International Journal of Burns and Trauma最新文献

Background: Burns are still one of the most prevalent injuries in the world. Allograft is in high demand as a biological dressing for any superficial open wounds, not just burn victims. Skin allograft is the gold standard for treating burns in people who do not have enough skin to cover all of the injured areas of their bodies. Studies have shown that skin allografts are superior to topical antimicrobial dressings in partial thickness burns and can reduce complications and length of hospital stay in burn patients. However, to the best of our knowledge very few studies have investigated these results in our country. The aim of the current study is to evaluate and report the outcomes of skin allograft on burn patient survival in Iran.

Method: This prospective clinical trial study was performed on patients admitted to the burn center of Imam Khomeini Hospital in Tehran between July 15, 2017 and April 27, 2021. The control group consisted of patients admitted to the burn ward who were not undergoing skin allografts. This group was matched with the case group in terms of sex, age, and percentage of burns. We compared the outcome of the study was the duration of hospitalization, and status of patients at discharge. The study protocol was approved by Iranian Registry of Clinical Trials (IRCT) under the code of IRCT2016112431074N1 (https://fa.irct.ir/trial/24517).

Result: Overall, 112 patients in the case group and 224 patients in the control group were studied. The length of hospital stay in the case group (41.13±11.7) was considerably longer than the control group (24.6±12.1) (P<0.001), but the mortality rate in the two groups was not statistically different (P=0.633). The average survival time of case group (53 days, 95% CI=45-56) was higher than the control group (49 days, 95% CI=39-58) (P=0.012). Number of allograft usage (OR=0.038, 95% CI=0.142-0.945) and also Age (OR=1.03, 95% CI=1.005-1.070) were predictors of death.

Conclusion: Although the use of skin allografts in large burns (more than 50%) reduced mortality in burn patients, their use in burns less than 50% has not been effective in reducing patient mortality. Due to the limited access to this valuable product, its use in burns less than 50% should be done with caution and, due to the limited access to skin allografts in most burn centers in Iran, patients with extensive burns (more than 50%) should be used as a priority.

Background: The morphology of distal femur and proximal tibia varies between different ethnicities, and it can affect the tunnel dimensions and positions while doing ACL reconstruction which may affect the clinical outcome. There is limited data on the clinical outcome and CT based tunnel placement evaluation in femur and tibia of Indian nonathletic population.

Methods: Thirty non-athletic patients with mean age of 25.50±6.9 years and ACL rupture who underwent single bundle hamstring autograft arthroscopic ACL reconstruction by anteromedial portal were included in the study. Their preoperative IKDC Score, Lysholm-Tegner score, Tegner activity level were calculated and knee stability was assessed clinically using anterior drawer test, Lachman test and pivot shift test. The CT scan of the operated knee was done once the complete extension of the knee was achieved. Using the multimodality workstation available at the department of radio-diagnosis the tunnel parameters of femoral and tibial tunnel was calculated. After 6 months the patients were reassessed for clinical and radiological outcome. The postoperative outcome was compared with preoperative outcome.

Results: There was a significant difference in preoperative and postoperative score, the difference in IKDC score was 15.08 points, improvement of 14.65 points was seen in Lysholm-Tegner score and there was marked improvement in Tegner activity level. Tests for knee stability were normal in >90% of patients postoperatively. The CT evaluation showed that the femoral tunnels were positioned at 28.45%±3.69% (20.16%-38.35%) along the deep-shallow axis and 25.81%±3.819% (20.69%-37.35%), the mean tunnel obliquity compared to the femoral shaft axis were 47.34°±5.427° (37.68°-58.16°) in the coronal plane and 47.93°±7.023° (35.11°-63.95°), the mean tunnel length was 3.38 cm±0.331 cm (2.79 cm-4.18 cm). The tibial tunnel were positioned at 45.63%±5.832% (32.23%-58.23%) along the anterior-posterior axis and 47.70%±2.26% (42.40%-51.96%) along the medio-lateral axis. The tibial tunnel length was found to be 3.89 cm±0.519 cm (3.05 cm-5.06 cm).

