TRAUMA MONTHLY
Year:2018 | Volume:23 | Issue:5|Papers Count:10

Background: The known early and late complications following splenectomy increase the tendency to preserve splenic tissue after splenic trauma. Objectives: This study was conducted to determine the safety and feasibility of auto-transplantation of splenic fragments in patients with severe splenic injury. Methods: Nineteen patients with severe splenic blunt trauma, who underwent total splenectomy and autotransplantation of splenic fragments at Besat hospital, Hamadan University of Medical Sciences, Iran during years 2015 and 2016, were enrolled in the study. Complete blood counts, blood smear for Howell-Jolly bodies, and phagocytic function tests were performed just before, at 3 months, and 6 months after surgery. Results: The means of red blood cell counts increased significantly at both 3 and 6 months after surgery (P = 0. 01 and 0. 049, respectively) and the means of hemoglobin, hematocrit, and the percentage of lymphocytes increased significantly at 3 months after surgery (P = 0. 001, 0. 046, and 0. 01 respectively) while this increase was not significant 6 months after surgery (P = 0. 52, 0. 15, and 0. 34, respectively). The Howell-Jolly bodies were present in 5 patients (26. 3%) at 3 months after surgery, which was significantly reduced to 3 (15. 8%), at 6 months after surgery (P = 0. 042). The median of splenic phagocytic function significantly increased from 3  1. 2 hotspots (range = 2 to 6) at 3 months after surgery to 4 1. 4 (range = 2 to 8) at 6 months after surgery (P = 0. 044). Conclusions: Auto-transplantation of splenic fragments may be feasible and safe and a suitable option for splenic tissue salvage in patients with severe splenic lesions, who require total splenectomy.

Introduction: Pediatric forearm fracture is one of the most common upper extremity fractures in young sters. The treatment is often non-surgical. In patients, who need surgical intervention, intramedullary nails are used. Growth disturbances in long bones of the lower extremity occur in youngsters however. Longitudinal overgrowth is very rare in the upper extremity. Case Presentation: This report presents a five-year-old child, who had radius and ulna shaft fracture in the distal one third of his forearm. This child was treated with radius fracture fixation by flexible intramedullary nails. After six months, the child had wrist pain and limitation in range of motion. On the radiography, 4mmincrease in radius was observed. Conclusions: Overgrowth of long bones after application of intramedullary nails is known in the lower extremity however it is uncommon in the upper extremity and the exact mechanism of this phenomenon has not yet been determined and needs further investigation.

Background: In recent years, there has been a significant increase in the incidence of injuries and the relevant morbidity and mortality in Iran. The present study was undertaken to determine the etiology, type, and treatment modalities applied to zygomatic fractures and investigate the correlation of postoperative complications with the treatment modality used in patients referring to Imam Reza hospital. Methods: The target population consisted of all the patients with zygomatic bone fractures referring to the oral and maxillofacial surgery service of Imam Reza hospital (2011-2012). Demographic data, the reason for trauma, the trauma date, the location and the type of fracture, and the clinical symptoms of fracture were recorded in checklists. The surgery was undertaken and the surgical procedure, the type of the therapeutic intervention and its complications, the type of the plate used, and the place it was used for fixation also were recorded in the checklists. Data were analyzed with descriptive statistics and chi-squared test using SPSS 21. Results: Of 165 patients with zygomatic fractures, 80% were male and 20% were female with a mean age of 32. 81 years. Motor vehicle accidents were the most important cause of zygomatic fractures (64. 8%), and the infraorbital nerve paresthesia was the most frequent symptom (62. 4%). Paresthesia was the most frequent complication remaining after surgery in three follow-up visits (38%). The most commonly used open surgical procedures were eyebrow (53. 9%), subciliary (46, 27. 8%), and vestibular (46, 27. 8%) surgeries, respectively. Conclusions: Male patients, with ameanage of 32 years, exhibited the highest rate of zygomatic fractures. Themostcommonlyused open surgical procedure was eyebrow surgery. Paresthesia of the infraorbital nerve was the most prevalent postoperative complication but these complications had no relationship with the surgical techniques used.

