the knowledge of the current literature listed in PubMed. It summarizes the current strategies for acute AC joint injuries.

Context

Acute acromioclavicular joint (ACJ) dislocations are very common in young and active adults. Despite the high incidence of this injury, there is still some controversy on its diagnosis and treatment.

Conclusions

Based on the current literature, there still is no gold standard for the diagnosis of acute AC joint injuries. As surgical techniques, the hook plate as well as the arthroscopic button techniques are commonly used leading to good and reproducible results. However, evidence of the superiority of these techniques over alternative methods is lacking.

Results

Acute injuries of the AC joint are very common among active individuals. Most authors recommend panorama- (stress-) view radiographs and additional radiographs for the horizontal instability. Low-grade injuries (Rockwood I-II) should be treated conservatively whereas high-grade injuries (Rockwood IV-VI) are best treated surgically. The most appropriate treatment for Rockwood III injuries is still a matter of debate and should be recommended based on the individual needs of the patient.

Evidence Acquisition

This review was based on the knowledge of the current literature listed in PubMed. It summarizes the current strategies for acute AC joint injuries.

Context

Acute acromioclavicular joint (ACJ) dislocations are very common in young and active adults. Despite the high incidence of this injury, there is still some controversy on its diagnosis and treatment.

Rockwood;Tossy;Acromio-Clavicular Joint;ACJ;Hook Plate;TightRope Rockwood;Tossy;Acromio-Clavicular Joint;ACJ;Hook Plate;TightRope http://www.archtrauma.com/index.php?page=article&article_id=40081 Maurice Balke Maurice Balke Sports Clinic Cologne, Department of Sports Traumatology, Cologne Merheim Medical Center, University of Witten/Herdecke, Cologne, Germany; Sports Clinic Cologne, Department of Sports Traumatology, Cologne Merheim Medical Center, University of Witten/Herdecke, Ostmerheimer Strasse 200, 51109 Cologne, Germany. Tel: + 49-221880728 Sports Clinic Cologne, Department of Sports Traumatology, Cologne Merheim Medical Center, University of Witten/Herdecke, Cologne, Germany; Sports Clinic Cologne, Department of Sports Traumatology, Cologne Merheim Medical Center, University of Witten/Herdecke, Ostmerheimer Strasse 200, 51109 Cologne, Germany. Tel: + 49-221880728
en 10.5812/atr.40447 Current Concepts of Prolotherapy in Orthopedic Surgery Current Concepts of Prolotherapy in Orthopedic Surgery review-article review-article Conclusions

There is a great interest to prolotherapy in orthopedic clinics, especially to manage musculoskeletal lesions. More research conducted in this area and many authors declared successful results in their studies. In spite of this increasing trend for prolotherapy injections, there were only one or two clinical studies investigated prolotherapy injections for different indications and most of them have limited participants, short-term follow-up or poor quality studies. There is still need for further high-quality studies investigated optimal strategy of the injections of prolotherapy.

Results

Numerous studies have been conducted on prolotherapy injections for different indications for orthopedics clinical care practice. Prolotherapy injections have successfully used for major orthopedic procedures in terms of rotator cuff lesions, knee ligamentous lesions, osteoarthritis-cartilage defects, and ligament-tendon injuries. Most of the studies showed that prolotherapy provided faster and better healing of tissues.

Context

Prolotherapy is a popular injection-based complementary treatment, which has shown promising results in the treatment of sprained and degenerated ligaments, and damaged dense connective tissues’ structures. More research was conducted in this area and many authors declared successful results for different indications.

Evidence Acquisition

The purpose of this study was to present a literature review regarding the current concepts of prolotherapy injections and improvements in the orthopedic clinical care practice. The Medline and PubMed databases were searched for the articles related to prolotherapy injections in the field of orthopedic surgery and additionally the reference list of each article was also included to provide a comprehensive evaluation.

Conclusions

There is a great interest to prolotherapy in orthopedic clinics, especially to manage musculoskeletal lesions. More research conducted in this area and many authors declared successful results in their studies. In spite of this increasing trend for prolotherapy injections, there were only one or two clinical studies investigated prolotherapy injections for different indications and most of them have limited participants, short-term follow-up or poor quality studies. There is still need for further high-quality studies investigated optimal strategy of the injections of prolotherapy.

Results

Numerous studies have been conducted on prolotherapy injections for different indications for orthopedics clinical care practice. Prolotherapy injections have successfully used for major orthopedic procedures in terms of rotator cuff lesions, knee ligamentous lesions, osteoarthritis-cartilage defects, and ligament-tendon injuries. Most of the studies showed that prolotherapy provided faster and better healing of tissues.

