Official Publication of the National Center for Trauma ResearchTrauma Monthly2251-746421120160201External Fixation vs. Skeletal Traction for Treatment of Intertrochanteric Fractures in the Elderly9996610.5812/traumamon.15477ENGholam Hossein KazemianMohammad EmamiAlireza ManafiFarideh NajafiMohammad Amin NajafiJournal Article19700101Background: Hip fractures are one of the causes of disability amongst elderly patients. External fixator and skeletal traction are two modes of treatment. Objectives: The aim of this study is to compare two different treatment modes for intertrochanteric fractures in elderly patients. Patients and Methods: Sixty elderly patients with intertrochanteric fractures were randomized for treatment with either skeletal traction (Group A) or an external fixation (Group B). In this study patients at least 60 years of age, with AO/OTA A1 or A2 type fracture and intertrochanteric fracture as a result of minor trauma, were enrolled. Results: Acceptable reduction was achieved in eight and 26 patients of group A and B, respectively. The mean duration of hospitalization in Group A and Group B was 14.3 ± 1.1 and 2.2 ± 0.6 days, respectively. Significant differences between the two groups were observed, regarding acceptable reduction and duration of hospitalization. Less pain was observed in group B, at five days and twelve months after surgery; the average HHS was 57 and 66, in group A and B, respectively (P > 0.05). Conclusions: Treatment with an external fixator is an effective treatment modality for intertrochanteric fractures in elderly high-risk patients. The advantages include rapid and simple application, insignificant blood loss, less radiation exposure, adequate fixation, pain reduction, early discharge from the hospital, low cost and more favorable functional outcome.https://www.traumamon.com/article_99966_2f8cc36359834d0429db5d0b06613531.pdfOfficial Publication of the National Center for Trauma ResearchTrauma Monthly2251-746421120160201Squat Winnowing: Cause of Meniscus Injuries in Non-Athletic Females9996710.5812/traumamon.19178ENYounis KamalHayat Ahmad KhanIrfan Ahmad LatooNaseemul GaniMunir FarooqSnobar GulJournal Article19700101Background: Sports activities were thought to be the major cause of meniscus injury in both men and woman, but our observations of non-athletic females show that the cause of meniscus injury was unrelated to any type of sports activity. Objectives: This study revealed squat winnowing to be a major cause of meniscus injury in non-athletic females. Patients and Methods: This retrospective study was conducted in a tertiary care orthopaedic hospital which caters to a population of 10 million people. We assessed 120 non-athletic females who had received treatment in our hospital over a period of 2 years. The most probable cause of knee injury, per initial patient history, was recorded for all non-athletic females who presented clinical signs and symptoms of meniscus injury. The diagnoses were confirmed by relevant MRI and arthroscopy of patients’ knees. All females who engaged in athletic activity and other females with unrelated, non-traumatic knee pathologies were excluded from the study. Results: Through our study, we found that 42% (n = 50) of females suffered an injury during squat winnowing of rice, either at home or at work. Another 29% (n = 35) of females cited a history of slipping and spraining their knee as a cause of knee injury, while 19% (n = 16) of females suffered a knee injury during complex accidents such as a traffic accident. Finally, 13% (n = 16) of the females had no definite history of knee injury. Conclusions: Our observations add to the knowledge base of the various causes of meniscus tears; this study also revealed that sociocultural factors influence and contribute to the mechanism of various types of knee injuryhttps://www.traumamon.com/article_99967_03a946e8bfaced0bb82439cb334ef346.pdfOfficial Publication of the National Center for Trauma ResearchTrauma Monthly2251-746421120160201Recurrent Dislocation of The Extensor Carpi Ulnaris Tendon in a Water-Polo Athlete9996810.5812/traumamon.19551ENIoannis P. StathopoulosKonstantinos RaptisEfstathios G. BallasSarantis-Petros G. SpyridonosJournal Article19700101Introduction: Dislocation/subluxation of the Extensor Carpi Ulnaris (ECU) tendon is a rare condition in the general population, but is a common problem among athletes that subject their wrists to forceful rotational movements. Pain and snapping sensation at the dorsoulnar aspect of the wrist especially during supination are the predominant symptoms that often necessitate surgical intervention. Case Presentation: We present a case of a professional water-polo athlete with recurrent ECU tendon dislocation, in whom a combination of direct repair of the tendon’s subsheath and reinforcement with an extensor retinaculum graft led to definitive resolution of her symptoms and resulted in her uneventful return to high-level sport activities 4 months postoperatively. Conclusions: The treatment of symptomatic ECU instability is still controversial, especially for acute dislocations. Depending on the type of injury many surgical techniques have been proposed. Combination of direct repair of the tendon’s subsheath and reinforcement with an extensor retinaculum graft is a reliable option.https://www.traumamon.com/article_99968_babebc6cc196f27269764416a0779c44.pdfOfficial Publication of the National Center for Trauma ResearchTrauma Monthly2251-746421120160201Efficacy of Intravenous Paracetamol Versus Intravenous Morphine in Acute Limb Trauma9996910.5812/traumamon.19649ENMohammad JaliliAli Mozaffarpour NooriMojtaba SedaghatArash SafaieJournal Article19700101Background: