International Journal of Burns and Trauma最新文献

Background: In December 2019, in Wuhan, China, several cases of viral pneumonia, caused by a new type of coronavirus (SARS-CoV-2, a disease that became known as COVID-19) emerged. Being an alarming situation, many resources were directed to fight this pandemic. However, other diseases and conditions, such as burn injuries, continued to occur in this period, thus creating multiple challenges.

Method: Four patients with COVID-19 treated in a reference burn treatment centre from the Northeast region of Brazil, in the city of Fortaleza were analysed between April to June 2020.

Results: All patients were admitted in the service without signs of COVID-19 infection; however the symptoms appeared a few days after hospitalisation. The most common symptom was fever, especially when it occurred in only one spike. Patients who evolved to an unfavourable outcome had comorbidities prior to the infection and burn injury. In addition to this, these two patients had a worsening of their renal function, in contrast to the other two patients that received hospital discharge.

Conclusion: The burned patient is a complex one that requires the health professional's attention and special care. This became even more evident during the period of the COVID-19 pandemic. Thus, the patients' changes and symptoms must be cautiously analysed, their diagnosis should not be delayed and it must be made under standardised protocols accordingly with the socio-economic and cultural realities of each service.

Background: Open Grade 3 femoral fractures are high-velocity injuries, often associated with other co-morbid injuries and are highly prone to infections; these fractures are commonly treated by staged procedures to minimize the complications. Early definitive fixation by intramedullary (IM) interlocking nails (ILN) has advantages like early mobility and better outcomes.

Study question: Are early definitive fixations of grade III shaft femur fractures with debridement & IM ILN effective in union and infection rates?

Materials and methods: Using relevant keywords, a total of 3357 articles were screened from the PubMed, Scopus and Embase database. 6 studies that evaluated at least 10 cases of grade III open femoral shaft fractures treated with early IM ILN during the index surgery were included in this review.

Results: Out of the 6 studies, only 1 was prospective, and the remaining 5 were retrospective in design. Out of 176 Grade III fractures, there were 8 non-unions, 3 malunions and 1 case of delayed union. Pooled analysis showed union rates of 94.8% for these fractures (4 studies). Infection was the most common complication. Pooled analysis showed that the mean rate of infection in these grade III fractures was 6.7%. Other complications included limb length discrepancy and stiff knee.

Conclusion: Intramedullary nailing in grade 3 femoral fractures as an early method of definitive fixation is an effective option. In such cases, optimizing controllable variables like surgical expertise and adequate antibiotic prophylaxis can improve outcomes.

Traumatic dental injuries (TDIs) are a public health concern that requires special attention in primary dentition due to the sequel that can be originated in permanent dentition. This paper aims to report a dental trauma injury highlighting the importance of follow-up the traumatized primary tooth until the eruption of its permanent successor. A 3-year-old female patient referred to a Dental Trauma Care Program (DTCP) in a Brazilian Public University after falling from her own height with the involvement of the deciduous maxillary left central incisor. The child's mother did not seek immediate care. The patient did not have any complaint and the tooth presented an enamel fracture during the clinical examination without radiographic alterations. The procedure performed was occlusal wear and insertion of the patient into the DTCP. After a 6-months clinical and radiographic follow-up, the primary maxillary left central incisor presented crown discoloration and periapical bone rarefaction. The treatment was pulpectomy followed by restoration of the tooth. In the 3-year follow-up, prolonged retention occurred and tooth extraction was the treatment of choice. After a 6-year follow-up, the permanent teeth erupted without any sequelae. TDIs are frequent in the primary dentition and, in some circumstances may interfere with the normal development of the permanent tooth causing irreversible sequelae. This case report reinforces the importance of seeking immediate care whenever dental traumas occur. Besides, a long-term follow-up of the traumatized tooth is essential for successful outcomes. Clinical and radiographic monitoring is fundamental to help dental professionals to decide the best treatment and to minimize potential complications.

Purpose: Assess the effect of residual intra-articular step and limb alignment on the outcomes of operated tibial plateau fractures.

Methods: After retrospectively enrolling 123 cases of operated tibial plateau fracture whole limb weight bearing X-rays of both knees and computed tomography scan was done to record the presence of knee osteoarthritis (OA), alignment and articular step. The Rasmussen functional score (RFS) and Visual Analogue scale (VAS) score was calculated. Depending on the articular step there were four groups, group A (no step), group B (<2 mm), group C (2 mm-5 mm) and group D (6 mm-10 mm). The patients were also divided into 3 groups based on knee alignment, group 1 (0-10° valgus angle), group 2 (varus angle upto 5°) and group 3 (varus angle of 5-15°).

