Official Publication of the National Center for Trauma Research Trauma Monthly 2251-7464 27 2 2022 04 01 External Iliac Artery Injury Occurring Following Pelvic Ring and Acetabulum Fracture: A Case Report 402 406 148845 10.30491/tm.2022.283531.1285 EN Reza Zandi Orthopaedic Department,Taleghani Hospital,Shahid Beheshti University of Medical Sciences 0000-0002-0095-6745 Mohammad Hassani Assistant Professor of Vascular Surgery,Department of Vascular and Endovascular Surgery,Ayatollah Taleghani Hospital,Shahid Beheshti University of Medical Sciences,Tehran,Iran 0000-0002-8671-5191 Alireza Manafi Department of Orthopedic Surgery, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 0000-0001-6355-704X Mohammad Kazem Emami Maybodi Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran. 0000-0003-3795-5428 Journal Article 2021 04 27 After head trauma, pelvic fractures are the most common cause of death in patients with multiple trauma. The primary cause of death in patients with a pelvic fracture is uncontrollable bleeding, and in cases of delayed intervention, hemorrhagic shock is the principal cause of death. Bleeding from the external iliac artery following Pelvic Ring and acetabulum fractur is an uncommon orthopedic emergency. A 48-year-old man who suffered pelvic trauma was referred to the hospital, and an Antero-Posterior Compression type- II (APC‎ II) of the Pelvic Ring‏ ‏and Acetabulum fracture was diagnosed. The patient developed thrombosis of the external iliac artery 48 hours after admission. CT angiography was performed for further assessment. Then, the anterior column of the acetabulum, disruption of the symphysis underwent open reduction. Internal fixation with a 3.5 reconstruction plate via a modified Stoppa approach was done. Sacroiliac disruption on the right side was repaired via percutaneous sacroiliac screw fixation. In the same session, the vascular repair was done via interpositional PTFE graft. After surgery, the patient's general condition was satisfactory, and he was discharged without complications.

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Official Publication of the National Center for Trauma Research Trauma Monthly 2251-7464 27 2 2022 04 01 Transverse Clival Fracture with Vertical Displacement: A Case Report 407 410 148847 10.30491/tm.2022.299404.1352 EN Arash Fattahi Iran University of Medical Sciences 0000-0002-1874-6527 Morteza Taheri Assistant Professor of Neurosurgery, 7 Tir Hospital, Department of Neurosurgery, Iran University of Medical Sciences, Tehran, Iran. Hooman Koohestani Resident of Neurosurgery, 7 Tir Hospital, Department of Neurosurgery, Iran University of Medical Sciences, Tehran, Iran. Moein Ravansalar Resident of Neurosurgery, 7 Tir Hospital, Department of Neurosurgery, Iran University of Medical Sciences, Tehran, Iran. Ali Shahhoseini Resident of Neurosurgery, 7 Tir Hospital, Department of Neurosurgery, Iran University of Medical Sciences, Tehran, Iran. Journal Article 2021 08 11 Clival fracture is a rare traumatic injury that usually occurs in patients suffering high-energy trauma to the head and neck. Here, we present and discuss our experience in a patient with a transverse clival fracture associated with significant vertical displacement. A 52-year-old comatose patient was admitted to our emergency department after a high-energy motor vehicle accident. The physical examination revealed a Glasgow Coma Scale (GCS) of 6 (with a motor scale of 4) associated with a left-sided six cranial nerve palsy, a left-sided fixed and dilated pupil; and quadriparesis that was more severe on the right side. The imaging tests revealed brain contusions, pneumocephalus, and generalized brain edema without local mass effect or midline shift. Also, it showed TCF with significant vertical displacement and a signal change within the medulla oblongata. The clival fracture was managed using a mild head flexion position without bracing, and a routine ICU exchange body positioning program. The follow-up imaging three months later showed complete bone fusion without any displacement. After 18 months, he was ambulated, and cranial nerve deficit improved except for mild diplopia due to a remnant 6 cranial nerve paresis. Transverse clival fracture, as most of the authors report, does not need surgical treatment. Bracing can be used in conscious ambulatory patients. A mild head-on-neck flexion position associated with supporative care for bedsores must be done for unconscious patients.