Background: Effective manpower is the main factor in success and significant achievement of health organizations. Objectives: This study was conducted to assess nursing perceptions regarding performance indicators and its correlation with productivity within the emergency departments of hospitals affiliated to Shahid Beheshti University of Medical Sciences in Tehran, Iran, during year 2016. Methods: This study was conducted by the cross sectional method, during year 2016. In this cross sectional study, the emergency departments of 4 hospitals of Shahid Beheshti University of Medical Sciences in Tehran were assessed. All nurses of emergency departments were selected through Census sampling methods. One of the researchers made a set of questionnaires for the assessment of the performance of nurses and a checklist as a means of productivity indicators to collect the data. Statistical analysis was conducted by the SPSS software version 18 and Pearson correlation test, T test, and analysis of variance (ANOVA). Results: The performance of the nurses had a positive aptitude with the percentage of the patients, whose condition was determined within 6 hours and the percentage of the remaining patients, whose condition was resolved within 12 hours in the studied hospitals. On the contrary, the performance of the nurses had a negative correlation with average triage duration in the studied hospitals. Moreover, according to Pearson’ s correlation coefficient, it could be said that the performance of the nurses had a negative correlation with unsuccessful CPR percentage indicator and also with the percentage of discharge against medical advice in the studied hospitals. Conclusions: According to the results, in order to achieve maximum outputs as productivity, the dimensions of performances needed to be improved. The Kardex evaluation items and shift reception evaluation achieved the lowest scores and need greater attention.

Background and Objective: A local nerve block is used to relieve pain and improve the positioning of patients during spinal anesthesia. This study attempted to compare femoral nerve block (FNB) versus fascia iliaca compartment (FIC) block. Methods: In this clinical trial, a total of 68 patients undergoing surgery for femoral shaft fractures were divided randomly to 2 groups of FNB and FIC. The patients’ pain was recorded by the visual analogue scale (VAS) before and during administration of femoral nerve block. Satisfaction of positioning for spinal anesthesia and duration of the procedure were also recorded in the 2 groups. Results: During the nerve block, the pain score of FIC was significantly lower than that of the FNB group (2. 5 0. 6, 3. 6 0. 8 and P = 0. 001). During the administration of spinal anesthesia, the mean pain in the FNB group was significantly lower than that of FIC (2. 7  1. 1, 3. 4 0. 6 and P = 0. 001). The satisfaction of patients with positioning in the FNB group was reported to be excellent by 40. 7% of patients, whereas none in the FIC group reported satisfaction. The completion time of sensory block was significantly lower in the FNB group than the FIC group (P = 0. 001). Conclusions: TheFNBseems to provide better analgesia during spinal anesthesia for the patient, even though the administration of FIC tends to be easier and less painful than the FNB. Shorter completion time of sensory and motor block in the FNB group could be indicative of the superiority of this method for providing the appropriate conditions for spinal anesthesia in an emergency setting.

Background: Thoracic trauma is an important cause of morbidity and mortality in trauma patients and rib fracture due to blunt trauma to the chest wall is the most common etiology. Objectives: This study analyzed the correlation between rib fractures and prognosis in multiple trauma patients. Methods: Onehundred eighty-four trauma patients suffering from rib fracture due to the blunt trauma were studied. Demographic data, injury characteristics, rib fracture characteristics, the associated injuries, and injury severity score (ISS) were recorded. The rib fracture was classified according to location (left, right, and bilateral) and level (upper [1st-2nd rib], middle [3rd-8th rib], and lower [9th-12th rib]); it also was categorized as lateral and posterolateral. Results: The rib fractures were posterolateral (69. 6%), lateral (30. 4%), upper (4. 3%), middle (92. 4%), and lower (3. 3%). Patients with posterolateral fracture had significantly more complications leading to airway intubation and more intensive care support, higher ISS, associated with pelvic and clavicular fracture. Upper rib fractures were associated with more length-of-stay (LOS) while lower rib fractures were associated more with abdominal trauma and lumbar/thoracolumbar vertebral fractures. A significant positive correlation was seen between the number of fractured ribs and ISS, hospital, and ICU LOS. There were no complications during a two-month follow-up. Conclusions: Upper rib fractures are associated with severe traumas requiring more hospitalization and ICU support due to the greater surgical and medical complications. Morbidity is higher in posterolateral fractures and these patients need more medical care