Context

Prolotherapy is a popular injection-based complementary treatment, which has shown promising results in the treatment of sprained and degenerated ligaments, and damaged dense connective tissues’ structures. More research was conducted in this area and many authors declared successful results for different indications.

Evidence Acquisition

The purpose of this study was to present a literature review regarding the current concepts of prolotherapy injections and improvements in the orthopedic clinical care practice. The Medline and PubMed databases were searched for the articles related to prolotherapy injections in the field of orthopedic surgery and additionally the reference list of each article was also included to provide a comprehensive evaluation.

Prolotherapy Injections;Preparation Protocols of Prolotherapy;Current Indications of Prolotherapy Prolotherapy Injections;Preparation Protocols of Prolotherapy;Current Indications of Prolotherapy http://www.archtrauma.com/index.php?page=article&article_id=40447 Serkan Akpancar Serkan Akpancar Department of Orthopedic Surgery, Gulhane Military Medicine Academy, Ankara, Turkey; Department of Orthopedic Surgery, Gulhane Military Medicine Academy, Ankara, Turkey. Tel: +90-5443229700, Fax: +90-312 3045500 Department of Orthopedic Surgery, Gulhane Military Medicine Academy, Ankara, Turkey; Department of Orthopedic Surgery, Gulhane Military Medicine Academy, Ankara, Turkey. Tel: +90-5443229700, Fax: +90-312 3045500 Mehmet Murat Seven Mehmet Murat Seven Department of Sports Medicine, Gulhane Military Medicine Academy, Ankara, Turkey Department of Sports Medicine, Gulhane Military Medicine Academy, Ankara, Turkey Harun Yasin Tuzun Harun Yasin Tuzun Department of Orthopedic Surgery, Gulhane Military Medicine Academy, Ankara, Turkey Department of Orthopedic Surgery, Gulhane Military Medicine Academy, Ankara, Turkey Levent Gurer Levent Gurer Department of Orthopedic Surgery, Gulhane Military Medicine Academy, Ankara, Turkey Department of Orthopedic Surgery, Gulhane Military Medicine Academy, Ankara, Turkey Safak Ekinci Safak Ekinci Department of Orthopedic Surgery, Haydarpasa Gulhane Military Medicine Academy, Istanbul, Turkey Department of Orthopedic Surgery, Haydarpasa Gulhane Military Medicine Academy, Istanbul, Turkey
en 10.5812/atr.27791 Road Fatalities and Their Determinants in Iran: Evidence From Panel Provincial Data Road Fatalities and Their Determinants in Iran: Evidence From Panel Provincial Data research-article research-article Conclusions

The government, ministry of health and policy makers must develop strategies for controling high levels of road fatalities in Iran.

Results

No significant relationships were found regarding the percentage of emergency sites and percentage of cars with road fatalities. Increase in the percentage of motorcycles, rain, highways and freeways increased the risk of road fatalities. The effect of highways in road fatalities was higher than freeways. Increase in the percentage of traffic police sites and people living in urban regions decreased the risk of accident fatalities.

Objectives

The aim of this study was to find factors affecting road fatalities in Iran using macro provincial data.

Materials and Methods

Panel data of provinces of Iran between 2008 and 2012 were used for this study. Panel data Poisson estimator was used for estimating the model. Hausman test and Breusch-pagan test were used for finding between pooled or panel and fixed or random effects.

Background

Studies have shown that the number of road fatalities has been decreasing in developed regions and increasing in less and middle developed regions. Iran has one of the highest road fatalities in the world. Controlling road fatalities is vital for less and middle developed countries like Iran.

Conclusions

The government, ministry of health and policy makers must develop strategies for controling high levels of road fatalities in Iran.

Results

No significant relationships were found regarding the percentage of emergency sites and percentage of cars with road fatalities. Increase in the percentage of motorcycles, rain, highways and freeways increased the risk of road fatalities. The effect of highways in road fatalities was higher than freeways. Increase in the percentage of traffic police sites and people living in urban regions decreased the risk of accident fatalities.

Objectives

The aim of this study was to find factors affecting road fatalities in Iran using macro provincial data.

Materials and Methods

Panel data of provinces of Iran between 2008 and 2012 were used for this study. Panel data Poisson estimator was used for estimating the model. Hausman test and Breusch-pagan test were used for finding between pooled or panel and fixed or random effects.

Background

Studies have shown that the number of road fatalities has been decreasing in developed regions and increasing in less and middle developed regions. Iran has one of the highest road fatalities in the world. Controlling road fatalities is vital for less and middle developed countries like Iran.