Efficient pain management is one of the most important components of care in the field of emergency medicine. Objectives: This study was conducted to compare intravenous paracetamol and intravenous morphine sulfate for acute pain reduction in patients with limb trauma. Patients and Methods: In a randomized double-blinded clinical trial, all patients (aged 18 years and older) with acute limb trauma and a pain score of greater than 3/10 in the emergency department were recruited; they received either 1 g intravenous paracetamol or 0.1 mg/ kg intravenous morphine sulfate over 15 minutes. The primary outcome was the pain score measured on a numerical rating scale at 0, 15 and 30 minutes after commencing drug administration. The requirement for rescue analgesia and the frequency of adverse reactions were also recorded. Results: Sixty patients randomly received either IV paracetamol (n = 30) or IV morphine (n = 30). The mean reduction in numerical rating scale pain intensity scores at 30 minutes was 3.86 (± 1.61) for paracetamol, and 2.16 (± 1.39) for morphine. However, pain relief was significantly higher in the paracetamol group compared to the morphine group (P < 0.001). Four patients in the paracetamol group and 15 patients in the morphine group needed rescue analgesia and the difference was significant (P = 0.05). Conclusions: Intravenous paracetamol appears to provide better analgesia than intravenous morphine in acute limb trauma. Further larger studies are required.https://www.traumamon.com/article_99969_5db3dcb745f22f91025cd4cf833de258.pdfOfficial Publication of the National Center for Trauma ResearchTrauma Monthly2251-746421120160201Effective Factors in Door-to-Needle Time for Streptokinase Administration in Patients With Acute Myocardial Infarction Admitted to the Emergency Department9997010.5812/traumamon.19676ENAli OmraninavaAmir Masoud HashemianBabak MasoumiJournal Article19700101Background: Cardiovascular incidents are a common cause of death around the world. Acute myocardial infarction (AMI) poses high risks for the patient due to plaque rupture or erosion along with a superimposed non-occlusive thrombus; therefore, timely treatment with antithrombotic agents plays a key role in reducing an AMI mortality rate. Objectives: The present study aimed to assess the time interval between the admission of AMI-suspected patients and treatment initiation. Patients and Methods: This cross-sectional study was conducted on 110 patients admitted to the emergency department of Imam Hussein hospital in Tehran, Iran. Data were collected using checklists, completed by the patients’ next of kin or the emergency staff. To analyze the data, student t- test and analysis of variance were used. Results: In this study, 31 female and 79 male subjects were included, respectively. The mean time to receive the first dose of streptokinase was 66.39 minutes (73.74 minutes for females and 63.5 minutes for male patients), varying from 49.92 minutes in the morning to 69.78 minutes in the afternoon and 72.68 minutes during night shifts. Conclusions: The door-to-needle (DTN) time, in a standard setting, is recommended to be less than 30 minutes. According to the results of this study, the DTN time is comparatively two times longer in females and afternoon and night shifts. Different variables including emergency staff, physicians, patients’ characteristics, and environmental/physical factors induced this difference.https://www.traumamon.com/article_99970_dfb5df56d716b273d73babf61d2d87a2.pdfOfficial Publication of the National Center for Trauma ResearchTrauma Monthly2251-746421120160201Missed Traumatic Thoracic Spondyloptosis With no Neurological Deficit: A Case Report and Literature Review9997110.5812/traumamon.19841ENKamran FarooqueKavin KhatriAnkit GuptaJournal Article19700101Introduction: Traumatic thoracic spondyloptosis is caused by high energy trauma and is usually associated with severe neurological deficit. Cases presenting without any neurological deficit can be difficult to diagnose and manage. Case Presentation: We reported a four-week spondyloptosis of the ninth thoracic vertebra over the tenth thoracic vertebra, in a 20-yearold male without any neurological deficit. The patient had associated chest injuries. The spine injury was managed surgically with insitu posterior instrumentation and fusion. The patient tolerated the operation well and postoperatively there was no neurological deterioration or surgical complication. Conclusions: Patients presenting with spondyloptosis with no neurological deficit can be managed with in-situ fusion via pedicle screws, especially when presenting late and with minimal kyphosis.https://www.traumamon.com/article_99971_81d5d73eb29e63684bd683ac05fcff49.pdfOfficial Publication of the National Center for Trauma ResearchTrauma Monthly2251-746421120160201Readability of Trauma-Related Patient Education Materials From the American Academy of Orthopaedic Surgeons9997210.5812/traumamon.20141ENAdam E. M. EltoraiNathan P. ThomasHeejae YangAlan H. DanielsChristopher T. BornJournal Article19700101Context: According to the american medical association (AMA) and the national institutes of health (NIH), the recommended readability of patient education materials should be no greater than a sixth-grade reading level. The online patient education information produced by the american academy of orthopaedic surgeons (AAOS) may be too complicated for some patients to understand. This study evaluated whether the AAOS’s online trauma-related patient education materials meet recommended readability guidelines for medical information. Evidence Acquisition: Ninety-nine articles from the "Broken Bones and Injuries" section of the