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   Table of Contents - Current issue
Coverpage
July-September 2021
Volume 10 | Issue 3
Page Nos. 109-179

Online since Monday, October 11, 2021

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REVIEW ARTICLES  

The effectiveness of functional brace in the treatment of tibia fracture: A review of literature p. 109
Mohammad Taghi Karimi, Mostafa Kamali
DOI:10.4103/atr.atr_74_20  
Background and Objectives: Various treatment methods have been used to manage tibia fracture, including conservative and surgical treatment. Various studies investigated the effects of functional brace on fracture of tibia. This review was aimed to summarize the evidence on the effectiveness of functional brace on tibia fracture. Methods: An electronic search was carried out through internationally published scholarly articles in EBSCO, Medline, PubMed, Embase, and ISI Web of Knowledge (from 1950 to 2020) with the following keywords: tibia fracture, healing, conservative treatment, functional orthosis, brace, and patellar tendon-bearing orthosis. The quality of the papers was assessed using the Down and Black tool. Results: On the basis of the keywords, 50 articles were found, of which 11 articles were selected in accordance with the selection criteria. Most of studies support the use of orthosis for tibial fracture. The scores of reporting, external validity, internal validity (bias), and internal validity (confounding) varied between 2–7, 1–2, 1–5, and 2–4, respectively. Conclusions: One of the most important treatment methods for tibia fracture is use of functional brace. Based on the results of the available literature, use of functional brace is a good approach for stable tibia fracture. Some parameters, such as the condition of surrounding muscles, initial shortening, angulations of tibia, and intact of fibula, play significant roles in this regard.
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Prevalence of sports-related eye injuries: A systematic review and meta-analysis p. 114
Behzad F Motlagh, Nazanin Zamani, Morteza Ghojazadeh, Hooman Nateghian, Hossein Hosseinifard, Fariba Pashazadeh, Shirin Yengejeh
DOI:10.4103/atr.atr_118_20  
Background and Objectives: More than 42,000 sports-related eye injuries are brought to emergency units every year. Although multiple studies have been conducted on the prevalence of sports-related eye injuries and consequent outcomes, no systematic review has been conducted to summarize the findings of these studies. Therefore, this study was conducted to systematically review the prevalence of sports-related eye injuries and blindness. Methods: A systematic search was conducted to locate the studies that addressed the global prevalence of sports-related eye injuries. The located articles (132 studies) were screened on different levels, and their quality was assessed using the JBI checklist for prevalence studies. The statistical analysis was conducted using CMA v. 3.2, and the results were considered significant for P < 0.05. Results: From a total of 132 studies, 27 articles were included for analyzing the prevalence of sports-related blindness which was 7.2%. Further, 51 studies were used for analyzing the prevalence of sports-related eye injuries in total eye injuries, and the obtained value was 9.3%. Moreover, 29 studies were analyzed to calculate the proportion of sports-related eye injuries to total sports injuries, and the obtained value was 6.7%. Conclusion: Findings of this study suggest that sport-related eye injuries account for a major part of eye injuries and a considerable portion of these traumas lead to blindness.
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ORIGINAL ARTICLES Top

Exploring effective factors in reducing the fall of hospitalized patients: A systematic review p. 133
Sayedeh Somayyeh Mousavipour, Davoud Khorasani Zavareh, Fatemeh Nouri, Abbas Ebadi, Mahnaz Saremi, Mousa Jabbari, Zohre Ghomian, Reza Mohammadi
DOI:10.4103/atr.atr_112_20  
Background and Objectives: Patient's fall is one of the factors threatening a patient's health in hospitals and medical centers, which in some cases can lead to disability or death. Therefore, this study was conducted to systematically examine the factors affecting the reduction of patient falls in the hospital. Materials and Methods: This systematic review was conducted to identify the factors affecting the reduction of patient's fall in the hospitals based on the Prisma protocol. On this basis, all English-language articles published in this field from 1990 to the end of September 2019 were extracted during a search in four international databases and publishers including Web of Science, PubMed, Scopus, Science Direct, and Google Scholar. Articles were searched and screened by three researchers independently and finally, the extracted articles were analyzed and classified through thematic content analysis. Results: According to the Prisma protocol, 6227 studies were extracted, of which 32 studies were finally included in the study process. Then, the thematic analysis of the studies showed that factors such as education, exercise, attention to physiological factors and treatment of the disease, environmental safety, use of fall detection device, and patient risk assessment were effective in reducing falls. Conclusions: The findings show that existing approaches to reduce falls have a favorable role. It is necessary to use several methods of fall prevention at the same time, in order to control most aspects and factors affecting the fall and reduce the rate of fall.