Accident Prevention;Cause of Death;Accidents;Motor Vehicles;Poisson Distribution;Econometric Model;Panel Data;Iran Accident Prevention;Cause of Death;Accidents;Motor Vehicles;Poisson Distribution;Econometric Model;Panel Data;Iran http://www.archtrauma.com/index.php?page=article&article_id=27791 Enayatollah Homaie Rad Enayatollah Homaie Rad Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, IR Iran Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, IR Iran Maryam Tavakkoli Maryam Tavakkoli Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, IR Iran; Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Guilan, IR Iran. Tel: +98-2177266861 Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, IR Iran; Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Guilan, IR Iran. Tel: +98-2177266861
en 10.5812/atr.36702 Efficiency of Respiratory Index in Determining Short-Term Prognosis of Multiple Trauma Patients: A Cross-Sectional Study Efficiency of Respiratory Index in Determining Short-Term Prognosis of Multiple Trauma Patients: A Cross-Sectional Study research-article research-article Conclusions

Based on the findings of this study, RI cannot properly estimate short-term prognosis of multiple trauma patients, but it can be used as an independent factor in evaluating the severity of injury.

Background

Being aware of trauma patients’ conditions and predicting their outcome has always been of a great interest. To determine the state and prognosis of these patients, we should find ways to enable the timely identification of those with poor health and allow the physicians to treat them before the situation gets out of hand.

Objectives

The present study aimed at evaluating the efficiency of respiratory index (RI) in determining the short-term prognosis of multiple trauma patients in comparison with revised trauma score (RTS).

Methods

In this cross-sectional study, all multiple trauma patients who were admitted to emergency department (ED) of Shahid Rajaee hospital, Shiraz, Iran, during September and October 2013 were included. Demographic data and data regarding vital signs (blood pressure, heart rate, respiratory rate, GCS, and oxygen saturation), respiratory tract status, trauma type, blood gases, procedures performed in resuscitation room, and final outcome of the patients (discharge, disposition to general unit, intensive care unit, or operating room, and dying) were recorded using a predesigned checklist. Based on the collected data, RTS and RI were calculated for each patient and their correlation and the final outcome were evaluated.

Results

Evaluating 187 multiple trauma patients showed that 131 (70%) patients had head injury, 78 (42%) chest injury, 66 (35%) abdominal injury, 49 (26%) extremity injury, 27 (14%) neck injury, and 4 (2%) vascular injury. A significant correlation was seen between RI and RTS (P = 0.024). RTS differentiated patients with good and poor health (P < 0.05), while RI showed no significant correlation with patients’ short-term final outcome.

Conclusions

Based on the findings of this study, RI cannot properly estimate short-term prognosis of multiple trauma patients, but it can be used as an independent factor in evaluating the severity of injury.

Background

Being aware of trauma patients’ conditions and predicting their outcome has always been of a great interest. To determine the state and prognosis of these patients, we should find ways to enable the timely identification of those with poor health and allow the physicians to treat them before the situation gets out of hand.

Objectives

The present study aimed at evaluating the efficiency of respiratory index (RI) in determining the short-term prognosis of multiple trauma patients in comparison with revised trauma score (RTS).

Methods

In this cross-sectional study, all multiple trauma patients who were admitted to emergency department (ED) of Shahid Rajaee hospital, Shiraz, Iran, during September and October 2013 were included. Demographic data and data regarding vital signs (blood pressure, heart rate, respiratory rate, GCS, and oxygen saturation), respiratory tract status, trauma type, blood gases, procedures performed in resuscitation room, and final outcome of the patients (discharge, disposition to general unit, intensive care unit, or operating room, and dying) were recorded using a predesigned checklist. Based on the collected data, RTS and RI were calculated for each patient and their correlation and the final outcome were evaluated.

Results

Evaluating 187 multiple trauma patients showed that 131 (70%) patients had head injury, 78 (42%) chest injury, 66 (35%) abdominal injury, 49 (26%) extremity injury, 27 (14%) neck injury, and 4 (2%) vascular injury. A significant correlation was seen between RI and RTS (P = 0.024). RTS differentiated patients with good and poor health (P < 0.05), while RI showed no significant correlation with patients’ short-term final outcome.