Conclusion: This study helps to ascertain that the ACL reconstruction via anteromedial portal technique using femoral offset zig followed by postoperative home-based rehabilitation technique gives favorable clinical outcomes in Indian non-athletic patients. All patients had improvement in stability of knee after the surgery. The position of femoral tunnels was anatomical but in comparison to Caucasian patients its placement was deeper and higher. Hence, we conclude that the anteromedial portal technique of ACL reconstruction provides favorable clinical outcome and adequate anatomical tunnel placement in Indian non athletic patients.

Object: Burn is the major cause of disability in developing countries, and most burn patients have burns involving the upper limbs. Upper limb burns can result in scarring, contractures, and weakness, leading to limitation of wide range of movements and social well-being, hence reducing the quality of life. General objective: To determine the quality of life among patients with burns of the upper limbs at KNRH.

Methods: This cross-sectional study recruited 108 participants of 5 years and above during their first six months post-discharge from Kiruddu National Referral Hospital with burns to upper limbs. Recruitment was consecutive from the burns unit clinic following ethical approval from the School of Medicine Research and Ethics Committee (SOMREC). Participants were given a burn-related QOL questionnaire. Data were then entered into Epidata 4.2 and imported into STATA 15.1 for analysis. Factors associated with poor quality of life were determined by modified Poisson regression to generate prevalence ratios with 95% confidence intervals.

Results: A total of 108 participants were recruited for the study; 97 (89.8%) were adults and responded to the adult QOL questionnaire, while the rest were pediatrics. The mean age of the adults was 28 years (SD=8.6), while the median age of the pediatrics was eight years (IQR=6-10), and 61.1% were male. The upper extremity function (physical) quality of life was good, while the social relationship quality of life was poor. The factors associated with poor quality of life were degree (deep) of burns, multiple surgeries, age above 55 years, and being divorced.

Conclusions: There is generally poor upper extremity function or physical QOL among adults and children, while there is generally good social relationship QOL among adults and children.

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are conditions characterized by an immune-mediated skin reaction that results in blistering and epidermal detachment. Most cases are caused by drug hypersensitivity; however, recently there have been many publications documenting the association between coronavirus disease 2019 (COVID-19) and SJS/TEN. Our objective is to explore a case of a 4-year-old female who presented with a papular rash on her thighs that progressively worsened and spread to her face, trunk, and genital area. The patient tested positive for COVID-19. She required treatment with intravenous immunoglobulin (IVIG) and IV methylprednisolone, but eventually made a full recovery. This case underscores the need for awareness of the wide spectrum of dermatologic presentations in COVID-19 patients.

Non-healing wounds are a major complication of diabetes that can lead to limb amputation and disability in patients. The normal process of wound repair progresses through well-defined stages including hemostasis, inflammation, proliferative, and remodeling, which may be impaired in diabetic wounds. In recent years, it has been reported that keratinocytes, a major cell type in human skin, play a key role in the healing process of wounds. In this overview, firstly, a summary of the wound healing process is provided and the role of keratinocytes in wound healing is briefly reviewed. Then, a set of evidence about the impaired keratinocytes activities in diabetic wounds and clinical trials focused mainly on improving keratinocytes in the context of diabetic wound therapeutics are summarized. Keratinocytes can produce signaling molecules that act in a paracrine and autocrine way, causing pleiotropic effects on various cell types. The affected cells respond to keratinocytes by creating several signaling molecules, which also adjust keratinocyte activation through wound healing. In diabetic wounds, disruption of various biological mechanisms leads to dysfunction of keratinocytes including impaired migration, adhesion, and proliferation. The function of abnormal keratinocytes can lead to poor diabetic wound healing. Taken together, clarification of molecular and functional disturbances of keratinocyte cells and applying them in diabetic wounds can contribute to enhanced treatment of diabetic wounds. Based on the location of keratinocytes in the epidermis and the central role of keratinocytes in the diabetic wound healing process, applying keratinocytes has great potential for the treatment of diabetic burn wounds.

