Background: Postmortem examination is indispensable to ascertain the cause of an unnatural death and as such is mandatory by the law. From ages, traditional autopsy (TA) has proved its worth in establishing the cause of death in the deceased despite some inherent difficulties and challenges and has enjoyed an insurmountable status. The increasing use of application of the modern-day radiology for postmortem examination has however opened a new arena overcoming some of the difficulties of the TA. There are conflicting reports in the published literature regarding superiority of one modality of the postmortem over the other. Objective: The objective of this study was to compare the findings of postmortem computed tomography (CT) scan and TA in the victims of traumatic deaths and to analyze whether postmortem CT can be used to replace TA. Materials and Methods: All patients with a history of trauma that were declared brought dead on arrival in the emergency department were subjected to full-body CT scan. An experienced radiologist reported the findings of CT scan. Subsequently, a forensic expert subjected the patients to TA. The physician who performed autopsy was blinded to the findings of CT scan and vice versa. An individual who was not part of the radiology or forensic team then entered the findings of CT scan and autopsy in a predesigned Pro forma. An unbiased assessor finally compared the findings of the two modalities and analyzed the results. McNemar's test was used to ascertain the level of significance between the findings reported by these two modalities considering P = 0.05 as statistically significant. The agreement or disagreement on cause of death reported by these two modalities was also assessed. Results: About 95% of the deceased were males. The mean age of the corpses was 35 years (range 16–67 years). CT was found superior in picking up most of the bony injuries, air-containing lesions, hemothorax, and hemoperitoneum. However, autopsy was found more sensitive for soft-tissue and solid visceral injuries. Both modalities were equally helpful in identifying extremity fractures. Statistically significant agreement (>95%) on cause of death by both modalities was not achieved in any patient of trauma. Conclusion: Postmortem CT scan is promising in reporting injuries in traumatic deaths and can significantly complement the conventional autopsy. However, at present, it cannot be considered as a replacement for TA.

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Circular saws and angle grinders are two of the most dangerous pieces of electrical equipment on a worksite. Besides the danger that any high-powered, sharp piece of equipment possesses, these pieces use circular saw blades that can splinter into projectile fragments. A 60-year-old male was cutting a steel pipe with a circular saw when a fragment of the 12-inch blade flew off, impaling him in the upper face just to the right of the midline. He was wearing eyeglasses, the bridge of which was driven into his skull on impact of the fragment. He was brought to the trauma center where he underwent imaging of his face and head. This revealed that the blade and his glasses had penetrated 1.2 cm into the right frontal lobe of the brain, resulting in facial fractures and intraparenchymal hemorrhage. He underwent bifrontal craniotomy, removal of the blade and his glasses, evacuation of hematoma, and dural reconstruction. Postoperatively, he was awake with a Glasgow Coma Scale of 15 and no neurologic deficits. The complex nature of craniofacial injuries makes a multidisciplinary approach to these patients essential. Prompt diagnosis and treatment by the appropriate specialists are vital to optimize patient outcomes.

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Simultaneous dislocation of the thumb carpometacarpal and metacarpophalangeal joints is an uncommon injury. Stability is the most important factor in the decision of treatment in these rare injuries. The treatment methods range from closed reduction and maintaining reduction with cast or percutaneous k-wires to complex reconstruction surgeries. In this paper, a case of 28-year-old female with complete dislocation of the left thumb metacarpal has been reported. She was treated with closed reduction and cast immobilization with excellent result. Treatment decision should be based on postreduction stability in complete dislocation of thumb metacarpal; cast immobilization is a management option in case of stable reduction.

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Background: The aim of this study was to assess the accuracy of high-resolution ultrasonography (USG) in the evaluation of rotator cuff tendinopathies and tears with magnetic resonance imaging (MRI) correlation to determine its sensitivity and specificity. Materials and Methods: The prospective study was conducted on 40 patients referred to the Department of Radiology for the evaluation of rotator cuff pathologies over a period of 18 months. All the patients underwent high-frequency USG followed by MRI. Variables such as sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and accuracy of high-frequency USG and MRI were evaluated. Results: The sensitivity, specificity, NPV, PPV, and accuracy of high-frequency USG in the evaluation of rotator cuff pathologies in comparison to MRI as standard were 90.6%, 87.5%, 96.6%, 70%, and 90%, respectively. Conclusion: High-frequency USG is almost equally sensitive and specific as MRI for the diagnosis of rotator cuff pathologies, and due to its cost-effectiveness, easy affordability, ease of evaluating contralateral shoulder, more patient compliance, noninvasiveness, and wider applications, we recommend it to be used as a primary modality for evaluating rotator cuff. MRI should be performed in case some extra information is required.

