Archives of Trauma Research
Year:2013 | Volume:2 | Issue:2|Papers Count:10

Among different groups of population involved with injuries, trauma during pregnancy is a unique event because two patients, the mother and her fetus, are at risk and need evaluation and management.Trauma is one of the most common causes of maternal mortality (1). Also fetal mortality rate following trauma is reported from 3% to 38% (2). Approximately 6 – 7% of pregnancies get complicated by traumatic injuries (3).Two thirds of maternal traumas are due to motor vehicle accidents, followed by many other mechanisms including partner violence, fall, burn, suicide, intoxication, sport and pedestrian injuries (1, 2, 4).

Context: Ischemia-reperfusion injury is a fascinating topic which has drawn a lot of interest in the last several years. Hepatic ischemia reperfusion injury may occur in a variety of clinical situations. These include transplantation, liver resection, trauma, and vascular surgery. Evidence Acquisition: The purpose of this review was to outline the molecular mechanisms underlying hepatic I/R injury and present the latest approaches, both surgical and pharmacological, regarding the prevention of it. A comprehensive electronic literature search in MEDLINE/PubMed was performed to identify relative articles published within the last 2 years.Results: The basic mechanism of hepatic ischemia – reperfusion injury is one of blood deprivation during ischemia, followed by the return of flow during reperfusion. It involves a complex series of events, such as mitochondrial deenergization, adenosine-5' -triphosphate depletion, alterations of electrolyte homeostasis, as well as Kupffer cell activation, oxidative stress changes and upregulation of proinflammatory cytokine signaling. The great number of variable pathways, with several mediators interacting with each other, leads to a high number of candidates for potential therapeutic intervention. As far as surgical approaches are concerned, the modification of existing clamping techniques and the ischemic preconditioning are the most promising techniques till recently. In the search for novel techniques of protecting against hepatic ischemia reperfusion injury, many different strategies have been used in experimental models.The biggest part of this research lies around antioxidant therapy, but other potential solutions have been explored as well. Conclusions: The management of hepatic trauma, in spite of the fact that it has become increasingly nonoperative, there still remains the possibility of hepatic resection in the hepatic trauma setting, especially in severe injuries. Hence, clinicians should be familiar with the concept of hepatic ischemia-reperfusion injury and respond appropriately and timely.

Background: The Ilizarov technique has been used in the UK for the last 20 years in the management of infected non-union of long bones. This method uses fine wires inserted percutaneously which are attached and tensioned to provide a strong frame construct. The majority of tibial and femoral non unions can be treated successfully by internal fixation. However, an infected non-union of the tibia can prove a difficult problem. The Ilizarov method can prove useful for treating these complex injuries. Objectives: To assess whether a new limb reconstruction centre in the UK has comparable results.Patients and Methods: Twelve patients (10 M: 2 F; Avg age 43.3 years) who had an infected tibial non-union between March 2009 and August 2010 treated with the Ilizarov technique. Intervention method was Ilizarov technique and main outcome measures include functional and radiological outcomes assessed using the Association for the Study and Application of Methods of Ilizarov (ASAMI) criteria, American Orthopaedic Foot and Ankle Score (AOFAS) and Visual Analogue Pain scores.Results: All twelve patients united. None required amputation. Mean time to union was 46 weeks (range 24 - 70/median 50). The average follow up time was 62 weeks (39 - 164/ median 59). According to the ASAMI score bone/radiological results ten were classed as excellent with the remainder being good. Functionally six were graded as excellent, four as good and two as poor. The average AOFAS score was 83/100 (70 - 90) and pain visual analogue scale (VAS) was two. Conclusions: Our results in terms of ASAMI scores are comparable with the published literature. Furthermore, our return to work is better than most European studies (63%). All our patients said they would have the procedure again. We attribute this success partly to the multidisciplinary approach. We recommend early referral to a dedicated unit if there is any evidence of a non-union.

Background: S100B is a calcium-binding protein, belonging to the S100 family proteins which are characterized by their high solubility and, currently, comprises 21 members which are expressed in a cell-specific manner. If we can predict the possibility of definite brain death after brain injury, we will rescue some organs of body to transplant proposes. Objectives: In this regard, our study focused on the S100B protein value in predicting brain death after head trauma. In this study, the use of serum level of protein S100, 24 hours after trauma has been considered as a reliable index for predicting brain death.Patients and Methods: 72 patients (50 male and 22 female) aged 5 - 80 years old (median 40±17.72 years) with severe head traumas (GCS£8) were recruited in this cross-sectional study. Glasgow Coma Scale (GCS) and computed tomography (CT) scan findings were recorded for all patients, and then a single 5mL blood sample was obtained from each patient on admission, after 48 hours and a week later or after brain death to determine the level of S100B protein.Results: Primary and the last GCS of patients had a predictive value in determining brain death (P<0.0005), also there was a significant correlation between GCS and level of S100B protein. There was a significant correlation between CT scan findings and S100B protein only after 48 hours of trauma. Conclusions: Changes in S100B protein, especially the levels of this dimer 48 hours after trauma can be used as marker to predict brain death. Alongside other known prognostic factors such as age, GCS and diameters of the pupils, however, this factor individually can not conclusive predict the patient's clinical course and incidence of brain death. However, it is suitable to use GCS, CT scan, clinical symptoms and biomarkers together for a perfect prediction of brain death.

