ORIGINAL_ARTICLE
Delayed Splenic Rupture; Normal Appearing Spleen on the Initial Multidetector Computed Tomography (MDCT) Can Sometimes Be Misleading
Introduction: Delayed splenic rupture (DSR) is an unusual outcome following blunt abdominal trauma. Although DSR is defined as bleeding more than 48 hours after blunt trauma in a previously hemodynamically stable patient, a review of the reported cases in the literature shows that in almost all of the cases the initial CT imaging revealed some form of damage to the spleen. Case Presentation: Here we describe an extremely rare condition in a case that presented with a DSR following blunt trauma and had a normal appearing spleen in the initial post trauma MDCT scan. Conclusions: DSR is a serious consequence of trauma and is associated with a significantly higher mortality rate compared with the overall mortality for acute splenic injuries. A High index of suspicion along with the liberal serial utilization of the imaging studies are the essential elements for early detection of DSR.We propose that DSR be considered as a differential diagnosis in patients presenting with hemodynamic instability late post trauma, even when the immediate post trauma MDCT scan has shown a normal appearing spleen. We suggest that every patient with a high impact injury or injuries to peri-splenic organs should have a repeat MDCT scan 2 - 3 days post trauma or before the patients is discharged from hospital.
https://www.traumamon.com/article_100031_c9f255c6afc6dac7a42ed950949881e5.pdf
2016-11-01
10.5812/traumamon.24465
Delayed Splenic Rupture
spleen
Blunt Trauma
Complications
CT scan
Imaging
Alireza
Hamidian Jahromi
1
AUTHOR
Matias
Migliaro
2
AUTHOR
Melisa
Romano
3
AUTHOR
Guillermo
Sangster
4
AUTHOR
ORIGINAL_ARTICLE
Validation of an Iranian Trauma Data Collection Form
Background: Knowing the direction of traumatic injury is important as the information can help avoid death after trauma. A trauma registry usually entails detailed information about the demographics, cause, intensity of the injury, and the final diagnosis and outcome of the trauma-affected patient. Researchers should be able to evaluate all aspects of trauma injury and the patient’s status. Objectives: The purpose of this study was to develop a trauma data collection form. Materials and Methods: The development of the trauma registry form began in February 2013. The variables were finalized by a team consisting of general and trauma surgeons, specialists in emergency medicine, orthopedists, neurosurgeons, and public health professionals who have special interest in trauma research. The scale was sent to 10 specialists for validation. Results: After assessing the scale validity twice, it was accepted with an integrator agreement of 0.89. The test-retest reliability was assessed in a convenience sample of 20 physicians (Kendall t = 0.97; P < 0.001). Such a high reliability may reflect redundancy of some items. Conclusions: It is essential to establish a secure multicenter trauma registry in Iran for data collection, storage, and assessment of traumatic injury and these registries must be easy to install and use.
https://www.traumamon.com/article_100032_71fbe3afe7585479f7a7b47184e3b7be.pdf
2016-11-01
10.5812/traumamon.24686
Trauma
Validation
Traumatic Injury
Hadi
Khoshmohabat
1
AUTHOR
Hamid Reza
Rasouli
2
AUTHOR
Zahra
Danial
3
AUTHOR
Mohammad Reza
Ghane
4
AUTHOR
ORIGINAL_ARTICLE
Vertical Patellar Dislocation: Reduction by the Push Up and Rotate Method, A Case Report and Literature Review
Introduction: Patellar dislocation is an emergency. Vertical patellar dislocation is rare, often seen in adolescents and mostly due to sports injuries or high-velocity trauma. Few cases have been reported in the literature. Closed or open reduction under general anesthesia is often needed. We report a case of vertical locked patellar dislocation in a 26-year-old male, which was reduced by a simple closed method under spinal anaesthesia. A literature review regarding the various methods of treatment is also discussed. Case Presentation: A 26-year-old male experienced a trivial accident while descending stairs, sustaining patellar dislocation. The closed method of reduction was attempted, using a simple technique. Reduction was confirmed and postoperative rehabilitation was started. Follow-up was uneventful. Conclusions: Vertical patellar dislocations are encountered rarely in the emergency department. Adolescents are not the only victims, and high-velocity trauma is not the essential cause. Unnecessary manipulation should be avoided. The closed reduction method is simple, but the surgeon should be prepared for open reduction.
