TRAUMA MONTHLY
Year:2021 | Volume:26 | Issue:5|Papers Count:8

Introduction: Multiple physical problems and psychosocial issues among chemical injured patients can be a source of stress. They often use mental strategies to cope with their problems. The aim of this research was to assess these issues and problems experienced by chemical warfare victims and how they cope with it. Methods: This qualitative study was conducted in 2017 using content analysis. Seventeen chemical weapons victims were selected based on purposeful sampling from veteran’, s recreation referral to therapeutic and training center in Chaboksar (A city in northern of Iran). Data were collected through conducting in-depth semi-structured interviews and making filed notes. Data analysis was performed according to the proposed steps by Granhym & Lundman. Results: During the data analysis, one main theme (Coping with pain in the shadow of values), four categories and twelve subcategories including physical pain (acute pain and chronic pain), psychological discomfort (nightmare, depression and misconception), unsuitable social context (feeling abandoned, fearing from an unforeseen future and stigmatization) and coping (coping because of patriotism, religious coping, family coping and coping by force) emerged from the interviews. Conclusion: Coping might be a way for facing to pain but it is certainly neither easy nor joyful. Putting to suffer the necessary facilities, social and family support and changing the culture beliefs for decreasing the social stigma are the most effective ways of their treatment.

Introduction: This study was conducted to determine the imaging criteria of anterior pelvis fractures. Methods: The present study was done as a cross-sectional study in the orthopedic clinic of Taleghani Hospital, Theran, Iran, from 2018 to 2020. All hospitalized patients with a diagnosis of pelvic fracture (unstable acetabular fracture) were included in the study. For sampling, the census method was used, which according to the inclusion criteria, 102 record were included. Results: The angle of coronal cut and sagittal cut at variable levels, the dimensions of the anterior pelvis in three areas of stenosis at variable levels and BMI, the distance from the bladder to the posterior border at the variable levels of BMI, the posterior border at the anterior column to venous at variable levels of BMI, the posterior border distance in the anterior column to the artery at variable levels of age and BMI, and lateral ileum to three narrowing zones at varying levels of gender, age, and BMI are significantly different. The age had a significant negative correlation with posterior border distance in the anterior column with artery, vein, and BMI index had a significant positive correlation with pelvic anterior column dimensions and lateral ileum distance. Conclusion: To determine the imaging criteria of the anterior pelvic column, variables such as age, gender, and body mass index must be considered.

Introduction: There are several models to predict the prognosis of trauma patients. The present study aimed to evaluate age, systolic blood pressure (GAP), revised trauma score (RTS), and new trauma score (NTS) to predict mortality rate in multiple trauma patients referring to Imam Reza Hospital, Tabriz, Iran. Methods: The present descriptive-analytical study was carried out on 544 multiple trauma patients from July 2018 to Aug 2019. GAP, RTS, and NTS models were adopted to collect data on the variables. The GAP, RTS, and NTS scores were calculated, and their relationship with hospital outcome was then assessed. Result: In total, 31 patients out of the selected sample died during the study. The cut-off point (sensitivity and specificity) of RTS, NTS, and GAP models for hospital survival rates was equal to 6. 07 (0. 97 and 0. 98), 5. 59 (0. 94 and 0. 99), and 15. 5 (0. 97 and 0. 97), respectively. A logistic regression test was run to determine the effects of GCS, GAP, RTS, and NTS models. The results showed that the RTS and NTS scores had the highest value in determining the chances of survival, with the respective odds ratios (OR) of 13. 74 and 10. 207. Conclusion: Considering the high sensitivity and specificity of RTS, GAP, and NTS models in determining patient survival rates, these models have good predictive value in determining hospital outcomes. The effect of these models on the patient outcome based on OR values, RTS and NTS models showed high values.

Introduction: Maxillofacial trauma resulting in fractures are among the most common reasons for referral to the ER. Epidemiological fracture patterns are widely dependent on cultural, environmental, and socio-economic parameters. This study aimed to assess the epidemiology and prominent patterns of maxillofacial injuries and fractures in Iran. Methods: This cross-sectional study was conducted at a trauma research center. In this study, medical records of patients with maxillofacial fractures from 2010 to 2015 were reviewed. Factors such as age, gender, GCS at admission, hospital stay, fracture cause, site of fractured bones, ocular injuries, brain injuries, trigeminal involvement, facial nerve involvement, soft tissue injuries, and upper face fractures were evaluated. Treatments rendered were also reviewed. Data analysis was performed using SPSS version 22. Results: 283 patients with a mean age of 32. 48 years and a male-to-female ratio of 4: 1 was seen. The most common age group was the third decade of life (38. 2%). The most common causes of fracture were MVA (66. 4%), falls (13. 1%), and assault (9. 2%). The most common fractured bones were: mandible (42. 04%), orbit (39. 57%), and maxilla (37. 1%). The most common treatment was open reduction (94%) and internal fixation with miniplates (49. 5%). The hospital stay duration was 3. 4 days (average). Conclusion: In this study males in the third decade of life were the most prone to facial fractures. Associated injuries were common and must not be neglected on physical examination. The profession, culture, and social differences in the society are influential in facial fractures and thus the pattern will differ in different nations.

