Kashan University of Medical Sciences
Archives of Trauma Research
2251-953X
2251-9599
4
4
2015
12
01
Operative Treatment of Isolated Bicondylar Hoffa Fracture With a Modified Swashbuckler Approach
EN
Ramanath K.
Sharath
Department of Orthopaedics, MS Ramaiah Medical College, Bangalore, India
Daksh
Gadi
Department of Orthopaedics, MS Ramaiah Medical College, Bangalore, India
Amit
Grover
Department of Orthopaedics, MS Ramaiah Medical College, Bangalore, India
Sandeep Kumar
Gour
Department of Orthopaedics, MS Ramaiah Medical College, Bangalore, India
10.5812/atr.25313
Introduction
An isolated coronal fracture of either or both femoral condyles is a rare entity and is usually associated with high-energy injury trauma. Such fractures should be meticulously fixed for a good functional outcome as they involve the articular surface of a weight bearing joint. A modified swashbuckler approach provides adequate exposure for appropriate reduction and fixation of such fractures.
Case Presentation
A 32-year-old male sustained a bicondylar Hoffa fracture of the right femur which was treated by open reduction and internal fixation using a modified swashbuckler approach. At two years of follow-up, the patient had excellent radiological and functional outcome.
Conclusions
In our study, we treated this rare fracture successfully using a modified swashbuckler approach and found it to be a good approach for such fractures as compared to the conventional approach.
Bicondylar,Hoffa Fracture,Swashbuckler Approach
https://archtrauma.kaums.ac.ir/article_62231.html
https://archtrauma.kaums.ac.ir/article_62231_9861aa8788be7c877e8bd7e73633318c.pdf
Kashan University of Medical Sciences
Archives of Trauma Research
2251-953X
2251-9599
4
4
2015
12
01
Functional Independence Measure in Iran: A Confirmatory Factor Analysis and Evaluation of Ceiling and Floor Effects in Traumatic Brain Injury Patients
EN
Sajjad
Rezaei
Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, IR Iran
Anoush
Dehnadi Moghadam
Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, IR Iran
Naeima
Khodadadi
Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, IR Iran
Pardis
Rahmatpour
Department of Nursing, Faculty of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, IR Iran
10.5812/atr.25363
Background
The functional independence measure (FIM) is one of the most important assessment instruments for motor and cognitive dependence in rehabilitation medicine; however, there is little data about its confirmatory factor analysis (CFA) and ceiling/floor effects from other countries and also in Iranian patients.
Objectives
The aim of this study was to evaluate a two-factor model (motor and cognitive independence as latent variables) and ceiling/floor effects for FIM in Iranian patients with traumatic brain injuries (TBI).
Patients and Methods
In this cross-sectional study, 185 subacute TBI patients were selected from emergency and neurosurgery departments of Poursina Hospital (the largest trauma hospital in northern Iran, Rasht) using the consecutive sampling method and were assessed for functional independence.
Results
The results of this study showed that the floor effect was not observed; however, ceiling effects were observed for the FIM total score and its subscales. The confirmatory factor analysis showed that the chi-square/df ratio was 2.8 for the two-factor structure and the fit indices for this structural model including root mean square error of approximation (RMSEA) = 0.099, normed fit index (NFI) = 0.96, tucker lewis index (TLI) = 0.97, comparative fit index (CFI) = 0.97 were close to standard indices.
Conclusions
Although ceiling effects should be considered for rehabilitation targets, the two-factor model of FIM (motor and cognitive independence) has an eligible fitness for Iranian patients with TBI.