https://www.traumamon.com/article_100033_9ef6aa2ac269f5b36648e86081860128.pdf
2016-11-01
10.5812/traumamon.24705
Vertical Patellar Dislocation
Closed Reduction
Push
up
and
Rotate Method
Hayat
Ahmad Khan
1
AUTHOR
Adil
Bashir Shah
2
AUTHOR
Younis
Kamal
3
AUTHOR
ORIGINAL_ARTICLE
Predictive Factors of Dependency in Activities of Daily Living Following Limb Trauma in the Elderly
Background: Traumatic injuries in the elderly often lead to permanent disabilities and long-term treatments that can adversely influence their activities of daily of living (ADL). The effect on ADL is an important outcome in elderly trauma. Objectives: The present study was designed to evaluate the predictive factors of dependency in ADL following limb trauma in elderly referred to Shahid Beheshti Hospital, Kashan, Iran, in 2013. Patients and Methods: This descriptive study was conducted on 200 traumatic patients admitted to the trauma emergency ward of Shahid Beheshti hospital in 2013. The questionnaire used in this study had three parts: demographic data, information related to trauma, and an independence scale of ADL (ISADL). The ISADL was completed in the emergency ward to declare pre-traumatic status; it was also completed one and three months after trauma. Statistical analysis was conducted by the t-test and analysis of variance (ANOVA). The repeated measure was used to study the trend of the ISADL and other demographic variables. The multiple regression analysis was also used to declare the predictive variables related to the ISADL. Results: The study population consisted of 81 males (40.5%) and 119 females (59.5%). The participants’ average age was 70.57 ± 9.05 years. In total, 80.5% of the elderly were completely independent in ADL before trauma; this decreased to 13.5% one month after trauma. The repeated measure analysis showed a significant improvement in the ISADL three months after trauma. Gender, age, and education had significant interaction with the ISADL. The multiple regression analysis showed that type of trauma and location of injured organ had predictive values related to the ISADL, one and three months after trauma. The place and cause of trauma, and having surgery showed a significant relationship with the ISADL three months after trauma. Conclusions: Many factors, such as gender, age, education, type of trauma, and location of injured organ,may predict ADL following limb trauma
https://www.traumamon.com/article_100034_a0baa5ce0126703cf651106d092dab97.pdf
2016-11-01
10.5812/traumamon.25091
Trauma
Elderly
activities of daily living
Azade
Safa
1
AUTHOR
Negin
Masoudi Alavi
2
AUTHOR
Masoumeh
Abedzadeh-Kalahroudi
3
AUTHOR
ORIGINAL_ARTICLE
Evaluation of the Effect of Glibenclamide in Patients With Diffuse Axonal Injury Due to Moderate to Severe Head Trauma
Background: Traumatic brain injury (TBI) is a major health problem worldwide. Secondary injuries after TBI, including diffuse axonal injury (DAI) often occur, and proper treatments are needed in this regard. It has been shown that glibenclamide could reduce secondary brain damage after experimental TBI and improve outcomes. Objectives: We aim to evaluate the role of glibenclamide on the short-term outcome of patients with DAI due to moderate to severe TBI. Patients and Methods: In this controlled randomized clinical trial, 40 patients withmoderate to severe TBI were assigned to glibenclamide (n = 20) and control (n = 20) groups. Six hours after admission the intervention group received 1.25 mg glibenclamide every 12 hours. The Glasgow coma scale (GCS) was administered at admission, in the first 24 and 48 hours, at one week post-trauma and at discharge. The Glasgow outcome scale (GOS) was also administered at discharge. All results were evaluated and compared between groups. Results: Patients treated with glibenclamide compared to the control group had a significantly better GCS score one week posttrauma (P = 0.003) and at discharge (P = 0.004), as well as a better GOS score at discharge (P = 0.001). The glibenclamide group also had a shorter length of hospital stay compared to the control group (P = 0.03). In the control group, two patients (10%) died during the first week post-trauma, but there was no mortality in the glibenclamide group (P = 0.48). Conclusions: Treatment with glibenclamide in patients with DAI due to moderate to severe TBI significantly improves short-term outcomes.
