International Journal of Burns and Trauma最新文献

The development of a Marjolin ulcer at the site of a split-thickness skin graft donor site is exceptionally rare. Here we describe the rapid development of squamous cell carcinoma at a split-thickness skin graft donor site in the setting of severe burn. We present a case of a 52-year-old male with no past medical history who presented with a 24% total body surface area burn caused by a flash flame. Four months after his initial excision and grafting, he presented for revision of a burn scar with an additional complaint of a rapidly developing skin lesion at his donor site, which arose over 2 weeks. The lesion was excised en bloc and found to be invasive squamous cell carcinoma. There are 5 previous cases of squamous cell carcinoma development at the site of split-thickness skin harvest in the setting of severe burn. While the typical Marjolin ulcer has a latency period of up to 30 years, lesions that arise in split-thickness skin graft donor sites appear to have a rapid onset of weeks to months. Squamous cell carcinoma at the site of split-thickness skin grafting is an uncommon but important sequelae of burn care.

Objectives: The aim of this study was to compare and evaluate Putty Index and Custom Template Technique for Direct Composite restoration of uncomplicated crown fractures in permanent anterior teeth.

Material and methods: A total of 100 teeth were randomly allocated to the respective groups, n=49 in Group I and n=51 in Group II. Composite build up using Putty Index technique in Group I and vacuum formed Custom Template in Group II was done followed by finishing and polishing of the restoration. The restorations were scored using Modified USPHS criteria by two blinded and calibrated evaluators at baseline, 6 months and 12 months followed by Spectrophotometric evaluation. The clinical chair side time was recorded using digital clock.

Results: No statistically significant difference was seen between ITT and PP analysis among the two groups at 6 months and 12 months follow-up. Mean time chair side time taken for Group I was 20 minutes and for 24.4 minutes for Group II which was statistically significant (P=0.00). No statistically significant change was seen in the colour of the restoration at 6 months (P=0.45) and 12 months (P=1.00) using spectrophotometer.

Conclusion: Custom Template technique and Putty Index technique showed no statistically significant difference in terms of clinical evaluation at baseline, 6 months and 12 months except for postoperative sensitivity.

Background: Clubfoot constitutes roughly 70 percent of all foot deformities in arthrogryposis syndrome and 98% of those in classic arthrogryposis. Treatment of arthrogrypotic clubfoot is difficult and challenging due to a combination of factors like stiffness of ankle-foot complex, severe deformities and resistance to conventional treatment, frequent relapses and the challenge is further compounded by presence of associated hip and knee contractures.

Method: A prospective clinical study was conducted using a sample of nineteen clubfeet in twelve arthrogrypotic children. During weekly visits Pirani and Dimeglio scores were assigned to each foot followed by manipulation and serial cast application according to the classical Ponseti technique. Mean initial Pirani score and Dimeglio score were 5.23 ± 0.5 and 15.79 ± 2.4 respectively. Mean Pirani and Dimeglio score at last follow up were 2.37 ± 1.9 and 8.26 ± 4.93 respectively. An average of 11.3 casts was required to achieve correction. Tendoachilles tenotomy was required in all 19 AMC clubfeet.

Result: The primary outcome measure was to evaluate the role of Ponseti technique in management of arthrogrypotic clubfeet. The secondary outcome measure was to study the possible causes of relapses and complications with additional procedures required to manage clubfeet in AMC an initial correction was achieved in 13 out of 19 arthrogrypotic clubfeet (68.4%). Relapse occurred in 8 out of 19 clubfeet. Five of those relapsed feet were corrected by re-casting ± tenotomy. 52.6% of arthrogrypotic clubfeet were successfully treated by the Ponseti technique in our study. Three patients failed to respond to Ponseti technique required some form of soft tissue surgery.

Conclusion: Based on our results, we recommend the Ponseti technique as the first line initial treatment for arthrogrypotic clubfeet. Although such feet require a higher number of plaster casts with a higher rate of tendo-achilles tenotomy but the eventual outcome is satisfactory. Although, relapses are higher than classical idiopathic clubfeet, most of them respond to re-manipulation and serial casting ± re-tenotomy.

Background: Thermal injury has a significant impact on disability and morbidity in pediatric patients. Challenges in caring for pediatric burn patients include limited donor sites for large total body surface area (TBSA) burn as well as optimization of wound management for long term growth and cosmesis. ReCell^® technology produces autologous skin cell suspensions from minimal donor split-thickness skin samples, allowing for expanded coverage using minimal donor skin. Most literature on outcomes reports on adult patients.

Objective: We present the largest to-date retrospective review of ReCell^® technology use in pediatric patients at a single pediatric burn center.

