International Journal of Burns and Trauma最新文献

Burn injuries can lead to a variety of short- and long-term complications, peripheral neuropathy has been known as the most common neuromuscular complication. 29% of the burn-related peripheral neuropathy has been found in both the upper and lower limbs. Moreover, literature failed to find the causative factors for specific presentations like foot drop in burn patients. This study reports a series of 10 patients who developed foot drop after burn injury and required occupational therapy follow up at King Abdulaziz Medical City in Riyadh. To assess the effect of different risk factors in the outcome of foot drop. 10 case records were reviewed, 70% among the patients were men and 30% were women with a mean age of 39 and a mean BMI of 28. Most of the patients 70% were burned by flame. The mean Total Body Surface Area (TBSA) was 62%. 4 of the cases (40%) were having comorbidities. There was a significant association between death and high TBSA. All cases were managed without surgical intervention, physiotherapy started immediately after the diagnosis of foot drop. Seventy percent of our patients improved while 3 cases have expired. Higher TBSA showed to be significantly associated with death.

Background: Traumatic brain injury, mainly caused by the unintentional falls and motor vehicle accidents, is a serious condition encompassing a spectrum of pathological features from axonal to hemorrhagic injuries. Among these, cerebral contusions significantly contribute to death and disability following the injury and occur in up to 35% of cases. This study aimed to investigate the predictors of radiological contusion progression in traumatic brain injury.

Methods: We performed a retrospective cross-sectional study using the files of the patients with mild traumatic brain injury who had cerebral contusions from 21 March 2021 to 20 March 2022. The severity of brain injury was determined using the Glasgow Coma Score. Furthermore, we used a cut-off value of a 30% increase in contusion size in the secondary CT scans (up to 72 hours) compared to the first one to define the significant progression of the contusions. For the patients with multiple contusions, we measured the biggest contusion.

Results: 705 patients with traumatic brain injury were found, the severity of the injury was mild in 498 of them, and 218 had cerebral contusions. 131 (60.1%) patients were injured in vehicle accidents. 111 (50.9%) had significant contusion progression. Most patients were conservatively managed, but 21 out of them (10%) required delayed surgical intervention.

Conclusion: We found that the presence of subdural hematoma, subarachnoid hemorrhage, and epidural hematoma were predictors of radiological contusion progression, and the patients with a subdural hematoma and epidural hematoma were more likely to undergo surgery. In addition to providing prognostic information, predicting risk factors for the progression of the contusions is crucial for identifying patients who might benefit from surgical and critical care therapies.

Introduction: This research aims to assess and analyze the fracture resistance of GC Everstick post with separate composite core buildup and Edelweiss prefabricated resin composite post and core single unit into immediate and delayed post space prepared teeth.

Methods: A total of 120 extracted human mandibular premolars have been subjected to a standardized protocol of mechanical trauma to simulate tooth fracture. Teeth samples were randomly divided into four groups (n = 30) on the basis of time taken for the preparation of post space (approximately following root canal obturation and 24 h after root canal obturation) for the single unit Edelweiss post and core system and GC post with separate core buildup. Compressive load has been utilized to do the analysis necessary to establish the fracture resistance using a universal testing machine. The fracture force calculated was in Newtons (N), and a stereomicroscope was utilized for investigating the common causes of failure.

Results: In an immediate post space prepared tooth, the GC post exhibited a mean failure load of 970.584 N. In contrast, the Edelweiss post, and core system showed a significantly higher mean failure load of 1250.349 N. In delayed post space prepared tooth, the GC Everstick post exhibited a mean failure load of 950.287 N. In contrast, the Edelweiss post, and core system showed a significantly higher mean failure load of 1229.348 N.

Conclusion: This study aims to assess and analyze the fracture resistance of the GC Everstick post with separate composite core buildup and the Edelweiss prefabricated resin composite post and core single unit in immediate and delayed post space prepared teeth. The study results showed that the failure modes in both groups were non-catastrophic in nature. These findings suggest that the Edelweiss post and core system may be a more suitable option for restoring teeth that have been subjected to traumatic conditions. The study provides valuable information for dental professionals in their decision-making process for post and core restoration techniques in teeth that have been subjected to trauma.