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Factors affecting the use of protective measures of farmers to prevent falling during the walnut collection period in Tuyserkan County p. 141
Saeid Bashirian, Salman Khazaei, Maryam Afshari, Ensiyeh Jenabi, Hamid Shokoohi, Zahra Zobdeh, Mehran Biglari, Behzad Gholamaliee
DOI:10.4103/atr.atr_117_20  
Background and Objectives: Fall is one of the main reasons for serious injuries in workplaces. Protective measures are not frequently used by farmers and farm workers. In Iran, there are no adequate data in recognizing the various effective factors of falls from height in the agricultural sector. Thus, we used the PRECEDE model to recognize causes and factors which can affect the acceptance of the protective measures for the prevention of fall from the walnut tree. Materials and Methods: From July until November 2018, a cross-sectional research was conducted in Tuyserkan County in the west of Iran among 222 farm workers and farmers from 12 villages. A questionnaire was developed to measure demographic features, history of injuries, and constructs recommended in the PRECEDE model. Data were gathered by face-to-face interviews. Results: Predisposing factors (β =0.348, t = 5.116), enabling factors (β =0.131, t = 3.672), and reinforcing factors (β =0.164, t = 2.128) had a positive impact on protective measures, with an explained variance of 35.3%. In this study, the goodness-of-fit value was obtained as 0.455, indicating an excellent overall fit of the model to the data. Conclusions: The results of this research recognized the causes of protective measures among farmers and farm workers. Our findings suggest that the PRECEDE model could help as a guide for developing a more effective intervention for the prevention of fall from the walnut tree.
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Driver's age and rear-end crashes associated with distraction p. 148
Khalil Pourebrahim, Alireza Bafandeh-Zendeh, Mirbahador Yazdani
DOI:10.4103/atr.atr_42_21  
Background and Objectives: Distraction is one of the affective factors in the occurrence of traffic accidents, which, in its turn, is the second leading cause of death and the main cause of years of life lost due to premature death and disability in Iran. The aim of the present study was to investigate the distracting behaviors of male drivers in rear-end crashes. Materials and Methods: This descriptive cross-sectional study was conducted on male drivers who had experienced a rear-end crash in Tabriz in 2018. In total, 395 samples (whose main reason for the crashes was inattention to the forward field of view) were selected through the information and files available at the traffic police, and after contacting the subjects, the required information was entered in the checklist. Nine distraction factors were classified and ranked into three age groups of young, middle-aged, and older drivers. Results: Findings showed that distractions caused by mobile phone use and passengers were ranked first to third in all three age groups and distracting factors such as eating or drinking while driving, alcohol consumption, and sleepiness were in the last ranks. In addition, older drivers were ranked first in not identifying the distraction factors, and in the middle-aged group, the distraction caused by billboards was the leading cause of crashes. Conclusions: Adopting appropriate policies, such as law enforcement and cultural interventions to prevent driver distractions, and to control the in-car conversation, and cell phone use while driving can be considered as effective interventions to prevent rear-end crashes.
