Fall Injuries: An Important Preventable Cause of Trauma
Mehrdad
Mahdian
Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
author
text
article
2013
eng
Archives of Trauma Research
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https://archtrauma.kaums.ac.ir/article_62147_5367f7227740d54c8d862dd47e450110.pdf
dx.doi.org/10.5812/atr.16079
Early Rehabilitation in Head Injury; Can We Improve the Outcomes?
Rajiv
Singh
Osborn Neurorehabilitation Unit, Northern General Hospital, UK
author
Guruprasad
Venkateshwara
Osborn Neurorehabilitation Unit, Northern General Hospital, UK
author
Julie
Batterley
Osborn Neurorehabilitation Unit, Northern General Hospital, UK
author
Sarah
Bruce
Osborn Neurorehabilitation Unit, Northern General Hospital, UK
author
text
article
2013
eng
Background
The quality of care after head injury is still very variable with a little coordination
between different specialties. Acute care dominates, often with little regard to
rehabilitation needs.
Objectives
To improve the outcomes of all head injury admissions to hospital, including mild and
moderate, by creating a head injury team to supervise a rehabilitation clinical
pathway.
Patients and Methods
A head injury team was established to manage the care of all non-neurosurgical
admissions with head injury to a large teaching hospital. Apart from inpatient care, the
team coordinates various services involved in the care of head injuries, arranged
suitable follow-ups, supported relatives and trained healthcare staff on general wards
in the treatment of head injured patients. Follow-up clinics at 6 weeks and 6 months
were arranged.
Results
In the first three years, the team managed the care of 812 admissions. Mean age was
44.3 years (SD = 24.8) and mean length of hospital stay was 6.1 days (SD = 10.9). Of
these individuals, 674 attended for 6 month follow-up with 52.2% having a good outcome
on Extended Glasgow outcome score. Patients and their relatives' feedbacks were
excellent with an average score of 4.7/5 on overall satisfaction rating. Following
presentations at national meetings and elsewhere, other centers in the United Kingdom
are now setting up similar pathways.
Conclusions
A dedicated clinical pathway and head injury team can improve the quality of care for
all admissions with head injury and enhance the role for rehabilitation medicine input
at an early stage.
Archives of Trauma Research
Kashan University of Medical Sciences
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https://archtrauma.kaums.ac.ir/article_62148_ff584cd7cf65f8ad46fc1b43bfdb759f.pdf
dx.doi.org/10.5812/atr.13665
Treatment of Open Pediatric Tibial Fractures by External Fixation Versus Flexible Intramedullary Nailing: A Comparative Study
Hossein
Aslani
Pediatric Orthopedic, Tehran University of Medical Sciences,Tehran, IR Iran
author
Ali
Tabrizi
Orthopedic Surgery, Shohada Educational Hospital, Tabriz University of Medical Sciences, Tabriz, IR Iran
author
Ali
Sadighi
Shohada Educational Hospital, Tabriz University of Medical Sciences, Tabriz, IR Iran
author
Ahmad Reza
Mirblok
Orthopedic Surgery, Poursina Educational Hospital, Guilan University of Medical Sciences, Rasht, IR Iran
author
text
article
2013
eng
Background
Tibial fractures are the third most common pediatric long-bone fracture after forearm and femoral fractures. Approximately 50% of pediatric tibial fractures occur in the distal third of the tibia. This is followed by midshaft tibial fractures (39%), and least commonly, the proximal third of the tibia is involved. Tibial fractures in the skeletally immature patient can usually be treated without surgery but tibial fractures resulting from high energy traumas are of special importance considering type of the selected treatment method affecting the children future. Manipulation and casting are regarded as definite treatments for children tibia fractures. They are used following compartment syndrome in poly-trauma, neurovascular damages, open fractures, and fasciotomy cases.
Objectives
In children, most open fractures occur due to high energy traumas and inappropriate treatment of the fractures may result in several complications. Flexible intramedullary nailing is one of the popular options as an effective method of treating long-bone fractures in children. The external fixator is used in cases with severe injuries and open fractures. The present study aims at comparing results of these two treatment methods in the pediatric tibial open fractures.
