Archives of Trauma Research
Year:2013 | Volume:2 | Issue:3|Papers Count:10

Fall is one of the most common causes of major injuries and responsible for many hospital admissions in Iran (1, 2). Falling may happen at any age, but children and the aged people are at higher risk for it. Approximately 47000 children fall to their death annually, but hundreds of thousands more sustain less serious injuries from a fall (3). Falls represent the third leading cause of death in children and are responsible for 5.9% of childhood deaths due to trauma (4). Generally, death due to falls is resulted from head injury (5). Falls in children tend to be from terraces, tables, windows, and trees, and most frequently have a tendency to occur in homes, followed by playgrounds and schoolyards (6).

Background: The quality of care after head injury is still very variable with a little coordination between different specialties. Acute care dominates, often with little regard to rehabilitation needs. Objectives: To improve the outcomes of all head injury admissions to hospital, including mild and moderate, by creating a head injury team to supervise a rehabilitation clinical pathway.Patients and Methods: A head injury team was established to manage the care of all non-neurosurgical admissions with head injury to a large teaching hospital. Apart from inpatient care, the team coordinates various services involved in the care of head injuries, arranged suitable follow-ups, supported relatives and trained healthcare staff on general wards in the treatment of head injured patients. Follow-up clinics at 6 weeks and 6 months were arranged.Results: In the first three years, the team managed the care of 812 admissions. Mean age was 44.3 years (SD=24.8) and mean length of hospital stay was 6.1 days (SD=10.9). Of these individuals, 674 attended for 6 month follow-up with 52.2% having a good outcome on Extended Glasgow outcome score. Patients and their relatives' feedbacks were excellent with an average score of 4.7/5 on overall satisfaction rating.Following presentations at national meetings and elsewhere, other centers in the United Kingdom are now setting up similar pathways. Conclusions: A dedicated clinical pathway and head injury team can improve the quality of care for all admissions with head injury and enhance the role for rehabilitation medicine input at an early stage.

Background: Tibial fractures are the third most common pediatric long-bone fracture after forearm and femoral fractures. Approximately 50% of pediatric tibial fractures occur in the distal third of the tibia. This is followed by midshaft tibial fractures (39%), and least commonly, the proximal third of the tibia is involved. Tibial fractures in the skeletally immature patient can usually be treated without surgery but tibial fractures resulting from high energy traumas are of special importance considering type of the selected treatment method affecting the children future. Manipulation and casting are regarded as definite treatments for children tibial fractures. They are used following compartment syndrome in poly-trauma, neurovascular damages, open fractures, and fasciotomy cases.Objectives: In children, most open fractures occur due to high energy traumas and inappropriate treatment of the fractures may result in several complications. Flexible intramedullary nailing is one of the popular options as an effective method of treating long-bone fractures in children. The external fixator is used in cases with severe injuries and open fractures. The present study aims at comparing results of these two treatment methods in the open pediatric tibial fractures.Materials and Methods: In this descriptive analytical study, 32 patients with open tibial fractures were treated with either fixator (n=18) or TEN nails (n=14) during 2006-2011. Some patients were treated with a combination method of TEN and pin. The results were evaluated considering infection, union, mal-union, and re-fracture and the patients were followed up for two years.Results: Mean time required for fracture union was 12.5 (11-14) and 11.8 (10-12) weeks for the external fixator and TEN groups, respectively. There was no statistical difference in time of union between the two methods. The main complications in external fixation were infection around the pin 4 (22.2%), leg-length discrepancy 2 (11.1%) and re-fracture 4 (22.2%). In the TEN group, 2 cases (14.2%) of painful bursitis were observed at the entry point of TEN and the pin was removed earlier. There was not any report of mal-union requiring correction in the groups. No complication was seen in 6 patients treated with a combined method of pin and flexible intramedullary nails.Conclusions: Although external fixation in open pediatric fractures and severe injuries is recommended, intramedullary nailing is also an effective method with low complications. Combining pins and flexible intramedullary nails is effective in developing more stability and is not associated with more complications.

Background: Accidents are the most important public health challenges in our society. To prevent the accidents, the identification of their epidemiological features seems necessary.Objectives: This study was conducted to reveal the epidemiological features of accidents and their casualties in Qom province in 2010.Patients and Methods: A cross–sectional study was conducted on 29426 injured people referred to Qom province hospitals in 2010. Information about place, time, type of accidents and traumas and demographic variables had been collected in a veteran hospital. Data were analyzed by SPSS (version 16) software, using chi-square test and logistic regression.Results: The incidence of accidents was about 27/1000 per year. The incidences of traffic accidents, motorcycle accidents, violence, burns, poisoning and suicides were 3, 1.6, 1.2, 0.3, 0.8, 0.37 cases per 1000 people respectively. Strikes (65%) and falls (12%) were the main causes of traumas. Forty-six percent of all injuries had occurred in 16 - 30 years groups. Most frequent accidents were as follows: fall (97%) and strike (50%) in<12, violence (46%) in 20 - 29, suicide (71%) in 15 - 29, poisoning (34%) and burns (20%) among<5 years old. Pedestrian and motorcycle accidents among+60 years old people were significantly higher than other (P=0.000). Odds ratio for suicide among female was about 3.36 and in 16-30 age-group was 15.7 more than+60 years old group (P=0.000).Conclusions: Most traumas in Qom province occurred among younger age-groups and strikes and falls are the main causes of such traumas. Therefore, safeties to prevent falls and traffic regulations to reduce strikes can be effective strategies.