https://www.traumamon.com/article_100035_d41d8cd98f00b204e9800998ecf8427e.pdf
2016-11-01
10.5812/traumamon.25113
Diffuse Axonal Injury
Traumatic Brain Injury
Glibenclamide
outcome
Peyman
Zafardoost
1
AUTHOR
Amir Abbas
Ghasemi
2
AUTHOR
Firooz
Salehpour
3
AUTHOR
Chia
Piroti
4
AUTHOR
Ehsan
Ziaeii
5
AUTHOR
ORIGINAL_ARTICLE
Femoral Intertrochanteric Fracture With Spontaneous Lumbar Hernia: A Case Report
Introduction: The diagnosis of lumbar hernia can be easily missed, as it is a rare case to which most orthopedists are not exposed in their common clinical practice. Approximately 300 cases have been reported in the literature since it was first described by Barbette in 1672. Case Presentation: A 76-year-old woman who had been diagnosed with a femoral intertrochanteric fracture was sent to our department. Physical examination revealed a smooth, soft, and movable mass, with no tenderness, palpable on her left flank, which had gradually increased during the last seven years and presented with a slight feeling of swelling. We initially misdiagnosed the case as a left lipoma combined with the femoral intertrochanteric fracture. However, after six hours, the patient presented with a sudden onset of nausea, vomiting, and abdominal distension. Afterward, computed tomography (CT) examination confirmed that the mass was a spontaneous lumbar hernia. Conclusions: A lumbar hernia may, on rare occasions, become incarcerated or strangulated, with the consequent complication of mechanical bowel obstruction. We suggest that a patient with a flank mass should always raise suspicions of a lumbar hernia.
https://www.traumamon.com/article_100036_1db6ccdeeb7c991ad9b8ce07f108407b.pdf
2016-11-01
10.5812/traumamon.25132
Intertrochanteric fractures
Lumbar
Hernia
Spontaneous
Peng
Luo
1
AUTHOR
Xing-Wen
HE
2
AUTHOR
Qing-Yun
Chen
3
AUTHOR
Hao
Hong
4
AUTHOR
Lei
Yang
5
AUTHOR
ORIGINAL_ARTICLE
Uncemented Total Hip Replacement After Two Years of Neglected Hip Dislocation With Fracture of Posterior Column and Wall of the Acetabulum
Introduction: Posterior hip dislocation of the hip with acetabular fracture is a challenging problem to treat. Such dislocations are associated with avascular necrosis of the femoral head if neglected. Managing such conditions with total hip replacement (THR) is very difficult because of associated altered anatomy. Case Presentation: We hereby report a two-year neglected hip dislocation with associated acetabular fracture successfully treated with uncemented THR. The patient was successfully treated with uncemented THR and experienced significant improvement in his functional status, with a Harris hip score of 82 at the two-year follow up. Radiologically, there were no radiolucent areas or osteolysis, with good consolidation of the bone graft. Conclusions: A neglected hip dislocation with acetabular fracture can be managed satisfactorily with uncemented THR. Bone reconstruction using chunk grafts and use of cementless components ensures long-term survival and also preserves adequate bone stock for revision, especially in young patients.
