International Journal of Burns and Trauma最新文献

The concomitant occurrence of posterior hip dislocation with an ipsilateral intertrochanteric fracture is an exceptionally rare and complex orthopedic injury that poses significant diagnostic and therapeutic challenges. This report presents two cases of this unusual injury pattern, each resulting from high-energy motor vehicle accidents. Patients presented with acute pain and functional impairment of the affected lower limb. Radiographic evaluation confirmed posterior dislocation of the hip associated with an ipsilateral intertrochanteric fracture. Prompt open reduction was necessitated to prevent iatrogenic complications and minimize the risk of avascular necrosis of the femoral head. Definitive fixation of the intertrochanteric fracture was achieved using a Dynamic Hip Screw (DHS) or Dynamic Condylar Screw (DCS), selected based on fracture morphology. Postoperative management focused on staged rehabilitation to optimize recovery. Both patients achieved satisfactory functional outcomes, with Harris Hip Scores of 78 and 82 at one-year follow-up, respectively. The aim of this case report is to present and analyze two rare cases of combined posterior hip dislocation with ipsilateral intertrochanteric fracture, highlighting the diagnostic complexities, surgical challenges and considerations for achieving favorable functional outcomes in the absence of standardized treatment protocols.

Objectives: Altered hip biomechanics following intertrochanteric fracture fixation can result in impaired mobility, decreased functional outcomes, and a reduced quality of life. Despite achieving optimal reduction and fixation, patients often fail to regain their pre-injury activity levels. This study aims to evaluate how changes in hip biomechanics after intertrochanteric fracture fixation using a proximal femoral nail impact the quality of life.

Methods: This prospective cohort study, conducted from July 1, 2020, to June 30, 2022, included individuals aged 18 years and older with isolated intertrochanteric fractures managed using the Proximal Femur Nail Antirotation 2 (PFNA2). Clinical assessments included range of motion, pain levels, abductor strength, the modified Harris Hip Score (HHS), and the Parker and Palmer Mobility Score (PPMS) at 6 weeks, 3 months, and 6 months' post-surgery. Hip biomechanics were evaluated radiographically through parameters such as telescoping, tip-apex distance (TAD), neck-shaft angle, and femoral offset. These findings were correlated with functional scores and health-related quality of life (EQ5D-EuroQol 5 Dimension) score.

Results: Out of 47 eligible patients, only 30 could be followed up for six months due to the COVID-19 pandemic, and three patients died in the postoperative period. 25 of 33 patients were over 60 years old. Twenty-nine patients had unstable fractures. All patients had hypovitaminosis D, and 92% of patients had osteoporosis. Fracture union occurred in all cases, with a mean union time of 2.9 ± 0.8 months. Radiographic evaluation showed minimal changes in tip-apex distance and other hip biomechanical parameters (femoral offset, neck shaft angle, telescopy). Functional scores, including modified Harris Hip score and health-related quality of life (HRQOL) measures, improved significantly after surgery. However, at six months, these scores were lower than pre-injury levels. Walking ability varied considerably between age groups (< 60 years' vs > 60 years) at 6 weeks, but abductor strength did not differ significantly in subsequent follow-ups.

Conclusion: Poor bone quality, characterized by osteomalacia and osteoporosis, is significantly associated with intertrochanteric fractures in Indian populations. The PFNA 2 nailing system effectively maintains reduction and prevents varus collapse. Functional outcomes and HRQOL improve over time with intramedullary fixation, yet patients seldom return to pre-injury levels, potentially influenced by recall bias.

Objective: Schatzker and AO/OTA classification are commonly used to classify tibial plateau fractures, but they are defined using plain radiographs and may not capture fully the complexity of these fractures. CT scan offers better visualization of occult fractures, joint depression and overall fracture morphology, but its impact on these classifications in term of interobserver variation is unclear. There is paucity of literature on this aspect, hence this study.

Methods: A total of 38 cases of tibial plateau fractures were classified by five different observers (four senior residents and one consultant) on the basis of Schatzker and AO/OTA classification. Initially, the observers classified the cases using plain radiographs and then reclassified the cases after supplementing the radiographs with CT scan images. The interobserver reliability was calculated using kappa coefficient.