AAOS-produced patient education website, orthoinfo.org, were analyzed for grade level readability using the Flesch-Kincaid formula, a widely-used and validated tool to evaluate the text reading level. Results for each webpage were compared to the AMA/NIH recommended sixth-grade reading level and the average reading level of U.S. adults (eighth-grade). Results: The mean (SD) grade level readability for all patient education articles was 8.8 (1.1). All but three of the articles had a readability score above the sixth-grade level. The readability of the articles exceeded this level by an average of 2.8 grade levels (95% confidence interval, 2.6 - 3.0; P < 0.0001). Furthermore, the average readability of the articles exceeded the average reading skill level of U.S. adults (eighth grade) by nearly an entire grade level (95% confidence interval, 0.6-1.0; P < 0.0001). Conclusions: The majority of the trauma-related articles from the AAOS patient education website have readability levels that may make comprehension difficult for a substantial portion of the patient population.https://www.traumamon.com/article_99972_b481a900e79d3c091de9592a56db6e16.pdfOfficial Publication of the National Center for Trauma ResearchTrauma Monthly2251-746421120160201Outcome of Radial Head Arthroplasty in Comminuted Radial Head Fractures: Short and Midterm Results9997310.5812/traumamon.20201ENArash MoghaddamTim Friedrich RavenEike DremelStefan Studier-FischerPaul Alfred GrutznerBahram BiglariJournal Article19700101Background: Comminuted radial head fractures are often associated with secondary injuries and elbow instability. Objectives: The aim of this retrospective study was to evaluate how well the modular metallic radial head implant EVOLVE® prosthesis restores functional range of motion (ROM) and stability of the elbow in acute care. Patients and Methods: Eighty-five patients with comminuted radial head fractures and associated injuries received treatment with an EVOLVE® prosthesis between May 2001 and November 2009. Seventy-five patients were available for follow-up. On average, patients were followed for 41.5 months (33.0: 4.0 - 93.0). Outcome assessment was done on the basis of pain, ROM, strength, radiographic findings, and functional rating scores such as Broberg and Morrey, the Mayo elbow performance index (MEPI), and disabilities of the arm, shoulder and hand (DASH). Our study is currently the largest analysis of clinical outcome of a modular radial head replacement in the literature. Results: Overall, there were 2 (2.7%) Mason II fractures, 21 (28%) Mason III fractures, and 52 (69.3%) Mason IV fractures. Arbeitsgemeinschaft fur osteosynthesefragen (AO) classification was also determined. Of the 85 patients in our study, 75 were available for follow-up. Follow-up averaged 41.5 months (range, 4 - 93 months). Average scores for the cohort were as follows: Morrey, 85.7 (median 90.2; range 44.4 - 100); MEPI, 83.3 (85.0; 40.0 - 100); and DASH 26.1 points (22.5; 0.0 - 75.8). Mean flexion/extension in the affected joint was 125.7°/16.5°/0° in comparison to the noninjured side 138.5°/0°/1.2°. Mean pronation/supination was 70.5°/0°/67.1° in comparison to the noninjured side 83.6°/0°/84.3°. Handgrip strength of the injured compared to the non-injured arm was 78.8%. The following complications were also documented: 58 patients had periprosthetic radioluceny shown to be neither clinically significant nor relevant according to evaluated scores; 26 patients had moderate or severe periarticular ossification, and scored substantially worse according to MEPI and Morrey. Four patients required revisional surgery due to loosening of the prosthesis and chronic pain. In addition, one patient required a neurolysis of the ulnaris nerve, one developed a neobursa, and one had extensive swelling and blistering. The time interval between injury and treatment appeared to have an effect on results. Thirty-five patients were treated within the first 5 days after accident and showed better results than the 40 patients who were treated after 5 days. Conclusions: Comminuted radial head fractures with elbow instability can be treated well with a modular radial head prosthesis, which restores stability in acute treatment. The modular radial head arthroplasty used in this study showed promising findings in short to midterm results.https://www.traumamon.com/article_99973_1e4d96db6dcd1a9f2a705f4a898e2b1b.pdfOfficial Publication of the National Center for Trauma ResearchTrauma Monthly2251-746421120160201A New Injury Severity Score for Predicting the Length of Hospital Stay in Multiple Trauma Patients9997410.5812/traumamon.20349ENOveis SalehiSeyed Ashkan Tabibzadeh DezfuliSeyed Shojaeddin NamaziMaryam Dehghan KhaliliMorteza SaeediJournal Article19700101Background: Trauma is a leading cause of morbidity and mortality among individuals under 40 and is the third main cause for death throughout the world. Objectives: This study was designed to compare our modified injury scoring systems with the current injury severity score (ISS) from the viewpoint of its predictive value to estimate the duration of hospitalization in trauma patients. Patients and Methods: This analytical cross-sectional study was performed at the general referral trauma center of Bandar-Abbas in southern Iran from March 2009 to March 2010. The study population consisted of all the trauma patients referred to the emergency department (ED). Demographic data, type and severity of injury, duration of admission, Glasgow coma scale (GCS), and revised trauma score (RTS) were recorded. The injury severity score (ISS) and NISS were calculated. The length of hospital stay was recorded during the patients follow-up and compared with