Journal of Trauma & Treatment

Purpose: To evaluate visual outcomes and anterior segment complications in patients with ocular contusion trauma.

Methods: All cases of ocular trauma were reviewed retrospectively from January 2008 to December 2010 via a computerized database; forty-six cases of ocular contusion were identified. Patients’ demographic features, initial and final clinical findings and also initial and final best corrected visual acuities (BCVA) of logMar were recorded. Patients were grouped according to age; 18 years or younger were grouped in group 1, and older than 18 years group 2. Initial and final anterior segment findings affecting the initial and final BCVA were investigated. Also anterior segment findings and initial and final BCVA were compared among the groups.

Results: In group 1 there were 19 (63.3%) males and 11 (26.7%) females; group 2 was comprised of 12 (75%) male and four (25%) female subjects. There was no statistically significant difference in initial BCVA between the groups (p>0.05), final BCVA difference in group 1 was found to be statistically significant (p< 0.05). Cataract and angle recession were found to be more prevalent in group 2 (p< 0.05). Initial anterior segment findings contributed to 61.4 % of initial BCVA, whereas final anterior segment findings explained 57.4 % of final BCVA.

Conclusion: Exact examination and management at the proper time of findings are essential for successful treatment and an improved visual prognosis for ocular contusion.

A syndrome of bleeding in the brain with retinopathy, but no external evidence of trauma, is known in infants. There is an association with excessive crying and feeding difficulties in this condition. This has led to the hypothesis that the injuries arise during violent shaking by an angry carer, causing the brain to rotate relative to the skull, (Shaken Baby Syndrome, SBS).

An alternative hypothesis, described here, (Dysphagic Infant Death Syndrome DIDS), is that injuries similar to those in SBS can result from venous hypertension during excessive coughing or vomiting. Such injuries occur “naturally” during paroxysms of coughing in Whooping Cough. High intra-abdominal pressure drives abdominal venous blood up into the head, rupturing intracranial veins and capillaries. This results in subdural haemorrhages, petechiae in skin and Valsalva Retinopathy in the eyes. This article considers when the excessive intra-abdominal pressures are caused by violent vomiting and retching in pyloric stenosis.

Some DIDS additional features, not occurring in SBS, may give warning of impending intracranial catastrophe. Infant skull suture growth rate depends on local stretch induced in the underlying Dura Mater. This will be increased during venous hypertension, accelerating head growth rate analogous to the hydrocephalous mechanism. The prolonged inconsolable crying would be explained by Mallory-Weiss tears at the oesophageal-stomach junction during repeated vomiting. Edema resulting from local leakage from over-distended cerebral veins and capillaries may temporarily disable axon transmission, causing temporary loss of consciousness. Transient “spiking” fevers may seen in this condition if the temperature limiter center in the hypothalamus is temporarily disabled by such flooding. (Brainstem tissue is drained by the vertebral vein system whose tortuous nature smoothes out pressure spikes. This provides some protection of breathing and cardiac mechanisms which may remain normal.)

It is concluded that, unlike SBS, preventative measures should be possible for DIDS.

The case repost presents a successful autotransplantation of maxillary second premolar, impacted at an unusual site, in its predecessor’s socket. The location of impacted tooth was diagnosed with the help of 3D construction 3D CT scan. 3D construction was further modified to unveil the exact location of impacted tooth making best use of softwares incorporated in modern imaging systems. The good diagnosis decreased the time to be taken in surgical procedure which in turn resulted in successful outcome of autotransplantation.

A rotator cuff tear in a polytraumatized patient can be a devastating injury if not identified early. Traumatic rotator cuff tears are often massive, and generally retract within a short period of time. If the tear is missed, the consequences are profound especially if the tear becomes irreparable and especially in the younger, more active population. These consequences include pseudoparalysis, persistent pain, and rotator cuff tear arthropathy. Specific examination of the polytraumatized patient with shoulder pain on secondary/tertiary survey should include a detailed assessment of the rotator cuff. Ultrasound has been advocated as a potential adjunct to MRI but most surgeons would agree that MRI is imaging study of choice for evaluation of the rotator cuff. The treatment of acute or acute on chronic traumatic rotator cuff tear in the polytraumatized patient should be early rotator cuff repair when the patient’s
medical status allows.

