2024-03-29T19:18:15Z
https://www.traumamon.com/?_action=export&rf=summon&issue=13539
Trauma Monthly
Trauma Mon
2251-7464
2251-7464
2011
16
4
Out With the Old; in With the New
Mohammad Hosein
Kalantar Motamedi
2011
01
01
153
153
https://www.traumamon.com/article_99781_d18b1978e84d7bd0cbe79fb93023ddf6.pdf
Trauma Monthly
Trauma Mon
2251-7464
2251-7464
2011
16
4
Treatment of Segmental Loss of the Tibia by Tibialisation of the Fibula: A Review of the Literature
Alireza
Rahimnia
Frank
Fitoussi
George
Penneçot
Keywan
Mazda
Segmental defects of the tibia are challenging therapeutic problems for both the physician and the patient. These defects may be caused by severe trauma, infection, tumors and congenital processes. Several different techniques have been described for treatment of these defects including the Papineau technique, allograft reconstruction, bone transport using the Ilizarov frame, free vascularized fibular graft, tibiofibular synostosis and medial transport of the fibula with Tuli’s technique, use of the Ilizarov frame and Huntington’s procedure. All of these techniques have their specific advantages as well as disadvantages. Some of these techniques are used rarely i.e. the Papineau technique. The procedure of choice for most large tibial defects is bone transport with Ilizarov’s technique; but in some cases the tibial remnant is inadequate for lengthening and we must use alternative treatments. In the three aforementioned techniques, the fibula is transferred with peroneal and anterior tibial muscles on a pedicle of peroneal vessels. This transfer retains a biological component of vital bone that allows for a shorter time for consolidation, increased remodeling potential and resistance to infection. It also has better long-term mechanical properties. Hypertrophy of the centralized fibula is described as attaining twice its original diameter or twice the size of the contralateral tibia. Hypertrophy has been seen in nearly all cases of the fibular centralization. Maximum hypertrophy is seen in children and besides patient age, is related to bony union and weight bearing. The reported time for hypertrophy of fibula varies from one to four years. No significant change in the diameter of the fibula was observed after five years. Fracture of tibialized fibula was not reported in many studies of fibular centralization with different techniques. In the reviewed articles, there were no cases of valgus deformity of the ankle. Either the patients were satisfied with the final results despite appearance of the lower extremity and the presence of some angular deformities, although in most cases, the deformities were mild. In this review we conclude that tibialisation of the fibula in selected cases is a reasonable alternative for the treatment of massive tibial defects.
segmental
Fibula
Ilizarov Technique
Tibia
2011
01
01
154
159
https://www.traumamon.com/article_99782_4388bc6a6df985fc20e72a79660e2cd0.pdf
Trauma Monthly
Trauma Mon
2251-7464
2251-7464
2011
16
4
Arterial Damage Accompanying Supracondylar Fractures of the Humerus
Mohammad Ali
Mohammadzadeh
Maryam
Mohammadzadeh
Ali
Mohammadzadeh
Rasoul
Herfatkar
Vahid
Mohammadzadeh
Iraj
Baghi
Hamid
Heydari
Sona
Najaf
Michael
Jalili
Background: Arterial damage is sometimes associated with supracondylar fractures of the humerus. Diagnosis and careful management of the fracture and arterial repair is crucial. Objectives: The aim of this study was to determine the prevalence and outcome of supracondylar fractures of the humerus with signs and symptoms of limb ischemia, before and after arterial decompression or arterial reconstruction. Materials and Methods: From September 2004 to July 2010, 225 consecutive patients with supracondylar fracture of the humerus were prospectively recruited. Results: From among 75 cases with Gartland type III fractures, 22 were found to have vascular injury.. Of the 22 cases with vascular injury, 7 patients underwent arterial reconstruction. The other 15 received arterial decompression. All patients had a satisfactory outcome. Conclusions: A high level of suspicion and careful clinical evaluation leading to an early diagnosis and management of vascular injury accompanying supracondylar fracture is very important to prevent unnecessary sequelae ranging from limb claudication, and compartment syndrome to more severe complications like Volkmann’s contracture and even limb loss.