ISS, NISS and modified injury scoring systems. Results: Five hundred eleven patients (446 males (87.3%) and 65 females (12.7%)) were enrolled in the study. The mean age was 22 ± 4.2 for males and 29.15 ± 3.8 for females. The modified NISS had a relatively strong correlation with the length of hospitalization (r = 0.79). The formula below explains the length of hospitalization according to MNISS score. Duration of hospitalization was 0.415 + (2.991) MNISS. Duration of hospitalization had a strong correlation with MISS (r = 0.805, R2: 0.65). Duration of hospitalization was 0.113 + (7.915) MISS. Conclusions: This new suggested scale shows a better value to predict patients’ length of hospital stay compared to ISS and NISS. However, future studies with larger sample sizes and more confounding factors such as prehospital procedures, intubation and other procedures during admission, should be designed to examine these scoring systems and confirm the results of our study.https://www.traumamon.com/article_99974_08ac9eb1d0963ff4530e53c3c454f796.pdfOfficial Publication of the National Center for Trauma ResearchTrauma Monthly2251-746421120160201Recurrence in a Laparoscopically Repaired Traumatic Diaphragmatic Hernia: Case Report and Literature Review9997510.5812/traumamon.20421ENNikita R. BhattMorgan McMonagleJournal Article19700101Introduction: Traumatic diaphragmatic hernia (TDH) develops infrequently following a traumatic diaphragmatic rupture (TDR). As TDR is frequently missed due to lack of sensitive and specific imaging modalities, a high index of suspicion for such injuries is essential, whether immediately posttraumatic, or even decades after the trauma. We describe a rare case of recurrence in a laparoscopically repaired TDH and review the current literature on the same. Case Presentation: A 23-year-old male with a history of primary laparoscopic repair of left-sided TDR two years ago presented with symptoms of acute large bowel obstruction. His chest X-ray showed a left-sided pleural effusion and a loop of the bowel in the left hemithorax, but no signs of free gas. An abdominal X-ray (AXR) demonstrated massively dilated large bowel with distension of the small bowel. At laparotomy, the obstructing lesion consisted of the large bowel with omentum herniated through the left hemidiaphragm, consistent with a left recurrent/chronic diaphragmatic hernia. The diaphragmatic defect was repaired with interrupted nylon. The patient made an uneventful recovery. Conclusions: Recurrence after repair of TDH is a less reported condition (with only two published articles) and little is known regarding the factors responsible for this. Laparoscopy is an excellent diagnostic tool, but currently management is probably best performed via an open technique using heavy non-absorbable suture material to prevent recurrence. Long term follow up of these patients should also be considered.https://www.traumamon.com/article_99975_f6035960d0c6536511011060f12b7a5f.pdfOfficial Publication of the National Center for Trauma ResearchTrauma Monthly2251-746421120160201Unusual Foreign Bone Fragment in Femoral Open Fracture9997610.5812/traumamon.22957ENHanon SadoniHamidreza ArtiJournal Article19700101Introduction: Femoral shaft fracture is one of the typical bone fractures due to high energy trauma and may occur as an open fracture. Some foreign materials may enter the fracture site such as sand, cloth particles and so on. Case Presentation: A 28-year-old motorcycle riding military member and his collaborator were received in the hospital because of multiple traumas due to a fall in a hollow during a surveillance mission. His collaborator died because of head trauma and multiple severe open fractures. When fixing the patients femoral fracture, a large femoral butterfly fragment was removed from the patient’s thigh as a foreign segment. The patient’s femur was fixed with a plate and screws. No femoral defect was detected during surgery or post-operative X-rays and CT scan. The removed segment was not a part of the patient’s femur. Conclusions: Surgical and post-surgical findings showed that this segment was not related to the patient’s femur. The foreign segment may have belonged to the other victim of this trauma.https://www.traumamon.com/article_99976_6657b8897a834491aa1824dad628c4e9.pdfOfficial Publication of the National Center for Trauma ResearchTrauma Monthly2251-746421120160201Nonsyndromic Isolated Temporal Bone Styloid Process Fracture9997710.5812/traumamon.24395ENHamed KermaniNima DehghaniFarzad AghdashiMohammad EsmaeelinejadJournal Article19700101Introduction: Fracture of the styloid process (SP) of the temporal bone is a rare traumatic injury in normal individuals who are not suffering from Eagle’s syndrome. Diagnosis and management of this problem requires comprehensive knowledge about its signs and symptoms. This study aimed to present an isolated styloid process fracture in a nonsyndromic patient. Case Presentation: A 50-year-old male patient was referred to our department with a complaint of sore throat. However, presentation of the problem resembled the symptoms of temporomandibular joint disorder (TMD). Fracture of the SP of the temporal bone was detected on the radiographs. Conservative treatment was undertaken for the patient. The symptoms diminished after about four months. Conclusions: Physicians should be aware of the signs and symptoms of different pain sources to prevent misdiagnosis and maltreatmenthttps://www.traumamon.com/article_99977_1664b9b744038a9a90e581022a93fd8b.pdfOfficial Publication of the National Center for Trauma ResearchTrauma Monthly2251-746421120160201Effect of Job Specialization on the Hospital Stay and Job Satisfaction of