https://www.traumamon.com/article_100037_e81b1d4078477fe39fe596b63fe9b214.pdf
2016-11-01
10.5812/traumamon.25301
Hip Dislocation
Neglected
THR
Uncemented
Sundaresh
DC
1
AUTHOR
Sharath K
Ramanath
2
AUTHOR
Amit
Grover
3
AUTHOR
Daksh
Gadi
4
AUTHOR
ORIGINAL_ARTICLE
A Comparison of Self-Inflicted Stab Wounds Versus Assault-Induced Stab Wounds
Background: Although self-inflicted and assault-induced knife injuries might have different mortality and morbidity rates, no studies have actually evaluated the importance of the cause of knife injuries in terms of patient outcomes and treatment strategies. Objectives: The aims of this study were to assess the difference between the outcomes of patients presenting with self-inflicted stab wounds (SISW) versus assault-induced stab wounds (AISW). Patients and Methods: A retrospective review of the relevant electronic medical records was performed for the period between January 2000 and December 2012 for patients who were referred to the department of surgery for stab wounds by the trauma team. The patients were divided into either SISW (n = 10) or AISW groups (n = 11), depending on the cause of the injury. Results: A total of 19 patients had undergone exploratory laparotomy. Of the nine patients with SISW undergoing this procedure, no injury was found in seven of the patients. In the AISW group, eight of the ten laparotomies were therapeutic. Three patients in the AISW group died during hospital admission. The average number of stab wounds was 1.2 for the SISW group and 3.5 for the AISW group. Organ injuries were more frequent in the AISW group, affecting the lung (2), diaphragm (3), liver (5), small bowel (2), colon (2), and kidney (1). Conclusions: Although evaluations of the initial vital signs and physical examinations are still important, the history regarding the source of the stab wounds (AISW vs. SISW) may be helpful in determining the appropriate treatment methods and predicting patient outcomes.
https://www.traumamon.com/article_100038_71a27cb52e6b04eb3c48bbed336ab9fc.pdf
2016-11-01
10.5812/traumamon.25304
Stab Wounds
Exploration
self
Stabbing
Assault
mortality
Sanghyun
Ahn
1
AUTHOR
Dong Jin
Kim
2
AUTHOR
Kwang Yeol
Paik
3
AUTHOR
Jae Hee
Chung
4
AUTHOR
Woo-Chan
Park
5
AUTHOR
Wook
Kim
6
AUTHOR
In Kyu
Lee
7
AUTHOR
ORIGINAL_ARTICLE
Tibial Lengthening Using a Fixator-Assisted Lengthening Plate: A New Technique
Background: There are many techniques that are used for limb lengthening. Lengthening a limb over a plate is an alternative choice used in children or when using an intramedullary nail is difficult. Objectives: In this study, we presented a new technique for tibial lengthening using a monolateral external fixator over a lengthening plate. Materials and Methods: For tibial lengthening, a monolateral external fixator was attached to the composite bone model medially. After a corticotomy was performed, the lengthening plate was placed laterally. Three locking screws were inserted proximally, and two cortical screws were inserted into a lengthening hole that was 1 cm below the osteotomy site. We avoided contact between the screws of the lengthening plate and the pins of the external fixator. During bone lengthening with the monolateral external fixator, the screws at the lengthening hole were able to slide distally with the distal segment of the tibia to allow for tibial elongation. Two locking screws were fixed at the distal locking holes of the plate when the bone elongation was complete. The external fixator was then removed. Results: The fixator-assisted lengthening plate allowed bone lengthening without malalignment. There were no mechanical problems associated with the external fixator during the lengthening process. Plate osteosynthesis was stable after the fixator was removed. There was no contact between the screws of plate and the Schanz pins of the external fixator under C-arm fluoroscopy. Conclusions: The fixator-assisted lengthening plate technique helps to maintain the stability and alignment at both sides of an osteotomy during tibial elongation. It allows the early removal of the external fixator immediately after lengthening is completed. This technique can be applied in children with open physes and in patients with a narrow medullary canal who are unsuitable for limb lengthening over an intramedullary nail.
https://www.traumamon.com/article_100039_624ebe00ee7c81095dcf5443f3fb7ee7.pdf
2016-11-01
10.5812/traumamon.25340
External Fixator
Lengthening Plate
Tibial Lengthening
Malalignment
Haci
Bayram Tosun
1
AUTHOR
Ismail
Agir
2
AUTHOR
Seyitali
Gumustas
3
AUTHOR
Sancar
Serbest
4
AUTHOR
Abuzer
Uludag
5
AUTHOR
Suat
Celik
6
AUTHOR
ORIGINAL_ARTICLE
Mass Fatalities in Hajj in 2015
https://www.traumamon.com/article_100040_767a398f91b4095d6e5497fbc7a8ed4c.pdf
2016-11-01
10.5812/traumamon.43253
Mohammad
Ganjeh
1
AUTHOR
Behzad
Einollahi
2
AUTHOR