International Journal of Burns and Trauma最新文献

The etiology of diabetic foot ulcers (DFU) is multifactorial, encompassing neuropathy, peripheral arterial disease, and susceptibility to infection. The management of DFU remains challenging due to high recurrence rates and amputation risks. While various treatments exist, a standardized, effective approach integrating holistic care is essential. This paper presents a detailed analysis of two representative cases of complex DFU managed within our institution. Both patients underwent a structured process involving immediate holistic assessment, formation of an MDT to devise personalized treatment strategies, surgery, application of NPWTi, and structured post-discharge planning including health education. Eventually, both patients achieved successful wound closure without major amputation. The successful management of complex DFU necessitates a paradigm shift from isolated interventions to a comprehensive strategy. This strategy should encompass 1) early holistic patient assessment, 2) centralized coordination via an MDT for personalized care plans, 3) meticulous surgical debridement, 4) judicious use of advanced adjunctive therapies like NPWTi, and 5) robust post-discharge follow-up and patient education to prevent recurrence. This framework serves as a practical guide until further robust evidence emerges to refine these recommendations.

Background: Subtrochanteric femoral fractures in children are uncommon but challenging to manage due to high mechanical stresses and their proximity to the growth plate. While the Titanium Elastic Nailing System (TENS) has proven effective for paediatric diaphyseal fractures, its role in subtrochanteric fractures is less well established.

Aim: The aim of this study was to evaluate the clinical and radiological outcomes of paediatric subtrochanteric femoral fractures treated with TENS, specifically assessing union rates, complications, and functional outcomes using Flynn's criteria.

Methods: We conducted a prospective observational study of 18 children aged 5-11 years with radiologicaly confirmed subtrochanteric femoral fractures treated using TENS at a tertiary care centre. Patient demographics, fracture patterns, associated injuries, time to surgery, postoperative immobilization, time to weight bearing, fracture union, complications, and outcomes were recorded and analysed.

Results: The mean age of patients was 7.7 years, with a male predominance (61%). The most common fracture patterns were oblique and spiral. Associated injuries were seen in 4 patients, and the average time to surgery was 2.1 days. Partial weight bearing was initiated by 4-5 weeks, and radiological union was achieved in all patients, with a mean union time of 9.5 weeks. Complications included limb length discrepancy (1 case), nail irritation (2 cases), and delayed union or malalignment (2 cases). According to Flynn's criteria, 72% had excellent, 22% good, and 6% satisfactory outcomes.

Conclusion: TENS is a safe, minimally invasive, and effective treatment for paediatric subtrochanteric femoral fractures in children aged 5-11 years. When applied with proper technique and patient selection, it results in reliable union, early mobilization, and favourable functional outcomes with minimal complications.

Background: Globally, burn injury is of public health concern; it is a significant health problem in both children and older adult populations. In Africa and especially in Uganda, burn injuries remain a major cause of prolonged hospital stays, disability, disfigurement and death. A lot of factors may be associated with the injury severity of burn wounds. Bacterial microorganisms take short hours to invade the burn wound and can be identified in the burn wounds less than 24 hours old. When a patient is alive after 3 days following a burn, then the commonest cause of death is infection. Bacterial infection is still the serious complication that might compromise with the patient's life after the early phase of the management, and the bacterial pathogens isolated from these wounds might still be resistant to the most common used antibiotics in our setting.

Objectives: The aim of this study was to determine the most common etiology, the factors associated with injury severity, and the bacterial susceptibility patterns of burn patients in six selected hospitals in Uganda.

Methods: This cross-sectional study was conducted in the departments of surgery at the six selected hospitals from April to July 2022.

Results: Around 76 patients admitted to those hospitals with burns during our study period were included. Those who were very severe without caretakers eligible to consent for them were excluded. The average age was 17.7 years. There were slightly more males with a male-to-female ratio of 1.05. The majority were from the rural areas accounting for 76.3%. The common etiology was thermal, accounting for 80.8%, dominated by scalds (60.5%). Patients with burn wounds at the sites mandating admission were 22 times more likely to have a severe injury. The most common organism isolated was staphylococcus aureus accounting for 45.2%, followed by Pseudomonas, accounting for 15.5%, and they % were resistant to most of the antibiotics used in our study. Despite that identified bacteria were resistant to most of antibiotics, a good number of them were sensitive to imipenem, amikacin, ciprofloxacin, and cloxacillin.