Materials and Methods
In this descriptive analytical study, 32 patients with open tibial fractures were treated with either fixator (n = 18) or TEN nails (n=14) during 2006-2011. Some patients were treated with a combination method of TEN and pin. The results were evaluated considering infection, union, mal-union, and re-fracture and the patients were followed up for two years.
Results
Mean time required for fracture union was 12.5 (11-14) and 11.8 (10-12) weeks for the external fixator and TEN groups, respectively. There was no statistical difference in time of union between the two methods. The main complications in external fixation were infection around the pin 4 (22.2%), leg-length discrepancy 2 (11.1%) and re-fracture 4 (22.2%). In the TEN group, 2 cases (14.2%) of painful bursitis were observed at the entry point of TEN and the pin was removed earlier. There was not any report of mal-union requiring correction in the groups. No complication was seen in 6 patients treated with a combined method of pin and flexible intramedullary nails.
Conclusions
Although external fixation in open pediatric fractures and severe injuries is recommended, intramedullary nailing is also an effective method with low complications. Combining pins and flexible intramedullary nails is effective in developing more stability and is not associated with more complications.
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https://archtrauma.kaums.ac.ir/article_62149_e7b5e18ea3f9709278dec9e5ff738829.pdf
dx.doi.org/10.5812/atr.13826
Epidemiology of Accidents and Traumas in Qom Province in 2010
Moharram
Karami Joushin
Health Deputy, Qom University of Medical Sciences, Qom, IR Iran
author
Abedin
Saghafipour
Health Deputy, Qom University of Medical Sciences, Qom, IR Iran
author
Mehdi
Noroozi
Department of Epidemiology, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
author
Hamid
Soori
Department of Health Education, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
author
Esmaeil
Khedmati Morasae
Health Deputy, Qom University of Medical Sciences, Qom, IR Iran
author
Mahmoud
Khodadoust
Department of Epidemiology, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
author
text
article
2013
eng
Background
Accidents are the most important public health challenges in our society. To prevent
the accidents, the identification of their epidemiological features seems necessary.
Objectives
This study was conducted to reveal the epidemiological features of accidents and their
casualties in Qom province in 2010.
Patients and Methods
A cross–sectional study was conducted on 29426 injured people referred to Qom
province hospitals in 2010. Information about place, time, type of accidents and traumas
and demographic variables had been collected in a veteran hospital. Data were analyzed
by SPSS (version 16) software, using chi-square test and logistic regression.
Results
The incidence of accidents was about 27/1000 per year. The incidences of traffic
accidents, motorcycle accidents, violence, burns, poisoning and suicides were 3, 1.6,
1.2, 0.3, 0.8, 0.37 cases per 1000 people respectively. Strikes (65%) and falls (12%)
were the main causes of traumas. Forty-six percent of all injuries had occurred in 16 -
30 years groups. Most frequent accidents were as follows: fall (97%) and strike (50%) in
< 12, violence (46%) in 20 - 29, suicide (71%) in 15 - 29, poisoning (34%) and burns
(20%) among < 5 years old. Pedestrian and motorcycle accidents among +60 years old
people were significantly higher than other (P = 0.000). Odds ratio for suicide among
female was about 3.36 and in 16 - 30 age-group was 15.7 more than +60 years old group (P
= 0.000).
Conclusions
Most traumas in Qom province occurred among younger age-groups and strikes and falls
are the main causes of such traumas. Therefore, safeties to prevent falls and traffic
regulations to reduce strikes can be effective strategies.
