International Journal of Burns and Trauma最新文献

A scar is a normal and an inevitable physiological response to the natural healing process of wounds or trauma in the human body. The essence of scar is a kind of abnormal and unsound tissue that does not possess the structure, physiological function and vitality of normal skin tissue. Scars not only affect the beauty of the body surface, but also impede the physiological function of the related tissues and organs, and even lead to deformities. Therefore, scar repair is of great significance to patients' appearance, physiological function as well as physical and mental health. Currently, the main approaches for scar repair in clinic are photorejuvenation or fruit acids. The purpose of this study is to investigate the current research progress of scar repair and the impact of scar repair on the physical and mental health of patients.

Transolecranon fracture-dislocations are a result of high-energy trauma, caused due to axial loading of the flexed forearm, with associated anterior dislocation of the ulna with respect to the distal humerus. The usual management of these comminuted and unstable fractures is by using locking compression plates via the dorsal approach. However, plating in cases of poor soft tissue coverage and open wounds can be precarious. In this study, we aimed to evaluate outcomes of cerclage wiring in the management of comminuted trans-olecranon fracture-dislocations in such scenario. A total of seven patients diagnosed with trans-olecranon fracture-dislocation with poor soft tissue coverage who underwent cerclage wiring were included in the study. The aim was to realign the proximal portion of the olecranon to the trochlea and restore the normal ulnohumeral articular relationships accomplished by the anatomical reconstruction of the greater sigmoid notch. Reconstruction of the proximal ulna was started from the distal to the proximal direction so as to convert an unstable fracture into a stable one. After the reduction of the proximal fragment, two long 2 mm K wires were inserted from the tip of the olecranon into the intramedullary canal (with at least 1 wire passed subchondrally), and later cerclage was done. Postoperatively the patient was immobilized for a duration of two weeks and was later started on active assisted mobilization of the elbow. All patients showed fair-to-excellent outcome on the Mayo elbow performance score (MEPS) at the final follow-up (five patients had an excellent score, one had a good score, and one had a fair score). At the final follow-up, the mean extension, flexion, pronation and supination were -20, 117.14, 82.85 and 78.57 degrees respectively. The key components of such management are the restoration of articular congruity, including continuity of the sigmoid cavity, ulnar length, and early initiation of active elbow movements to avoid joint stiffness. Optimal functional results can be achieved with K wire and cerclage when a stable anatomic reconstruction is accomplished, as a feasible alternative to plating.

Background: Mandibular condylar fractures mostly result from traumatic accidents or strife. There is still dispute on the effectiveness of various therapeutic methods. Here we aimed to evaluate and compare the open or closed repair methods for mandibular condylar fractures.

Methods: This is a clinical trial that was performed in 2015-2021 in Iran on all patients that referred to our medical centers with mandibular fractures due to traumatic events. Those cases with severe lateral dislocation of the mandibular condyles or severe dislocations of the fractured parts were assigned to the open surgical treatment group. The other patients were treated using Arch bar + intermaxillary fixation (IMF). The patient's abilities of mouth opening were assessed in centimeters within 1 month, 3 months, 6 months, 1 year and 2 years after the operations.

Results: 726 mandibular fractures were evaluated. Our data showed that 302 fractures (41.6%) were in the mandibular condyles. Of the 302 condylar fractures, 172 fractures (57.1%) occurred due to automobile accidents and 82 fractures (27.5%) occurred due to direct trauma. 203 patients (67.2%) underwent the close surgical procedures using maxillary and mandibular fixation using arch bar + IMF. 99 patients (32.8%) underwent open mandibular fixation operation and internal fixation (ORIF). Assessments of mouth opening showed significant improvements in this ability within the follow-up period in both groups (P<0.001 for both). Furthermore, we observed that patients treated by the open mandibular fixation procedure had significantly better results within the 6 months and 1 year after the procedures but after 2 years, no significant differences could be observed between groups.

Conclusion: Both open and closed surgical approaches for condylar fractures are associated with significant improvements, however, patients that were treated with ORIF had better clinical results in the first year after the surgical procedures.

Introduction: In this study, we investigated the usefulness of blood white blood cell (WBC), C-reactive protein (CRP) and Procalcitonin (PCT) levels with a clinical diagnosis of infection in patients with severe burns, with a bacterial culture (+) wound site, in patients with SIRS and sepsis.

Materials and methods: In the study, 23 patients with (+) burn wound culture hospitalized in the intensive care unit of Gazi Yaşargil Training and Research Hospital Burn Center burn between January 2016 and January 2021 were analyzed. While five of these patients were showing symptoms of SIRS. Sepsis was observed in five patients.