Results: The interobserver agreement for Schatzker classification was found to be moderate on plain radiographs (mean κ_X-ray = 0.593) and substantial after addition of CT scan images (mean κ_{(X-ray + CT scan)} = 0.630). The interobserver agreement for AO/OTA classification was found to be fair on plain radiographs as well as after addition of CT scan images (mean κ_X-ray = 0.313 and mean κ_{(X-ray + CT scan)} = 0.320).

Conclusion: After providing advanced imaging both the classification systems showed improvement in the interobserver reliability. However, the change was found to be non-significant. This highlights the weakness of the plain radiograph based classification systems and indicates adoption of classifications based on advanced imaging.

Objectives: Tracheal intubation (TI) is an essential skill for various healthcare providers, including emergency medicine specialists and anesthesiologists. The ramped position has been hypothesized to facilitate TI. In this study, we assessed the success rate of the semi-sitting position compared with the supine position in emergency intubation.

Methods: In this double-blind clinical trial, 162 traumatic patients admitted to the emergency department at Al-Zahra Hospital were randomly assigned to three groups. Patients in Group I underwent TI in the supine position. Patients in Group II underwent TI in a semi-sitting position at a 25-degree angle, while Group III underwent TI in a semi-sitting position at a 35-degree angle. The Cormack-Lehane (C-L) grade and the number of intubation attempts were compared among the groups.

Results: Our findings showed a significant reduction in the number of intubation attempts in Groups II and III compared to Group I (P < 0.001). However, the semi-sitting positions (Groups II and III) were associated with a higher incidence of Grade III and IV C-L views, indicating poorer glottic visualization (P < 0.01).

Conclusions: The semi-sitting (ramped) position improves the success rate of TI by reducing the number of intubation attempts. However, it significantly worsens glottic visualization, which may pose challenges during airway management. Further studies are needed to optimize patient positioning in emergency intubation.

Atrial fibrillation (AF) is increasingly prevalent in the elderly population and is associated with an elevated risk of osteoporotic fractures. This systematic review aimed to compare the risk of osteoporotic fractures between direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs), particularly warfarin, in patients with AF and to conduct head-to-head comparisons among different DOACs. We systematically searched literature published between January 2020 and October 2024 across multiple scientific databases. The included studies focused on adult patients with AF taking anticoagulants with fracture outcomes. We extracted and synthesized data on the fracture risk across different anticoagulant types. Our analysis revealed that DOACs, particularly rivaroxaban and apixaban, were associated with a lower fracture risk in AF patients than VKAs. Among the DOACs, apixaban appeared to have the most favorable profile for reducing hip fracture risk. Multiple studies have confirmed that DOACs are associated with decreased vertebral fracture risk compared to warfarin, with risk reductions ranging from 18-32% depending on the specific DOAC. DOACs appear to offer a safer alternative to VKAs in terms of fracture risk in patients with atrial fibrillation. This protective effect may be attributed to their lack of interference with vitamin K-dependent bone metabolism. Although evidence suggests that apixaban and rivaroxaban may have superior bone-protective profiles among DOACs, further research is needed to establish definitive comparisons between individual DOACs and elucidate their protective mechanisms.

Objectives: This study evaluated the efficacy of precise platelet-rich plasma (PRP) injection, guided by arthroscopy, in patients with grade II meniscus tears.

Methods: The study protocol was reviewed and approved by the Institutional Review Board (IRB) of AJA University of Medical Sciences (Code: IR.AJAUMS.REC.1399.258). This study has also been approved by Iranian Registry of Clinical Trials (IRCT) with the code of: IRCT20200217046523N18. In this study, 90 patients with grade II meniscus tears, randomly assigning them to either a PRP injection group (n=45) or a conservative treatment control group (n=45) were enrolled. All patients included in the study had anterior cruciate ligament (ACL) tears and underwent arthroscopic ACL reconstruction. PRP was prepared using a standardized protocol, and injection was performed under arthroscopic guidance using a specialized cannulated loop navigator. Outcomes were assessed using magnetic resonance imaging (MRI) evaluation at baseline, 6, and 12 months post-intervention, and clinical evaluations at the same time points.

Results: While the PRP group showed a trend towards improved meniscus tear healing compared to the control group at 6 months (P=0.0552), this difference was not statistically significant at either 6 or 12 months. Similarly, clinical scores showed slight improvements in the PRP group over time, but these differences were not statistically significant compared to baseline or the control group.