Results: Group A had 53, group B 31, group C 23 and group D 16 cases. The mean follow up was 10.23 years. The difference in the RFS/VAS score and OA rate amongst the 4 groups based on articular step had a P>0.05. Based on knee alignment RFS and OA rate amongst three groups had a P<0.05 with better results in group 1.

Conclusions: Mal-alignment is a more important predictor of outcome in operated tibial plateau fractures than articular step.

Introduction: Arthritis in trapeziometacarpal joint is one of the most common types of osteoarthritis which do not respond to conservative therapies in progressed cases and require surgical processes. The current study compares the two successful techniques, ligament reconstruction and tendon interposition (LRTI) versus hematoma distraction arthroplasty (HDA).

Methods: The current randomized clinical trial has been conducted on 56 patients with trapeziometacarpal joint osteoarthritis whom were randomly divided into two groups undergone surgical procedures of LTRI (n=28) and HDA (n=28). The patients were evaluated regarding hand function, pain intensity and pinching power using The Disabilities of the Arm, Shoulder and Hand (DASH), VAS and pulp pinching test, respectively, as well as radiological findings, including (proximal migration, lateral migration, and first web space) at baseline, within 3, 6 and 12 months postoperatively.

Results: Pain intensity, pinching power, function based on DASH and radiological findings, including proximal and lateral migration and first web space significantly improved in a-year follow-up assessments (P-value <0.001). The comparison of the techniques showed superior results of HDA regarding pinching power (P-value =0.004) and DASH (P-value =0.03).

Conclusion: Based on this study, both LTRI and HDA were accompanied by significant improvement in function, pinching power and decrease in pain among the patients with the first carpometacarpal (CMC) joint osteoarthritis; however, the outcomes of HDA were generally superior.

Pulp canal obliteration (PCO) presents itself as a frequent pulp complication in traumatized primary teeth, characterized as a progressive deposition of hard tissue in the root canal. In this context, this study aimed to evaluate the association between PCO due to the occurrence of traumatic dental injuries (TDI) in deciduous teeth and specific factors. For this, a retrospective study was carried out through 210 medical records selected from the Dental Trauma Care Program from 2012 to 2019. After applying the eligibility criteria, 371 deciduous teeth were included. Statistical analysis was performed using chi-square and Fischer's exact test. The occurrence of PCO was observed in 4.9%. Associated factors such as age (P=0.63), sex (P=0.47) and search for care (P=0.87) did not influence the occurrence of PCO. Concerning the type of TDI and development of PCO, the injury of subluxation showed a statistically significant association (P=0.01). There was an association of PCO with other TDI complications such as crown discoloration (P<0.01) and acceleration of physiological root resorption (P=0.01). No statistically significant association was found regarding the development of sequelae in permanent successors and PCO (P>0.05). Based on this study, PCO was not a frequent complication of TDI in deciduous teeth in the population evaluated. PCO was associated with subluxation, crown discoloration, and acceleration of physiological root resorption. However, it did not show association with any related factor (age, sex, and seeking care) and the development of clinical or radio graphical sequelae in permanent successors.

Two therapeutic options for deep dermal hand burns are autologous split-thickness skin graft (STSG) following tangential excision and the application of the temporary wound dressing Suprathel following removal of burn blisters. We compared elasticity and perfusion of burn scars after both types of therapy at least one year after completion of treatment. A case series of 80 patients of our department with deep dermal hand burns between 2013 and 2018 was examined in the year 2019 at least one year after completion of treatment (24 females and 56 males with a median age of 47.6 years). The clinical assessment of the scar was performed with the Vancouver Scar Scale (VSS) and Patient and Observer Scar Assessment Scale (POSAS) and the objective assessment with suction cutometry (MPA 580) and an O2C device on both hands. Our statistical analysis showed no statistically significant differences for the R2 and R5 elasticity values between the two types of therapy. The 95% confidence intervals for the ratios of elasticity, and microcirculatory perfusion parameters and scar scale scores of burn scars to respective healthy areas of skin after STSG and Suprathel-therapy mostly covered 1. Subgroup analysis of R2 viscoelasticity and analyses with adjustments for scar compression therapy, nicotine consumption, age, palmar or dorsal localization of the burn scar and interactions of age with smoking and localization gave similar results. The adjusted analysis of SO2 showed statistically significant lower SO2 values, 9% less, after STSG compared to Suprathel treatment. Split-thickness skin graft following tangential excision and the application of Suprathel following removal of burn blisters may be equivalent options for treatment of deep dermal hand burns. To detect possible small differences, further studies with larger samples are required.