https://www.traumamon.com/article_148847_e2030b4a76875fb39c94275a216d19b3.pdf

Official Publication of the National Center for Trauma Research Trauma Monthly 2251-7464 27 2 2022 04 01 Assessment of Endoscopic Colonic Stenting Outcomes in Patients with Acute Malignant Colonic Obstruction 411 417 134769 10.30491/tm.2021.281231.1277 EN Mikhail Bokarev Sechenov First Moscow State Medical University, Department of Hospital Surgery, Moscow 0000-0003-0679-8132 Aleksandr Mamykin Department of Hospital Surgery, Sechenov First Moscow State Medical University Evgeny Muntyanu Department of Hospital Surgery, Sechenov First Moscow State Medical University Denis Kryazhev Endoscopy Department, Eramishantsev City Clinical Hospital Andrei Demyanov Department of Hospital Surgery, Sechenov First Moscow State Medical University Arnold E. Markarov Eramishantsev City Clinical Hospital, Moscow, Russian Federation Journal Article 2021 04 14 Background: The traditional method of treating patients with acute malignant colonic obstruction (AMCO) is emergency surgery, which is often accompanied by the development of severe complications and high mortality. Endoscopic colonic stenting with self-expandable metal stents (SEMS) is a promising way to treat such patients. However, its capabilities are not yet fully explored. We present a cross-sectional study with endoscopic colonic stenting using SEMS in AMCO patients, treated from 2016-2020 to clarify and identify the factors that may influence the result. Methods. Our study included 218 patients with AMCO in whom surgeons attempted to eliminate acute colonic obstruction using endoscopic stenting. The capabilities of endoscopic stenting were assessed based on calculated technical and clinical efficacy, complications, and mortality. The patients were divided into two groups namely the clinical success group (182 patients) and the clinical failure group (36 patients). Results: The results showed that the technical efficiency of endoscopic stenting of the colon was 91.7%, and its clinical efficiency was 83.5%. The incidence of intra-abdominal complications was 8.3%, the incidence of somatic complications was 11.9%, and mortality was 5%. Comparative analysis of the groups revealed significant differences ( P<0.05) for the oncological process stage, the duration, and the severity of intestinal obstruction. Conclusion: Endoscopic stenting of the colon with SEMS is an effective way to treat patients with AMCO. The success rate may vary depending on the severity of trophic disorders in the intestinal wall.

https://www.traumamon.com/article_134769_dc97fbcb84b46aa1e3186902957ddcb8.pdf

Official Publication of the National Center for Trauma Research Trauma Monthly 2251-7464 27 2 2022 04 01 Treatment of Acute Type I Proximal Fifth Metatarsal Fractures; Casting vs Bracing 418 426 148848 10.30491/tm.2022.225911.1097 EN Mohsen Mardani-Kivi Ghaem clinical Research and Development Unit, Guilan University of Medical Science, Rasht, Iran 0000-0002-9437-5756 Zoleikha Azari Department of Anatomical Sciences & Cell Biology, Mashhad University of medical sciences, Mashhad, Iran 0000-0001-5923-0482 Journal Article 2020 04 14 Introduction: The acute type I proximal fifth metatarsal fracture is one of the most common fractures of the small bones of the foot. The current study aimed to compare the results of two non-invasive treatment methods namely casting with ultrasound and bracing with ultrasound. Methods: Patients with acute type I proximal fifth metatarsal fracture were divided into two groups namely casting and bracing based on a randomized complete block design and were followed at six, 12, and 18 weeks. The variables studied included age, gender, body mass index (BMI), mechanism of trauma, sports activity level, visual analogs scale (VAS), re-fracture, nonunion, the average time to clinical and radiographic union, as well as AOFAS (the American Orthopedic Foot and Ankle Society hind-foot) and short form-36 satisfaction scores, which were collected via questionnaires by the participant and the physician. Results: Of 117 patients, 57 were treated by casting and 60 by bracing and were followed up for 18 weeks. The mean age of patients was 27.5 ± 1.25 years. There were no significant differences between the groups at the time of radiographic and clinical union, degree of AOFAS at all-time points, and the level of pain at 12 and 18-week follow-ups. The VAS score in the casting group was lower than that of the bracing group at the six-week follow-up. The mean times for radiographic and clinical union in both groups were 70 and 40-41 days respectivly. Based on SF-36, the level of satisfaction was higher at all time points with bracing. Conclusion: According to the results of this study, both methods used had acceptable results, but, given the greater satisfaction reported by the subjects in the bracing group, it seems that the bracing is an appropriate alternative to the casting technique in the treatment of this type of fracture.