Background: Fractures of the proximal femur account for 30% of all fractures requiring surgical treatment. The optimal treatment for per- and intertrochanteric fractures, particularly associated with trochanter instability, is still open to debate. For these reasons, some authors have recently supported the use of bipolar arthroplasty or hemiarthroplasty as a treatment capable of reducing the risk of complications and obtaining a better functional result. The purpose of this study was to evaluate the functional and clinical outcomes at minimum six months of follow up of bipolar hemiarthroplasty as the primary treatment for intertrochanteric fracture in older patients. A secondary objective was to study the risk of early and intraoperative complications.

Methods: From November 2020 to April 2022, 102 patients with lateral proximal femur fracture underwent surgical operation with implant of a long-stemmed bipolar hemiarthroplasty. 86 patients were enrolled. The average age at the time of fracture was 87.4 ± 4.6 (range 77-98) years. Of the patients, 76.7% were female. For all patients intra- and perioperative data were extracted. All available patients were evaluated at a minimum 6-months follow-up to investigate: Charlson Comorbidity Index, autonomy (Barthel Index), use of walking aids (Koval Grade), memory quality or dementia (Mental Score), subsequent hospitalizations for surgical operations relating to the operated hip.

Results: The average time from trauma to surgery was 1 ± 0.7 days. The surgical time was 78.9 ± 21.9 minutes. At least one cerclage was used in 73.3% of patients. 87.5% of patients were verticalized on the first day. The average hospitalization time was 5.5 ± 2.9 days. During follow-up 20 deaths occurred, with a distance to surgery of 6.6 ± 7.2 (range 0.3-22.7) months. Six months after surgery, out of 86 patients, 12 deaths occurred, corresponding to 13.95%. 12 months after surgery, out of 57 patients, 15 deaths occurred, corresponding to 26.31%.

Conclusions: Long stemmed bipolar hemiarthroplasty following intertrochanteric fracture can be considered a safe procedure, especially in patients over 80 with associated comorbidities and short life expectancy.

Necrotizing fasciitis (NF) is a severe soft tissue infection caused by bacterial fascia invasion and quick spreading to the muscle and subcutaneous tissues. Treatments of NF should be conducted by extensive debridement and antibiotic therapies. This report presented a 53-year-old woman with diabetes mellitus (DM) and hypothyroid who was referred to our medical center with lower limb pain and significant swelling after mild trauma. The patient was diagnosed with NF due to E. coli. She underwent surgical interventions for debridement and long-term antibiotic therapy. The patient recovered successfully without complications or range of motion (ROM) restriction in the hip and knee. It is recommended that immediate actions be taken in NF cases to preserve the remaining tissues and provide better outcomes.

Pantalar dislocation means the simultaneous dislocation of the talocalcaneal, talonavicular, and tibiotalar joint. It is a rare injury comprising only 3.4% of major talar injuries. Treatment of closed Pantalar dislocation is controversial. However, the aim should be to attain a stable anatomic reduction of the Talus in the ankle joint. To prevent further damage to the skin and neurovascular structures, closed reduction of these dislocations should be performed as soon as possible. We report a case of Pantalar dislocation where we tried to reduce the talus both by closed and open methods but it was not possible to reduce the dislocation until the talonavicular joint was reduced first. Intending to improve the clinical knowledge of Pantalar dislocation, we want to convey our clinical experience and results from this rare dislocation.

Background: Evidence suggests that referral cases of traumatic injuries have decreased during the COVID-19 pandemic both in childhood and in adulthood. Still we have very little evidence of referrals due to traumatic brain injury among children during the COVID-19 outbreak. The present study aimed to describe epidemiological and clinical features of pediatric traumatic brain injuries.

Methods: This cross-sectional study was performed on all patients under 15 years with any evidence of head trauma, referring to Poursina teaching hospital, a referral center for trauma and road accidents in northern Iran. The patients' data were retrospectively collected by reviewing the hospital recorded files and the trauma-specific hospital information system.

Results: Of all 543 pediatric traumatic injuries referred to our hospital during the two pointed periods, 166 had any evidence of head and neck injuries leading to an overall prevalence rate of 30.6%. In this regard, the prevalence rate of head/neck injuries was estimated to be 140 out of 436 within a pre-COVID-19 period (32.1%) and 26 out of 107 within the COVID-19 period (24.3%) indicating no significant difference between the two time periods (P = 0.243). However, assessing the rate of head/neck injuries pre-COVID-19 and COVID-19 periods according to patients' age showed a higher rate of such injuries in pre-COVID-19 as compared to COVID-19 periods in patients aged less than two years (55.6% versus 37.5%, P = 0.013) as well as aged 2 to six years (45.8% versus 30.0%, P = 0.036).

