International Journal of Burns and Trauma最新文献

Background: Closed reduction and casting remain the gold standard treatment for tibial shaft fractures in children and adolescents. However, surgical intervention is indicated in cases of unstable fractures, open fractures, polytrauma, compartment syndrome, and fractures with severe soft tissue injury. The present study aimed to evaluate the safety and efficacy of Titanium Elastic Nailing System (TENS) in the management of compound tibial shaft fractures in children and adolescents. Methods: This retrospective study reviewed 18 cases of tibial shaft fractures treated with TENS from 2018 to 2021. Clinical outcomes were assessed based on fracture alignment, delayed union, non-union, infection, range of motion (ROM) of the knee and ankle, limb length discrepancy, and time to fracture union during follow-up visits. Outcomes were classified according to Flynn's criteria. Results: All patients achieved fracture union at a mean duration of 11.6 weeks, with full weight-bearing permitted at an average of 10 weeks. Limb shortening was observed in 4 patients. There were no cases of delayed union or non-union. At the final follow-up, 10 patients demonstrated excellent outcomes, while 8 had satisfactory outcomes. The most common complication was infection at the fracture site, observed in 6 patients. Conclusion: TENS is a safe, reliable, and effective treatment modality for compound tibial shaft fractures in children and adolescents. It facilitates rapid fracture healing with an acceptable complication rate.

Objectives: To evaluate changes in hemodynamic parameters using the Ultrasound Cardiac Output Monitoring (USCOM) method during general anesthesia for burn wound excision and skin grafting surgery in patients with severe burns.

Methods: This prospective observational study included 40 severe burn patients, aged 18-60 years, treated at the Intensive Care Unit (ICU) of Le Huu Trac National Burn Hospital (Hanoi, Vietnam). All patients underwent burn wound excision and skin grafting between June 2023 and March 2024.

Results: The average heart rate (HR) at the study time points ranged from 116.8 to 124.3 beats/min. The differences in HR at T₁, T₂, T₃, T₅, and T₆ compared to T₀ were statistically significant (P < 0.05). Mean arterial pressure (MAP) at the study time points ranged from 73.8 mmHg to 95.68 mmHg. The differences in MAP at T₁, T₂, T₃, T₄, and T₅ compared to T₀ were statistically significant (P < 0.05). Cardiac Output (CO) and Cardiac Index (CI) values at all study time points were within normal ranges (6-7.04 l/min and 3.66-4.33 l/min/m², respectively). CO and CI were highest at T₀ (7.04 l/min; 4.33 l/min/m²) and lowest at T₁ (6 l/min; 3.66 l/min/m²). The differences in CO and CI at T₁, T₂, T₄, T₅, and T₆ compared to T₀ were statistically significant (P < 0.05). Stroke Volume (SV) and Stroke Volume Index (SVI) values at all time points were within normal ranges (51.2-56.75 ml and 30.93-34.53 ml/m²). The differences in SV and SVI at T₁, T₄, and T₅ compared to T₀ were statistically significant (P < 0.05). Systemic Vascular Resistance (SVR) and Systemic Vascular Resistance Index (SVRI) values at all time points were within normal ranges (1006.03-1240.45 d.s.cm^-5 and 1681.98-2060.4 d.s.cm^-5.m²). SVR and SVRI were highest at T₆ (1240.45 d.s.cm^-5 and 2060.4 d.s.cm^-5.m²) and lowest at T₁ (1006.03 d.s.cm^-5 and 1681.98 d.s.cm^-5.m²). The differences in SVR and SVRI at T₁ compared to T₀ were statistically significant (P < 0.05).

Conclusion: The study demonstrated that hemodynamic parameters, including CO, CI, SV, SVI, SVR, and SVRI, remained within normal ranges throughout the anesthesia process. However, heart rate and blood pressure tended to be elevated, reflecting the hemodynamic characteristics of burn patients. This underscores the importance of close monitoring and adaptive management during anesthesia and resuscitation to ensure hemodynamic stability tailored to the characteristics of severe burn patients.