Traumatic Brain Injury,Confirmatory Factor Analysis,Disability Evaluation
https://archtrauma.kaums.ac.ir/article_62232.html
https://archtrauma.kaums.ac.ir/article_62232_8798eaecf757a58336cb5488655c2115.pdf
Kashan University of Medical Sciences
Archives of Trauma Research
2251-953X
2251-9599
4
4
2015
12
01
Open Repair Versus Thoracic Endovascular Aortic Repair in Multiple-Injured Patients: Observations From a Level-1 Trauma Center
EN
Stephan
Brand
Trauma Department, Hannover Medical School (MHH), Hannover, Germany
Ingo
Breitenbach
Department of Cardiothoracic and Vascular Surgery, Public Hospital Braunschweig, Braunschweig, Germany
Philipp
Bolzen
Department of Diagnostic Radiology, Hannover Medical School, Hannover, Germany
Maximilian
Petri
Trauma Department, Hannover Medical School (MHH), Hannover, Germany
Christian
Krettek
Trauma Department, Hannover Medical School (MHH), Hannover, Germany
Omke
Teebken
Division of Vascular Surgery, Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
10.5812/atr.27183
Background
Blunt trauma of the thoracic aorta is a rare but potentially life-threatening entity. Intimal tears are a domain of non-operative management, whereas all other types of lesions should be repaired urgently. There is now a clear trend favoring minimally invasive stent grafting over open surgical repair.
Objectives
The aim of the present study was to retrospectively evaluate the mortality and morbidity with either treatment option. Therefore, a retrospective observational study was performed to compare two different treatment methods at two different time periods at one trauma center.
Patients and Methods
Between 1977 and 2012, all severely injured patients referred to our level 1 trauma center were screened for blunt aortic injuries. We compared baseline characteristics, 30-day and overall mortality, morbidity, duration of intensive care treatment, procedure time, and transfusion of packed red blood between patients who underwent open surgical or stent repair.
Results
During the observation period, 45 blunt aortic injuries were recorded. The average Injury Severity Score (ISS) was 41.8 (range 29 - 68). Twenty-five patients underwent Open Repair (OR), and another 20 patients were scheduled to emergency stent grafting. The 30-day mortality in the surgical and stent groups were 5/25 (20%) and 2/20 (10%), respectively. The average time for open surgery was 151 minutes; the mean time for stent grafting was 67 minutes (P = 0.001). Postoperative stay on the intensive care unit was between one and 59 days (median 10) in group one and between four and 50 days in group two (median 26)(P = 0.03). Patients undergoing OR required transfusion of 6.0 units of packed red cells in median; patients undergoing stent grafting required a median of 2.0 units of packed red cells (P < 0.001). In the stent grafting group, 30-day mortality was 10% (2/20).
Conclusions
Due to more sophisticated diagnostic tools and surgical approaches, mortality and morbidity of blunt aortic injuries were significantly reduced over the years compared to thoracic endovascular aortic repair and OR over two different time periods.
Aortic Rupture,Traffic Accident,Injury severity score,In-Hospital Mortality,Multiple Injuries
https://archtrauma.kaums.ac.ir/article_62233.html
https://archtrauma.kaums.ac.ir/article_62233_3de2b7886e9f214e31749210593f26ed.pdf
Kashan University of Medical Sciences
Archives of Trauma Research
2251-953X
2251-9599
4
4
2015
12
01
Rib Fracture Fixation Restores Inspiratory Volume and Peak Flow in a Full Thorax Human Cadaveric Breathing Model
EN
Gerard P.
Slobogean
Department of Orthopaedics, University of Maryland School of Medicine, R. Adams Cowley Shock Trauma Center, Baltimore, Maryland, USA
Hyunchul
Kim
Fischell Department of Bioengineering, Orthopaedic Mechanobiology Laboratory, University of Maryland, College Park, Maryland, USA
Joseph P.
Russell
Fischell Department of Bioengineering, Orthopaedic Mechanobiology Laboratory, University of Maryland, College Park, Maryland, USA
David J.
Stockton
Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
Adam H.
Hsieh
Fischell Department of Bioengineering, Orthopaedic Mechanobiology Laboratory, University of Maryland, College Park, Maryland, USA
Robert V.
O’Toole
Department of Orthopaedics, University of Maryland School of Medicine, R. Adams Cowley Shock Trauma Center, Baltimore, Maryland, USA
10.5812/atr.28018
Background
Multiple rib fractures cause significant pain and potential for chest wall instability. Despite an emerging trend of surgical management of flail chest injuries, there are no studies examining the effect of rib fracture fixation on respiratory function.
