TRAUMA MONTHLY
Year:2016 | Volume:21 | Issue:3|Papers Count:12

Background: Lateral epicondylitis is a common cause of pain and upper limb dysfunction. The use of counterforce straps for treatment of lateral epicondylitis is widespread. This kind of orthosis can be modified to have a greater effect on relieving pain by reducing tension on the origin of the extensor pronator muscles.Objectives: To determine the immediate effects of a newly designed orthosis on pain and grip strength in patients with lateral epicondylitis.Materials and Methods: Twelve participants (six men and six women) were recruited (mean age=416.7 years) and evaluated for pain and grip strength in three sessions. A 48-hour break was taken between each session. The first session was without any orthosis, the second session was with the new modified tennis elbow orthosis, and the third session was with a conventional tennis elbow strap.Results: Both counterforce straps were effective. However, significantly more improvement was observed in pain and grip strength after using the newly modified orthosis (P<0.05).Conclusions: The newly designed strap reduces pain more effectively and improves grip strength by causing greater localized pressure on two regions with different force applications (two component vectors versus one).

Background: The management of distal tibia fractures continues to remain a source of controversy and debate.Objectives: The aim of this study was to evaluate the various complications of minimally invasive percutaneous plate osteosynthesis (MIPPO) using a locking plate for closed fractures of distal tibia in a retrospective study.Patients and Methods: Twenty-five patients with distal tibial fractures, treated by minimally invasive percutaneous plate osteosynthesis, were evaluated in a retrospective study. We studied the rate, probable etiological factors and preventive and corrective measures of various complications associated with minimally invasive plating of distal tibia.Results: Mean age of the patients was 41.16 years (range 22 - 65). There were 13 male and 12 female patients. All fractures united at an average duration of 16.8 weeks. There were two cases of superficial and two cases of deep infection, and deep infections required removal of hardware for cure. There were four cases of ankle stiffness, most of them occurring in intra-articular fractures, three cases of palpable implant, three cases of malunion, one case of loss of reduction and one patient required reoperation. The average AO foot and ankle score was 83.6.Conclusions: We found MIPPO using locking plate to be a safe and effective method for the treatment of distal tibial fractures in properly selected patients yet can result in a variety of complications if proper precautions before, during and after surgery are not taken care of.

Background: India currently has the dubious distinction of experiencing the highest number of road traffic accidents in the world.Objectives: We believe that this study on road traffic accidents may help to identify factors in the pre-hospital setting that may influence mortality rates.Patients and Methods: A prospective observational study was carried out in a metro area in India over a period of one year. The study included consecutive patients admitted to the trauma service after road traffic accidents. Demographic information, time and place of accident, and details regarding the vehicle and the events leading up to the hospital admission were recorded. Injury severity, management in the hospital, and final outcomes in terms of mortality were noted. The data were analyzed with SPSS software.Results: A total of 773 patients were enrolled. Of these, there were 197 deaths and 576 survivors. The majority of patients were aged 15 - 40 years (67%) and were male (87.84%). More accidents occurred at night (58.2%) than during the day (41.8%). Mortality was not significantly associated with age, sex, or time of accident. City roads (38.9%) saw more accidents than highways (26.13%), but highway accidents were more likely to be fatal. Two-wheeler riders (37.65%) and pedestrians (35.75%) formed the majority of our study population. Mortality was significantly associated with crossing the road on foot (P=0.004). Pillion riders on two-wheeler vehicles were more likely to experience poor outcomes (relative risk [RR] =1.9, P=0.001). Front-seat occupants in four-wheeler vehicles were at an increased risk of not surviving the accident (61.98%; RR=2.56, P=0.01). Lack of safety gear, such as helmets, seat belts, and airbags, was significantly associated with mortality (P=0.05). Delays in transfers of patients to the hospital and a lack of pre-hospital emergency services was significantly associated with increased mortality (P=0.000).Conclusions: A lack of respect for the law, weak legislation and lawenforcement, disregard for personal safety, and driving vehicles under adverse conditions are some of the leading causes of road traffic accidents. There should be an emphasis on emergency trauma care in the pre-hospital setting.

Dear Editor, We read with interest the article by Ettehad et al. (1), in which the authors provide a detailed discussion of the variations in serum vitamin D levels during the course of fracture healing. We have a few considerations regarding this study.