humerus
Fractures
Bone
2011
01
01
160
163
https://www.traumamon.com/article_99783_5c3f5cd4cb9edf4085c0435d3d0db0cf.pdf
Trauma Monthly
Trauma Mon
2251-7464
2251-7464
2011
16
4
Addition of Clonidine in Caudal Anesthesia in Children Increases Duration of Post-Operative Analgesia
Marzieh
Lak
Hasan
Araghizadeh
Shahnas
Shayeghi
Behroz
Khatibi
Background: Pain in infancy is a developmental process. Due to the underdeveloped pain pathways in the spinal cord, the threshold of stimulation and sensation of pain is low at birth and has potential impacts on increasing the central effects of pain. Primary trauma during infancy can cause long term changes in structure and function of pain pathways that continue until adulthood. Lack of pain management in children can result in morbidity and mortality. Objectives: In this study we examined the duration of post-operative analgesia in children when clonidine is added to bupivacaine in caudal anesthesia. Materials and Methods: In this clinical trial, 40 children aged 1-8 years who were candidates for elective inguinal hernia repair were studied. Induction and maintenance of anesthesia were achieved using sodium thiopenthal, halothane and nitrous oxide. Children were randomly divided into 2 groups in a double-blind fashion, and were given caudal anesthesia with 0.125% bupivacaine (1ml/kg) alone or b bupivacaine plus 2 µg/kg clonidine. Blood pressure and heart rate were recorded peri-operatively. Analgesia was evaluated using objective pain scale (OPS) and sedation was assessed using Ramsay sedation scale (RSS). Acetaminophen was administered rectally for cases with OPS score greater than five. Results: Duration of analgesia was found to be significantly longer in the group given bupivacaine plus clonidine (mean 417.50 min vs. 162.00 min). Peri-operative hypotension or bradycardia, post-operative respiratory depression, nausea or vomiting were not recorded in any patient. Conclusions: We concluded that addition of clonidine to bupivacaine prolongs the duration of post-operative analgesia without any respiratory or hemodynamic side-effects.
analgesia
Bupivacaine
Clonidine
anesthesia
Caudal
2011
01
01
170
174
https://www.traumamon.com/article_99784_eae6fb2e100a52be1a07802e7d234ee3.pdf
Trauma Monthly
Trauma Mon
2251-7464
2251-7464
2011
16
4
Milligan-Morgan Hemorrhoidectomy vs Stapled Hemorrhoidopexy
Seyed Mohsen
Towliat Kashani
Shaban
Mehrvarz
Seyed Morteza
Mousavi Naeini
Reza
Erfanian
Background: The stapled hemorrhoidopexy (SH) is a procedure for prolapse and hemorrhoids . At first SH seemed to be a good alternative for the Milligan Morgan (MM) hemorrhoidectomy and preliminary results in early 2000 confirmed it. However, further studies and evaluation of long-term results showed poorer outcomes. Objectives: This study aimed to evaluate and compare the results of these 2 surgical procedures in terms of recovery, improvement of symptoms and incidence of complications. Materials and Methods: This study was conducted from April 2008 to August 2010. A total of 80 patients were divided into 2 groups of 40 each. In the SH group, there were 24 males (60%) and 16 females (40%) with a mean age of 48 ± 12.5 yrs. In the MM group, there were 30 males (75%) and 10 females (25%) with a mean age of 50.6 ± 17.3 yrs. Patients with grade 3 and 4 prolapsed hemorrhoids were entered in the study. Data were entered using SPSS software and analyzed using t-test and Chi-square test. Results: The two groups had no significant difference in terms of age or sex. Duration of surgery was 35 ± 7 minutes in the SH and 23.6 ± 13.5 minutes in the MM group. This difference was statistically significant (P = 0.000). Post-operative pain and complete pain relief was slightly lower in the MM group (not significant). Hospital stay was significantly longer in the MM group (P = 0.003). Return to work was similar in both groups. Three patients in the SH group (7.5%) and 2 in the MM group (5%) had hemorrhoid recurrence. Conclusions: Both techniques are efficient treatment methods for grade III and IV hemorrhoids and are associated with greater than 95% recovery rate. Overall, outcomes are the same in both techniques. Lower postoperative pain was the only advantage of SH over MM technique.