Method: Patients were treated at a quaternary care, free-standing, American Burn Association verified Pediatric Burn Center. A retrospective chart review was performed from September 2019 to March 2022, during which time twenty-one pediatric burn patients had been treated with ReCell^® technology. Patient information was collected, including demographics, hospital course, burn wound characteristics, number of ReCell^® applications, adjunct procedures, complications, healing time, Vancouver scar scale measurements, and follow-up. A descriptive analysis was performed, and medians were reported.

Results: Median TBSA burn on initial presentation was 31% (ranging 4%-86%). The majority of patients (95.2%) had placement of a dermal substrate prior to ReCell^® application. Four patients did not receive split thickness skin grafting with their ReCell^® treatment. The median time between date of burn injury and first ReCell^® application was 18 days (ranging 5-43 days). The number of ReCell^® applications ranged from 1-4 per patient. Median time until wound was classified as healed was 81 days (ranging 39-573 days). The median maximum Vancouver scar scale measurement per patient at time healed was 8, ranging from 3-14. Five patients who received skin grafts had graft loss and three of these patients had graft loss from areas with ReCell^®.

Conclusion: ReCell^® technology provides an additional method for wound coverage, either on its own or in conjunction with split thickness skin grafting, and is safe and effective in pediatric patients.

Background: Topical desiccation agent (TDA) is an acidic species in a gel with a potent hygroscopic action. When in contact with (water in) biofilm and necrosis, rapid desiccation occurs, with the dehydrated tissues typically sloughing off in 1-3 days. This allows for quick granulation tissue formation which is an essential step for healing by secondary intention or as wound bed preparation for grafting.

Methods: A series of nine non-healing, post-trauma lesions on the lower leg were treated with TDA, followed by treatment of the lesion with vaseline gauze.

Results: The average age of the patients was 77.0 years and the lesions had been in existence for 5.6 months on average. The average size of the lesion was 15.9 cm². Complete granulation of all lesions was reached in an average of 34.1 days while the time to complete reepithelialization averaged, 69.8 days (data from one outlier removed). There were no adverse events.

Conclusion: These data suggest TDA treatment is an effective and efficient way to debride lesions, and to prepare them for healing by secondary intention or for grafting.

Chordoma is an uncommon malignant bone tumour of low metastatic potential, the commonest site of which being sacrum. We intend to report two cases of giant sacrococcygeal chordoma managed surgically. The first patient presented with natal cleft swelling since past 3 years which on examination had a size of 12*10*14 and was mildly tender, non reducible, non pulsatile and non fluctuant. The swelling had a variegated surface and extended from sacral region till 2 cm above anal verge. The second patient presented with low backache with radiation to the left lower limbs along with numbness in posterior aspect of left thigh. Physical examination in the second patient was near similar to that in first case except the decreased perianal sensation with otherwise normal neurology in the second patient. The imaging and histopathology was consistent with sacroccocygeal chordoma in both cases. Both patients underwent wide margin resection with preservation of both S2 and right S3 roots. Effective management of sacrococcygeal chordoma requires early diagnosis, accurate preoperative staging, definitive and adequate surgical resection with proved tumour-free cut margins while in those declining surgery, radiotherapy can be considered as an alternative.

Purpose: The effects of residual displacement on the functional outcome of the patient are not distinctly known and the acceptability criteria of residual displacement of the pelvic ring remain disputed. The purpose of this study is to evaluate the effect of residual displacement on functional outcome in pelvic ring injuries.

Materials and methods: A total of 49 patients with pelvic ring injuries (both operative and non-operative) were followed up for six months. Anteroposterior (AP), Vertical and rotational displacements were measured at admission, after surgery and at six months. Resultant displacement (vector addition of AP and vertical displacement) was taken for comparison. Displacement was graded as excellent, good, fair and poor according to Matta's criteria. Functional outcome assessment was done at six months using Majeed score. Work adjusted Majeed score was calculated for non-working patients by taking the percentage score.

Results: We compared the means of residual displacement with functional outcome (Excellent/Good/Fair) and found that there was no significant difference between the groups in operative (P=0.33) or non-operative patients (P=0.09). This showed that patients with relatively higher residual displacement also had satisfactory functional outcomes. The functional outcomes were compared after dividing the residual displacement into 2 groups: <10 mm and >10 mm and no significant difference was found in outcomes for either operative or non-operative patients.

Conclusion: Up to 10 mm of residual displacement is acceptable in pelvic ring injuries. More prospective studies with a longer follow up are needed for determination of correlation between reduction and functional outcome.