ED Nurses9997810.5812/traumamon.25794ENVahid ShamsiHosein MahmoudiMasoud Sirati Nir Sirati NirHosein Babatabar DarziJournal Article19700101Background: In recent decades, the increasing crowdedness of the emergency departments has posed various problems for patients and healthcare systems worldwide. These problems include prolonged hospital stay, patient dissatisfaction and nurse burnout or job dissatisfaction. Objectives: The aim of this study was to investigate the effect of emergency department (ED) nurses’ job specialization on their job satisfaction and the length of patient stay in the ED. Patients and Methods: This before-after quasi-experimental study was conducted from April to May 2014 at the Baqiyatallah Hospital, Tehran, Iran. Initially, 35 patients were recruited as controls and the length of their stay in the ED was measured in minutes via a chronometer; Moreover, nurses’ job satisfaction was evaluated using the Mohrman-Cooke-Mohrman job satisfaction scale. Then, a job specialization intervention was developed based on the stabilization model. After that, 35 new patients were recruited to the treatment group and received specialized care services. Accordingly, the length of their stay in the ED was measured. Moreover, the same nurses’ job satisfaction was re-evaluated after the study. The study intervention lasted one month. Data were analyzed using the SPSS software version 20 and statistical tests such as the Kolmogrov-Smirnov, the paired and the independent t, and chi-square tests. Results: There was a significant difference between the two groups of patients concerning the length of their stay in the ED (P < 0.001). Moreover, compared with the pretest readings, nurses had greater job satisfaction after the study (P < 0.001). Conclusions: The job specialization intervention can improve nurses’ satisfaction and relieve the crowdedness of the EDs.https://www.traumamon.com/article_99978_b0b4501a50609874f47564dfa023b57c.pdfOfficial Publication of the National Center for Trauma ResearchTrauma Monthly2251-746421120160201Overview of Agents Used for Emergency Hemostasis9997910.5812/traumamon.26023ENHadi KhoshmohabatShahram PaydarHossein Mohammad KazemiBehnam DalfardiJournal Article19700101Context: In today’s modern world, despite the multiple advances made in the field of medicine, hemorrhagic shock is still the main cause of battlefield mortality and the second most prevalent cause of mortality in civilian trauma. Hemostatic agents can play a key role in establishing hemostasis in prehospital situations and preventing hemorrhage-associated death. In this respect, this article aims to review different aspects of known hemostatic agents. Evidence Acquisition: A comprehensive search of the academic scientific databases for relevant keywords was conducted; relevant articles were compiled and assessed. Results: Hemostatic agents can establish hemostasis by means of different mechanisms, including concentrating coagulation factors, adhesion to the tissues, in which traumatic hemorrhage occurred, and delivering procoagulant factors to the hemorrhage site. Presently, these hemostatics have been significantly improved with regard to efficacy and in adverse consequences, resulting from their use. Several hemostatic dressings have been developed to the degree that they have received FDA approval and are being used practically on the battlefield. In addition, there are currently several case reports on the use of such hemostatics in the hospital setting, in conditions where commonly known approaches fail to stop life-threatening bleeding. Conclusions: The use of hemostatic dressings and agents is one of the main advancements achieved in recent decades. However, it can be claimed that the ideal hemostatic has not been recognized yet; therefore, this topic needs to be brought into focus and further addressed.https://www.traumamon.com/article_99979_20d8cb8c11a5837b952c3889e4a3b24b.pdfOfficial Publication of the National Center for Trauma ResearchTrauma Monthly2251-746421120160201Limitation of Mandibular Movement: A Rare Case Report of Unilateral Zygomatico-Coronoid Interference9998010.5812/traumamon.26225ENFahimeh AkhlaghiMohammad EsmaeelinejadJournal Article19700101Introduction: Zygomatico-coronoid interference is a rare type of mandibular extracapsular ankylosis. There is a lack of information on the treatment of these cases in the literature. Condylectomy and coronoidectomy are not always the best options for the treatment of limitations in mandibular movement. Case Presentation: A 51-year-old woman presented with mouth-opening limitation due to zygomatic bone displacement and interference with the coronoid process. The treatment plan was bilateral coronoidectomy through an intraoral approach and osteotomy of the right zygomatic arch through an extraoral incision. The patient was able to open her mouth to approximately 40 mm after surgery. The patient underwent physiotherapy during follow-up appointments. There was no relapse after three months of follow-up. Conclusions: This study shows that simultaneous arch osteotomy and coronoidectomy may be an appropriate treatment procedure for zygomatico-coronoid interferencehttps://www.traumamon.com/article_99980_26b01d5d78b99144c0ff9e3d5a940836.pdfOfficial Publication of the National Center for Trauma ResearchTrauma Monthly2251-746421120160201Efficacy of Pedicle Screw Fixation in Unstable Upper and Middle Thoracic Spine Fractures9998110.5812/traumamon.28627ENAmir Abbas GhasemiSoudabeh AshooriJournal Article19700101Background: Treatment of unstable upper and middle thoracic spine fractures remains controversial. There is no consensus regarding optimal treatment. Objectives: In this study, we