https://www.traumamon.com/article_148848_1ada2318d479e5b5dc6504a80b875808.pdf

Official Publication of the National Center for Trauma Research Trauma Monthly 2251-7464 27 2 2022 04 01 Multidisciplinary Approach for Early Rehabilitation of Multiple Trauma Patients 427 435 148843 10.30491/tm.2022.315619.1401 EN Kian Norouzi Tabrizi Sina Trauma and Surgical Research Center, Tehran University of Medical Sciences, Tehran, Iran. 0000-0001-7439-6691 Fatemeh Pashaei Sabet Department of Community Health Nursing, School of Nursing and Midwifery, University of Shahid Beheshti Medical Sciences, Tehran, Iran 0000-0001-9330-9530 Vafa Rahimi-Movaghar Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran. Maryam Shabany Sina Trauma and Surgical Research Center, Tehran University of Medical Sciences, Tehran, Iran. 0000-0002-2132-6734 Soheil Saadat Sina Trauma and Surgical Research Center, Tehran University of Medical Sciences, Tehran, Iran. Hamid Reza Khankeh Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran. Journal Article 2021 11 18 Background: Trauma is one of the major non-communicable diseases threatening public health. Trauma injuries are the leading cause of disability and mortality globally. This study aimed to explore and understand the challenges of early rehabilitation care in multiple trauma patients using a qualitative research method. Methods: This study was conducted via the qualitative research approach using qualitative content analysis. The participants interviewed were seven nurses, two doctors, three physiotherapists, and two occupational therapists in inpatient wards and outpatient setting. Data were collected through semi-structured interviews with a purposive sampling continued until data saturation. Results: Overall, 800 codes were extracted from depth description of the participant opinions. Two main themes namely the lack of holistic care and support structure were extracted for analysis, and constant comparison. Conclusion: The results showed that comprehensive and rehabilitation-based care was essential to achieve important goals in this group of patients. Understanding the challenges of early rehabilitation care in multiple trauma patients may help health policymakers solve these problems and improve the general health of this group.

https://www.traumamon.com/article_148843_338e32734f48ad201330994f1f85a9ac.pdf

Official Publication of the National Center for Trauma Research Trauma Monthly 2251-7464 27 2 2022 04 01 Effect of Bilva Herbal Ointment and Silver Sulfadiazine on Healing, Pain and Itching of Burn Wounds 436 444 148849 10.30491/tm.2022.312344.1392 EN Safa Tabnak Department of Clinical Biochemistry,Tabriz University of Medical Sciences,Tabriz,Iran Mohammad Hossein Rafiei MSc Student in Surgical Technology, School of Allied Medical Sciences, Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran 0000-0002-0134-8645 Ahmad Mirza Aghazadeh Attari Department of Basic Sciences, Faculty of Paramedicine, Tabriz University of Medical Sciences, Tabriz, Iran. Babak Davami Plastic Surgeon, Sina Hospital, Tabriz University of Medical Sciences, Tabriz, Iran. Afsaneh Noubakht Faculty of Nursing and Midwifery, Sina Hospital, Tabriz University of Medical Sciences, Tabriz, Iran. Mojgan Lotfi Department of Medical Surgical Nursing, Faculty of Nursing and Midwifery, Sina Hospital, Tabriz University of Medical Sciences, Tabriz, Iran 0000-0003-3298-6882 Journal Article 2021 10 27 Background: The most common method for burn wound dressing is silver sulfadiazine (SSD); however, its side effects on wound healing and the need for repeated use are often painful. This study sought to compare two different dressings, namely Bilva and SSD ointments, on wound healing, pain, itching, and scarring of burn wounds. Methods: This clinical trial was performed on 35 patients with superficial second-degree burns hospitalized in the Burn Ward of Sina Hospital in Tabriz, Iran, from 2019 to 2020. After irrigation of the wound, Bilva ointment was applied randomly on one side and SSD ointment on the other side to treat the burns. Patients were followed on days 1, 7, 14, 21, and the first, second, and third months after burns; data related to the wound healing process, pain, itching, and scar status of the patients were collected with a checklist. Results: There was no statistically significant difference between the two groups of variables related to the wound healing process on any of the time-points. The amount of burn wound scar did not differ between the two groups on day 21 and the first, second, and third months. Pain and itching were significantly better in the Bilva group on the 7th (p<0.01), 14th (p<0.01), 21st days (p<0.01), and the first month (p<0.01) after burns. Conclusion: Bilva ointment had a similar effect on healing of the burn wounds of patients compared to SSD, and it was more effective in controlling pain and itching of burn wounds. Further studies are needed to evaluate the cost-effectiveness of this dressing method on superficial burn wounds.