Mammalian bites to the face challenges not only related to wound healing but also to aesthetic outcomes. This study aims to summarize 7 years of experience in treating mammalian bite wounds and propose a surgical approach for managing these wounds. From July 2016 to August 2023, 185 cases were treated and retrospectively evaluated. Variables collected included age, gender, anatomical location, wound features, and treatment management. The postoperative results were reviewed and analyzed. Of the 185 patients, 27.57% were under 18 years of age; with dog bites accounting for approximately 89.19% of cases. Notably, 59.46% of the injuries occurred in females. The most common injury sites were the forehead, chin, and cheek. Primary closure was utilized for 96.22% of the wounds. The fatty areas, such as the cheek, parotid gland, and mandibular region, were identified as high-risk areas for bite infections. In contrast, the forehead, periocular, nose, ear, and lip were classified as low-risk areas, while other regions were considered moderate-risk zones. The infection rates post-primary closure for high, moderate and low-risk areas are 9.09%, 6.67%, and 2.56%, respectively. Complex mammalian bite wounds should receive prompt plastic and reconstructive surgical treatment at a tertiary center. Most wounds can be effectively repaired with primary closure and other plastic techniques. Special attention should be given to high-risk bite wounds to prevent infection. This paper provides essential considerations and recommendations for the medical and surgical management of patients presenting with bite injuries.

Chondromyxoid fibroma (CMF) in the foot is a rare condition. We report a case of CMF in a 7-year-old girl, affecting the distal phalanx of the great toe. Radiographs revealed a lytic lesion involving the entire distal phalanx, with destruction of both the medial and lateral cortices, while the articular surfaces remained intact. The diagnosis was confirmed through histopathological examination. The patient underwent extensive curettage followed by bone grafting. After a six-month follow-up, no signs of recurrence were observed. This case report aims to present and underscore the uncommon occurrence of CMF in the distal phalanx of the toe in a paediatric patient, drawing attention to its atypical location and age of presentation.

Objectives: Osteoporosis is a complex disease that is influenced by several genetic markers. Many studies have examined the link between the COL1A1 gene rs1800012 polymorphism and osteoporosis risk. However, the findings of these studies are contradictory. Therefore, we performed a meta-analysis to aggregate additional information and obtain increased statistical power to more efficiently examine this correlation.

Methods: A meta-analysis was conducted to evaluate the association between the COL1A1 rs1800012 (G > T) polymorphism and the risk of osteoporosis or fracture. A total of 30 case-control studies were included that contained 2,943 patients and 4,724 control subjects. The Stata 11.0 statistical software package was used to evaluate the odds ratio (OR) and 95% confidence interval.

Results: Overall, the recessive and homozygote models showed no heterogeneity, with a significant fixed effect pooled OR (P < 0.001). Moreover, the allelic (P < 0.001), dominant (P < 0.001), and heterozygote (P = 0.002) models were associated with a significantly increased risk of osteoporosis or fracture by random effect analysis. Sub-group analyses revealed that all the hereditary models showed an increased risk of osteoporosis or fracture in a European population. Additionally, we found a significant association in the dominant (P = 0.035) and heterozygote (P = 0.030) models in North Americans. In addition, we observed an association between COL1A1 and osteoporosis and fracture risk.

Conclusions: Combined with data from previous studies, this meta-analysis suggested that COL1A1 is associated with osteoporosis or fracture risk.

The management of complex burn injuries has evolved significantly, with various surgical techniques developed to improve outcomes. This review examines the evolution of these methods, focusing particularly on mesh grafting and the Meek technique. While mesh grafting is effective, it poses challenges such as limited graft coverage and a high demand for autologous skin. In contrast, the Meek technique, a specialized method reintroduced in 1993, offers notable advantages for extensive burns by achieving higher skin expansion ratios of up to 1:9 and reducing the need for large donor sites. The Meek technique uses a meshing device to create tiny perforations in small skin grafts, facilitating their expansion to cover larger wound areas and improving healing outcomes. Recent studies highlight its effectiveness across various burn severities and age groups, especially when combined with Cultured Epithelial Autografts (CEA). Additionally, bioengineering advancements like Biobrane offer temporary skin substitutes to aid burn wound healing in pediatric cases, though they ultimately require replacement with autografts. While the Meek technique presents certain challenges, such as a 6-day delay before applying allografts, it remains a robust alternative to traditional methods. Clinical experience indicates that the Meek technique, particularly when combined with CEA, can achieve superior results for severe burns compared to conventional mesh grafting. This review emphasizes the Meek technique's potential as a valuable tool in burn wound management, offering a promising approach for improving patient outcomes in complex burn injuries.