Objectives
Using a novel full thorax human cadaveric breathing model, we sought to explore the effect of flail chest injury and subsequent rib fracture fixation on respiratory outcomes.
Patients and Methods
We used five fresh human cadavers to generate negative breathing models in the left thorax to mimic physiologic respiration. Inspiratory volumes and peak flows were measured using a flow meter for all three chest wall states: intact chest, left-sided flail chest (segmental fractures of ribs 3 - 7), and post-fracture open reduction and internal fixation (ORIF) of the chest wall with a pre-contoured rib specific plate fixation system.
Results
A wide variation in the mean inspiratory volumes and peak flows were measured between specimens; however, the effect of a flail chest wall and the subsequent internal fixation of the unstable rib fractures was consistent across all samples. Compared to the intact chest wall, the inspiratory volume decreased by 40 ± 19% in the flail chest model (P = 0.04). Open reduction and internal fixation of the flail chest returned the inspiratory volume to 130 ± 71% of the intact chest volumes (P = 0.68). A similar 35 ± 19% decrease in peak flows was seen in the flail chest (P = 0.007) and this returned to 125 ± 71% of the intact chest following ORIF (P = 0.62).
Conclusions
Negative pressure inspiration is significantly impaired by an unstable chest wall. Restoring mechanical stability of the fractured ribs improves respiratory outcomes similar to baseline values.
Flail chest,Inspiratory Volume,Operative Stabilization,peak flow,Rib Fixation
https://archtrauma.kaums.ac.ir/article_62234.html
https://archtrauma.kaums.ac.ir/article_62234_8301d31ce62c0ace6380297654dc04d4.pdf
Kashan University of Medical Sciences
Archives of Trauma Research
2251-953X
2251-9599
4
4
2015
12
01
Prevalence of Posttraumatic Stress Disorder and Related Factors Among Patients Discharged From Critical Care Units in Kashan, Iran
EN
Zohreh
Sadat
Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
Mohammad
Abdi
Department of Nursing, School of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, IR Iran
Mohammad
Aghajani
Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
10.5812/atr.28466
Background
Posttraumatic Stress Disorder (PTSD) is a severe anxiety disorder occurred due to past adverse experiences. Several researches have demonstrated that PTSD is quite common among patients discharged from critical care unit.
Objectives
This study aimed to investigate the prevalence of PTSD and its related factors among patients discharged from critical care units in Kashan, Iran, during 2014.
Patients and Methods
A descriptive prospective study was performed on 332 patients admitted to critical care units of Kashan Shahid Beheshti Hospital using a convenience sampling method. Data were collected in wards during hospitalization and one month after their discharge from hospital using questionnaires on demographic, medical information and PTSD Checklist (PCL). The PCL scores of 45 or more were considered as PTSD. Data were analyzed using chi-square, t-test, Mann-Whitney U and logistic regression.
Results
From a total of 332 patients, 160 cases (48.2%) had PTSD and the mean total PCL score in participants was 44.24 ± 19.89. There was a significant difference between the total score of PTSD and its domains in patients with and without PTSD. the univariate analysis showed a significant association between PTSD and increasing age, increased length of hospital stay, more children, having additional comorbidities, unemployed, use of mechanical ventilation (P < 0.001), drug abuse (P = 0.003) and single patients (P = 0.028). However, there was no significant association between PTSD and gender, type of the critical care unit, level of education and admission due to trauma. However, in multivariate analysis using logistic regression, factors associated with PTSD were older age of the participants, use of mechanical ventilation having additional comorbidities, unemployed (P
Posttraumatic Stress Disorder,Critical care unit,Patient
https://archtrauma.kaums.ac.ir/article_62235.html
https://archtrauma.kaums.ac.ir/article_62235_e3285a195f997aaa2fc8a5e29a6c1782.pdf
Kashan University of Medical Sciences
Archives of Trauma Research
2251-953X
2251-9599
4
4
2015
12
01
Effectiveness of Five-Level Emergency Severity Index Triage System Compared With Three-Level Spot Check: An Iranian Experience
EN
Mohammadreza
Maleki
Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, IR Iran
Razieh
Fallah
Amol Imam Reza Hospital, Mazandaran University of Medical Sciences, Sari, IR Iran
Leila
Riahi
Department of Health Services Management, Faculty of Management and Economics, Science and Research Branch, Islamic Azad University, Tehran, IR Iran
Sajad
Delavari
Health Human Resources Research Center, School of Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, IR Iran
Satar
Rezaei
Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, IR Iran
10.5812/atr.29214
Background
Triage for patients’ prioritization in the emergency department is a suitable solution to decrease overcrowding. Different methods are used for prioritization that needs effectiveness evaluation.