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Official Publication of the National Center for Trauma Research Trauma Monthly 2251-7464 27 2 2022 04 01 Minimally Invasive Plate Osteosynthesis (MIPO) for Treatment of Delayed or Nonunion of Humerus Shaft Fracture: A New Technique 445 452 148846 10.30491/tm.2021.299527.1355 EN Mohammad Ali Okhovatpour Associate professor, Department of Orthopedics, Taleghani Hospital Research Development Committee, Medical school, Shahid Beheshti University of medical sciences, Tehran, Iran. 0000-0001-6779-6662 Esmaeel Yousefi-Hajivand Shahid Beheshti University of Medical Sciences, Tehran, Iran. 0000-0002-9337-0662 Arash Khojasteh Department of Medical Biotechnology, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 0000-0002-5378-852X Ali Tabrizi Department of Orthopedics, Imam Khomeini Hospital, Urmia University of Medical Science, Urmia, Iran 0000-0002-4385-6445 Alireza Mirahmadi Shahid Beheshti University of medical sciences, Tehran, Iran. Journal Article 2021 08 13 Background: The humerus shaft fracture (HSF) is a typical long bone fracture. Following non-surgical therapy, some patients experience delayed or non-union of the HSF. The most common treatment is open reduction and internal fixation (ORIF) with plates and bone grafts. However, substantial tissue dissection increases radial nerve damage and delays union. Because of its minimally invasive nature, the minimally invasive plate osteosynthesis (MIPO) method may be a suitable replacement technique. MIPO helps in protection of soft tissue and nerves in the area of the fracture. Methods: All patients were treated with the MIPO method using bone graft implantation. A specific six-hole locking plate was used. Physical examinations and radiological studies were used to monitor the patients' progress. UCLA and the MEPS scoring system assessed shoulder and elbow function. The average follow-up period was six months. Result: The mean age of patients was 39.8 years (19-73 years). The mean fracture site distance from the elbow joint was 12.1 cm. The mean maximum final rotation was 3.3 degrees. The last rotation alignment was within normal limits. No shortening was detected. Average scores were 35 for UCLA and 100 for MEPS. Radial nerve damage was not reported. Malunion, delayed union, or nonunion did not occur. Mean union time was 2.8 months. Conclusion: MIPO technique combined with bone transplant causes micromotion at the fracture site, resulting in a better and faster union. Its minimally invasive nature also helps prevent iatrogenic injury to nerves and soft tissue. Less tissue manipulation and dissection help shoulder and elbow function progress more quickly and reduce the rate of malunion. We recommend this method in delayed union and nonunion of HSF patients for better outcomes and lesser complications.

https://www.traumamon.com/article_148846_b009cb73034f2d20ec4f7bd1cd60f95e.pdf

Official Publication of the National Center for Trauma Research Trauma Monthly 2251-7464 27 2 2022 04 01 Comparison of Surgery First Versus Orthodontics First Approaches in Management of Skeletal Class III Malocclusion: A Systematic Review 453 459 148856 10.30491/tm.2022.316408.1406 EN Fatemeh Samieizadeh Orthodontist, Fellow of Orthosurgery, School of Dentistry, Department of Orthodontics, Shahid Beheshti University of Medical Sciences, Tehran, Iran Ladan Eslamian 2- Professor of Orthodontics, School of Dentistry, Department of Orthodontics and Center of Dentofacial Deformity, Shahid Beheshti University of Medical Sciences, Tehran, Iran Mohammad Farahani Assistant Professor, School of Dentistry, Department of Orthodontics, Shahid Beheshti University of Medical Sciences, Tehran, Iran Journal Article 2021 11 22 Background: This study aimed to review the articles comparing orthodontic first (OFA) and surgery first approaches (SFA) orthognathic approaches from various aspects in patients with class III skeletal malocclusion. Methods: Electronic databases were systematically searched, including PubMed, Scopus, and Web of Science. We included experimental cohort and retrospective studies that compared the orthodontics first (conventional method) and surgery first approaches in the management of patients with skeletal class III malocclusion from various aspects. Results: A total of 294 records were found through database searching; after removing duplicates, 131 papers were assessed. Finally, 17 studies were included. The included studies evaluated a vast spectrum of outcome measures ranging from quality of life and duration of treatment to cephalometric measures. The amount of surgical movement, post-surgical change, and the relapse rate were the most prevalent assessed outcome measure in 10 out of 17 included studies, followed by total treatment time, which was evaluated in 8 studies. Other less common outcome measures were temporomandibular joint (TMJ) disorders and the oral health-related quality of life (OQLQ) questionnaire. Conclusion: Two OFA and SFA orthognathic surgery approaches were not significant different in terms of the final amounts of surgical change in the mandible and maxilla. Also, these two approaches can remarkably improve the quality of life with no intergroup differences. There is no united consensus on the effects of OF and SF approaches on the outcomes of patients with class III skeletal malocclusions.

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