Background: Gastrointestinal Injuries (GI) during gynecological operation are uncommon but proper management of these injuries is very important. Objectives: The aim of this study was to review the causes and management of gastrointestinal injuries during gynecological and obstetrical operations.Patients and Methods: In this descriptive retrospective study, 25 patients with gastrointestinal injuries during gynecological and obstetrical operation at Shabihkhani Maternity Hospital in Kashan city were reviewed. Demographic data such as age, gravid, parity, type of surgery or procedure, history of laparotomy, the surgical operation, injury site, time of diagnosis and method of treatment were extracted from medical records.Results: The mean age of women was 33.2±7.57 years. Fourty-four percent of the patients had a history of abdominal scar. Thirty-two percent of all GI injuries occurred during total abdominal hysterectomy (TAH). The small bowel was injured in 36% of cases. Fifty-two percent of injuries were diagnosed during the operation and the mean time of injury diagnosis was 2.8±0.9 days. Conclusions: All of the gynecologic surgeons must be aware of gastrointestinal injuries and should anticipate injury to these organs, especially in high-risk patients for decreasing patient morbidity.

Background: With increasing incidence of traumatic fractures, the use of orthopedic intervention such as traction has increased. Inappropriate traction care may cause substantial morbidity and delay the patient rehabilitation. Objectives: This study was conducted to evaluate the quality of care for patients with traction in the orthopedic unit of Shahid-Beheshti Hospital, Kashan, Iran.Patients and Methods: This observational study was conducted on 100 patients with traumatic fractures of hip and femur bones who were admitted to Kashan Shahid-Beheshti Hospital during the first 6 months of 2012, and for whom skeletal or skin traction was performed.Data were collected using a checklist including questions about the personal characteristics and 23 items related to care for patients with tractions. These items were in three domains including caring while establishing traction, recording care and patient's education. Descriptive statistics were calculated and data were analyzed using the independent sample t-test and Pearson correlation coefficient.Results: The mean age of patients was 51.16±23.28 years and 66% of them were male. In total, 47% of the patients were treated by skin traction and 53% by skeletal traction. The overall mean score of quality of care was 10.20±2.64. Quality of establishing traction was good in 55% of patients, but the quality of care was poor in the domains of recording care (88%) and patient education (96%). Total mean of quality of care was significantly different between male and female patients (P<0.02). Conclusions: The quality of care of patients with traction was not optimal. Therefore, it is necessary to improve measures in this area.

Background: Hyponatremia is a common disorder in patients with brain injury. It can result in acute and chronic complications providing this electrolytic disorder is not diagnosed and treated in due time. Objectives: The aim of this study was to evaluate the prevalence of hyponatremia in 95 brain injury patients hospitalized in the intensive care unit (ICU) in Kashan Shahid-Veheshti hospital.Patients and Methods: This trans-sectional study was conducted on brain injury patients (brain traumas, brain hemorrhage, meningitis and brain tumors) during their six-month stay in the ICU in Kashan Shahid-Beheshti hospital. Data were analyzed after excluding cases of pseudohyponatremia.Results: Ninety-five patients with brain injury (69.5% male and 30.5% female (had a mean age of 42.85±22.59 years, while the hyponatremic patients had a mean age of 48.37±24.03 years. Prevalence and occurrence of hyponatremia were 31.6% and 9.29±6.8 days, respectively. This study revealed no meaningful differences between age, sex, underlying disease and the prevalence of hyponatremia. Conclusions: Our study showed an elevated frequency of hyponatremia in patients with brain injuries in ICU which demands the effective approaches for an accurate and timely diagnosis of this electrolyte disorder.

Introduction: Gastric emphysema or pneumatosis is a rare finding. Early endoscopy and urgent laparotomy is advised in post-trauma patients. Case Presentation: A 29 year old man presented with blunt abdominal injury following a high-speed motorbike crash. He complained of abdominal pain and abdomen was distended. CT abdomen revealed air in the gastric wall with disruption of gastric mucosa. He had normal white cell counts, bleeding parameters and blood gases. He was treated conservatively with nasogastric decompression, intravenous analgesics and antibiotics with which he recovered well. Conclusions: Early surgical management is indicated in post-trauma patients in whom bowel infarction is suspected. In a stable patient, a negative laparotomy is a major additional stress post trauma - conservative management with close clinical observation is a suitable management alternative.

Dear Editor: We have read with great interest the article by Mogadam and colleagues on utilization of gabapentin and diclofenac for management of post-operative pain in patients undergoing tonsillectomy (1). Perhaps the most intriguing aspect of this study was the observation that pre-operative administration of gabapentin or diclofenac resulted in reduced post-operative utilization of meperidine, an opioid analgesic.

Dear Editor: Concerning the article “Comparison of Analgesic Effect between Gabapentin and Diclofenac on Post-Operative Pain in Patients Undergoing Tonsillectomy” published in one of the previous issues of Archives of Trauma Research (1), I would like to sincerely congratulate the authors on the results obtained in their study.