Results: From 23 patients, 18 (78.3%) were male, and 5 (21.7%) were female. The majority of our patients were lived in rural areas. The average age of patients was 1,061±17,273 years. The wound culture results of the 23 patients were (+), mostly due to Staphylococcus aureus in 21.7% (n=5) and Staphylococcus epidermidis in 21.7% (n=5). PCT and CRP results did not statistically differ in patients with sepsis, SIRS and (+) wound culture.

Conclusion: The laboratory biomarkers WBC, CRP and PCT do not have a superior value in determining and monitoring infection processes in patients with serious burns.

Background: Intramedullary nailing and closed reduction are one of the most important treatment strategies for femoral shaft fractures. Malrotation in the femoral shaft is a complication that requires exact investigations. Here we aimed to evaluate and report the outcomes of malrotation of femur in patients with femoral shaft fractures following antegrade intramedullary nailing.

Methods: In this cross-sectional study, 140 patients who had referred to Shahid-Beheshti Hospital in Abadan, Iran and had undergone antegrade intramedullary fixation for isolated femoral shaft fracture during a 6-year period from 2015 to 2021 were enrolled. Demographic information and disease-related information were collected. During operation, the patients were assessed clinically for malrotation of femur with 90° of the knee flection and with the hip in 0° flexion and then in the postoperative follow-up period, the patient was examined again and a computed tomography scan requested to identify the degree of malrotation of femur and the observers were unaware of the CT scan result at the time of the clinical examination. We also measured the amount of internal and external rotation while the patient in the lying supine position with 90° flexion in the knee and hip joint and lying prone position with hip extension. In CT imaging to determine the amount of malrotation of femur, the angle between a line drawn across the two femoral condyles in the posterior aspect and the femoral neck shows the amount of rotation.

Results: Degree of rotational deformity, less than 5°, 5 to 10° and 10 to 15° was less than 8.6%, 75.7% and 15.7% respectively and did not relate to age, sex, fracture location and activity of the patients (P>0.05). There was a strong linear correlation with the average predictive power between clinically detected torsional deformity in comparison with the CT detected torsional deformity (r=0.333 and P=0.005), which was stronger in women than men (r=0.336 in men and r=0.659 in women) (P<0.05). There was a strong linear correlation with the average predictive power between clinically detected torsional deformity in comparison with the CT detected torsional deformity was observed only in external malrotation of femur (r=0.541 and P=0.001). A poor inverse linear relationship was observed between clinically detected and CT detected torsional deformity with the age of the patients which the correlation of clinically detected was more than the CT detected (r in clinical examination =-0.285 and r in CT measurement =-0.246) (P<0.05).

Conclusion: In this study, there was no femoral malrotation over 15° that was associated with clinical symptoms. However, a CT scan should be performed for accurate diagnosis and necessary measures but it does not seem necessary to perform in all patients.

Introduction: Femur neck fractures are common fractures among the elderly. Hemiarthroplasty is a surgical choice for femur neck fractures in patients older than 70 years. This surgery is performed using two main methods: Posterolateral and Direct lateral. Here in this study, we aimed to evaluate and compare surgical and post-surgical complications of these two methods.

Materials and methods: This retrospective study was performed on 154 patients with femur neck fractures between 2017-2021. All patients with femur neck fractures who had been under hemiarthroplasty entered this study. Data regarding complications such as dislocation, mortality, cause of mortality, repeated surgery and incidence of deep vein thrombosis (DVT) in both Posterolateral and Direct lateral surgical approaches were collected and analyzed.

Results: We indicated that there is no significant difference between the two surgical approaches regarding dislocation (P=0.06), mortality (P=0.598) and repeated operation (P=0.550).

Conclusion: Taken together there are no significant differences between the two surgical approaches and we suggest that clinicians could decide based on their experiences and the clinical condition of patients.

Background: The literature is gradually drifting towards a graft of larger diameter for successful ACL reconstruction. There is no published literature regarding the anthropometric predictors for the diameter of the peroneus longus tendon (PLT) graft obtained in ACL reconstruction through the inframalleolar approach.

Methods: Fifty-two patients were finally evaluated for anthropometric parameters to predict quadrupled PLT graft diameter in ACL reconstruction using the inframalleolar technique. Intraoperative quadrupled PLT graft diameter was correlated to the patient's anthropometric data such as age, height, weight, duration of injury, and BMI. We used regression analysis in a stepwise manner to ascertain anthropometric indices associated with the graft diameter.

Results: This study included 46 males and six females. Mean age was 28.2 ± 7.4 years, mean height was 172.7 ± 2.8 cm, mean weight was 75.6 ± 3.4 kg, mean BMI was 25.3 ± 0.9 kg/m², mean duration of injury was 9.2 ± 3.9 months, and mean graft diameter was 9.3 ± 0.4 mm. Positive correlation with graft diameter was found only with height (r = 0.6, P < 0.01) and weight (r = 0.4, P < 0.01). On analysing through linear regression, height and weight had significant association with graft diameter, and we formulated the following prediction equation: PLT graft diameter (mm) = 0.083 × height (cm) + 0.011 × weight (kg) -5.854.

