International Journal of Burns and Trauma最新文献

Background: Fractures of the thoracolumbar and lumbar regions are very important. There is still debate on the use of braces after surgical operations. The current study aims to evaluate and report the outcomes of postoperative bracing following pedicle screw fixation in patients with thoracolumbar and lumbar fractures in Iran.

Methods: This is a clinical trial performed from 2012 to 2022 on 144 patients diagnosed with lumbar and thoracolumbar fractures. Demographic data of patients including age and gender were obtained. Patients' fractures were classified as Frankel (A to E) in terms of clinical and neurological manifestations. Patient's quality of life (QOL) was measured using the 36-Item Short Form Survey (SF-36). All patients underwent surgical fixation of the fracture. Patients were then randomized into two groups using Random Allocation Software. The first group received post-operation bracing and the second group did not receive braces. Thus, radiographic and clinical evaluation data of 1, 3, and 12 months after surgery were used to determine bone fusion.

Results: The most common mechanisms of trauma included falling from a height in 99 patients (68.7%), vehicle accidents in 39 patients (27.1%), and the most common fracture sites were the L1 vertebrae in 73 patients (50.7%), 111 patients (77.1%) had burst fractures, and 105 patients (72.3%) had no neurological defects (Frankel E). At the beginning of the study, there were no significant differences between the two groups regarding the mentioned data, patients' QOL, and pain severity. All patients (100%) had early mobilization. Most patients (85.4%) did not report persistent back pain 12 months after surgeries. 90.2% returned to their daily activities and all patients (100%) had full fusion based on radiologic data. The QOL and pain severity of patients improved significantly compared to baseline (P < 0.001 for both).

Conclusion: The use or non-use of braces did not affect the treatment results. As a result, patients who have received pedicle screw fixation for unstable thoracolumbar fractures do not require braces in the postoperative period.

Because few studies have assessed blood alcohol concentration (BAC)-positive risk conditions in trauma activation patients, this retrospective investigation pursued such an analysis. The parent database included consecutive trauma center admissions from January 21 to July 21 for 2018-2020. The supplementary electronic medical record audit of trauma activation patients aged 18-60 years (TA18-60) assessed alcohol misuse, smoking history, and serum bicarbonate levels. An alcohol misuse risk score was created by assigning a value of 0 (no) or 1 (yes) for each risk condition: 1) smoking history, 2) BAC-positive status, 3) BAC ≥ 100 mg/dL with Glasgow Coma Scale score (GCS) ≥ 13, 4) age ≥ 40 years, and 5) bicarbonate level ≥ 20 mmol/L in BAC-positive patients and summing the total score (range, 0-5). Of 2,076 patients, BAC testing occurred in 60.9% (n = 1,265). BAC positivity was greater in TA18-60 (36.9%) than in other patients (20.8%; P < 0.0001; odds ratio [OR] = 2.2). In the TA18-60 audit (n = 742), categorizations were available for BAC status, 98.5%; smoking history, 99.3%; alcohol misuse history, 99.5%; and bicarbonate level, 99.5%. BAC positivity was greater in smokers (41.3%) than in non-smokers (31.5%; P = 0.0061; OR = 1.5). BAC positivity was greater with alcohol misuse (87.0%) than without (17.7%; P < 0.0001; OR = 31.2). BAC-positive was associated with a greater proportion of bicarbonate levels < 20 mmol/L (52.0%) than BAC-negative (31.8%; P < 0.0001; OR = 2.3). The alcohol misuse proportion was greater with an alcohol misuse risk score of 3-5 (74.4% [142/191]) than with a risk score of 0-2 (10.4% [57/546]; P < 0.0001; OR = 24.9; area under the receiver operating characteristic curve = 0.89). This retrospective study demonstrates that BAC positivity is associated with TA18-60, smoking and alcohol misuse histories, and metabolic acidosis. An alcohol misuse history is associated with multiple risk conditions. Trauma center leadership should provide procedures to identify patients who are BAC-positive or have a positive smoking or alcohol misuse history. Then, such patients should be referred to care providers who can offer assistance and guidance for enhancing overall patient wellbeing.

Introduction: Multi-planar external fixation is used for the management of complex distal tibia fractures. This study aims to describe our experience of treating distal tibia fractures using the Ilizarov, Taylor Spatial Frame and True-Lok Hex external fixation methods.

Methodology: We conducted a retrospective analysis of clinical and radiological records of all distal tibia fractures that were managed with multi-planar external fixation over a period of 3 years. A total of 13 cases were included, of which most were high-energy injuries.

Results: The average age of the patients was 44 years old. 11 (85%) cases were high-energy trauma due to road traffic accidents. 8 (62%) cases involved the revision of a previous fixation method. Most (77%) cases were AO classification Type 3, and the majority (62%) of cases were open fractures. The average duration in the external fixator frame and time to radiological union was 5 months and 6 months respectively. The average malalignment at union was 1.3 degrees and 0.5 degrees in the coronal plane and sagittal plane respectively. All fractures involving the joint line were adequately restored. There were 2 (16%) case of non-union and 2 (15%) cases of pin site infections. 1 case required a corticotomy and subsequent lengthening.