surgical procedures
Milligan Morgan
Stapled Hemorrhoidopexy
2011
01
01
175
177
https://www.traumamon.com/article_99785_23e43e93933e701514db7188d591f2d9.pdf
Trauma Monthly
Trauma Mon
2251-7464
2251-7464
2011
16
4
Experience With Reverse Sural Flap to Cover Defects of the Lower Leg and Foot
Ali
Ebrahimi
Nasrin
Nejadsarvari
Ehsan
Shams Koushki
Background: Coverage of traumatic soft-tissue defects in the lower limb is a common procedure. Objectives: The purpose of this prospective case series study was explore the capacity of the perforator-based sural flap in reconstruction surgery of patients with high velocity gunshot wounds in the distal third of the leg and heel pad of the foot. Patients and Methods: A prospective case series study was undertaken to assess the sural fasciocutaneous flap carried out in our hospital, from 2010 to 2011. This case series study comprised eight patients, seven men and one woman with an average age of 35 years (19-55) and with a mean follow-up duration of 13 months (6-24 months). All patients had a history of a gunshot wound in distal part of the leg and heel pad of the foot with large soft-tissue defects; treatment was done using the reverse sural flap.. Results: We performed reverse sural flaps in eight gunshot patients, to cover the defects of the lower leg and foot. Surgical site infection observed in one patient (12.5%) was treated successfully with antibiotic therapy. The reverse sural flap provided a satisfactory coverage for gunshot defects in all the patients. Conclusions: Reverse sural flap is a useful and versatile reconstructive method in patients with gunshot wounds of the lower leg and foot.
Sural Nerve
Surgical Flaps
Wounds
Gunshot
Lower extremity
2011
01
01
178
181
https://www.traumamon.com/article_99786_4ec6e2cfa83eb5603f96377c76709e58.pdf
Trauma Monthly
Trauma Mon
2251-7464
2251-7464
2011
16
4
Comparison of the Efficacy of Two Local Haemostatic Agents
Nader
Nowshad
Masoud
Saghafinia
Farzad
Panahi
Shahram
Bolandparvaz
Nader
Tanideh
Background: In modern life, the incidence of traumatic injuries increases daily. In accidents which lead to trauma, massive bleeding is the main cause of death. Nowadays, many different chemical and herbal agents are available for quick control of bleeding. Objectives: In this study, we compare the effectiveness of two different types of chemical agents for control of bleeding in an animal model. Materials and Methods: This research was done comparing two hemostaticagents- "Chitohem" and "Quikclot". Ten healthy IR Iranian sheep were chosen and were blindly divided into two different groups. In each of the groups, one of the aforementioned agents was to be applied. First, four main limb arteries of the sheep were dissected linearly and after measuring the volume of bleeding in the first 60 seconds, the chemical agent was applied to the site of bleeding. After that, the duration of bleeding, the volume of bleeding and the secondary blood pressure were measured and compared. Results: There were no significant differences between the primary features of the animals in two groups (Weight, Baseline Systolic Blood Pressure and Pre-treatment Blood loss). In dependent quantities such as the volume of bleeding after the usage of chemical agents, secondary systolic blood pressure, the results were in favor of "Quick Clot" (P < 0.001 for volume of bleeding, P = 0.008 for secondary blood pressures and P < 0.001 for the necessary time for the bleeding to stop). Conclusions: In this study, it seems that activity of "Quikclot" in cessation of bleeding of large arterial vessels was slightly better than "Chitohem". Due to limitations which we had in this study, further studies are necessary to show the actual differences between these agents and their side effects.
Trauma
Models
animal
2011
01
01
188
190
https://www.traumamon.com/article_99787_60d55dcee394fa1407850a57e46fa07a.pdf
Trauma Monthly
Trauma Mon
2251-7464
2251-7464
2011
16
4
Assigning Residents of Emergency Medicine to Screen Patients Before Admission: a Strategy to Overcome Overcrowding
Hamid Reza
Javadzadeh
Amir
Davoudi
Farnoush
Davoudi
Sadrollah
Mahmoodi
Mohammad Reza
Ghane
Hasan
Goodarzi
Mehrdad
Faraji
Background: The overcrowded hospital is an unsafe one. Overcrowding the emergency department (ED) results in increased patient suffering, prolonged waiting time, deteriorating level of service, and on occasion, a worsened medical condition or even death. Objectives: This study proposes a strategy to overcome ED overcrowding. Materials and Methods: The proportion of acute area admitted patients to screened patients (A/S), and the proportion of patients who were finally transferred to inpatient wards (W/A) to those admitted in ED acute area were investigated during 6 consecutive months. Emergency medicine residents were assigned to screen patients before ED admission and afterwards. Results: The average A/S changed from 82.4% to 44.2% (P = 0.028), and the average W/A changed from 28.3% to 51.48% (P = 0.028) before and after screening patients respectively. The initiative resulted in 97 less patients in the acute area per day. Conclusions: Decreased number of acute area admitted patients, and increase W/A proportion showed that the initiative was successful in obviating ED overcrowding while provision of care to those most in need was not altered.