Objectives
The aim of this study was to assess the effectiveness of the emergency severity index (ESI) 5-level triage system in contrast with spot check triage.
Patients and Methods
Data for this quasi-experimental study were extracted using a form to review 770 records of patients referred to emergency department of Imam Khomeini hospital (in Sari, north of Iran) during two separated periods each for four months; the first from 20th March to 19th July 2010 and the other from 21 March to 20 July 2011. The method used in the first time was spot check triage and the second one ESI triage. Data were processed with descriptive statistics and analyzed using independent samples t-test (CI = 95%).
Results
Increase from 6.46 to 8.92 minutes in the average time from patient arrival to being visited by a physician (P < 0.001) and increase in average time from physician visit to receive the first nursing care from 7.68 to 15.89 minutes were significant (P < 0.001). The average waiting time for laboratory services was significantly decreased from 112.3 to 84.1 (P = 0.033). Increase in the average waiting time for radiology, decrease in average waiting time for sonography, average length of stay in the emergency department, and number of patients per emergency bed were not significant.
Conclusions
Between the two systems of triage, ESI was more effective than the spot check and in the spatial and temporal domain of research, was a successful method in improving some indicators of emergency and improving the performance indices. Hospital managers by implementation of ESI system can take a step toward new health policies and improve the processes as key tools of continuous quality improvement system.
Emergency Service,triage,Comparative Effectiveness Research
https://archtrauma.kaums.ac.ir/article_62236.html
https://archtrauma.kaums.ac.ir/article_62236_2d726a3cf8350696e2236c8e95713ca5.pdf
Kashan University of Medical Sciences
Archives of Trauma Research
2251-953X
2251-9599
4
4
2015
12
01
Management and Prognostic Factors for Delayed Reconstruction of Neglected Posterior Shoulder Fracture-Dislocation
EN
Taner
Bekmezci
Department of Orthopaedics and Traumatology, Liv Hospital, Bahcesehir University, Istanbul, Turkey
Egemen
Altan
Orthopaedics and Traumatology, Selcuk University, Konya, Turkey
10.5812/atr.29903
Introduction
Posterior fracture-dislocations of the shoulder are rare conditions. Misdiagnosis can occur in 50% - 80% of the patients. Due to the size of the lesion, stability of the joint could not be achieved with transfer of subscapular tendon or tuberosity.
Case Presentation
A 54-year-old male patient was referred to our hospital with a neglected posterior shoulder fracture-dislocation. Functional results of the patient, and technical informations were explained in this case report. The reverse Hill-Sachs lesion involved 40% of the articular surface. Depressed and malunited fragment was elevated, and fixated to the humeral head.
Conclusions
Glenohumeral joint reduction with reconstruction of the humeral head seems to be possible even in a neglected locked posterior shoulder fracture-dislocation. If the depressed osteochondral fragment is still spheric, signs of the avascular necrosis are absent on CT, and malunion of the fragment has occurred, it is quite possible to reconstruct the head. Although results of the case are good, it is worthwhile to follow these patients for long-term complications.