evaluated the efficacy of pedicular screw in the management of middle thoracic spine fractures to correct kyphosis and anterolisthesis and improve neurologic condition of patients. Patients and Methods: Twenty-five patients with unstable T1-T10 fractures treated with pedicle screw fixation technique were studied. Neurologic situation, preoperative and postoperative radiographs were evaluated. Radiographic measurements included kyphotic deformity and anterolisthesis. An American Spinal Injury Association (ASIA) scale was used for neurologic classification of the patients. Results: From a total of 25 patients, 21 cases were male and 4 were female. The mean age of the patients was 35.40 ± 14.39 years. The mean degree of kyphosis improved from 27.04 ± 7.33 degrees preoperatively to 15.96 ± 5.76 degrees at final follow-up. The mean of anterolisthesis improved from 6.44 ± 4.93 mm to 0.96 ± 0.36 mm at final follow-up. Kyphosis (P = 0.0001), anterolisthesis (P = 0.0001) and neurological state (P = 0.01) improved significantly after operation. No cases of hardware failure, neurological deterioration and loss of correction were reported. Conclusions: Application of pedicular screw in unstable upper and middle thoracic spine fractures is an effective method that can correct kyphotic deformity and anterolisthesis and improve neurologic deficit.https://www.traumamon.com/article_99981_eeb65c4a23951871b6233dc03c18e0fe.pdfOfficial Publication of the National Center for Trauma ResearchTrauma Monthly2251-746421120160201Physical and Mental Health of Patients Immediately After Discharge From Intensive Care Unit and 24 Hours Later9998210.5812/traumamon.29231ENMarzieh MomennasabTahereh GhahramaniShahrzad YektatalabFarid ZandJournal Article19700101Background: Monitoring the health status of patients discharged from intensive care units is a crucial method of service evaluation. Objectives: This study aimed to assess the physical and mental health status of patients immediately after discharge from the ICU and 24 hours later. Patients and Methods: This descriptive comparative study was conducted on 104 patients discharged from the ICUs of a referral trauma center in Shiraz, Southwest Iran. Physical parameters, including respiratory rate, need for supplemental oxygen, heart rate, blood pressure, and need for cardiac monitoring, were assessed. Hospital anxiety and depression scale (HADS) was used for mental health evaluation. The mental and physical status of patients were assessed before ICU discharge and 24 hours later; data were recorded in information forms and were analyzed using SPSS statistical software version 17. Results: At the time of discharge, the respiratory rate of 28% of the participants was more than 24 minutes, and 95.2% received supplemental oxygen. However, after 24 hours these values decreased to 10% and 21.6%, respectively. The mean heart rate and systolic blood pressure were within the normal range at both time points. Additionally, 63% of the patients had anxiety scores above 11 at both time points, reflecting high anxiety. The number of patients who reported depression increased from 58.7% at ICU discharge to 69.6% after 24 hours. Conclusions: Despite the considerable improvement in most of the patients’ physical condition in the first 24 hours after discharge from ICU, a significant number of them remain at risk for the development of adverse effects from this transition. The high prevalence of mental health disorders in these patients reveals the necessity to conduct follow-up consultations.https://www.traumamon.com/article_99982_34bf3319ce0da1a596a313c340aae1d9.pdfOfficial Publication of the National Center for Trauma ResearchTrauma Monthly2251-746421120160201Serum 25-Hydroxyvitamin D Levels in Pediatric Burn Patients9998310.5812/traumamon.30905ENBehnam SoboutiAina RiahiShahrzad FallahMasoumeh EbrahimiAzin Shafiee SabetYaser GhavamiJournal Article19700101Background: Previous studies have implicated the important and active role of vitamin D in the immune system. Objectives: The aim of this study was to evaluate serum levels of 25-hydroxyvitamin D in children with burn injuries. Materials and Methods: In this cross-sectional study, 118 patients with various degrees of burn injuries were enrolled. A checklist consisting of demographic data, total body surface area (TBSA) affected by burn, degree of burn, serum level of 25(OH)D, total protein, albumin, electrolytes, and parathyroid hormone was recorded for each patient. Results: Sixty-eight (57.6%) males and 50 (42.4%) females with a mean age of 4.04 years (SD = 3.04) were evaluated. The mean level of 25(OH) D was 14.58 ng/mL (SD = 6.94). Levels of 25(OH)D in four (3.39%) cases were higher than 30 ng/mL, while 95 (81.35%) cases had levels lower than 20 ng/mL, and 19 (16.10%) cases had levels of 21 - 30 ng/mL. The level of 25(OH)D was below recommended levels in 96.61% of cases, while 81.34% had vitamin D deficiency and 16.1% had insufficiency. We found a significant correlation between vitamin 25(OH)D and total protein, albumin, and total and ionized calcium (P < 0.001). There was also a significant negative correlation between 25(OH)D and TBSA affected by burn (P = 0.001). Conclusions: The levels of 25(OH)D in children suffering from severe burns were low. Supplementation might be useful in patients with very low levels of serum vitamin D.https://www.traumamon.com/article_99983_9ffab15db552869bdf63d0f3f4407619.pdfOfficial Publication of the National Center for Trauma ResearchTrauma Monthly2251-746421120160201A Prospective Study of Survival After In-Hospital Cardiopulmonary Resuscitation and its Related Factors9998410.5812/traumamon.31796ENSedigheh MiranzadehMohsen