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Identifying and prioritizing risk factors involved in motorcyclists' traffic accidents in Tehran p. 153
Ali Moradi, Amir Kavousi, Pegah Ameri, Mohyeddin Amjadian, Mohammad Hossein Vaziri
DOI:10.4103/atr.atr_14_21  
Background and Objectives: Motorcyclists are one of the most vulnerable groups compared to other road users. Motorcycle road safety can be assured by identifying risk factors, using safety equipment, and improving roads for traveling. This study sought to identify and prioritize the risk factors involved in motorcyclists' traffic accidents in Tehran. Methods: In this descriptive-analytic study, the fuzzy TOPSIS method was used to develop a systematic process to achieve an optimal model through the selected criteria. To find significant risk factors in the model, the interviewed experts first selected the target criteria from an available long list of functional criteria. Then, using the SMART method, the key criteria in motorcyclists' traffic accidents were determined, and they were ranked according to their weights and weighting ratios. Results: Fifty people, including 42 (84%) males and 8 (16%) females, participated in the study. The mean and standard deviation scores of participants' age were 44.18 and 7.03 years, respectively. Based on the fuzzy analysis, alcohol intake, cell phone use, breaching the speed limit, failure to use safety equipment, and driver's age, among other criteria, were ranked first to fifth. Conclusion: This study showed that the most important risk factors associated with motorcyclists' traffic accidents were the human ones. Given that various studies in Iran have shown that human factors are the leading causes of traffic accidents, policymakers and administrators need to take the necessary measures to manage and control them.
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The Relation between Human Traffic Accident and Personality Traits p. 161
Seyed Mohammad Mousavi, Elnaz Vafadar Moradi, Ali Yazdani, Ali Taghipour, Amir Rezaei Ardani, Sayyed Majid Sadrzadeh
DOI:10.4103/atr.atr_36_21  
Background and Objectives: Accidents of motor vehicles are one of the largest causes of traumas, disabilities, and mortalities. Driving accident and crashes with more than 20000 deaths/year are the second cause of morality in the nation after cardiovascular diseases. Personality traits of a person may affect his/her dangerous driving behaviors and perception of health and risk. Materials and Methods: This case–control study was conducted on accident victims referred to Hasheminejad Hospital in Mashhad during 2017–2018 and conducted on two case and control groups. The researchers directly interviewed case group patients using a Temperament and Character Inventory-125 questionnaire. Results: The mean age of the participants was 32 in the case group and 34 in the control group. The most common vehicle was motorcycle in the case group and car in the control group, respectively. In “novelty seeking,” the mean scores were 3.3 ± 9.94 and 8.32 ± 3.57 in the case and control groups, respectively (P = 0.02). In “harm avoidance,” mean scores were 7.72 ± 2.65 and 8.68 ± 3.57 in the case and control groups, respectively (P = 0.02). Conclusion: The present study demonstrated that accident rates reduced as age increased. It was also cleared that personality traits played a major role in the human factor of traffic accidents. Thus, preventive measures could be made and educational packages could be produced at the school level and younger ages aimed at changing some personality traits to some extent.
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Seat belt use behavior among teen students: The role of their demographic characteristics and family members' behaviors p. 165
Forouzan Rezapur-Shahkolai, Fatemeh Malekpour, Leili Tapak, Babak Moeini, Homayoun Sadeghi-Bazargani
DOI:10.4103/atr.atr_61_21  
Background and Objectives: The lack of seat belt use is considered as one of the most common behavioral factors encountering the life of a driver or an occupant to traffic injury risk. The aim of this study was to determine the relationship between seat belt-wearing behavior among school students and their demographic characteristics and family members' behaviors. Methods: In this cross-sectional study, 942 students (497 girls and 445 boys) were included and randomly selected from junior high schools in Tabriz, Iran. A questionnaire on the seat belt-wearing behavior of students and their parents was used to collect data, followed by applying a generalized estimating equation approach to identify the correlation of pupils' traffic behaviors to account for intra-cluster correlation. Results: The results revealed that seat belt-wearing behaviors among male students were significantly more frequent compared to female students (P < 0.0001). The mother's occupation, the father's age, and the student's educational level had a significant impact on seat belt wearing among the students (P < 0.01). In addition, student's adherence to traffic rules was correlated with their seat belt-wearing behavior. Finally, the seat belt-wearing behavior of parents and siblings had a significant positive effect on students' behaviors (P < 0.01). Conclusion: Male students further demonstrated risky behaviors compared to their female peers, and family has an important role in improving the seat belt-wearing behavior of their children. Therefore, involving adolescents' families including their parents and sibling can be important and helpful in developing preventive programs for promoting the use of seat belts among adolescents.