Conclusion: Patients' characteristics, including height and weight, have a significant correlation with quadrupled PLT graft diameter and the average diameter of graft is > 9 mm through this approach.

Introduction: Sideswipe injuries are most commonly described in passengers traveling in a car or bus, but here we report an unusual mode of sideswipe injuries, in passengers traveling in a train sitting on window seats with elbow protruding outside the window.

Case series: Four patients reported to our Orthopaedic emergency 2 hours after a railway track accident with more or less similar pattern of injury, an open proximal forearm monteggia fracture-dislocation with bone and soft tissue loss along with closed fracture humerus, and with or without radial nerve palsy and intact distal pulses. We followed a multidisciplinary approach with initial wound lavage followed by wound debridement, stabilization of monteggia and humerus fractures with different justifiable modalities of treatment with an exploration of the radial nerve.

Discussion and conclusion: Sideswipe injury is a well-known case entity in literature, classically described mode of trauma is when an elbow protruding out of the window of a vehicle struck by a moving or fixed object. However, in our series patients sitting in a train on window seat with elbow protruding outside sustained sideswipe injury which has not been reported in literature. We also explained the mechanism of impact forces caused bony and soft tissue injury in our series presented in diagrammatic representation. Hence, the purpose of this case series is to spread the awareness regarding such kind of preventable injury which can be easily prevented with awareness, and an appropriate preventive measure can be taken by the local administration.

Metacarpal fractures are common injuries and comprise nearly 36% to 42% of all fractures in the hand. The majority of these can be managed non-surgically. Operative fixation when needed, can be done by a variety of techniques. In this study, we have compared the outcomes of two techniques, plate-screw fixation and K-wire fixation. We have conducted a prospective, non-randomized, comparative study of patients who presented with extra-articular metacarpal shaft fractures of non-thumb metacarpals over a period of 18 months. 30 patients were enrolled according to the inclusion criteria and were alternately allotted to the plate-screw group and the K-wire group. At admission, patient demographics, clinical features, number of fractures, and fracture patterns were recorded, and radiographs were taken. In the plate-screw group, low-profile plates and screws were used, and in the K-wire group, 1 or 2 K-wires were used for fixation after fracture reduction. Hand mobilization exercises were started within one week in the plate-screw group, while in the K-wire group full mobilization was allowed at 4 weeks post-surgery. The Disabilities of Arm, Shoulder and Hand (DASH) score was calculated and compared between the two groups at 6 months and 12 months after surgery. The mean 6-month DASH score in the plate-screw group was 6.3287±2.2453, while it was 17.1627±6.2103 in the K-wire group (p value <0.001). At the end of 1-year follow-up, the mean DASH score in the plate-screw group was 5.1080±1.6637, and in the K-wire group, it was 5.1073±1.9392 (p value =0.848). In conclusion, extra-articular metacarpal shaft fractures of the non-thumb metacarpals treated by plate-screw fixation had significantly better DASH scores and hence better functional outcomes at the end of 6 months. However, at the end of 1 year, the DASH scores in both the groups were almost similar, suggesting similar functional outcomes in the long term.

Background: Burn trauma is a significant health problem that has physical, psychological, and economic reaction on affected patients. Burn patients have different length-of-stay (LOS) due to the complexity of the injury itself. This study aimed to find factors affecting the LOS and cost of burn patients (2017-2018) in Guilan province, north of Iran.

Materials and methods: This cross-sectional study includes all 899 hospitalized burn patients who were admitted for the first time (first visit). Data about cost, LOS, and demographic variables were extracted from the hospital registry system. Data were analyzed using t-test, ANOVA, and Linear regression by SPSS 22 software.

Results: Nearly 62% of the burn patients were male, and 38% were female. Hot liquid or vapor were the leading causes for burns hospitalization (n = 345; 39.07%). The majority of patients (n = 465; 52.31%) were at level three of burn (total thickness). The upper limb that included head, neck, shoulder, back, hand (45.44%), lower limb (38.25%), multiple or total body (11.36%) were the most organs that were affected by burning. Direct medical costs for patients varied from 0 to 18,550 US$, which was 1489 US$ on average. Patients' length of stay ranged from 1 to 47 days, which was 3.22 days on average.

Conclusion: The result showed Adverse consequences burned hot liquid and hot steam burns most common reason that it is important to take preventative methods for this type of patient. Improved patients with the third level cost more and stay longer. Other factors such as underlying disease, urbanity, used antibiotics, sex, and insurance coverage can also be decisive. The burnt percentage also has a direct and significant relationship with medical costs and length of stay. Insurance organization has a direct and significant relationship with the length of stay. Also there was a direct relationship between multiple burns and the patients' length of stay and hospitalization costs.