Glasgow Coma Scale;Multiple Trauma;Patients;Prognosis;Respiratory Index Glasgow Coma Scale;Multiple Trauma;Patients;Prognosis;Respiratory Index http://www.archtrauma.com/index.php?page=article&article_id=36702 Golnar Sabetian Golnar Sabetian Assistant Professor of Anesthesiology and Critical Care, Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran Assistant Professor of Anesthesiology and Critical Care, Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran Shahram Paydar Shahram Paydar Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran Ali Rasti Ali Rasti Resident of Ophthalmology, Shiraz University of Medical Sciences, Shiraz, Iran Resident of Ophthalmology, Shiraz University of Medical Sciences, Shiraz, Iran Zahra Ghahramani Zahra Ghahramani Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran; Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran. Tel: +98-7136360697, Fax: +98-7136254206 Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran; Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran. Tel: +98-7136360697, Fax: +98-7136254206
en 10.5812/atr.39725 The Minimum Dataset and Inclusion Criteria for the National Trauma Registry of Iran: A Qualitative Study The Minimum Dataset and Inclusion Criteria for the National Trauma Registry of Iran: A Qualitative Study research-article research-article Conclusions

This study presents how we developed the MDS in order to uniform data reporting in the NTRI and define our inclusion and exclusion criteria for trauma registry. Applying the MDS and the case definition in pilot studies are needed in next steps.

Results

The finalized MDS consisted of 109 data variables including demographic information (n = 24), injury information (n = 19), prehospital information (n = 26), emergency department information (n = 25), hospital procedures (n = 2), diagnosis (n = 2), injury severity (n = 3), outcomes (n = 5), financial (n = 2), and quality assurance (n = 1). For a patient sustained one or more traumatic injury in a defined diagnostic ICD-10 codes, the inclusion criteria considered as one of the followings: If the patient stayed > 24 hours in the hospital, any death after hospital arrival, any transfer from another hospital during the first 24 hours from injury.

Objectives

The present study aimed to describe the steps undertaken in the development of the minimum dataset (MDS) and define the inclusion and exclusion criteria for a case of trauma registry by the national trauma registry of Iran (NTRI).

Methods

The working group consists of sixteen elected expert representatives from seven established countrywide active trauma research centers. Following a structured extensive review of the literature, the working party identified the data variables that included key registry goals for pre-hospital and hospital, outcome and quality assurance information. We used data variables from three trauma registry centers: National trauma data standard questionnaire, European trauma care (UT stein version), and Sina trauma and surgery research center. Then, we performed two email surveys and three focus group discussions and adapted, modified and finally developed the optimized MDS in order to prepare the quality care registry for injured patients.

Background

Burden of injuries is an important public health problem, especially in developing countries. However, a national standard tool for data collection of trauma registry has not been developed in Iran yet.

Conclusions

This study presents how we developed the MDS in order to uniform data reporting in the NTRI and define our inclusion and exclusion criteria for trauma registry. Applying the MDS and the case definition in pilot studies are needed in next steps.

Results

The finalized MDS consisted of 109 data variables including demographic information (n = 24), injury information (n = 19), prehospital information (n = 26), emergency department information (n = 25), hospital procedures (n = 2), diagnosis (n = 2), injury severity (n = 3), outcomes (n = 5), financial (n = 2), and quality assurance (n = 1). For a patient sustained one or more traumatic injury in a defined diagnostic ICD-10 codes, the inclusion criteria considered as one of the followings: If the patient stayed > 24 hours in the hospital, any death after hospital arrival, any transfer from another hospital during the first 24 hours from injury.

Objectives

The present study aimed to describe the steps undertaken in the development of the minimum dataset (MDS) and define the inclusion and exclusion criteria for a case of trauma registry by the national trauma registry of Iran (NTRI).

Methods

The working group consists of sixteen elected expert representatives from seven established countrywide active trauma research centers. Following a structured extensive review of the literature, the working party identified the data variables that included key registry goals for pre-hospital and hospital, outcome and quality assurance information. We used data variables from three trauma registry centers: National trauma data standard questionnaire, European trauma care (UT stein version), and Sina trauma and surgery research center. Then, we performed two email surveys and three focus group discussions and adapted, modified and finally developed the optimized MDS in order to prepare the quality care registry for injured patients.

Background

Burden of injuries is an important public health problem, especially in developing countries. However, a national standard tool for data collection of trauma registry has not been developed in Iran yet.

