Chinese Journal of Traumatology最新文献

To overcome the drawbacks of traditional balloon tibioplasty (BT), this study designed a complete scheme for applying 3-dimensional (3D)-printed guide plate to BT, and preliminarily verified the feasibility. The authors report a patient with tibial plateau fracture. 3D models were constructed using CT data of patient. Guided K-wires and reduction fragments were generated using the Mimics/Geomagic software. A 3D model of the quasi-platform part was subsequently generated using the outer platform surface profile. Extension arms and Kirschner pinholes were generated by sketching, wrapping, shearing, and performing Boolean and other operations. The guide plate was created using 3D printing and surgically verified. The verification results showed that the quasi-platform part was placed smoothly, fitted the physiological curvature of the articular surface, and maintained stable reduction, demonstrating the feasibility of the guide plate. Compared with traditional BT, 3D-printed guide plate-assisted BT has the theoretical advantages of accurate reduction, prevention of bone cement leakage, short operation time, and low surgical difficulty, thus providing a new method for the treatment of Schatzker type II/III tibial plateau fractures.

Purpose: Pedestrian chest injuries remain a significant global concern, ranking as the second leading cause of death in traffic accidents. Although human body model (HBM) provides a strain-based methodology for predicting pedestrian chest injuries, conventional deflection-based injury metrics remain valuable due to their hard validation of HBM biofidelity at the tissue response level. Consequently, achieving accurate chest injury assessment through HBM technology represents a critical biomechanical research challenge. This study aims to identify the optimal method for defining thorax deflection in HBM to improve injury assessment in vehicle-pedestrian collisions.

Methods: A simulation matrix was designed, incorporating 5 different vehicle front-end types, 3 impact angles, 4 collision speeds, and 2 pedestrian postures, resulting in a total of 120 pedestrian-vehicle collision simulations. The simulations utilized the Total Human Model for Safety version 4.02 pedestrian model and predefined chest bands spanning from the upper to the lower chest. A total of 4 distinct methods for defining chest deflection were tested across the simulations. Principal component analysis was applied for dimensionality reduction to further refine the analysis. Two biomechanically distinct injury risk functions were employed to assess chest injury: the strain-based method, incorporating principal strain distributions across 12 ribs, and the deflection-based method, based on our pre-defined 6 chest band measurements.

Results: Our experimental findings reveal that injury risk decreases initially as the bonnet leading edge height increases, reaching a minimum around 950 mm with abbreviated injury scale 3+ and the number of fractured ribs (NFR) 3+ risk below 0.2, and then increasing thereafter. The study also demonstrated minimal chest injury risk acrossNFR2+/NFR3+ and NFR7+ conditions, with NFR risk below 0.2, despite localized high rib strain observed in certain individual ribs up to 8.28 × 10^-3. Meanwhile, A newly developed index termed PC_deflection, which is derived from the sum of the products of the weighting factors corresponding to 2 optimal thorax deflection measurement methods with NFR3+ correlation coefficients of 0.743 and 0.753, was identified as an effective predictor of injury risk in HBM simulations.

Conclusion: This study successfully determined the optimal method for measuring thorax deflection for HBM chest injury prediction, which could serve as a complementary metric for pedestrian chest injury assessment.

Purpose: Driven by population aging, osteoporosis, and the frequent coexistence of multiple chronic conditions, hip fractures mainly occur in adults aged ≥70 years. Nevertheless, the specific burden attributable to this population remains insufficiently understood. This study sought to address key gaps in the literature by analyzing the Global Burden of Disease 2021 dataset to investigate hip fracture patterns across age, sex, and sociodemographic index (SDI).

Methods: We extracted hip fracture incidence, prevalence, years lived with disability (YLD), and age-standardized rates from the Global Burden of Disease 2021 database and stratified the data by age, sex, SDI, and geographic regions. Temporal trends were assessed by Joinpoint Regression Analysis and average annual percentage change, while uncertainty intervals were calculated to reflect modeling variability.