Conclusion: Multi-planar circular external fixation is a reliable method to treat complex distal tibia fractures, both in the acute setting and as revision surgery. The rates of fracture union is high, with minimal malalignment. Although pin site infections are relatively common, they are uncomplicated and easily treated.

Trochanteric hip fractures have become very common with 35-40% of these fractures being unstable. Trochanteric fractures, especially unstable ones are associated with high rates of mortality and morbidity and thus remain an inordinate challenge for surgeon to treat these fractures with proper choice of implant. Aim of the study was to compare the proximal femoral nail and dynamic condylar screw in the management of unstable trochanteric fractures. Our study was a prospective comparative study which included 26 patients with fresh (≤3 weeks old) unstable trochanteric fractures AO 31A2 and AO 31A3, with age ≥18 years of both sexes. Eleven patients in DCS and fifteen patients in PFN were included. Harris hip score was used to compare functional outcomes. Average age of patients in DCS group was 59.82±11.59 years and PFN was 54.2±16.22 years. AO 31A2 fracture pattern (63.64%) was more common than AO 31A3 in DCS group and AO 31A3 fracture pattern (60.00%) was more common than AO 31A2 in PFN group. Mean operative time for DCS was 96.36±15.51 minutes and for PFN it was 79.67±12.02 minutes with P-value of 0.003. Two patients in DCS group and 1 patient in PFN group were lost to follow up. Two patients in DCS group and 1 patient in PFN group died. Seven out of 11 (63.64%) patients in DCS group and 13 out of 15 (86.60%) patients in PFN group were available for final follow up. Union seen in 2 (28.57%) patients with DCS and 12 (92.31%) patients fixed with PFN with P-value of 0.007. Mean HHS of 62.29±24.26 in DCS and 86.92±11.65 in PFN with P-value of 0.037. Patients with combined excellent and good HHS in DCS group and PFN group were 2 (28.57%) and 11 (84.62%) respectively. Non-union was seen in 5 (71.43%) patients fixed with DCS and 1 (7.69%) patient fixed with PFN. Implant failure was seen in 3 (42.86%) patients in DCS group in which barrel plate was broken in 2 (28.57%) patients and lag screw cut out through femoral head in 1 (14.29%) patient and 1 (7.69%) patient in PFN group due to varus collapse and complete backout of screw. Varus collapse was seen in 3 (42.86%) patients in DCS group and 4 (30.76%) patients in PFN group. Proximal femoral nail is better implant as compared to dynamic condylar screw which was statistically significant in terms of lesser operative time, higher union rate and better functional outcome. So PFN is a better implant choice for unstable trochanteric fractures when compared with DCS.

Introduction: Surgical site infections (SSI) encompass 20-25% of all hospital-acquired infections with their prevalence ranging from 2.5 to 41.9% across the world. Prevalence and risk factors of SSI vary greatly between countries and between healthcare institutions within a country. There is limited data on the pattern and risk factors of SSI in the Indian healthcare scenario. This study is an attempt to identify risk factors of SSI in patients who underwent elective laparotomy in the general surgery department of a tertiary care hospital in India.

Methodology: This is an observational cross-sectional retrospective study, conducted over 5 years from January 1, 2015, to December 31, 2019. A total of 112 patients who underwent elective laparotomy in the department of general surgery, were enrolled in the study. Data collection was done from hospital case records and discharge summaries of patients.

Results and discussion: Out of the 112 patients, a total of 16 patients (14.29%) developed surgical site infections. Preoperative serum total protein (W-465.500, P 0.012) and length of hospital stay (W=1235.000, P≤0.001) were found to have a significant association with surgical site infection. Age, gender, smoking, comorbidity, class of surgical wound and, preoperative albumin did not show any significant association with the development of SSI. Escherichia coli was the predominant organism isolated in culture.

Conclusion: Measures to curtail SSI can only be adopted after a thorough understanding of its prevalence and predictors. The characteristics and pattern of SSI will help identify prevalent organisms, their resistance pattern and will aid in formulating antibiotic policy tailor-made for the healthcare institution.

Background: Renal failure is one of the dangerous chronic diseases that different solutions are used for dialysis in these patients. Arteriovenous graft (AVG) and arteriovenous fistula (AVF) are two communication methods for dialysis in these patients, associated with pain, sensory and Pulse disturbances, and even limb necrosis. Using cubital AVF and AVG for hemodialysis is a critical issue in vascular surgery. Arterial steal syndrome is an essential medical condition requiring surgical interventions. In this research project, we decided to measure the incidence of steal syndrome among AVF and AVG patients and compare them with each other.

Methods: This cohort study was performed in Al-Zahra Hospital, Isfahan, Iran, from 2018 to 2020. Two hundred one patients undergoing AVF or AVG were included, and patients were followed for six months. The frequency of pain symptoms, anesthesia and pulse disorders, necrosis of the limbs, and the frequency of steal syndrome were assessed.