Introduction: The debate regarding the description on classification and nomenclature of the injury which includes olecranon fracture associated with radial neck fractures in children is ongoing. We report two pediatric cases that could not be classified in a Monteggia-equivalents system and were treated with open reduction and k-wire fixation. The aim of this study was to perform a systematic review regarding pediatric radial neck fractures associated with olecranon fractures and presentation of two pediatric cases of olecranon fractures associated with radial neck fractures with radiocapitellar dislocation.Case Presentation: Two boys, aged 7 and 12, came to two separate clinics on the same day after initial injury. On physical examination, the patients’ elbow range of motion was limited and painful. Their upper extremities were intact. Radiographs revealed the radial neck fracture with prominent anterolateral radiocapitellar dislocation of radial head-associated with non-displaced olecranon fracture. Radial neck fracture was reduced easily by pushing posteromedially manually with the finger and secured with two K-wires. The olecranon fracture was visualized and confirmed that it was non-displaced and secured with two k-wires in the first case and one k-wire in the second case. After 2 months of follow-up, both patients had no pain in their elbow and a full functionality with a full range of motion of the elbow. The posterior intraosseous nerve functions were normal.Conclusions: The fracture of olecranon if it does not extend into the metaphyseal region; it could not fascilitate diastasis of the proximal radioulnar joint and radial head dislocation. So this type of fracture must not be addressed as a Monteggia-fracture dislocation.The description of radioulnar diastasis must be included when this type of injury is to be classified.

Background: The importance of decreasing bleeding in spine surgery is not only important to maintain the patient’s hemodynamic balance but also allow a better view of the surgical field.Objectives: The current study aimed to compare dexmedetomidine and Esmolol™ as agents to induce hypotension in lumbar spine surgeries.Patients and Methods: A total of 50 patients aged 20 to 65 years belonging to the American society of anaesthesiologist (ASA) class I - II scheduled for decompression and fixation of the lumbar spine were included and divided into two groups namely, Group I, who received Esmolol and group II, who received dexmedetomidine, intravenously. The patients were compared for intraoperative hemodynamic parameters, estimated blood loss, operation time, intraoperative analgesic (fentanyl) consumption, and total fall in haemoglobin (Hb) during the perioperative period.Results: The study results showed that dexmedetomidine had lower (100.8 g) fentanyl and sevoflurane consumption (1.2%), and less blood loss (278 mL) in comparison to the Esmolol group.Conclusions: Both dexmedetomidine and Esmolol can be used as agents to control hypotension in patients undergoing lumbar spine decompression and fixation surgery; the dexmedetomidine group, however, was associated with better intraoperative hemodynamic stability and reduced intraoperative analgesic and volatile anaesthetic requirement.

Background: Renal ischemia-reperfusion (IR) contributes to the development of acute renal failure (ARF). Oxygen free radicals are considered to be the principal components involved in the pathophysiological tissue alterations observed during renal IR.Objectives: In this study, we compared the effects of melatonin (MEL) and erythropoietin (EPO), both known antioxidant and anti-inflammatory agents, on IR-induced renal injury in rats.Materials and Methods: Wistar albino rats were unilaterally nephrectomized and then subjected to 45 minutes of renal pedicle occlusion followed by 24 hours of reperfusion. MEL (10 mg/kg, i.p) and EPO (5000 U/kg, i.p) were administered prior to the onset of ischemia. After 24 hours of reperfusion and following decapitation, blood samples were collected for the determination of the hemoglobin (Hb) and hematocrit (Hct) levels. Additionally, renal samples were taken for histological evaluation.Results: Ischemia-reperfusion significantly decreased the observed Hb and Hct values. The histopathological findings in the IR group confirmed that there was an increase in the hyaline cast and thickening of the Bowman capsule basement membrane. Treatment with EPO or MEL significantly increased the Hb and Hct values. In the MEL+IR group, the histopathological changes were lower than those found in the EPO+IR group.Conclusions: Treatment with EPO and MEL had a beneficial effect on renal IR injury. The results may also indicate that MEL protects against morphological damage better than EPO in renal IR injury.

Background: Iranian people celebrate the last Wednesday eve of the year as Chaharshanbe Suri and use explosives and firecrackers as part of this festival.Objectives: This study concerned fireworks injuries related to the Chaharshanbe Suri festival in Tabriz, a provincial capital in East Azerbaijan, Iran, to evaluate the epidemiology and provide data to prevent and manage these accidents.Patientsand Methods: This study was comprised of patients who were treated at the emergency department of Tabriz Sina hospital with burn injuries related to fireworks. The patients’ demographics, time of the accidents, locations of the burns, and the type of explosive were recorded. Descriptive statistics were used to analyze the data.Results: Forty-nine patients were seen in the emergency department. The mean age was 17.16  9.1, ranged from 3 to 36. Forty patients were male (81.6%) and 9 were female (18.4%). Twenty-one patients had second degree burns (47.7%), 10 patients had first degree burns (22.7%), 9 patients had third degree burns (20.5%), and 4 patients had first and second degree burns (9.1%).Conclusions: The study shows that walking in the streets or driving with open windows can be dangerous in Iran during Charshanbe suri.