Focus Group Discussion;Iran;Patient Selection;Registries;System;Wound and Injuries Focus Group Discussion;Iran;Patient Selection;Registries;System;Wound and Injuries http://www.archtrauma.com/index.php?page=article&article_id=39725 Zahra Ghodsi Zahra Ghodsi Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, IR Iran Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, IR Iran Vafa Rahimi Movaghar Vafa Rahimi Movaghar Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, IR Iran Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, IR Iran Mohammadreza Zafarghandi Mohammadreza Zafarghandi Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, IR Iran Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, IR Iran Soheil Saadat Soheil Saadat Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, IR Iran Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, IR Iran Mahdi Mohammadzadeh Mahdi Mohammadzadeh Trauma Research Center, Kashan University of Medical science, Kashan, IR Iran Trauma Research Center, Kashan University of Medical science, Kashan, IR Iran Mohammadreza Fazel Mohammadreza Fazel Trauma Research Center, Kashan University of Medical science, Kashan, IR Iran Trauma Research Center, Kashan University of Medical science, Kashan, IR Iran Mojtaba Sehat Mojtaba Sehat Trauma Research Center, Kashan University of Medical science, Kashan, IR Iran Trauma Research Center, Kashan University of Medical science, Kashan, IR Iran Mohammad Javad Fatemi Mohammad Javad Fatemi Burn Research Center, Iran University of Medical Sciences, Tehran, IR Iran Burn Research Center, Iran University of Medical Sciences, Tehran, IR Iran Hadi Khoshmohabat Hadi Khoshmohabat Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran Shahram Paydar Shahram Paydar Shiraz Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran Shiraz Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran Hamid Pahlavanhosseini Hamid Pahlavanhosseini Trauma Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, IR Iran Trauma Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, IR Iran Hamid Heydari Hamid Heydari Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Guilan, IR Iran Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Guilan, IR Iran Ahmad Shafaeizadeh Ahmad Shafaeizadeh Electronic Health Institute, Amirkabir University of Technology, Tehran, IR Iran Electronic Health Institute, Amirkabir University of Technology, Tehran, IR Iran Payman Salamati Payman Salamati Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, IR Iran; Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, IR Iran. Tel: +98-2166757001-5, Fax: +98-2166757009 Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, IR Iran; Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, IR Iran. Tel: +98-2166757001-5, Fax: +98-2166757009
en 10.5812/atr.44176 Diagnostic Value of Serial Ultrasound in Blunt Abdominal Trauma Diagnostic Value of Serial Ultrasound in Blunt Abdominal Trauma research-article research-article Conclusions

The sensitivity of ultrasound to detect intraperitoneal fluid in blunt abdominal trauma cases will be increased by repeated ultrasound examinations.

Objectives

The present study was conducted to evaluate the diagnostic value of the repetitive ultrasound in diagnosis of free intraperitoneal fluid.

Methods

In this study, 125 patients with abdominal blunt trauma were recruited prospectively for ultrasound evaluation. Ultrasound and CT- scan were performed for all recruited patients in the study. In case of positive ultrasound or CT-scan (free fluid in the peritoneal cavity), patients underwent surgical operation. In the presence of negative ultrasound and CT-scan, and if the patient was alert and had stable vital signs, then, he/she would undergo exact supervision. In such patients, ultrasound and CT-scan were repeated 12 and 24 hours after admission. If any of the tests were positive, the patient underwent laparotomy. Moreover, if ultrasound and CT-scan examinations were negative 24 hours after admission, the patients with normal laboratory tests were discharged according to the surgeon's decision. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated.

Results

Of the 125 patients with abdominal blunt trauma, 90 patients finally underwent laparotomy. Based on the surgical outcome as the gold standard, the initial, 12 hours, and 24 hours sensitivity were measured to be 19.8%, 75.2%, and 82.2%, respectively. These numbers for specificity were 91.7, 75, and 70.8, respectively; they were 90.9, 92.6, and 92.2 for PPV, and 21.3, 41.8, and 48.5 for NPV, respectively.

Background

Ultrasound has widely been used to assess patients with blunt abdominal trauma and detect free fluid in the abdomen. Nevertheless, different studies reported different false negative for this imaging technique.

Conclusions

The sensitivity of ultrasound to detect intraperitoneal fluid in blunt abdominal trauma cases will be increased by repeated ultrasound examinations.

Objectives

The present study was conducted to evaluate the diagnostic value of the repetitive ultrasound in diagnosis of free intraperitoneal fluid.

Methods

In this study, 125 patients with abdominal blunt trauma were recruited prospectively for ultrasound evaluation. Ultrasound and CT- scan were performed for all recruited patients in the study. In case of positive ultrasound or CT-scan (free fluid in the peritoneal cavity), patients underwent surgical operation. In the presence of negative ultrasound and CT-scan, and if the patient was alert and had stable vital signs, then, he/she would undergo exact supervision. In such patients, ultrasound and CT-scan were repeated 12 and 24 hours after admission. If any of the tests were positive, the patient underwent laparotomy. Moreover, if ultrasound and CT-scan examinations were negative 24 hours after admission, the patients with normal laboratory tests were discharged according to the surgeon's decision. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated.