Conclusion: The rate of admission of children due to traumatic brain injury during the COVID-19 period does not show a significant change compared to before, and only in children under 6 years of age a decrease in referrals due to brain trauma during the COVID-19 period was observed.

Background: Pedicle screw insertion at the level of the fractured vertebra has been shown to improve clinical and radiological outcomes in unstable thoracolumbar and lumbar fractures, albeit this requires further evidence. The study aims to evaluate the effect of pedicle screw placement on the fractured vertebra in such cases.

Methods: A prospective study included adult patients with thoracolumbar and lumbar fractures treated with short-segment posterior instrumentation with a pedicle screw into the fractured vertebra. Anterior vertebral body height loss, kyphotic angle and degree of spinal canal compromise were measured preoperatively and postoperatively in radiographs and CT scans. The neurological status was followed up for one year of the postoperative period.

Results: The study included a total of 30 patients. Five patients (16.7%) had grade C, three patients (10%) had grade D, and 22 patients (73.3%) had grade E neurological status. The mean (SD) preoperative kyphotic angle, vertebral body height and canal compromise were 5.54 (5.35), 39.67% (8.04), and 31.59% (10.62), respectively. Postoperatively there was a significant canal decompression, with a mean postoperative spinal canal compromise of 5.53% (SD=7.70; p-value <0.001). At the end of one year of follow-up, the radiological evaluation showed a correction of the kyphotic angle to 6.62 (SD=2.57; p-value <0.001), and the mean anterior vertebral body height was 70.38% (SD=11.25; p-value <0.001). At the end of one year, there was a significant overall neurological recovery with a final neurological status of grade D in 5 (16.7%) and grade E in 25 patients (83.3%). There was no significant association between canal decompression and neurology at the end of the one-year follow-up.

Conclusion: Unstable thoracolumbar and lumbar fractures surgically treated with short-segment fixation with an additional intermediate screw can achieve significant restoration of vertebral body height and correction of kyphotic angle without any added complications.

Emphysematous osteomyelitis is a rare but potentially fatal condition, which classically features intraosseous air on imaging without a direct communication with the atmosphere. Prompt recognition and treatment of the disease cannot be overstated as there is a high mortality rate associated with this condition. Here we report a case of emphysematous osteomyelitis of the calcaneus in a sixty-one-year-old male with diabetes mellitus and end-stage renal disease. This case of osteomyelitis was associated with an overlying necrotizing soft tissue infection, mandating an urgent below-knee amputation for source control. This case report is the first of its kind in the literature involving the calcaneous as emphysematous osteomyelitis more commonly involves the vertebral column. The purpose of this case report is to discuss the presentation and treatment of emphysematous osteomyelitis involving the calcaneous as well as provide a review of the current literature on this diagnosis.

Background: Postoperative delirium is a common complication with a high morbidity rate. This study was designed to consider the effectiveness of melatonin in prevention and treatment of postoperative delirium.

Methods: Seventy-two patients aged >60 years old with Abbreviated Mental Test (AMT) >8 scheduled for orthopedic surgery under spinal anesthesia, were randomly distributed equally to melatonin or placebo groups. In the melatonin group, the patients were given 5 mg melatonin capsules orally the night before surgery, the night of the operation, and two nights after the surgical operation at 9 pm. Likewise, in the placebo group, the patients received placebo in the same times. For diagnosis of postoperative delirium, the AMT test was used before the operation and three days after that. The Generalized estimating equations model (GEE) with logit link to Multivariate analysis was used in the study and P<0.05 was considered statistically significant.

Results: In total, 72 patients completed the study. Thirty-three patients (45.8%) were male with a mean (SD) age 71.4 (3.6) years. On the first day after the surgery, the incidence of delirium was significantly lower in the melatonin group compared to the placebo group (22.2% vs. 44.4%, P=0.046). On the second and third days after the surgery, the level of delirium in the melatonin group was also significantly lower than that in the placebo one. The GEE model showed a significant interaction between time and treatment groups.

Conclusion: The findings of the study showed that melatonin prevented delirium after the orthopedic surgeries in the elderly patients and could be useful for the patients as such.