Results: From 1990 to 2021, the global burden of hip fractures in adults aged ≥70 years increased significantly, with age-standardized prevalence rates climbing from 3521.6 to 4366.8 per 100,000 and age-standardized incidence rates increasing from 1866.9 to 2218.5 per 100,000, whereas the age-standardized YLD rate demonstrated minimal growth (384.4-386.5 per 100,000). Notably, a persistent gender gap was observed, with females bearing a higher absolute burden, while males exhibited significantly faster growth rates in prevalence, incidence, and YLD. Moreover, the burden increased dramatically with advancing age. Geographically, high-SDI regions retained the highest absolute caseload; middle-SDI regions exhibited the fastest-growing prevalence and incidence rates, whereas low-SDI regions recorded the highest YLD rate.

Conclusions: Global hip fracture burden in adults aged ≥70 years arises from aging populations, biological vulnerabilities, and healthcare inequities. High-income nations face the largest caseloads due to demographic shifts, while low-resource settings grapple with rising disability rates from delayed diagnosis and limited care. Effective mitigation requires age-specific osteoporosis screening, fall prevention programs, and multidisciplinary care, demanding collaborative efforts for equitable resource allocation and regional-tailored strategies in aging populations worldwide.

Genitourinary tract injury is involved in around 10% of blunt abdominal trauma, with the kidney accounting for most cases. Surgical treatment in the form of exploration has been traditionally used to control bleeding. Newer advances in interventional radiology, with improvement in precise imaging and the localization of bleeding vessels, have led to a high success rate of angioembolization. We describe here a case of grade 4 right renal injury that underwent successful superselective angioembolization of the renal artery. A 26-year-old male presented to the emergency department of the trauma center, All India Institute of Medical Sciences, Patna with an alleged history of road traffic injury. A contrast-enhanced CT abdomen was done, which showed grade 4 right renal injury with active contrast leak from the branch of the right renal artery. On post-injury day 1, he had a drop in hematocrit/hemoglobin. He also had more progressive hematuria. He was shifted to the digital subtraction angiography room, where imaging showed contrast extravasation from a branch of the right middle segmental renal artery. There was no contrast extravasation seen after coil embolization. He was discharged after 1 week of hospital stay. He came for follow-up after 4 weeks, where a renal function test was normal and repeat ultrasonography of the abdomen showed a focal defect with scarring of the right renal mid-pole, along with mild right pyelectasis and maintained vascularity at all renal poles. The major cause of bleeding after renal trauma is due to rupture of the renal artery and its branches. Such a patient undergoes a routine CT with contrast to determine the source and grade of renal injury. Such cases are now best managed using superselective angioembolization, depending on the availability of interventional radiology.

Purpose: Lactate and base excess are being utilized for management and prognostication in trauma patients despite their inherent limitations. Recently, parathyroid hormone (PTH) showed better accuracy in predicting blood transfusion and mortality compared with lactate. This study compared the utility of lactate, base excess, and PTH as biomarkers in trauma resuscitation as well as outcome.

Methods: A prospective observational study was performed at a Level I trauma centre in consecutive adult patients presenting primarily with at least class III trauma haemorrhagic shock from January 2021 to December 2023. Eighty-two patients were included. The comparison was done based on resuscitation response, mortality and need for emergency surgical intervention. Most of them sustained blunt injuries, the mean age was (34.3 ± 12.6) years, and 80% were men. PTH measurement was added to the standard laboratory workup on presentation and subsequently during resuscitation. The categorical variables were analysed using Chi-square test whereas continuous variables were analysed with student t-test. The data were analysed using SPSS 30 software.

Results: Patients who were non-responders to initial resuscitation measures (28.0%) had significantly higher mean initial lactate levels compared with responders (5.9 ± 4.5 vs. 7.6 ± 4.3; p = 0.043). Base excess and PTH level difference were not statistically significant. No biomarkers were significantly different between patients needing emergency surgery in comparison to those who did not. Initial mean base excess levels were significantly high in the deceased group compared with survivors (-12.0 ± 7.4 vs. -8.5 ± 5.6; p = 0.071). At reassessment, all 3 biomarkers were significantly different between survivors and non-survivors.

Conclusion: Lactate, base excess, and PTH in isolation could not predict response and outcomes among trauma patients with haemorrhagic shock. Failure of these markers to normalize over time was associated with significantly higher need for blood product transfusion as well as mortality.