Adib-HajbagheryNadimeh HosseinpourJournal Article19700101Background: Despite several studies, there is no agreement on factors that affect survival after in-hospital cardiopulmonary resuscitation (CPR). Objectives: This study aimed to evaluate the survival rate of in-hospital CPR and its related factors at Shahid Beheshti hospital in Kashan, Iran, in 2014. Patients and Methods: A descriptive study was conducted on all cases of CPR performed in Kashan Shahid Beheshti hospital during a 6-month period in 2014. Through a consecutive sampling method, 250 cases of CPR were studied. A three-part researcher-made instrument was used. The outcome of CPR was documented as either survival to hospital discharge or unsuccessful (death of the patient). Chi-square test, t test, and logistic regression analysis were used to analyze the data. Results: Of all CPR cases, 238 (95.2%) were unsuccessful and 12 (4.8%) survived to hospital discharge. Only 2.6% of patients who were resuscitated in medical units survived to hospital discharge, whereas this rate was 11.4% in the emergency department. Only 45 (18%) patients were defibrillated during resuscitation; in 11 patients, defibrillation was performed between 15 to 45 minutes after the initiation of CPR. The mean time from initiation of CPR to the first DC shock was 13.93 ± 8.88 minutes. Moreover, the mean duration of CPR was 35.11 ± 11.42 minutes. The survival rate was higher in the morning shift and lower during the time of shift change (9.4% vs. 0). The duration of CPR and speed of arrival of the CPR team were identified as factors that predicted the outcome of CPR. Conclusions: The survival rate after in-hospital CPR was very low. The duration of CPR and the time of initiating CPR effects patients’ outcomes. These findings highlight the crucial role of an organized, skilled, well-established and timely CPR team.https://www.traumamon.com/article_99984_887795ddb56be4f2360a1e69b9fd3e35.pdfOfficial Publication of the National Center for Trauma ResearchTrauma Monthly2251-746421120160201Bilateral Abducent Nerve Palsy After Neck Trauma: A Case Report9998510.5812/traumamon.31984ENHamed AminiahidashtiSajad ShafieeMohammad SazegarNazanin NosratiJournal Article19700101Introduction: The abducent nucleus is located in the upper part of the rhomboid fossa beneath the fourth ventricle in the caudal portion of the pons. The abducent nerve courses from its nucleus, to innervate the lateral rectus muscle. This nerve has the longest subarachnoid course of all the cranial nerves, it is the cranial nerve most vulnerable to trauma. It has been reported that 1% to 2.7% of all head injuries are followed by unilateral abducent palsy, but bilateral abducent nerve palsy is extremely rare. Case Presentation: A 65-year-old woman presented to the emergency department following a motor vehicle accident. A neurological assessment showed the patient’s Glascow coma scale (GCS) to be 15. She complained of double vision, and we found lateral gaze palsy in both eyes. A hangman fracture type IIA (C2 fracture with posterior ligamentous C1 - C2 distraction) was found on the cervical CT scan. A three-month follow-up of the patient showed complete recovery of the abducent nerve. Conclusions: Conservative treatment is usually recommended for traumatic bilateral abducent nerve palsy. Our patient recovered from this condition after three months without any remaining neurological deficit, a very rare outcome in a rare case.https://www.traumamon.com/article_99985_cc995b0c54e1700059a99ee6a4afbf30.pdfOfficial Publication of the National Center for Trauma ResearchTrauma Monthly2251-746421120160201National Getaways for the Weary Trauma Surgeon; Part 6: Chal Nakhjir, a Living 7-Million-Year-Old Cave!9998610.5812/traumamon.37007ENHadi KhoshmohabatJournal Article19700101https://www.traumamon.com/article_99986_5f7c3416fd95faeb1afec39619133186.pdfOfficial Publication of the National Center for Trauma ResearchTrauma Monthly2251-746421120160201A Selective Corrective Exercise to Decrease Falling and Improve Functional Balance in Idiopathic Parkinson’s Disease9998710.5812/traumamon.23573ENParisa SedaghatiHassan DaneshmandiNoureddin KarimiAmir-Hossein BaratiJournal Article19700101Background: Posture instability and unsteady gait disorders in Parkinson’s Disease (PD) usually contribute to fall-related fractures. Fall-related trauma in PD is the most common reason for injury. Despite providing modern care for PD patients (PP) in the recent years, anti-PD drugs have no effect on falling. There is an urgent need to administer exercise interventions to reduce falls and related injuries in the rehabilitation program of PP. Objectives: To explore the effect of a selective 10-week corrective exercise with an emphasis on gait training activities (GTA) on the number of falls (NOFs), fear of falling, functional balance, timed up and go (TUG) test among PD patients. Patients and Methods: A purposeful sampling was performed on PP who had fallen or were at risk of falling in 2014. The study intervention consisted of a 10-week (3 sessions each week, each lasting 60 min) corrective exercise program. Participants were randomly allocated to control and two exercise groups; the exercise group with balance pad (EGBP) or exercise group with no balance pad (EGNBP). The analysis of variance (ANOVA) and paired t-test were used for comparison between the groups (P ≤ 0.05). Results: Administrating a selective corrective exercise in exercise group with balance pad (EGBP) showed a significant difference in number of falls (NOF), Fall Efficacy Scale-international (FES-I), Berg balance scale (BBS) (and timed up and go) TUG (P = 0.001); while administrating the same exercise in exercise group