Conclusion: This study did not demonstrate statistically significant superior outcomes with precise arthroscopically-guided PRP injection as a standalone treatment for grade II meniscus tears compared to conservative management at 6 and 12-month follow-up. Further research with larger sample sizes and longer follow-up periods is needed to definitively assess the role of PRP in the management of grade II meniscus tears.

Background: Burn injury (BI) represents a major epidemiologic problem worldwide, mostly in children. BIs greater than 40% of the total body surface, are considered severe, and entail a hepatic hypermetabolic response, which is associated with proteins depletions and prolonged hypermetabolism.

Objective: This study aims to evaluated the effects of short- and long-term insulin treatment on liver morphology and the use of a biomarker related to oxidative damage to DNA (8-OHdG) to better understand the anabolic action of this hormone in the liver.

Methods: Wistar rats aged 21 d were distributed into four groups: control (C), control with insulin (C+I), scald burn injury (SBI), and SBI with insulin (SBI+I). The SBI groups were subjected to a burn 45% total body surface area. The C+I and SBI+I groups received insulin (5 UI/Kg/d) for 4- or 14 d. The livers were analyzed for morphometric, histopathological, and immunohistochemical for 8-OHdG.

Results: The main results showed that, in a short time, insulin increases the density of binucleated hepatocytes as an organ response to burn injury. In the long term, insulin increased the area of hepatocytes in the SBI+I group in relation to SBI, highlighting the similar values between the SBI+I and the control groups. Regarding sinusoidal cells, insulin was able to modulate this liver proliferative reaction. Insulin reduces 8-OHdG immunoexpression in short and long-term post-burn moments.

Conclusion: The insulin modulation of 8-OHdG makes us infer that a study about the control of 8-OHdG as a potential biomarker in patients could be an efficient precursor of the level of oxidative stress associated with hepatic dysfunction associated to extensive burn injury.

Background: Tuberculous tenosynovitis is a rare manifestation of musculoskeletal tuberculosis, often misdiagnosed due to its indolent course and nonspecific presentation. Compound palmar ganglion, a chronic form of tuberculous tenosynovitis, can mimic benign conditions like ganglion cysts, leading to diagnostic delays, especially in immunocompromised individuals.

Case report: We report a case of a 35-year-old HIV-positive female who presented with a painless swelling on the volar aspect of the wrist for six months. MRI revealed flexor tendon thickening and synovial proliferation, raising suspicion of infectious tenosynovitis. Surgical excision was performed, and histopathological examination confirmed tuberculous tenosynovitis with caseous granulomas. Ziehl-Neelsen staining identified acid-fast bacilli, confirming the diagnosis. The patient was started on standard anti-tubercular therapy (ATT) and showed complete resolution of symptoms at six months.

Conclusion: Tuberculous compound palmar ganglion should be considered in chronic wrist swellings, particularly in endemic regions and immunocompromised patients. Early diagnosis using imaging and histopathology is crucial for timely management. A combination of surgical excision and ATT ensures favorable outcomes.

Objective: Skin burns can occur due to exposure to heat, chemicals, electricity, or sunlight, and can cause significant damage to the skin. Burns are classified based on their severity. Research has indicated that herbal extracts may help treat burns. This study aimed to assess the effectiveness of Stachys Lavandulifolia extract ointment in healing burn wounds in rats.

Methods: In this study, the efficacy of Stachys Lavandulifolia ointment was evaluated in treating second-degree burns by comparing it with silver sulfadiazine ointment. The study involved preparing Stachys Lavandulifolia extract in 2% and 4% concentrations. Thirty Wistar rats were divided into six groups, including a negative control group, a positive control group, and groups treated with silver sulfadiazine ointment, Stachys Lavandulifolia extract at 2% and 4% concentrations, and Eucerin ointment.

Results: The study found that applying 2% Stachys Lavandulifolia ointment is effective in treating second-degree burns. Biochemical analysis revealed significant differences in tissue FRAPS levels between the normal control group and the groups treated with 2% Stachys Lavandulifolia, 4% Stachys Lavandulifolia, and 1% silver sulfadiazine ointment. Statistical analysis indicated that on day 21, the burn area in the 2% and 4% Stachys Lavandulifolia ointment groups was significantly smaller than in the positive control and Eucerin groups.

Conclusion: The Stachys Lavandulifolia ointment, with its antioxidant ingredients, can potentially prevent oxidative damage, lower inflammatory factors, and speed up the healing process for burns.