Results

Of the 125 patients with abdominal blunt trauma, 90 patients finally underwent laparotomy. Based on the surgical outcome as the gold standard, the initial, 12 hours, and 24 hours sensitivity were measured to be 19.8%, 75.2%, and 82.2%, respectively. These numbers for specificity were 91.7, 75, and 70.8, respectively; they were 90.9, 92.6, and 92.2 for PPV, and 21.3, 41.8, and 48.5 for NPV, respectively.

Background

Ultrasound has widely been used to assess patients with blunt abdominal trauma and detect free fluid in the abdomen. Nevertheless, different studies reported different false negative for this imaging technique.

Abdominal Injuries;Ultrasonography;Hemoperitoneum Abdominal Injuries;Ultrasonography;Hemoperitoneum http://www.archtrauma.com/index.php?page=article&article_id=44176 Abdolhossein Davoodabadi Abdolhossein Davoodabadi Department of Surgery, Kashan University of Medical Sciences, Kashan, IR Iran Department of Surgery, Kashan University of Medical Sciences, Kashan, IR Iran Faramarz Marzban Faramarz Marzban Department of Surgery, Kashan University of Medical Sciences, Kashan, IR Iran Department of Surgery, Kashan University of Medical Sciences, Kashan, IR Iran Leila Ghafoor Leila Ghafoor Department of Surgery, Kashan University of Medical Sciences, Kashan, IR Iran Department of Surgery, Kashan University of Medical Sciences, Kashan, IR Iran Hamid Reza Talari Hamid Reza Talari Department of Radiology, Kashan University of Medical Sciences, Kashan, IR Iran Department of Radiology, Kashan University of Medical Sciences, Kashan, IR Iran Esmaeil Abdolrahim-Kashi Esmaeil Abdolrahim-Kashi Department of Surgery, Kashan University of Medical Sciences, Kashan, IR Iran Department of Surgery, Kashan University of Medical Sciences, Kashan, IR Iran Hossein Akbari Hossein Akbari Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran; Trauma Research Center, Kashan University of Medical Sciences, Qutb-e Ravandi Blvd. Postcode: 8715988141, Kashan, IR Iran. Tel: +98-9131638113, Fax: +98-36155575057 Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran; Trauma Research Center, Kashan University of Medical Sciences, Qutb-e Ravandi Blvd. Postcode: 8715988141, Kashan, IR Iran. Tel: +98-9131638113, Fax: +98-36155575057 Mehrdad Mahdian Mehrdad Mahdian Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
en 10.5812/atr.33512 When Domestic Violence Causes Gallbladder Injuries: A Case Report of Gallbladder Perforation When Domestic Violence Causes Gallbladder Injuries: A Case Report of Gallbladder Perforation case-report case-report

Traumatic injuries to the gallbladder are rare. This is attributed to its anatomical location and protection by the liver. Direct penetrating trauma is the commonest mechanism of injury. Here is the report of a 27-year-old otherwise healthy male who sustained gallbladder perforation following the penetration of abdominal injury in a domestic fight. A high index of suspicion is necessary for early diagnosis. He safely underwent an open cholecystectomy and his postoperative recovery was uneventful.

Traumatic injuries to the gallbladder are rare. This is attributed to its anatomical location and protection by the liver. Direct penetrating trauma is the commonest mechanism of injury. Here is the report of a 27-year-old otherwise healthy male who sustained gallbladder perforation following the penetration of abdominal injury in a domestic fight. A high index of suspicion is necessary for early diagnosis. He safely underwent an open cholecystectomy and his postoperative recovery was uneventful.

Gallbladder Perforation;Domestic Violence;Open Cholecystectomy Gallbladder Perforation;Domestic Violence;Open Cholecystectomy http://www.archtrauma.com/index.php?page=article&article_id=33512 Paul K Okeny Paul K Okeny Department of Surgery, Gulu Regional Referral and Teaching Hospital, Gulu, Uganda; Department of Surgery, Gulu Regional Referral and Teaching Hospital, P. O. Box: 160, Gulu, Uganda Department of Surgery, Gulu Regional Referral and Teaching Hospital, Gulu, Uganda; Department of Surgery, Gulu Regional Referral and Teaching Hospital, P. O. Box: 160, Gulu, Uganda Geoffrey Ndikaboona Geoffrey Ndikaboona Department of Surgery, Gulu Regional Referral and Teaching Hospital, Gulu, Uganda Department of Surgery, Gulu Regional Referral and Teaching Hospital, Gulu, Uganda
en 10.5812/atr.37157 Donkey Bite Leading to a Catastrophic Outcome: Bilateral Visual Loss Donkey Bite Leading to a Catastrophic Outcome: Bilateral Visual Loss case-report case-report

In this report we present a case of severe facial injury due to a donkey bite. Immediate repair with surgical flaps was performed. No significant complication was observed at the time of surgery or during follow up and the result was acceptable. Animal bites are relatively frequent and most often are done by dogs. Besides dogs, other animals such as cats, horses and donkeys may be responsible for this type of injuries. Although donkey bites to the facial area are very rare, they can cause severe and life-threatening injuries. Early management of facial injuries caused by animal bites is acceptable nowadays and guarantees satisfactory outcome.