Conclusions: Implementation of burn infection control policies is needed. There is a need to include sites mandating admission in the parameters of the ABSI score. Based on microorganisms isolated, empirical treatment with ciprofloxacin or cloxacillin should be considered.

Objectives: Over-resuscitation is a formidable complication of burn resuscitation and increased morbidity and mortality. Currently, the Advanced Trauma Life Support recommends using a modified Brooke's formula to minimise its incidence; however, supporting evidence is very limited. We aimed to compare the resuscitative and clinical outcomes between the Parkland and modified Brooke's formulas in patients with burn trauma.

Methods: A retrospective cohort study was conducted through a chart review of patients admitted to the burn unit. The patients were divided into two groups: Group 1 (2017-2019) was resuscitated using Parkland's formula and Group 2 (2020-2022) with modified Brooke's formula. The main outcome measures were mortality rate, length of stay, complication rate exceeding the Ivy index (250 mL/kg) in the first 24 h, and overall fluid administered in the first 24 h.

Results: We included 125 patients, of whom fifty-five were resuscitated using Parkland's formula and seventy using the modified Brooke's formula. Patients in group 1 had higher resuscitation volume (5.04 vs. 3.37 mL/kg/total body surface area, P < 0.0001) and were more likely to exceed the Ivy index (250 mL/kg) (32.73% vs. 12.86%, P = 0.0074) in the first 24 h compared to those in group 2. There were no significant differences in clinical outcomes between the two groups.

Conclusions: The modified Brooke's formula resulted in lower resuscitative volumes in the first 24 h than Parkland's formula, with no differences in complication rates. Our findings are consistent with currently recommended guidelines.

Traction tables have been widely used by orthopaedic surgeons for the management of femoral shaft fractures. Although complications associated with their use are uncommon, they can still occur. Among neurological complications, sciatic and pudendal nerve palsies are the most frequently reported. Recognizing the potential causes and analyzing these complications are crucial for raising awareness among surgeons and implementing preventive strategies to enhance patient safety during surgical procedures. A 22-year-old male sustained a comminuted fracture of the left femoral shaft following a road traffic accident. The patient had an intact distal neurovascular status (DNVS) at presentation. Open reduction and internal fixation (ORIF) with femoral interlocking nail (FIN) was done using a traction table. Post-operatively, he developed signs of both sciatic and pudendal nerve palsy. The simultaneous occurrence of pudendal and sciatic nerve palsy is rare. In this case, pudendal nerve palsy was likely caused by prolonged traction with sustained hip adduction throughout the procedure, while sciatic nerve palsy was attributed to postoperative hematoma formation. To minimize such complications, it is advisable to limit soft tissue dissection during femoral shaft fracture reduction and promptly release traction after interlocking screw placement. Additionally, adherence to a "tourniquet safety protocol" that is, releasing traction every 120 minutes in prolonged surgeries can be beneficial. Hip adduction beyond the neutral position should also be avoided to reduce the risk of nerve injury.

Objective: To evaluate the effectiveness of virtual reality-based interventions in promoting functional recovery among individuals with burn injuries.

Data sources: PubMed/Medline, Scopus, Ovid, CINAHL, PEDro, Google Scholar, and Cochrane Library.

Methods: Multiple data sources were explored from beginning to March 31, 2024, with study design of randomized clinical trials describing Range of Motion, enhanced ability for self-care (ADLs) and independence, quality of life in adult with burn injury. ROM was primarily measured using goniometers and electronic digital goniometers to assess the degrees of movement at affected joints before and after VR-based rehabilitation sessions. Two independent authors analyzed the results and selected the data. Cochrane Criteria Risk of Bias version 2 was used to measure risk of bias. Patient demographics, treatment regimen and outcome measuring tool, results and change in the patients' conditions were also extracted. Each study was appraised to check the level of evidence.

Results: 8 publications were selected with a total of 293 patients included in these studies. Level of evidence analysis revealed that 8 studies were classified as level of evidence A2. The lowest PEDro score was 6 for one study only while other studies scored 7, 8, and 9 accordingly. In this review, seven studies were categorized as low risk of bias, while one study had some risk of bias. Our results showed that virtual reality can increase range of motion, enhanced ability for Self-Care (ADLs) and independence, improved quality of life in patients with burn injury, though strength of conclusion for mobility and ADLs was moderate.