Following severe burns, the predominant concern is significant fluid loss, for which balanced crystalloid solutions are widely recommended as the primary intravenous resuscitation fluids. However, current literature lacks a clear distinction among various buffered crystalloid types that might be most effective in the early resuscitation of burn patients. This retrospective study was conducted to identify the optimal resuscitation fluid for major burns and to assess the clinical outcomes associated with isotonic crystalloid solutions compared to hypotonic crystalloids, specifically in terms of urinary output, acid-base balance, and electrolyte stability. Conducted over one year at the Burn Care Center of the Pakistan Institute of Medical Sciences in Islamabad, the study involved 132 patients who were divided equally into two groups, each with 66 patients. Group A received isotonic crystalloids, while Group B was administered hypotonic crystalloids. The mean pre-infusion levels of sodium, potassium, bicarbonate, and pH were identical across both groups. Following infusion, sodium and chloride levels remained within normal ranges in the isotonic group. Among children under 12 years of age, none in the isotonic group exhibited a urine output below 1 ml/kg/h, while 22.7% of those in the hypotonic group had urine output below this threshold. In patients over 12 years, only one individual in the isotonic group presented a urine output of less than 0.5 ml/kg/h, compared to 19.7% of those in the hypotonic group. These findings indicate that isotonic crystalloids are superior to hypotonic crystalloids, demonstrating improved urinary output and better serum electrolyte balance in patients with severe burns.

Purpose: To evaluate the identification of nasal bone fractures and their clinical diagnostic significance for three-dimensional (3D) reconstruction of maxillofacial computed tomography (CT) images by applying artificial intelligence (AI) with deep learning (DL).

Methods: CT maxillofacial 3D reconstruction images of 39 patients with normal nasal bone and 43 patients with nasal bone fracture were retrospectively analysed, and a total of 247 images were obtained in three directions: the orthostatic, left lateral and right lateral positions. The CT scan images of all patients were reviewed by two senior specialists to confirm the presence or absence of nasal fractures. Binary classification prediction was performed using the YOLOX detection model + GhostNetv2 classification model with a DL algorithm. Accuracy, sensitivity, and specificity were used to evaluate the efficacy of the AI model. Manual independent review, and AI model-assisted manual independent review were used to identify nasal fractures.

Results: Compared with those of manual independent detection, the accuracy, sensitivity, and specificity of AI-assisted film reading improved between junior and senior physicians. The differences were statistically significant (P<0.05), and all were higher than manual independent detection.

Conclusions: Based on deep learning methods, an artificial intelligence model can be used to assist in the diagnosis of nasal bone fractures, which helps to promote the practical clinical application of deep learning methods.

A 30-year-old male sustained a road traffic accident and presented to our trauma centre with injuries to his pelvis and right knee. Radiology showed closed fractures of the right posterior wall and posterior column of the acetabulum and PCL bony avulsion with posteromedial tibial plateau osteochondral fracture, without any distal neurovascular deficit. He was managed with surgical intervention for both injuries. His hip and knee healed well with a good functional range of motion at 12 months of follow-up. The aim of highlighting this case is that it underscores the rarity of concurrent PCL and semimembranosus (SM) avulsion injuries, emphasizing the importance of comprehensive evaluation and tailored surgical management. Utilizing CT imaging proves instrumental in identifying the associated posteromedial osteochondral fragment. Successful reduction and posterior buttressing of the fragment are crucial for stability against vertical shear forces and subsequent union.

Background: The surgical treatment of non-union of long bones are challenging especially when bones are osteoporotic or there is a large bone gap due to repeated surgeries and implant failures. Plate with intramedullary fibula provides a stable construct as fibula acts as a second implant with better anchorage and high pull-out strength. The aim of our study is to present our experience of treating complex non-union of long bones using compression plating (LCP_s/DCP_s) in combination with autologous non-vascularized fibular graft (ANVFG).

Material and methods: 10 cases of complex non-union of long bones (tibia, femur, humerus) treated with debridement, decortication followed by intramedullary fibular strut grafting and rigid osteosynthesis by LCP_s/DCP_s were included in this study. DASH score and LEFS score was used for upper limb and lower limb functional assessment.

Results: All patients had clinico-radiological union with a mean time of 11.4 months. Pre-operative mean DASH and LEFS score was 45.9±2.1 and 20.6±2.03 At the last follow-up, mean DASH and LEFS score was 19.8±1.1 and 60.6±2.6.

Conclusion: Compression plating with ANVFG is a viable option for treating complex non-union of long bones. Intramedullary fibula acting as a second implant provides mechanical stability and support biological healing with its osteogenic property at the non-union site.