In this report we present a case of severe facial injury due to a donkey bite. Immediate repair with surgical flaps was performed. No significant complication was observed at the time of surgery or during follow up and the result was acceptable. Animal bites are relatively frequent and most often are done by dogs. Besides dogs, other animals such as cats, horses and donkeys may be responsible for this type of injuries. Although donkey bites to the facial area are very rare, they can cause severe and life-threatening injuries. Early management of facial injuries caused by animal bites is acceptable nowadays and guarantees satisfactory outcome.

Donkey Bite;Facial Laceration;Primary Repair Donkey Bite;Facial Laceration;Primary Repair http://www.archtrauma.com/index.php?page=article&article_id=37157 Mansooreh Jamshidian Tehrani Mansooreh Jamshidian Tehrani Ophtalmic Plastic and Reconstructive Surgery Unit, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, IR Iran Ophtalmic Plastic and Reconstructive Surgery Unit, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, IR Iran Shahbaz Nekoozadeh Shahbaz Nekoozadeh Ophtalmic Plastic and Reconstructive Surgery Unit, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, IR Iran Ophtalmic Plastic and Reconstructive Surgery Unit, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, IR Iran Mohammad Soleimani Mohammad Soleimani Ophtalmic Plastic and Reconstructive Surgery Unit, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, IR Iran Ophtalmic Plastic and Reconstructive Surgery Unit, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, IR Iran Seyed Ali Tabatabaei Seyed Ali Tabatabaei Ophtalmic Plastic and Reconstructive Surgery Unit, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, IR Iran; Ophtalmic Plastic and Reconstructive Surgery Unit, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, IR Iran. Tel: +98-9121096496 Ophtalmic Plastic and Reconstructive Surgery Unit, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, IR Iran; Ophtalmic Plastic and Reconstructive Surgery Unit, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, IR Iran. Tel: +98-9121096496 Bahram Eshraghi Bahram Eshraghi Ophtalmic Plastic and Reconstructive Surgery Unit, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, IR Iran Ophtalmic Plastic and Reconstructive Surgery Unit, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
en 10.5812/atr.38931 Locked Posterior Dislocation of Shoulder With Fracture of the Lesser Tuberosity of the Humerus: A Case Report and Review of the Literature Locked Posterior Dislocation of Shoulder With Fracture of the Lesser Tuberosity of the Humerus: A Case Report and Review of the Literature case-report case-report Conclusions

Fracture fixation plays a crucial role in stability after reduction. Several techniques have been suggested for surgical treatment including fixation with screw and the modified McLaughlin technique. Similar to the previous case reports, according to our experience, careful attention to the fracture concomitant with posterior dislocation is of the utmost importance.

Introduction

Posterior shoulder dislocation associated with fracture of the lesser tuberosity is considered as a rare shoulder trauma. It can lead to the locked shoulder with a very high possibility of unsuccessful closed reduction.

Case Presentation

In this case, the patient was a 30-year-old male motorcyclist with the right shoulder injury who had posterior shoulder dislocation with lesser tuberosity fracture. Early attempt for closed reduction was unsuccessful and led to iatrogenic brachial plexus injury. This patient is treated by open reduction and fracture fixation with screw. Subscapularis partial rupture was repaired. Finally, full stability was achieved.

Conclusions

Fracture fixation plays a crucial role in stability after reduction. Several techniques have been suggested for surgical treatment including fixation with screw and the modified McLaughlin technique. Similar to the previous case reports, according to our experience, careful attention to the fracture concomitant with posterior dislocation is of the utmost importance.

Introduction

Posterior shoulder dislocation associated with fracture of the lesser tuberosity is considered as a rare shoulder trauma. It can lead to the locked shoulder with a very high possibility of unsuccessful closed reduction.

Case Presentation

In this case, the patient was a 30-year-old male motorcyclist with the right shoulder injury who had posterior shoulder dislocation with lesser tuberosity fracture. Early attempt for closed reduction was unsuccessful and led to iatrogenic brachial plexus injury. This patient is treated by open reduction and fracture fixation with screw. Subscapularis partial rupture was repaired. Finally, full stability was achieved.