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CASE REPORTS Top

Unusual injuries of the hand: Impalement injuries p. 173
Sandesh Bharat Singh, Aakansh Jain, Arun Kumar Singh
DOI:10.4103/atr.atr_115_20  
Impalement injuries are relatively rare. The most common anatomical site of involvement is the extremities. Impalement injuries are defined as penetrating injuries where a traumatic agent remains impaled in the human body. Foreign body penetration of the hand and wrist is presented as emergency cases. Due to the rarity of such finial impalement injuries presenting to the emergency, the management of this clinical condition remains controversial. Here, we report two cases of impalement injuries of the hand and their successful management. The patients even though been injured by such an object had minimum injuries, the chances of which are quite low. Case 1: A 27-year-old female presented with a history of accidental slipping in the staircase and sustained penetrating injury over the right hand by iron fence finial 5 h before presentation. Case 2: A 42-year-old male presented with a history of slipping while trying to cross a fence. He sustained penetrating injury over his left hand by iron fence finial 7 h before presentation.
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Closed reduction of volar distal radio-ulnar joint dislocation p. 176
Rabie Ayari, Omar Fendri, Anis Bouaziz, Chabchoub Amine, Mohamed Samih Kacem, Amri Khalil
DOI:10.4103/atr.atr_94_20  
Volar dislocation of the distal radio-ulnar joint (DRUJ) is a rare occurrence in the literature, with only a few cases reported. Dorsal dislocation is more common than a volar dislocation. It can be easily missed due to the lack of a specific clinical presentation. They can be treated by closed reduction or more commonly by open reduction internal fixation. We present a case of volar dislocation of the DRUJ with an ulnar head fracture reduced by closed reduction. We report the case of a right-handed 35-year-old patient with no medical history who presented to our emergency department after sustaining a fall on his left hand. The trauma dated of 1 day and X-ray was initially judged normal in the emergency department. Due to the persistence of the pain and the functional impotence, the patient presented again to our department. The investigation showed that the patient's hand was in a supine position when the fall occurred. On physical examination, the forearm was locked in supination, with no passive or active pronation elicited. There was a loss of the dorsal ulnar prominence with a palpable deformity on the volar aspect of the wrist. There was no skin lesion and the neurovascular status of the hand was normal. Initial radiographs were made. Anteroposterior and lateral radiographs of the forearm and wrist showed a volar dislocation of the DRUJ with an associated ulnar head fracture. A closed reduction attempt in the emergency department was unsuccessful. The patient was admitted and under general anesthesia, the dislocation was reduced by pronating the forearm and applying direct pressure over the distal ulna. The wrist was tested after the reduction and the DRUJ was stable. Above-elbow cast was applied in a pronation position for a period of 5 weeks. Upon cast removal, the result was excellent. The patient regained full range of motion of the wrist and elbow, there was no instability nor pain or tenderness. Grip force was conserved. A radiographic assessment confirmed the reduction. Volar locked dislocation of DRUJ is a rare injury. A high index of clinical suspicion and proper X-ray is required for prompt detection. Computed tomography scanning can be useful if the diagnosis is not certain. If the reduction of the joint is stable, there is no need for fixation. Early diagnosis and appropriate treatment are the keys for a good outcome.
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