Reverse Hill-Sachs,Posterior Instability,shoulder
https://archtrauma.kaums.ac.ir/article_62237.html
https://archtrauma.kaums.ac.ir/article_62237_0f2c45eca2a689bcffd6ea0a7fd349c8.pdf
Kashan University of Medical Sciences
Archives of Trauma Research
2251-953X
2251-9599
4
4
2015
12
01
Operative Treatment of an Atypical Segmental Bipolar Fracture of the Clavicle
EN
Nikolaos
Varelas
Department of Surgery, Division of Orthopaedic Surgery and Traumatology, Centre Hospitalier du Centre du Valais, Sion, Switzerland
Pieter
Joosse
Department of Surgery, Medisch Centrum Alkmaar, Alkmaar, The Netherlands
Philippe
Zermatten
Department of Surgery, Division of Orthopaedic Surgery and Traumatology, Centre Hospitalier du Centre du Valais, Sion, Switzerland
10.5812/atr.29923
Introduction
Clavicle fractures are very common, accounting for approximately 4% of all adult fractures. Segmental bipolar fractures involving the lateral and the medial ends of the clavicle are extremely rare, with only isolated cases reported in the literature. The injury mechanism is often unclear and the management of these fractures remains controversial.
Case presentation
Here is to report a case of a segmental bipolar fracture of the clavicle with a lateral fracture and a displaced medial fracture without dislocation of the sternoclavicular joint following a low energy fall to the outstretched hand, and discuss its management.
Conclusions
Stability of the clavicle is crucial for shoulder function and care should be taken not to miss or underestimate segmental bipolar fractures even with a low energy mechanism. Authors believe that operative treatment should be taken into consideration for displaced fractures.
Clavicle,bone fracture,Bipolar,Care Management
https://archtrauma.kaums.ac.ir/article_62238.html
https://archtrauma.kaums.ac.ir/article_62238_a3b6848434b8b1c000087f30a22cf00d.pdf
Kashan University of Medical Sciences
Archives of Trauma Research
2251-953X
2251-9599
4
4
2015
12
01
Evaluation of the Safe Ischemic Time of Clamping During Intermittent Pringles Maneuver in Rabbits
EN
Mohsen
Kolahdoozan
Department of General Surgery, Isfahan University of Medical Sciences, Isfahan, IR Iran
Akbar
Behdad
Department of General Surgery, Isfahan University of Medical Sciences, Isfahan, IR Iran
Mehrdad
Hosseinpour
Department of General Surgery, Isfahan University of Medical Sciences, Isfahan, IR Iran
Samin
Behdad
Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
Mohammad Taghi
Rezaei
Department of General Surgery, Isfahan University of Medical Sciences, Isfahan, IR Iran
10.5812/atr.30244
Background
The liver is the most commonly injured organ in blunt abdominal trauma. Although major hepatic bleeding may be partially controlled with portal triade clamping (the Pringle’s maneuver), continuous prolonged clamping results in liver ischemia.
Objectives
The purpose of this study was to determine the safe time of Pringle maneuver based on pathologic changes of liver in rabbit models.
Materials and Methods
In an experimental study, 20 New-Zealand white rabbits were selected. In laparotomy, a blunt dissector was passed through the foramen of Winslow and the hepato-duodenal ligament encircled with an umbilical tape. En masse Pringle maneuver was performed using atraumatic flexible clamps. Rabbits were divided into four groups based on Pringle maneuver time (30 minutes, 45 minutes, 60 minutes, and 75 minutes). A hepatic biopsy was performed at the beginning of operation. The degree of tissue injury was evaluated using blood markers.
Results
There were five rabbits in each group. At the end of 60 minutes ischemia, only minor alterations were observed in pathological specimens. At the end of 75 minutes, hepatocyte damage and necrosis were observed. The serum levels of alanine aminotransferase (Group A: P = 0.02; Group B: P = 0.01; Group C: P = 0.0002; Group D: P = 0.01) and Aspartate aminotransferase (Group A: P = 0.03; Group B: P = 0.002; Group C: P = 0.0004; Group D: P = 0.0003) were significantly increased post-operatively. The maximum level was in the first day after operation.