with no balance pad (EGNBP) showed no significant difference in NOF (P = 0.225) and a significant difference in FES-I (P = 0.031), BBS (P = 0.047) and TUG (P = 0.012). The control group showed no significant difference in each of the dependent variables. Conclusions: Performing a selective corrective exercise on balance pad improves falling and functional balance in idiopathic PD.https://www.traumamon.com/article_99987_bbf09db975a3e28ea7e5c6fef58b0c18.pdfOfficial Publication of the National Center for Trauma ResearchTrauma Monthly2251-746421120160201Comparison of Roll Stitch Technique and Core Suture Technique for Extensor Tendon Repair at the Metacarpophalangeal Joint level9998810.5812/traumamon.24563ENHamid NamaziKamran MozaffarianMohammad Reza GolmakaniJournal Article19700101Background: Proper suturing technique is needed to ensure good outcome in extensor tendon surgery. Different techniques have been reported for the repair of extensor tendon injuries at the level of the metacarpophalangeal joint (MCPJ). These reports were in vitro studies on cadaver models. Repair techniques must be clinically tested, to determine results. Objectives: The purpose of this in vivo study was to compare results of extensor tendon repair, using roll stitch and core suture techniques. Patients and Methods: Forty two fingers, in 38 patients (aged 15- 45 years), with simple complete extensor tendon injuries in the MCPJ area, were identified and operated by a single surgeon. The patients were divided into two groups, according to the technique used for tendon repair. The first group consisted of 21 digits, in 19 patients, who were repaired with roll stitch technique, while the second group consisted of 21 digits, in 19 patients, who were repaired with core suture technique. The same splint and rehabilitation regimen (early passive range of motion) were given to all patients. The splints were removed at 6 weeks after surgery and range of motion of the operated fingers was measured and compared to uninjured hands, after 12 weeks. Results: Five patients were lost to follow up or excluded from the study. There was no rupture of the repaired tendons in the groups. There was no statistically significant difference in mean MCPJ flexion, proximal interphalangeal joint (PIPJ) flexion, distal interphalangealjoint (DIPJ) flexion and total range of motion of the fingers, between the two groups. However, extension lag was significantly more common in the second group (11 of 19 digits) compared the first group (four of 17 digits). Conclusions: Roll stitch technique had superior outcome compared to the modified Kessler technique, when performed in the MCPJ area. Level of evidence: Therapeutic (Level III)https://www.traumamon.com/article_99988_6569c0a9716bd83bc12c14e50120317f.pdfOfficial Publication of the National Center for Trauma ResearchTrauma Monthly2251-746421120160201Effects of Normobaric Hyperoxia in Traumatic Brain Injury: A Randomized Controlled Clinical Trial9998910.5812/traumamon.26772ENAbbas TaherZahra PilehvariJalal PoorolajalMashhood AghajanlooJournal Article19700101Background: Traumatic brain injury (TBI) is one of the important causes of morbidity and mortality throughout the world, especially in young people. In recent years normobaric hyperoxia has become an important and useful step for recovery and improvement of outcome in TBI. Objectives: The purpose of this study was to evaluate the effects of normobaric hyperoxia on clinical neurological outcomes of patients with severe traumatic brain injuries. We used the Glasgow outcome scale (GOS), barthel index, and modified rankin scale (mRS) to measure the outcomes of patients with TBI. Patients and Methods: Sixty-eight consecutive patients with severe TBI (mean Glasgow coma scale [GCS] score: 7.4) who met the inclusion criteria were entered in this randomized controlled clinical trial. The patients were randomized into two groups, as follows: 1) experimental: received 80% oxygen via mechanical ventilator in the first 6 hours of admission, 2) control: received 50% oxygen by mechanical ventilator in the first 6 hours of admission and then standard medical care. We measured the GOS, Barthel Index, and mRS at the time of discharge from hospital and reassessed these measurements at the 6-month follow-up after injury. Results: According to our study, there were no significant sex or age differences between the two groups (P = 0.595 and 0.074). The number of days in the intensive care unit (ICU) in the control group and experimental group were 11.4 and 9.4 days, respectively (P = 0.28), while the numbers of days of general ward admission were 13.9 and 11.4 days (P = 0.137) respectively. The status of GOS at time of discharge were severe = 13 and 10, moderate = 16 and 19, and low = 5 and 5 in the control and experimental groups, respectively (P = 0.723); 6 months after injury, the scores were as follows: moderate = 16 and 9, low = 15 and 25, and severe = 3 and 0 (P = 0.024). The Barthel index scores in the control and experimental groups were 59.7 and 63.9 at time of discharge (P = 0.369) and 82.7 and 91.3 at 6 months after injury (P = 0.018), respectively. The mRS results were 2.6 and 2.3 at time of discharge (P = 0.320) and 1.6 and 0.7 at 6 months after injury (P = 0.006) for the control and experimental groups, respectively. Conclusions: According to the results of this study, oxygen therapy by mechanical ventilator in the first 6 hours after injury in patients with severe TBI can improve the final GOS, Barthel index, and mRS scores. It could also improve long-term outcomes and enhance rehabilitation and the quality of life.https://www.traumamon.com/article_99989_f383d126b302d8287d24c6b4ad7a4891.pdf