Introduction: Post-operative pain management following total knee replacement (TKA) is crucial. The introduction of some available, inexpensive, and effective methods for post-operative pain management is necessary. Therefore, this randomized clinical trial was done comparing the analgesic effect of an oral low-cost drug (oxycodone) and ultrasound-guided nerve block (saphenous nerve block) to assess the best method for post-operative pain management after TKA surgery. Methods: This single-blind, randomized, controlled, single-center clinical trial was performed from June 2017 to June 2018. There were 80 patients undergoing TKA randomly divided into two groups,group A received a single shot ultrasound-guided saphenous nerve block and, group B took oxycodone which started before and continued every 6 hours after surgery to control post-operative pain. The pain score by visual analog scale (VAS), nausea-vomiting, and diclofenac use were assessed postoperatively at 2, 6, 12, and 24 hours’,post-spinal anesthesia administration. Data were analyzed by SPSS-21, Chi2, Fishers' exact test, and Mann-Whitney test were used for comparing data between the two groups. Result: The pain intensity according to the visual analog scale at 2, 6, 12, and 24 h post-operative was 1. 25±, 1. 37, 4. 12±, 1. 11, 5. 25±, 0. 89, and 4. 57±, 095 in group A, and 1. 10±, 0. 953. 77±, 0. 99, 4. 05±, 0. 78, and 2. 95±, 0. 78 in the group B, respectively,this was significantly lower in group B at 12 and 24 hours (P<0. 05). The mean diclofenac use was 87. 01±, 68. 02 mg in group B and 262. 04±, 92. 05 mg in the group A (P<0. 001). Also, the incidence of nausea and vomiting was significantly higher in group B compared to group B (P<0. 001). Conclusion: Oral oxycodone can control post-operative pain better than saphenous nerve block in the management of post-operative pain and reducing total additional analgesic drug consumption. Although, adverse effects such as nausea and vomiting were lower in saphenous nerve block.

Introduction: Hemothorax is one of the most prevalent complications after thoracic trauma. Extended Focused Assessment with Sonography for Trauma (e-FAST) is one of the diagnostic methods for hemothorax assessment. This study aimed to assess the diagnostic value of e-FAST in detecting hemothorax and its size in patients with blunt thoracic trauma. Methods: This cross-sectional diagnostic assessment was conducted on 400 adult patients with blunt trauma who needed a chest CT scan. Chest X-ray (CXR), sonography, and chest CT scans were performed and hemothorax size was assessed with sonography and CTscan. Sensitivity, specificity, and positive or negative predictive values of sonography and CXR were calculated. Hemothorax size on sonography was compared with the results of CT-scan as the gold standard. Results: The mean age of participants was 43. 67±, 22. 03. Based on CT scan findings, 176 participants (44%) had a hemothorax. The sensitivity, specificity, positive and negative predictive values, and correct classification rate of sonography were 79%, 99. 1%, 98. 6%, 85. 7%, and 90. 2%, respectively. The accuracy of sonography was 97. 1% for small hemothorax, 46. 9% for medium hemothorax, and 33. 3% for large hemothorax. Conclusion: Sonography is a sensitive diagnostic modality for the detection of hemothorax in multiple trauma patients but tends to underestimate moderate to large-sized hemothorax. Chest sonography can be an acceptable imaging modality if a CT scan is not available or desired.

Introduction: The femoral neck fracture is a disabling injury that disrupts the patient's health. The fracture healing is long and sometimes unreliable. Therefore, the finding of fracture repair aids that accelerates healing speed and reliability helps in the healing process. The parathyroid hormone is a good option as a systematic mediator in calcium and bone metabolism. The study aimed to use Cinnopar to improve and accelerate rate of the healing process and reduce complications of femoral neck fractures in people aged 40 to 60 years. Methods: In the study, 34 femoral neck fracture patients were included in two groups as receiving Cinnopar group(N=17) and not receiving Cinnopar group(N=17). The patients were imposed with 20 micrograms of injected Cinnopar subcutaneously once a day, and the other group received only routine postoperative drugs. Results: The patients with no return to activity was two (33/13%) in the receiving Cinnopar group. There were five patients (33/33%) with no return to the activity for the not-receiving Cinnopar group. The return to activity was compared in both groups three months after the operation, and the two groups were significantly different (p-value = 0. 03). The results of the radiographic union showed ten unions (66. 66%), three incomplete unions (20%), and two non-unions (13. 33%) in the receiving Cinnopar group at three months after the operation. There were eight unions (53. 33%), four incomplete unions (26. 66%), and three non-union (20%) in the not receiving Cinnopar group, and the two groups were similar. Conclusion: Receiving Cinnopar immediately after femoral neck fracture surgery can reduce pain. It can also prevent non-return to activity during the first three months after surgery and improve femoral neck union.

Introduction: Pregabalin is a co-analgesic to improve the pain control after colorectal cancer surgeries. There is less knowledge about the effect of Pregabalin on postoperative sleep and the ability to change the position of patients after surgery. This study aimed to assess the impact of Pregabalin on postoperative morphine consumption, pain, sleep, mood, and ability to change position after colorectal cancer surgery. Methods: This double-blind, randomized, controlled, single-center clinical trial was performed in Tehran, Iran, from June 2017 to June 2018. Seventy patients were included for colorectal cancer surgery randomly divided into two groups (A, B). Group A received two doses Pregabalin (150 mg) pre-operative and post-operative, and group B as a placebo was administered at the same scheme. The two groups had similar analgesia and anesthesia regimens. The pain was scored by a numerical rating scale (NRS),disturbance in sleep, and mood. The daily activity was numbered based on a scoring system such as BPI questionnaires,and, nausea-vomiting, morphine consumption, and fatigue headache were evaluated 48 hours after surgery. Results: Morphine consumption was lower in the Pregabalin group 24 h after surgery (P=0. 01). The two groups were similar regarding sleep interference scores and side effects (P>0. 05). But, mood and actions interference scores in the Pregabalin group showed a significant improvement in 48 h postoperative (P<0. 05) (Table 3). Conclusion: The results showed that Pregabalin could reduce postoperative morphine consumption and improve mood and actions interference scores after colorectal cancer surgery. However, there was no difference between Pregabalin and placebo in postoperative pain management and sleep interference scores after colorectal cancer surgery.