Background: It was suggested that the direction of incision for medial hamstring tendons harvesting influences the incidence of injury to the infrapatellar branch of the saphenous nerve (IPBSN), a common complication following arthroscopically-assisted anterior cruciate ligament reconstruction (ACLR). Objectives: The main purpose of current study was to compare the incidence of IPBSN injury between vertical and oblique incisions utilizing electrophysiological evaluation.Patients and Methods: There were 60 patients underwent arthroscopically-assisted ACLR assigned to two equal vertical or oblique incision groups, randomly. One year postoperatively, the patients were electrophysiologically examined to detect whether IPBSN is injured. The Lysholm score was completed. The patients' satisfaction with surgical outcomes determined utilizing visual analogue scale (VAS). Finally, two groups were compared and the effect of IPBSN injury on function and satisfaction was investigated.Results: The incidence of IPBSN injury was higher in the vertical group (4 patients vs.10 patients), but the difference was not statistically significant. The mean of Lysholm and VAS scores were the same. Also, the mean of Lysholm score was the same in patients with and without IPBSN injury. However, patients without IPBSN injury were more satisfied (8.9±9 vs.7.4±1.1; P<0.001). Conclusions: IPBSN injury is a common complication following arthroscopically-assisted ACLR and, if not significant, oblique direction of the incision is associated with decreased incidence of the injury. IPBSN injury has no effect on the function but because of the disturbance with patients' satisfaction, authors believe the oblique incision is preferable to avoid the nerve injury during medial hamstring tendons harvesting.

Background: An appropriate animal model of ischemia stroke is essential for evaluation of different therapeutic methods. Two and four-vessel global ischemia models are one of the most common types of transient cerebral ischemia. Objectives: In this study, the morphology of rat hippocampal CA1 neurons in modified models of two and four-vessel ischemia and reperfusion were evaluated. Materials and Methods: In this study, 20 Wistar rats were randomly divided into five groups. In group 2 and 3, both common carotid arteries were occluded for 10 minutes in either 3 or 24 hours of reperfusions, respectively. In group 4 and 5, both common carotid and vertebral arteries were occluded for 10 minutes in either 3 or 24 hours of reperfusions, respectively. Group 1 as control, underwent the whole surgery without any arteries occlusion. Hippocampi of the rats in all groups were processed and tissue sections were stained using the Nissl method. The morphology of CA1 neurons were studied under a light microscope and compared different groups.Results: In all groups ischemic changes were apparently observed in hippocampus CA1 neurons. In two-vessel occlusion model, after 3 and 24 hours of reperfusions, ischemic cells accounted for 14.9% and 23.2%, respectively. In four-vessel occlusion model, after 3 and 24 hours of reperfusions, ischemic cells accounted for 7.6% and 44.9% (P<0.0001), respectively. Conclusions: Modified four-vessel occlusion model resulted in significant ischemic changes after 24 hours of reperfusion in CA1 neurons of rat hippocampus.

Introduction: A wandering spleen occurs when there is a laxity of the ligaments that fix the spleen in its normal anatomical position. Case Presentation: This is a case report of a wandering spleen with horseshoe kidney in a 29-year-old male admitted with acute lower abdominal pain and vomiting to emergency department of Shariati hospital in Isfahan province. Sonographic examination showed a homogeneous 21×15×8 cm mass in the lower part of the abdomen and pelvis associated with a horseshoe kidney. Laparotomy confirmed the clinical and ultrasound findings. Conclusions: The association of horseshoe kidney with a wandering spleen in this case may be due to an embryological anomaly.

Background: Major vascular injury during a spinal surgery is a rare but most dreaded complication. Case Presentation: A 39 years old female undergoing microscopic lumbar discectomy suddenly developed severe hypotension on table. The procedure was abandoned and the patient turned supine. It was diagnosed to be a major vessel tear and the patient was taken up for immediate successful vascular repair. To best of our knowledge such a repair procedure has not been described in literature. Conclusions: Majority of such vascular injuries are dealt with primary repair of the defect by a vascular surgeon; however in our case the rent was big and placed on the undersurface making it very difficult for the vascular surgeon to approach or repair it primarily.

Dear Editor: We read with great interest the recent manuscript by Mostafa Alavi-Moghaddam et al. (1) on “Application of Queuing Analytic Theory to Decrease Waiting Times in Emergency Department: Does it Make Sense?” published in the Archives of Trauma Research. In this article, the authors described a discrete events simulation (DES) model deployed on the ARENA simulation software to model the processes in an Emergency Department (ED). The simulation model was based on empirical data of actual ED operations for The Imam Hosein Hospital located in Tehran, Iran, with annual input of approximately 50, 000 patients, 24 general emergency beds and 14 trauma emergency beds.

Dear Editor: We have examined attentively the latest manuscript by Yeganeh Mogadam et al. entitled “Comparison of Analgesic Effect between Gabapentin and Diclofenac on Post-Operative Pain in Patients Undergoing Tonsillectomy” available in Archives of Trauma Research (1). Ninety patients were included to receive 20 mg/kg oral gabapentin (n= 30), 1.0 mg/kg rectal diclofenac (n=30) or placebo (n= 30) preoperatively. Pain was evaluated postoperatively at 2, 6, 12 and 24 hours. Authors concluded that gabapentin and diclofenac reduced postoperative pain and opioid consumption without any obvious side effects.