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https://archtrauma.kaums.ac.ir/article_62150_0c1528e508d2d755f20b150927466ddf.pdf
dx.doi.org/10.5812/atr.8382
Electrophysiological Assessment of Injury to the Infra-patellar Branch(es) of the Saphenous Nerve during Anterior Cruciate Ligament Reconstruction Using Medial Hamstring Auto-grafts: Vertical versus Oblique Harvest Site Incisions
Reza
Tavakoli Darestani
Orthopedics Surgery Department, Beheshti University of Medical Sciences , Tehran , IR Iran
author
Mohammad Mehdi
Bagherian Lemraski
Orthopedics Surgery Department, Beheshti University of Medical Sciences , Tehran , IR Iran
author
Mehrdad
Hosseinpour
Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
author
Amin
Kamrani-Rad
Orthopedics Surgery Department, Beheshti University of Medical Sciences , Tehran , IR Iran
author
text
article
2013
eng
Background
It was suggested that the direction of incision for medial hamstring tendons harvesting
influences the incidence of injury to the infrapatellar branch of the saphenous nerve
(IPBSN), a common complication following arthroscopically-assisted anterior cruciate
ligament reconstruction (ACLR).
Objectives
The main purpose of current study was to compare the incidence of IPBSN injury between
vertical and oblique incisions utilizing electrophysiological evaluation.
Patients and Methods
There were 60 patients underwent arthroscopically-assisted ACLR assigned to two equal
vertical or oblique incision groups, randomly. One year postoperatively, the patients
were electrophysiologically examined to detect whether IPBSN is injured. The Lysholm
score was completed. The patients' satisfaction with surgical outcomes determined
utilizing visual analogue scale (VAS). Finally, two groups were compared and the effect
of IPBSN injury on function and satisfaction was investigated.
Results
The incidence of IPBSN injury was higher in the vertical group (4 patients vs. 10
patients), but the difference was not statistically significant. The mean of Lysholm and
VAS scores were the same. Also, the mean of Lysholm score was the same in patients with
and without IPBSN injury. However, patients without IPBSN injury were more satisfied
(8.9 ± 9 vs. 7.4 ± 1.1; P < 0.001).
Conclusions
IPBSN injury is a common complication following arthroscopically-assisted ACLR and, if
not significant, oblique direction of the incision is associated with decreased
incidence of the injury. IPBSN injury has no effect on the function but because of the
disturbance with patients' satisfaction, authors believe the oblique incision is
preferable to avoid the nerve injury during medial hamstring tendons harvesting.
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dx.doi.org/10.5812/atr.11146
Morphology of Rat Hippocampal CA1 Neurons Following Modified Two and Four-Vessels Global Ischemia Models
Mohammad Ali
Atlasi
Anatomical Sciences Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
author
Homayoun
Naderian
Anatomical Sciences Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
author
Mahdi
Noureddini
Physiology Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
author
Esmaeil
Fakharian
Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
author
Abolfazl
Azami
Anatomical Sciences Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
author
text
article
2013
eng
Background
An appropriate animal model of ischemia stroke is essential for evaluation of different therapeutic methods. Two and four-vessel global ischemia models are one of the most common types of transient cerebral ischemia.
Objectives
In this study, the morphology of rat hippocampal CA1 neurons in modified models of two and four-vessel ischemia and reperfusion were evaluated.
Materials and Methods
In this study, 20 Wistar rats were randomly divided into five groups. In group 2 and 3, both common carotid arteries were occluded for 10 minutes in either 3 or 24 hours of reperfusions, respectively. In group 4 and 5, both common carotid and vertebral arteries were occluded for 10 minutes in either 3 or 24 hours of reperfusions, respectively. Group 1 as control, underwent the whole surgery without any arteries occlusion. Hippocampi of the rats in all groups were processed and tissue sections were stained using the Nissl method. The morphology of CA1 neurons were studied under a light microscope and compared different groups.
Results
In all groups ischemic changes were apparently observed in hippocampus CA1 neurons. In two-vessel occlusion model, after 3 and 24 hours of reperfusions, ischemic cells accounted for 14.9% and 23.2%, respectively. In four-vessel occlusion model, after 3 and 24 hours of reperfusions, ischemic cells accounted for 7.6% and 44.9% (P < 0.0001), respectively.
Conclusions
Modified four-vessel occlusion model resulted in significant ischemic changes after 24 hours of reperfusion in CA1 neurons of rat hippocampus.