Results: Among the studied patients, 2 cases in the AVF group and 10 cases in the AVG group had steal syndrome, and there was a significant difference between the two groups based on the frequency of steal syndrome (P=0.007). Also, there was a considerable difference between the two groups based on the pulse disorder (P<0.05), but there was no significant difference between the two groups in terms of symptoms of sensory impairment, pain, and evidence of necrosis (P>0.05).

Conclusion: AVF technique is better than AVG in creating symptoms of steal syndrome, and also, the number of symptoms such as pulse disorder was relatively less seen in the AVF method.

Background: Clubfoot is one of the most common foot deformities in children. Surgical treatment is the only choice for patients who have failed conservative treatment. To the best of our knowledge, no studies have been done to compare the McKay surgery with a pin versus without a pin. Our study aimed to compare the outcomes of McKay surgery with and without pins in clubfoot patients.

Method: This study is an analytical study. The sample size included patients referred to Imam Reza Hospital from 2016 to 2018. Children who did not respond to plaster therapy were under McKay surgery. In this study, patients were divided into two groups of 50 patients. In the first group, after ligament release and tendon extension, a pin was used to maintain the direction of the talonavicular joint. In the second group, no pin was used. Every six months, radiographs were taken of the patients to monitor their progress. After collecting the study data, they were entered into SPSS software (version 25, IBM Corporation, Armonk, NY) and analyzed.

Result: The mean age of patients was 5.36±2.07 months. Of these, 79 were boys and 21 girls, most of the subjects were aged 4-6 months, and 24% had unilateral one-way clubs. The severity of the disease was 7 feet in grade 2 (moderate) and 93 feet in grade 3 (severe). There was a significant relationship between age, outcome and type of complications with surgical type.

Conclusion: Finally, it can be concluded that McKay surgery (both with and without a pin) is exceptionally effective at treating clubfoot.

Background: Intramedullary nail fixation is currently the modality of choice in surgical treatment for atypical femoral fractures (AFF). Its uses are limited, however, in severely bowed femurs, narrow medullary canals, or in the presence of thick endosteal callus at the apex of the femoral curve. In these cases, extramedullary plate osteosynthesis is preferred. The consideration when adopting plate osteosynthesis is whether a short or long segment fixation is superior. We hypothesize that a long segment fixation has the potential advantage of protecting the entire length of the femur from future fractures in the adynamic bone. In this series, we present two cases from our institution, with the aims of discussing the benefits and limitations of short versus long segment plate fixation in AFF.

Case summary: We report two uncommon cases of bisphosphonate-related AFF in two Asian patients with severe femoral curvature, who were treated with extramedullary plate osteosynthesis at our institution. One patient underwent fixation with a short segment plate osteosynthesis, and the other received a long plate osteosynthesis spanning the proximal to distal femur in an attempt to protect the bone from future fractures. Both patients showed a favourable and uncomplicated course post-surgery, with early return to ambulation and radiographic bone union at follow up.

Conclusion: We expect to see an increase in the number of patients with AFF and bowed femurs, especially with the increased usage of bisphosphonates given an ageing Asian population. Surgical treatment with short and long plate osteosynthesis are options with their own advantages and limitations. With the advent of new anatomical plate options, long segment fixation has become more accessible and may be considered in this patient group as it has the potential advantage of protecting the adynamic femur from future fractures. Further studies should be targeted to determine which method of treatment is superior in this particular group of patients.

The problem of deep frostbites belongs to one of the most complex in surgery. Treatment of such victims is very prolonged, expensive, requiring crippling operations resulting in disability. The purpose of this present study is of etiological structure of the wound microflora and its tolerance to antibacterial preparations in patients with cold injury in the regions with warm climate of severe degree. 57 microbiological investigations of wound secretions in 38 patients with severe cold injury treated in our Burn Department of RSCUMA, Samarkand, Uzbekistan had been carried out. Microflora of wounds in patients who suffered from cold injury is characterized by polyetiology and is presented by gramnegative (49.5%) and grampositive (50.5%) microorganisms. There are Pseudomonas aeruginosa (17.9%). Among gramnegative microorganisms. In this context sensitivity to preparations owing activity to Pseudomonas aeruginosa-Ceftazidim, Ceferin and Amycacin makes 48.8%, 54.5% and 81.3% accordingly. Prevailing flora of grampositive is Staphylococcus aureus (26.3% of agents), of which 60% makes MRSA. High resistance to Ciprofloxacin (66.6%), Erythromycin (52.5%) and Lincomycin (44.4%) is noted. The investigations give evidence that ABT in patient with severe frostbites is a serious problem and needs well-ground approach in prescribing antibacterial preparations.

Pyogenic granuloma (PG) is a benign vascular proliferative tumor of the skin and mucous membranes, it can appear spontaneously or following triggering factors. Different clinical aspects are described, pyogenic granulomas following burns (GB) are rare. We report a case of post-burn pyogenic granuloma confirmed by histological study and treated surgically. This new observation will allow us to further clarify this condition.