Conclusions
Continuous portal triade clamping (the Pringle maneuver) during liver ischemia (30 and 45 minutes) in rabbits resulted in no ischemic change. Increasing time of clamping to 30 minutes was safe in intermittent Pringle maneuver.
Liver,Pringle’s Maneuver,Ischemia
https://archtrauma.kaums.ac.ir/article_62239.html
https://archtrauma.kaums.ac.ir/article_62239_ff517c6e2104d433f6cda21bef2642bd.pdf
Kashan University of Medical Sciences
Archives of Trauma Research
2251-953X
2251-9599
4
4
2015
12
01
Intravenous Paracetamol Versus Patient-Controlled Analgesia With Morphine for the Pain Management Following Diagnostic Knee Arthroscopy in Trauma Patients: A Randomized Clinical Trial
EN
Seyed Masoud
Hashemi
Department of Pain Management, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
Aliakbar
Esmaeelijah
Department of Orthopedics, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
Samad
Golzari
Department of Anesthesiology, Tabriz University of Medical Sciences, Tabriz, IR Iran
Sohrab
Keyhani
Department of Orthopedics, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
Azita
Maserrat
Department of Anesthesiology, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
Gholamreza
Mohseni
Department of Anesthesiology, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
Seyed Hosein
Ardehali
Department of Anesthesiology, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
10.5812/atr.30788
Background
Most patients undergoing outpatient surgeries have the unpleasant experience of high level pain after surgery. Compared with open surgeries, arthroscopic procedures are less painful; however, inadequate pain management could be associated with significant concerns. Opioids alone or in combination with local anesthetics are frequently used for diminishing postoperative pain using intravenous or epidural infusion pumps. Despite morphine various disadvantages, it is commonly used for controlling pain after surgery.
Objectives
The aim of this study was to compare intravenous paracetamol and patient-controlled analgesia (PCA) with morphine for the pain management following diagnostic knee arthroscopy in trauma patients.
Patients and Methods
Sixty trauma patients who were scheduled to undergo knee arthroscopy were randomly divided into two groups. Patients immediately received intravenous infusion of 1 g paracetamol within 15 minutes after surgery and every 6 hours to 24 hours in the paracetamol group. The patient-controlled analgesia group received morphine through PCA infusion pump at 2 mL/h base rate and 1mL bolus every 15 minutes. Pain level, nausea and vomiting, and sedation were measured and recorded during entering the recovery, 15 and 30 minutes after entering the recovery, 2, 6, and 24 hours after starting morphine pump infusion in the morphine and paracetamol in the paracetamol groups.
Results
There was no significant difference regarding the pain level at different times after entering the recovery between the two groups. No one from the paracetamol group developed drug complications. However, 22.3% in the PCA morphine suffered from postoperative nausea; there was a statistically significant difference regarding the sedation level, nausea, and vomiting at various times between the two groups.
Conclusions
Intravenous administration of paracetamol immediately after knee arthroscopy improved postoperative pain, decreased analgesic administration, maintained stable hemodynamic parameters, had no complications related to opiates, no nausea and vomiting, and increased patient satisfaction and comfort in comparison to PCA with morphine.
analgesia,Patient-Controlled,patient safety,Pain management,Arthroscopy,Acetaminophen,Morphine
https://archtrauma.kaums.ac.ir/article_62240.html
https://archtrauma.kaums.ac.ir/article_62240_7510b67e2b7ff2c8c500f45a5cd7e69e.pdf
Kashan University of Medical Sciences
Archives of Trauma Research
2251-953X
2251-9599
4
4
2015
12
01
Happy New Year, Happy Yalda, Hope a Peaceful Year
EN
10.5812/atr.35949
https://archtrauma.kaums.ac.ir/article_62241.html
https://archtrauma.kaums.ac.ir/article_62241_d41d8cd98f00b204e9800998ecf8427e.pdf