Archives of Trauma Research
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https://archtrauma.kaums.ac.ir/article_62152_1a6a72deb34075bc297fa062d5e08341.pdf
dx.doi.org/10.5812/atr.10240
Wandering Spleen in an Adult Man Associated With the Horseshoe Kidney
Mohammadreza
Memari
Najafabad Azad University, Najafabad, IR Iran
author
Mohsen
Nikzad
Faculty of Medicine, Kashan University of Medical Sciences, Kashan, IR Iran
author
Hossein
Nikzad
Anatomical Sciences Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
author
Aliakbar
Taherian
Anatomical Sciences Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
author
text
article
2013
eng
Introduction
A wandering spleen occurs when there is a laxity of the ligaments that fix the spleen in its normal anatomical position.
Case Presentation
This is a case report of a wandering spleen with horseshoe kidney in a 29-year-old male admitted with acute lower abdominal pain and vomiting to emergency department of Shariati hospital in Isfahan province. Sonographic examination showed a homogeneous 21 × 15 × 8 cm mass in the lower part of the abdomen and pelvis associated with a horseshoe kidney. Laparotomy confirmed the clinical and ultrasound findings.
Conclusions
The association of horseshoe kidney with a wandering spleen in this case may be due to an embryological anomaly.
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https://archtrauma.kaums.ac.ir/article_62153_747a8a02086145a51e0ecf1c89044b12.pdf
dx.doi.org/10.5812/atr.9332
Innovative Technique of Vascular Repair in Intra-Operative IVC Rupture During Lumbar Microdiscectomy: A Case Report
Sandeep
Singh
Primus Super Specialty Hospital, Chankayapuri, New Delhi, India
author
Arun
Bhanot
Primus Super Specialty Hospital, Chankayapuri, New Delhi, India
author
Nipun
Bajaj
Primus Super Specialty Hospital, Chankayapuri, New Delhi, India
author
Pooja
Rustagi
Primus Super Specialty Hospital, Chankayapuri, New Delhi, India
author
text
article
2013
eng
Background
Major vascular injury during a spinal surgery is a rare but most dreaded complication.
Case Presentation
A 39 years old female undergoing microscopic lumbar discectomy suddenly developed severe hypotension on table. The procedure was abandoned and the patient turned supine. It was diagnosed to be a major vessel tear and the patient was taken up for immediate successful vascular repair. To best of our knowledge such a repair procedure has not been described in literature.
Conclusions
Majority of such vascular injuries are dealt with primary repair of the defect by a vascular surgeon; however in our case the rent was big and placed on the undersurface making it very difficult for the vascular surgeon to approach or repair it primarily.
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https://archtrauma.kaums.ac.ir/article_62154_6f4b50e1a5aee943b7ac0a59a7fc6b39.pdf
dx.doi.org/10.5812/atr.11005
Application of Queuing Analytic Theory to Decrease Waiting Times in Emergency Department: Does it Make Sense?
Sean Shao
Wei Lam
Health Services Research Unit, Singapore General Hospital, Singapore
author
Marcus Eng
Hock Ong
Department of Emergency Medicine, Singapore General Hospital, Singapore
author
text
article
2013
eng
Archives of Trauma Research
Kashan University of Medical Sciences
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https://archtrauma.kaums.ac.ir/article_62155_dd8aaf4d9241049af08bcf7bf12c98ad.pdf
dx.doi.org/10.5812/atr.11376
Comparison of Analgesic Effect between Gabapentin and Diclofenac on Post-Operative Pain in Patients Undergoing Tonsillectomy
Mario
I Ortiz
Medicine Academic Area, Health Sciences Institute at the Autonomous University of Hidalgo State, Pachuca, Hidalgo, Mexico
author
Luis C
Romero-Quezada
Medicine Academic Area, Health Sciences Institute at the Autonomous University of Hidalgo State, Pachuca, Hidalgo, Mexico
author
text
article
2013
eng
Archives of Trauma Research
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https://archtrauma.kaums.ac.ir/article_62156_a2f919cb1d27183f5f83d54dfcf18585.pdf
dx.doi.org/10.5812/atr.10441