Trauma nurses commonly encounter stress and burnout and have increased negative affect states and decreased positive affect traits. This study investigated whether trauma center nurses would have improvements in wellbeing scores after reading and contemplating Spiritual Flow: Pathways to Proficient Patient Care and Nurse & Physician Wellbeing (Spiritual Flow). Trauma center surgical intensive care unit nurses completed a baseline and follow-up survey before and after reading and contemplating Spiritual Flow, which provides insights into spirituality and mindfulness. The survey contained four positive affect (PA) items, each rated 1-very little to 5-extremely, that were summed to create a PA score (PAS). The seven negative affect (NA) survey items were similarly rated and reverse coded, 1-extremely to 5-very little, to create a nonstress score (NSS). The PAS (4-20) and NSS (7-35) were summed to create a wellbeing score (WS). Nurses rated the degree to which they felt more peaceful or inspired after contemplating the book. Thirty-seven of 39 (95%) routine nursing staff members completed both surveys. Follow-up values increased for WS (P = 0.0001) and NSS (P = 0.0001) after reading and contemplating Spiritual Flow compared to baseline values. No changes occurred for PAS (P = 0.1606). Because 16% of nurses had a high PAS on the baseline survey, further analyses were performed on the other 84%. Significantly increased values were noted on follow-up for PAS (P = 0.0171), NSS (P = 0.0015), and WS (P = 0.0003) compared to baseline scores. Of 37 nurses, 24 (64.9%) rated feeling more peaceful and/or inspired as moderately or quite a bit. This pilot study suggests that contemplating Spiritual Flow was associated with improvements in surgical intensive care trauma center nurse wellbeing. These preliminary findings need to be confirmed in an investigation that includes a control group and randomization.

Introduction: Burns is the most common condition that requires extensive skin grafting. Treatment of burns is associated with long hospital stays, expensive medications, multiple surgeries, and long-term rehabilitation. Rapid healing of skin donor areas in partial-thickness burn wounds is important for the patient. Partial-thickness skin grafting is a technique that can reduce healing time and improve the treatment. Nanocrystalline silver contains antibacterial and anti-inflammatory properties. This study aimed to evaluate the efficacy of Agicoat in the treatment of partial-thickness skin graft donor sites of burn patients in terms of healing time, pain and scarring.

Method: This clinical trial study was performed on 100 patients who burn and were referred to Imam Khomeini Hospital in Tehran from July to January 2020. Patients with second- and third-degree burns who had burned 10 to 30 percent of their body surface and required partial-thickness skin graft surgery, were considered for this study. Each patient was compared to herself. The skin donor site was then randomly divided into three parts A, B and C and each part was dressed with Agicoat^TM, Mepitel and Vaseline gauze. On days 4 and 8, the amount of pain when changing the dressing was recorded based on visual analog scale (VAS). After six months, the patients were evaluated and compared for the scarring site based on Vancouver Scar Scale (VSS).

Result: Comparison of the average healing time between groups showed that the average healing time in both groups was significantly shorter than the Vaseline group (P=0.005). Comparison of wound pain between groups on Day 4 showed that the mean pain in the Agicoat group and also the Mepitel group was significantly lower than the Vaseline group (P=0.004). However, Agicoat and Mepitel groups did not show a significant difference. Also, a comparison of pain between groups on Day 8 and the mean VAS six months after skin graft showed no difference between groups.

Conclusion: According to the findings of this study, if the Agicoat dressing is cost-effective, it can be a good alternative to cover the wound of the skin donor site, and it heals faster and reduces pain.

Introduction: There are several studies on the angle of the femoral neck in different countries. It seems that data of diverse races might help the prediction of femoral neck fractures. The present study aimed to evaluate the femoral neck-shaft angle (FNSA) as a predictive factor of neck fracture in Iranian people.

Methods: In this cross-sectional study, the FNSA was measured using radiographs in 635 patients referred to Poursina Hospital in Rasht from September 2018 to October 2019. The body mass index (BMI) was calculated, age and sex of patients were recorded. Data were analyzed by SPSS. The level of statistical significance was adjusted to P<0.05.

Results: According to the measured variables, gender, age, BMI and right FNSA are significant in the way that participants with normal BMI have higher FNSA. FNSA decreased with age and height. Obese people had lower FNSA than normal and overweight people. Comparison of left and right angles using the Wilcoxon test showed a statistically significant difference (P<0.001). The right side FNSA was more than the left (59.94%). Only in 39.9%, the left FNSA was more than the right, and in 0.15% both were the same.