Posterior Fracture Dislocation;Lesser Tuberosity Fracture;Reverse Hill-Sachs Lesion Posterior Fracture Dislocation;Lesser Tuberosity Fracture;Reverse Hill-Sachs Lesion http://www.archtrauma.com/index.php?page=article&article_id=38931 Ali Tabrizi Ali Tabrizi Assistant Professor of Orthopedics Surgery Department, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, IR Iran; MD, Moderres Ave, Imam Khomeini Educational Hospital, Urmia University of Medical Sciences, Urmia, IR Iran. Tel: +98-9143130829 Assistant Professor of Orthopedics Surgery Department, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, IR Iran; MD, Moderres Ave, Imam Khomeini Educational Hospital, Urmia University of Medical Sciences, Urmia, IR Iran. Tel: +98-9143130829 Mir Bahram Safari Mir Bahram Safari Assistant Professor of Orthopedics Surgery Department, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, IR Iran Assistant Professor of Orthopedics Surgery Department, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, IR Iran Hassan Taleb Hassan Taleb Assistant Professor of Orthopedics Surgery Department, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, IR Iran Assistant Professor of Orthopedics Surgery Department, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, IR Iran Nasrin Navaeifar Nasrin Navaeifar Assistant Professor of Orthopedics Surgery Department, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, IR Iran Assistant Professor of Orthopedics Surgery Department, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, IR Iran
en 10.5812/atr.40787 Intrahepatic Artery Pseudoaneurysm as a Delayed Presentation of Blunt Abdominal Trauma Intrahepatic Artery Pseudoaneurysm as a Delayed Presentation of Blunt Abdominal Trauma case-report case-report

Arterial pseudoaneurysm is an uncommon life-threatening complication in blunt trauma patients. Blunt liver injury may lead to hepatic artery pseudoaneurysm. Radiological intervention is the method of choice in diagnosis and treatment of hepatic artery pseudoaneurysm. However, surgical intervention is advised for unstable patients with large leaking defects. This study reports a case of 53-year-old female who was admitted with vague abdominal pain. She had experienced a blunt abdominal trauma a year ago and had gone under liver packing procedure. The CT-scan results showed hematoma in RUQ region and leaking pseudoaneurysm of right hepatic artery. Hematoma was drained and partial liver resection and hepatic arterioraphy were done through laparotomy.

Arterial pseudoaneurysm is an uncommon life-threatening complication in blunt trauma patients. Blunt liver injury may lead to hepatic artery pseudoaneurysm. Radiological intervention is the method of choice in diagnosis and treatment of hepatic artery pseudoaneurysm. However, surgical intervention is advised for unstable patients with large leaking defects. This study reports a case of 53-year-old female who was admitted with vague abdominal pain. She had experienced a blunt abdominal trauma a year ago and had gone under liver packing procedure. The CT-scan results showed hematoma in RUQ region and leaking pseudoaneurysm of right hepatic artery. Hematoma was drained and partial liver resection and hepatic arterioraphy were done through laparotomy.

Hepatic Artery;Pseudoaneurysm;Blunt Abdominal Trauma Hepatic Artery;Pseudoaneurysm;Blunt Abdominal Trauma http://www.archtrauma.com/index.php?page=article&article_id=40787 Behnam Sanei Behnam Sanei General Surgery Specialist, Pancreatic and Hepatobiliary and Transplant Subspecialist, Assistant Professor, Isfahan University of Medical Sciences, Isfahan, IR Iran General Surgery Specialist, Pancreatic and Hepatobiliary and Transplant Subspecialist, Assistant Professor, Isfahan University of Medical Sciences, Isfahan, IR Iran Mohsen Kolahdouzan Mohsen Kolahdouzan General Surgery Specialist, Thoracic Surgery Subspecialist, Associate Professor of Isfahan University of Medical Sciences, Isfahan, IR Iran; General Surgery Specialist, Thoracic Surgery Subspecialist, Associate Professor of Isfahan University of Medical Sciences, Isfahan, IR Iran General Surgery Specialist, Thoracic Surgery Subspecialist, Associate Professor of Isfahan University of Medical Sciences, Isfahan, IR Iran; General Surgery Specialist, Thoracic Surgery Subspecialist, Associate Professor of Isfahan University of Medical Sciences, Isfahan, IR Iran Hamid Reza Jafari Hamid Reza Jafari MD, Department of General Surgery, Isfahan University of Medical Sciences, Isfahan, IR Iran MD, Department of General Surgery, Isfahan University of Medical Sciences, Isfahan, IR Iran