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Background: There is an ongoing debate if bone graft substitutes (BGSs) are beneficial in the treatment of displaced intra-articular calcaneal fractures (DIACFs). The purpose of this study was to evaluate the effect of an injectable calcium sulfate/hydroxyapatite BGS (CERAMENT^TM iBONE VOID FILLER, BONESUPPORT AB, Lund, Sweden) in internal fixation of calcaneal fractures. Methods: The records of patients presenting with calcaneal fractures type Sanders III and IV and treated with internal fixation plus BGS were reviewed. Radiographs were analyzed using different measurements (including Böhler's angle and calcaneal facet height). The clinical outcome was evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale. Results: A total of 20 fractures were available for radiographic and clinical examination at a minimum follow-up of 12 months. No decrease in Böhler's angle was recorded in six fractures, a reduction of <5° in 6 and of more than 5° in 8 fractures. In all fractures, the BGS was completely resorbed at 12 months on radiographs. The AOFAS score was on an average 89.8 (range, 68–99) at 1-year follow-up and indicated an excellent outcome in 11, a good outcome in 8, and a fair outcome in 1 fracture. Conclusions: The study results support the use of an injectable, in situ hardening calcium sulfate/hydroxyapatite BGS in DIACFs. The BGS is easy and safe to use as an augment to open reduction and internal fixation.

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Objective: Venous thromboembolism (VTE) which includes deep vein thrombosis (DVT) and pulmonary embolism is a preventable complication in hospitalized trauma patients. Currently, the VTE guideline is the standard of care. However, underutilization of the guideline was reported. This study aimed to report the adherence to the VTE guideline in a Level 1 trauma center in Thailand. Methods: A retrospective review was performed on adult trauma patients admitted between January and December 2013. The inclusion criteria were Injury Severity Score ≥9 and admission in the hospital ≥7 days. The patients were classified into “very high risk of DVT,” “high risk of DVT,” and “high risk of bleeding” groups according to the hospital guideline. Adherence to the guideline, utility of the prophylaxis, and VTE occurrence were recorded. Results: During a 12-month period, 352 cases met the inclusion criteria. The overall adherence to the guideline was 28.9%, 5.2% in the “very high risk of DVT” group, 18.4% in the “high risk of DVT” group, and 57.9% in the “high risk of bleeding” group. VTE occurrence was 11 incidences in 10 patients (2.8%). The “high risk of bleeding” group had the highest in VTE occurrence (10 of 11 incidences). Conclusions: The adherence to the VTE prophylaxis guideline in Thailand was higher than previous studies. The pharmacological prophylaxis should be initiated as soon as possible.

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Background and Objectives: This study aimed at investigating the burden of injuries, including spinal cord injuries and limb amputation, caused by the Bam earthquake. Materials and Methods: The data related to morbidity of spinal cord injuries were collected from records provided by State Welfare Organization of Iran. Then, morbidity and mortality data for amputation and also mortality of spinal cord injuries were obtained from a previous study using the network scale-up method. Then, we followed the World Health Organization guidelines to assess the burden of this disease, and then years of life lost (YLL) and years of life lost due to disability (YLD) were calculated. Results: The disability-adjusted life years (DALYs) caused by the spinal cord injury were 15,435 years. YLL due to premature mortality was 13,134 and YLD was 2301 years and the number of DALY caused by limb amputation was equal to 2184, all of which were due to YLD. Conclusions: According to the results of the present study, spinal cord injuries and amputations resulting from the earthquake impose many burdens on society. This provides outcomes and evidence for policymaking and planning in the field of health care for policymakers.

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