Conclusion: The present cross-sectional study shows a significant relationship between BMI and FNSA. It is suggested that physician evaluates these parameters for prediction of fracture risk in individuals.

Background: Treatments of pilon fracture is an important operative challenge due to high prevalence of post-operative complications. In this paper, we aimed to evaluate the complications of the use of low profile plates for pilon fractures.

Methods: This clinical trial that was performed in 2017-2021 in Isfahan on 27 patients with pilon fractures. Demographic data of patients such as age, gender, type of pilon fracture and baseline pathology of pilon fractures were collected. Patients were treated using low profile plates under surgical procedures. Within 1 month, 3 months and 6 months after surgeries, patients were visited and assessed regarding superficial wound infections, deep wound infections, and evidence of osteomyelitis, vascular injuries, non-union and mal-union using both physical examinations and imaging studies via X-ray. We also measured the functions of cases using The American Orthopedic Foot and Ankle Score (AOFAS) questionnaire.

Results: Most cases had 3 days (33.3%) and 5 days (33.3%) of hospitalization. Superficial wound infection was observed in 7 cases (26%). Deep surgical site infections were observed in 2 cases (7.4%) and we had only 1 case of osteomyelitis (3.7%). No vascular injuries were observed in this study. Evaluation of union among patients showed that 2 cases (7.4%) had non-union and 5 cases (18.5%) had malunion in the anterior-posterior axis, but none of the patients had malunion in the coronal axis. Based on AOFAS questionnaire, the mean score in patients was 88.36±14.20.

Conclusion: Treatments of pilon fractures by low profile plates have similar complications compared to other treatment options.

Introduction: Hemiarthroplasty is considered to be the treatment of choice for femoral neck fractures in elderly, however there is no consensus to support the choice between unipolar or bipolar hemiarthroplasty. Several studies found that patients with bipolar hemiarthroplasty had a better outcome of pain, a higher rate of return to the pre-injury state, and a greater range of hip motion. Some studies have demonstrated equal hip functional outcome between unipolar and bipolar hemiarthroplasty, but unipolar hemiarthroplasty was favoured due to its lower cost. The purpose of this study was to compare the functional and radiological outcome of cemented unipolar vs modular bipolar hemiarthroplasty in displaced femoral neck fracture in elderly patient population.

Methods: It is a prospective randomized study, with 44 patients in each group. Elderly Patients (>60 years of age) with traumatic displaced femoral neck fractures were included in the study. Cemented unipolar or modular bipolar hemiarthroplasty was performed in the respective patient groups using posterior or anterolateral approach. Functional outcome evaluation was done by Harris Hip Score and radiological outcome evaluation was done for acetabular erosion. The data was entered in MS EXCEL spread sheet and analysis was done using Statistical Package for Social Sciences (SPSS) version 20.0 (IBM, Chicago).

Results: The mean age in the unipolar and bipolar group was 67.2 and 66.1 years respectively. The average follow-up period was 20.1 and 22.3 months in the unipolar and bipolar group respectively. Mean operating time was significantly more in the modular bipolar group (78.3 minutes) compared to the unipolar group (67.3 minutes). Two patients (4.5%) had acetabular erosion in each group. Mean Harris Hip score at 3 months follow-up was significantly higher (p value <0.05) in bipolar group (75.8±4.2) than the unipolar group (77.7±2.9). However, subsequent follow-ups at 6 months (80.9±2.8, 82.0±2.5, p value >0.05) 12 months (83.1±2.2, 83.2±1.2, p value >0.05) and 24 months (85.5±2.4, 85.2±2.8, p value >0.05) did not show any significant difference between the two groups. The incidence of general complications was 34% in bipolar and 20.4% in unipolar hemiarthroplasty group.

Conclusion: Functional outcome in terms of Harris Hip Score are better in the bipolar group at 3 months follow up but there was no significant difference in the functional outcome between the two groups at 6, 12 and 24 months follow up. The operative time for unipolar is lower and statistically significant compared to bipolar hemiarthroplasty of the hip.