Introduction: Femoral neck fractures present a significant challenge for orthopedic surgeons, especially in young patients who want to preserve their natural femoral head. Conventional methods for fixing these fractures often lead to poor outcomes and high complication rates. The Biplane Double-supported Screw Fixation (BDSF) technique is a novel approach that involves placing screws in two planes simultaneously, creating a two-point support for the screws in the neck and head of the femur.

Methods: This study aimed to evaluate the effectiveness of the BDSF technique in treating femoral neck fractures in patients aged 20-60 years. A total of 28 patients with fresh femoral neck fractures (less than three weeks old) were treated with closed reduction and internal fixation using the BDSF method. The patients' functional outcomes were evaluated using the Harris hip score, and the radiographic outcomes of union, femoral neck shortening, screw back-out, and femoral head avascular necrosis (AVN) were also evaluated.

Results: The results showed that the BDSF technique is a safe and effective method for treating femoral neck fractures in young adults. Out of the 25 patients who were followed up for a mean time of 18 months (range 6-24 months), 20 (80%) achieved fracture union in a mean time of 5.2 months. Non-union occurred in five patients (20%), and AVN of the femoral head was observed in three patients (12%). Two patients experienced varus collapse, but their fractures united successfully.

Conclusion: The BDSF technique offers several advantages over conventional methods, including increased stability and improved fixation strength. It can be considered as an alternative to conventional methods for managing femoral neck fractures in young adults, with a low incidence of non-union and avascular necrosis and no cases of fixation failure or varus collapse.

Grisel's syndrome is a non-traumatic subluxation of the atlantoaxial joint following an inflammatory process in the upper respiratory tract. Patients with Down syndrome have higher risks of developing atlantoaxial instability. This issue is mainly due to low muscle tone, loose ligaments, and alterations to the bone in patients with Down syndrome. Accompaniment of Grisel's syndrome and Down syndrome was not perused in recent investigations. To our knowledge, only one case of Grisel's syndrome in an adult patient with Down syndrome has been reported. In this study, we present a case of Grisel syndrome in a 7-year-old boy with Down syndrome following lymphadenitis. A 7-year-old boy with Down syndrome was admitted to the orthopedic ward of Shariati hospital with a possible diagnosis of Grisel's syndrome and treated with mento-occipital traction for ten days. In this case report, we represent a child with Down syndrome with Grisel's syndrome for the first time. We also imitated a simple and applicable non-surgical treatment for Grisel's syndrome.

Background: The COVID-19 pandemic has affected everyone's life. In India, the nationwide lockdown was enforced from March 25, 2020. It has significantly affected the healthcare delivery system. Both-bone forearm (BBFA) fractures are commonly encountered as an emergency. Surgical management with plate fixation is often the primary mode of management in adults and adolescents. During the first wave of the COVID-19 pandemic, follow-up of patients with BBFA fractures who had undergone surgery before the lockdown was severely affected. To understand the effect of lack of regular follow-up on the outcome of BBFA fracture patients, in this study, we assessed their radiological, functional, and clinical outcomes at least 12 months after surgery. This study examined if a lack of routine follow-ups in surgically treated BBFA fracture patients has any impact on their short-term outcomes.

Methods: We included 30 patients with BBFA fractures who were operated prior to the COVID-19 lockdown and assessed their radiological, functional, and clinical outcomes 12 months after surgery. Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, Patient-Rated Wrist Evaluation (PRWE) score, Grace and Eversmann's score, and Mayo Elbow Performance Index (MEPI) score were assessed subjectively. Fracture site tenderness, and wrist, forearm, elbow, and grip strength range of motion (ROM) were objectively evaluated. Radiological union was recorded using standard forearm anteroposterior and lateral radiography.

Results: At follow-up, 28 patients had union at the fracture site, and two patients had a nonunion. A significant reduction was observed in the mean ROM of the injured forearm compared with the uninjured forearm in supination (17.76% less), pronation (31.4% less), dorsiflexion (32% less), palmar-flexion (24.6% less), elbow flexion-extension arc (2.5% less), and grip strength (18% less). The percentage reduction in pronation and dorsiflexion was higher than that in supination and palmar-flexion, respectively. Grace and Eversmann's score was excellent in 16 patients, good in 4, acceptable in 7, and poor in 3 patients. The mean QuickDASH score was 6 ± 6.6. The mean PRWE and MEPI scores were 7 ± 4.5 and 87.16, respectively. The MEPI score was excellent in 21 patients, good in 6, fair in 2, and poor in 1 patient.

Conclusion: The clinical, functional, and radiological outcomes of adult patients with BBFA fractures who were treated with compression plating were satisfactory. Inadequate follow-up during the COVID-19 first wave in India had minimal to no effect on their short-term outcomes.