Introduction: Bilateral clavicular fracture is a rare finding in which the injury usually involves the compression of both shoulders. Case Presentation: We report a rare case of bilateral midshaft clavicular fracture, accompanied by unilateral acromioclavicular (AC) dislocation. AC dislocation was reduced by open reduction and fixed with 2 pins. Both clavicular fractures were fixed with titanium elastic nails (TENs) and inserted from the sternal end with good cosmetic and functional results. Conclusions: This case report is a rare case of a bilateral midshaft clavicular fracture, accompanied by unilateral AC joint dislocation.

Background: This study aimed to assess satisfaction of emergency medicine residents and specialists. Methods: This was a cross-sectional survey conducted in Tehran, Iran. All emergency medicine specialists and residents in Iran at the time of study were eligible and included. A modified questionnaire, originally developed by Lloyd et al. was used. The final statistical analysis was done on the questionnaires. Results: A total of, 210 questionnaires from 143 residents and 67 emergency medicine specialists were collected. The overall satisfaction in specialists and residents was 50% and 42%, respectively (P < 0. 05). The status of specialists’ recruitment, managerial aspects, available facilities, current lifestyle, and challenges related to the job, showed significant differences. Conclusions: Based on the findings of this study, although both residents and specialist satisfaction rates were at a moderate level, however, specialists were more satisfied with their job in comparison to residents.

Context: The aim of the study was to review medical aspects of earthquakes in Iran in order to help clinicians obtain a better understanding of this natural disaster and select better therapeutic methods. Methods: Two authors independently searched articles through scientific databases, such as PubMed, MEDLINE, Wiley, EMBASE, ISI Web of Knowledge, andScopus. The keywords that were applied to search these articles included: Earthquake, disaster, Iran, physical phenomena, geological phenomena, health, trauma, medicine, wounds, and injuries. Tworesearchers independently assessed titles and abstracts of all studies and then included them based on the relevance. Results: Fourteen studies were included in the current study. Fractures were the most common injury. The results showed hospitals, relief agencies, and municipal services should be built in a manner appropriate for earthquake conditions. A gender-sensitive approach for planning and management of trauma patients after a disaster could allow better and more effective healthcare delivery. Conclusions: This review of earthquakes that occurred in Iran aimed to provide a better understanding of this natural disaster, and allow selection of better therapeutic methods, which is important in disaster management.

Background: The safe community initiative was developed by theWorld Health Organization following the increasing trend in the frequency of injuries. Similar to most countries, it was implemented in Iran to improve community safety. The aim of this study was to quantitatively analyze the Iranian designated safe communities. Methods: Using a descriptive design, this study analyzed the reports by Iranian designated safe communities (n, 33) in 2016. Data were extracted from the website of WHOcollaborating centre on community safety promotion in Sweden, using an objective-based questionnaire. Microsoft Access 2010 was used for data management, and SPSS version 21 was utilized for data analysis. Results: The Iranian designated safe communities were all located in 3 out of 31 provinces of Iran, namely Tehran, Fars, and Khorasan Razavi. All the safe communities had covered traffic safety. In total, 69. 7% of the safe communities reported the incorporation of occupationalandsport safety activities, as well as violenceandsuicide prevention interventions. Nosignificant differencewasfound among provinces in the frequency distribution of improved safety issues (P > 0. 05). Moreover, 26 (78. 8%) communities reported having an injury surveillance system. Conclusions: Iranian safe communities used a set of strategies to improve community safety. Accordingly, the neglected areas must be acknowledged by other interested communities. Moreover, rigorous scientific studies are required to assess the effectiveness of interventions.