Dear Editor, Post-tracheostomy stenosis is a rare but serious complication that may be encountered in the emergency department (ED). The incidence of severe tracheal stenosis (TS) with symptoms is seen in 1-2% of patients (1-3). Patients with severe TS may present with respiratory difficulty, requiring emergency intubation in the ED.

Background: Stand-up paddle-boarding is an increasingly popular water sport; however no published data to our knowledge exists on the nature and type of injuries sustained in this sport.Objectives: This study aims to describe the frequency, pattern, and mechanism of paddle-boarding injuries.Materials and Methods: Descriptive data of paddle-boarding injuries were collected using an interactive website-based, multiple choice survey. Data were collected from May 2012 over a 6-month period.Results: Completed surveys were obtained from 142 individuals, 20 paddle-boarders reporting 18 injuries and 122 surfers reporting 4 paddleboard-related injuries. Fifty percent of responding paddle-boarders reported an injury. For all injuries sustained paddle boarding, sprains accounted for 50% (n=9), lacerations for 22% (n=4), contusions 17% (n=3) and fractures 5% (n=1). Seventy-eight percent of injuries were to the lower extremity, and 17% to the head and neck. Seventeen percent (n=3) sustained recurrent injuries, 2 sustained 2 twisting knee injuries resulting in sprains, one sustained>3 ankle injuries, resulting in sprains. Seventeen percent of injuries resulted from contact with one’s own paddle-board, 17% from another paddle-board, and 5% from the sea floor.Conclusions: All paddle-boarding injuries were sustained by individuals who surf waves on a paddle-board, rather than paddle on calm water. Despite concerns, paddle-board related injuries only accounted for 1% of 326 injuries suffered by surfers. We suggest equipment and practice modifications that may decrease the risk for injury and challenge the anecdotal theory that paddleboarding injuries are sustained due to inexperience.

Context: Developing official protection policies for disasters is a main strategy in protecting vulnerable people. The aim of this study was to analyze official documents concerning policies on protecting vulnerable people during disasters.Evidence Acquisition: This study was conducted by the qualitative document analysis method. Documents were gathered by searching websites and referring to the organizations involved in disaster management. The documents were assessed by a researcher-made data collection form. A directed content analysis approach was used to analyze the retrieved documents regarding the protection policies and legislation for vulnerable people.Results: A total of 22 documents were included in the final analysis. Most of the documents referred to women, children, elderly people, poor, and villagers as vulnerable people. Moreover, the documents did not provide information regarding official measures for protecting vulnerable people during different phases of disaster management.Conclusions: A clear and comprehensive definition of “vulnerable people” and formulation of official policies to protect them is needs to be formulated. Given the high prevalence of disasters in Iran, policy makers need to develop effective context-based policies to protect vulnerable people during disasters.

Background: Epidemiology of cervical spine fractures (CSfx) in trauma patients of general population is not yet exclusively known.Objectives: The purpose of this study was to evaluate the epidemiology of CSfx in trauma patients.Patients and Methods: Data from trauma patients admitted in the emergency room (ER) of Shiraz Shahid Rajaei hospital during the 3.5 years period from September 22, 2009 to March 21, 2013, were gathered. All trauma patients with CSfx and/or spinal cord injuries were included in the study. The time of the trauma, mechanism of trauma, injury position, and incidence of cervical spine fractures in the patients were recorded.Results: A total of 469 patients met the inclusion criteria. The mean age of the patients was 34.7 years old, with a minimum age of 16 years old and a maximum age of 89 years old. Young adults were most frequently affected. Out of 469 cases, 368 patients (78.47%) were male and 101 (21.53%) were female. We had a total of 17 SCI cases among our patients (3.62%), out of which 5 (29.41%) were deceased. The total number of deaths in our study was 29 (6.18%); 5 (17.24%) with SCI and 24 (82.76%) without SCI.Conclusions: This study demonstrated that most victims of CSfx in our region are 16 to 40 years of age. A male predominance was observed, and motor vehicle collisions were the most frequent trauma mechanism leading to cervical spine injury (mostly due to car rollover accidents), with falls as the second most frequent. The rate of SCI in our study was 3.62% of all cases and the mortality rate was 6.18%.