Conclusion: Preliminary evidence indicates that virtual reality "V.R." interventions could be beneficial in promoting functional recovery in patients with burn injuries. The studies reviewed suggest Virtual Reality can reduce pain during rehabilitation, improve range of motion, and increase patient engagement. However, the limited number of studies and the variability in VR methods and outcome measures restrict the generalizability of these findings. Further rigorous research with standardized protocols is needed to validate these results and guide clinical practice. Future investigations should aim for larger sample sizes and longer follow-up periods to thoroughly evaluate the effectiveness of VR in burn rehabilitation.

Femoral nerve palsy is a rare but serious complication following total hip arthroplasty (THA), particularly when performed through the posterolateral approach. Early diagnosis and prompt rehabilitation are crucial for functional recovery. We report two cases of femoral nerve palsy following THA, highlighting the clinical course, management, and outcomes. The first case involved a 53-year-old male with ankylosing spondylitis that underwent right-sided uncemented THA via the posterolateral approach. Postoperatively, he developed femoral nerve palsy, likely due to skin traction applied for residual hip flexion contracture. Early removal of traction, initiation of physiotherapy, and use of a static knee brace led to gradual recovery, with full restoration of quadriceps function by one year. The second case involved a 46-year-old obese female with a history of hip tuberculosis who underwent uncemented THA via the posterolateral approach. She developed femoral nerve palsy immediately postoperatively, likely related to intraoperative retractor placement difficulties due to tight soft tissues. Early mobilization and physiotherapy led to complete recovery of quadriceps strength within six months. Femoral nerve palsy, though uncommon after posterolateral THA, can significantly impact postoperative recovery. Awareness of risk factors such as soft tissue tightness and traction, combined with early diagnosis, rehabilitation, and supportive bracing, can lead to favorable outcomes. Surgeons must be cautious during soft tissue handling and retractor placement to minimize this complication.

Gout is a metabolic disorder characterized by hyperuricemia, leading to the deposition of monosodium urate crystals in joints and soft tissues. It commonly affects the first metatarso-phalangeal (MTP) joint, but atypical presentations can pose significant diagnostic challenges. In this report, we describe a rare case of gouty arthritis affecting the proximal interphalangeal (PIP) joint of the second toe, which was initially suspected to be a case of joint tuberculosis. A 38-year-old male presented with a painful swelling over the second toe for two months, with imaging and laboratory findings suggesting an infectious etiology. Despite clinical suspicion of tuberculosis, histopathological examination of the lesion confirmed the presence of amorphous eosinophilic material with chronic inflammatory infiltrate and giant cell reaction, indicative of gout. Subsequent serum uric acid evaluation revealed hyperuricemia, leading to a definitive diagnosis. The patient underwent surgical evacuation of the tophaceous deposits followed by medical management with colchicine, nonsteroidal anti-inflammatory drugs (NSAIDs), and allopurinol. Postoperative follow-up demonstrated complete resolution of symptoms with no recurrence. Aim of the study: This case report aims to highlight the diagnostic challenges of atypical gout presentations, particularly when mimicking infectious conditions such as tuberculosis. It underscores the importance of maintaining a broad differential diagnosis, utilizing histopathology for confirmation, and considering gout even in uncommon anatomical locations.

Nasal reconstruction remains one of the most complex challenges in reconstructive plastic surgery due to its intricate three-dimensional architecture and functional demands. While the forehead flap has emerged as the gold standard for nasal reconstruction, conventional techniques inevitably produce conspicuous longitudinal forehead scarring at the pedicle site. We present an innovative approach combining external temporoparietal fascia prefabrication (E-TPFF) with tissue expansion technology to address these limitations. This article aims to enhance the existing method to meet the demand for nasal defect repair while eliminating the operation's drawbacks. Our modified technique offers three significant advantages: (i) complete elimination of visible forehead scarring through an external temporoparietal fascia prefabricated forehead flap (E-TPFF); (ii) providing a flap with reliable vascular supply through temporoparietal fascia prefabrication, and (iii) generation of sufficient flap volume and pedicle length to accommodate even extensive maxillofacial defects. Preliminary results demonstrate that the E-TPFF technique maintains all benefits of traditional forehead flaps while overcoming their most notable aesthetic drawbacks, representing a substantial advancement in facial reconstructive surgery.