emergency services
intervention
2011
01
01
191
193
https://www.traumamon.com/article_99788_94550d7e4e0cdd8c7bbdbf46da99f64e.pdf
Trauma Monthly
Trauma Mon
2251-7464
2251-7464
2011
16
4
Femoral Pseudoaneurysms Requiring Surgical Treatment
Hannu
Savolainen
Iris
Baumgartner
Juerg
Schmidli
George
Heller
Do-Dai
Do
Torsten
Willenberg
Background: Despite use of arterial closure devices (APCDs) and thrombin injection , surgery is needed at times to repair femoral pseudoaneurysms (FPA) in patients undergoing endovascular interventions. We analysed the indications and results of surgical repair in a tertiary referral center performing more than 6.000 angiographies and/or interventions annually. Objectives: The aim of this retrospective observational study was to identify local and clinical factors related to the need of surgical repair. Patients and Methods: In this retrospective study, 122 (0.06%) FPAs treated among 21060 patients over a period of five years were assessed. Patient characteristics and therapeutic procedures were analyzed through hospital records. Results: There were 15.163 (72%) coronary and 5.897 (27%) peripheral interventions, respectively. In 89 (73%) patients, FPA was successfully treated by ultrasound guided compression (USGC) alone.Thirty-three (28%) patients underwent open surgical repair. Indication for operative treatment was hemodynamic instability in 9 (7%) patients, rapidly expanding haematoma unsuitable for USGC or after unsuccessful USGC in 23 (19%). One (0.8%) patient had an arterio-venous fistula. Intraoperative findings suggest that atypical endovascular access (e.g. deep femoral artery, lateral or medial puncture) and multiple puncture sites and/or laceration of the vessel wall were related to the need for surgery in 22 (67%) cases. Most patients had active antithrombotic therapy. Gender or the nature of procedure (diagnostic vs. intervention) did not increase risk for open repair. One (0.8%) patient died. No amputations were performed. Mean hospital stay of patients undergoing open surgical repair was 11 (range 4-36) days. Conclusions: Technical puncture problems were identified in 2/3 of patients requiring open surgery.
Angiography
Catheters
Indwelling
femoral artery
Endovascular
2011
01
01
194
197
https://www.traumamon.com/article_99789_37c4fd560fed06ff552e0841f6788b7a.pdf
Trauma Monthly
Trauma Mon
2251-7464
2251-7464
2011
16
4
Intraosseous Ganglion Cyst of the Lunate
Shahram
Nazerani
Adel
Ebrahimpour
Arvin
Najaf
Ehsan
Shams Koushki
Bone Cysts
Ganglion Cysts
Lunate Bone
Wrist
2011
01
01
198
200
https://www.traumamon.com/article_99790_edcac9899fd63ea3c497901e2ab5e440.pdf
Trauma Monthly
Trauma Mon
2251-7464
2251-7464
2011
16
4
Improvements in the Management of Trauma Patients With the Introduction of a Lower Limb Trauma Coordinator
Dulani
Mendis
Martin
Vesely
Mortality and morbidity from trauma continues to be a serious, ubiquitous public health problem. Our short communication reports on the benefits of a dedicated lower limb trauma coordinator (LLTC) to the trauma service of a busy inner-London Plastics unit. This is based on a retrospective case-note based audit; performed 19 months prior to the introduction of the LLTC and for 16 months after. After the introduction of a LLTC our statistical analysis demonstrated a significant improvement in trauma timings in terms of injury to referral time, time to first plastics operation and duration of inpatient stay. This suggests the use of a fully qualified nurse with an orthopaedic background as a coordinator may prove to be highly advantageous over a non-clinical administrator improving the overall journey of the lower limb trauma patient in the English National Health Service.
Lower extremity
Trauma
2011
01
01
201
202
https://www.traumamon.com/article_99791_6ec3e3b7064c99f910f45c85ba0f05f7.pdf
Trauma Monthly
Trauma Mon
2251-7464
2251-7464
2011
16
4
Avoiding Traumatic Injury to the Tissues in the New Millennium
Seyed Mehdi
Jafari
Wounds and Injuries
tissues
2011
01
01
203
204
https://www.traumamon.com/article_99792_62d996b6901d3d1018fc7951f23c0473.pdf
Trauma Monthly
Trauma Mon
2251-7464
2251-7464
2011
16
4
Trauma to the Temporomandibular Joint Following Tooth Extraction via Dental Students
Mohammad Ali
Dolatabadi
Esshagh
Lassemi
Temporomandibular Joint Disorders
Tooth Extraction
2011
01
01
205
205
https://www.traumamon.com/article_99793_5ec94a97ab05ac7ef7692aef59f6d0ee.pdf