Introduction: Bankart procedure is considered a safe and effective technique in the management of traumatic shoulder dislocation. Various studies have evaluated the results of Bankart Repair in different populations. The aim of the current study is to evaluate and report the outcomes of Bankart capsulorrhaphy in patients with recurrent shoulder dislocation in Iran.

Methods: This is a clinical trial without a control group that was performed in 2021. The study population consisted of all patients diagnosed with recurrent anterior shoulder dislocation and Bankart lesion that were candidates for Bankart capsulorrhaphy in 2012-2020. All patients that met the inclusion criteria entered the study using census method. We assessed variables including shoulder range of motion (ROM), shoulder joint symptoms using Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, Rowe score, Constant Shoulder Score and patient's quality of life using 36-Item Short Form Survey Instrument (SF-36) before surgeries and within 2 months, 6 months and 1 year after surgeries.

Results: Data of 300 patients were analyzed. All patients underwent Bankart capsulorrhaphy. Patients were followed up for minimum of 1 year after surgery. These data showed improvements in external rotation, abduction, DASH score, Rowe score and SF-36 in patients (P < 0.05 for all items). No significant changes were observed within 1 year in forward elevation (P = 0.07), internal rotation (P = 0.125) and Constant Shoulder Score (P = 0.082).

Conclusion: Bankart surgery is an effective method for reducing pain and recurrence of shoulder dislocation. Based on our results, using Bankart surgery led to significantly increased shoulder functions among patients.

Background: Intensive care unit (ICU) patients are exposed to several surface eye disorders ranged from minor complications like corneal dryness to more serious ones such as corneal perforation and blindness. This study is then to assess the incidence of the ocular complications and related factors.

Materials and methods: During a prospective cross sectional study in a general adult ICU, ocular complications of the patients were assessed by an ophthalmologist. Data were analyzed using descriptive analysis. A P-value of ≤0.05 was considered significant.

Results: Out of 155 patients, 130 cases (260 eyes) were covered during the study period, 2016-2017. The most common complications among the patients included dry eye and corneal abrasion (25.8%) followed by conjunctivitis (25%). The mean time of occurrence for dryness and corneal abrasion was 4±2.93 days after admission to the ICU. Lower Glasgow coma scale (GCS) and longer hospital stay were significantly associated with ocular complications in the ICU (P<0.05).

Conclusion: Eye surface complications are commonplace in critically ill patients admitted in the ICU. Dry eye, corneal abrasion, and conjunctivitis have been revealed as the most prevalent complications in this study. Lower GCS and longer stay in the ICU predisposed the cases to these complications. Efficient eye care protocol and training the ICU staff are both recommended to reduce complication rates as such.

Matrix metalloproteinase-9 (MMP-9) and its endogenous inhibitor, tissue inhibitor of metalloproteinase-1 (TIMP-1), are key mediators of acute inflammation and regulators of the wound healing process. The aim of this systematic review was to determine the local and systemic involvement of the MMP-9/TIMP-1 system following burn injury. Two databases (Scopus and MEDLINE) were searched for all studies reporting MMP-9 and/or TIMP-1 after burn injury. Based on our eligibility criteria, we reviewed 24 studies involving 508 burns patients in 11 clinical studies and 367 animals in 13 preclinical studies. Local, systemic, and peripheral gene expression, protein levels and activity of MMP-9 and TIMP-1 were assessed. Increased MMP-9 was reported at the site of injury early after burn trauma in all studies, and remained elevated in non-healing wounds. Increased TIMP-1 expression in burn wounds occurred later than MMP-9, and was persistent in hypertrophic burn scars. Similar to local expression, systemic MMP-9 and TIMP-1 concentrations were significantly elevated after burn injury in response to upregulation of proinflammatory cytokines. While no association was found between systemic MMP-9 concentration and extent of injury or outcome, serum or plasma TIMP-1 showed good correlation with survival and burn severity. This review also found evidence of the MMP-9/TIMP-1 system contributing to secondary tissue damage distant from the burn site, including burn-associated musculoskeletal damage and acute lung injury. In addition, increased MMP-9 synthesis and activity in the brain after peripheral burn may lead to blood-brain barrier dysfunction and cerebral edema, a significant contributor to mortality. This systematic review provides an overview of the available evidence of the role of MMP-9 and TIMP-1 in burn injury pathophysiology and finds that TIMP-1 may be a promising biomarker in outcome prognostication of burns patients. Large-scale studies of both pediatric and adult burns patients with increased female representation and repeated sampling are recommended to validate the reliability of TIMP-1 as a prognostic marker following burn injury.