Recently, prosthetic replacement has been commonly applied as a standard procedure for the elbow joint destruction by arthritis or trauma, and elbow arthrodesis has been used only for patients who are unsuitable for other conventional treatment methods. In most cases, ulnohumeral arthrodesis is performed, considering the geometry and the amount of surface area of the distal humerus and proximal ulna. In this report, we present a successful case of the radiohumeral arthrodesis using unilateral external fixation without bone grafting for a patient who sustained severe open communited fracture with transarticular massive bone loss. We decided to fuse the elbow at 70 degrees of flexion, and the forearm was fixed at 80 degrees of pronation. At 13-month after the operation, radiographic evidence of solid enlarged right elbow fusion was gained. At more than three years after operation, we evaluated patient-oriented quantitative functional disability using Disabilities of the Arm, Shoulder and Hand (DASH) to confirm that radiohumeral arthrodesis fixed at this angle could be accepted. This technique can be recommended as a salvage procedure in the face of significant bone loss of the proximal ulna.

Parallel screw alignment can be challenging. We describe a simple, reproducible technique for the fixation of the medial malleolar fragment with two parallel screws, using a 1.6mm K-wire and the small fragment AO drill-guide.

Background: Pneumomediastinum creation, in blunt chest trauma, results from Mackin effect in more than 95% of cases. Objectives: In this article we report two cases of blunt chest trauma, underlining the relationship between Macklin effect, pneumomediastinum and pneumoperitoneum, and analysing conservative and invasive treatment. Case reports: We report two cases of blunt chest trauma with Pneumomediastinum creation and no evidence of airway lesions. The first patient presented with malignant pneumomediastinum, created by Macklin effect, and pneumoperitoneum with intra-abdominal hypertension. He underwent invasive treatment. The second case shows how Macklin effect can be self-limiting. This patient underwent conservative treatment. Conclusions: In any case of post-traumatic pneumomediastinum, the Macklin effect should be suspected. Clinical observation is the treatment of choice since Macklin effect is self-limiting. There are some life-threatening event, like malignant pneumomediastinum and intra-abdominal hypertension that must be relieved and treated immediately.

Background:Efficient and accurate patient tracking during high-throughput situations is critical, especially for resource-limited medicine incurred during natural disasters, terrorist events, chemical threats and other mass casualty situations. Use of air traffic control practices modified to track patients shows promise in military medical applications. We tested a similar application in a busy, level 1 trauma center utilizing a system we call the Mass Casualty Tracking Application (MCTA).

Methods: Third party surveyors compared current system to a system using MCTA on sixty four patients in July 2010. Four data points on paired patients were surveyed randomly each hour resulting in 56 total surveys with 50 useable. Written opinion comments were submitted by four staff members exposed to both systems.

Results:Overall, MCTA had no significant difference in errors compared to FirstNet regarding patient data. Hospital staff exposed to both systems preferred FirstNet over MCTA due to familiarity. Hospital staff surveyed for comments on the MCTA indicated that they envisioned the system would be very useful for power outages and/or mass casualty incidents, for determining bottlenecks in patient flow, for tracking patients sent for imaging with useful prompting to seek out imaging read results and as a backup to FirstNet.

Conclusions:MCTA in a busy trauma center is equivalent in its ability to track patients in this specific high-throughput system regarding data correctness/patient location. Though not designed as a replacement to electronic systems, MCTA is capable of performing this task and may be a useful asset for mass casualty events and/or as a backup system due to its “pen and ink” simplicity.

Subacute progressive ascending myelopathy is a rare, poorly understood neurological complication of spinal cord injury, unrelated to mechanical compression, instability, or syrinx formation at the level of injury or above. To date, there is no known treatment for this dramatic spinal cord injury complication. We present a case of subacute progressive myelopathy after lumbar spine trauma. The therapy consisted of plasmapheresis, hyperbaric oxygen, high-dose cortisol, antibiotic, and antiviral drugs. At 1 year post injury, the patient had recovered most of his lost upper-extremity function and MRI demonstrated only discrete signal intensity alterations extending to T3/4.