Journal of Trauma & Treatment

Severely displaced distal metaphyseal fractures of radius can some times be difficult to reduce by manipulation. In such cases, the operating surgeon normally proceeds with an open reduction of the fracture through a standard incision. In cases where manipulation has failed to achieve proper reduction of fracture, and open reduction is being considered, a technique is presented by the author, which he has used for a number of years, to achieve satisfactory reduction through a very small incision instead.

This study was aimed to find out the supplemental value of topiramate therapy in infraorbital nerve paresthesia following post miniplate fixation of zygomatic complex fracture. Total four cases of unilateral  zygomatic complex fracture which were one week old had infra orbital nerve paresthesia were treated. All the patients were treated with fracture reduction and miniplate fixation of zygomatic buttress region were supplemented with tab topiramate in therapeutic dosages. The dosages were increased depending upon tolerability and improvement. Functional recovery was observed postoperatively from first week and complete recovery was within three months of treatment.
Conclusion: We suggest that topiramate could be a useful supplemental form in the treatment of infra orbital nerve injury. Further studies (Double-blind) are needed with precise neurological examination to determine the recommendations of topiramate supplementation.

Background: The use of diagnostic imaging in medicine has changed with the advancement of  technology – now faster, more detailed and more available. Advanced Trauma Life Support (ATLS)  provides clear criteria for plain film assessment but the guidance on CT scanning in acute trauma is defined less well and depends upon national guidelines and local protocols. There has been a marked increase in the use of CT across the spectrum of trauma patients. This has paved the advent of multiple scans on admission and Whole-Body CT (WBCT) scans during resuscitation. The question is: Is it truly indicated?
Methods: Over a ten-month period from June 2011 to April 2012, 100 adults admitted to the state trauma unit were randomly selected for prospective data collection. Our primary outcome was mortality and our secondary outcome was identification of a Significant Injury (SI) on CT scanning. A significant injury was defined as; any finding on CT which resulted in a change of management.
Results: There were 100 patients recruited for prospective data collection during ten months, from June 2011 and April 2012. The study population was predominantly males (79%), from the metropolitan area, involved in motor vehicle accidents. Mortality rate was 0% at three months follow up. The prevalence of significant injury demonstrated on WBCT and regional body CT appear equivocal, with the exception of CT pelvis.
Conclusion: In the acute trauma setting CT of head and cervical spine delivers valuable clinical information in a timely and low cost manner. With consideration for cost and long term implications on patient safety, we believe that further scanning of the Chest/Abdomen/Pelvis should be clinically driven. We propose that continued careful history taking and physical examination remain a key component to assessing the indication for CT Chest/Abdomen/Pelvis in acute trauma patients.

Objectives: Alexithymia involves difficulty identifying and describing emotions and has been linked to a variety of psychological problems, particularly exposure to trauma, interpersonal difficulties, and depression. Currently, alexithymia is most commonly assessed through self- report questionnaires. A neuropsychological test may be a more valid assessment of alexithymia because it uses a performance-based design and focuses on the underlying cognitive process in question: affective-processing. This impaired processing may be useful in testing an explanatory model for the relationship between trauma exposure and the subsequent development of alexithymia, interpersonal problems, and depression.
Participants and methods: Fifty-three undergraduate students pre-screened for trauma exposure, were given questionnaires measuring alexithymia, interpersonal problems, and depression, and then administered a neuropsychological test of Auditory-Affective Perception (AAP). Correlational analyses compared the neuropsychological measure with the alexithymia questionnaire. A hierarchical regression tested a meditational model.
Results: Performance on the neuropsychological measure of AAP did not significantly correlate with the alexithymia questionnaire (p>0.05). Alexithymia was found to partially mediate between trauma exposure and depression (p=0.03). The over-all model was significant, F(2.50)=25.17, p<0.001, adjusted-R2=0.48.
Conclusions: Regression analyses supported self-reported alexithymia as a partial mediator of the relationship between trauma exposure and depression, suggesting that depressive symptoms developed following trauma exposure are partially related to the development of alexithymic symptoms. AAP performance was not significantly correlated with the measure of alexithymia suggesting self-reported alexithymic symptoms are independent of the ability to recognize auditorially-presented emotions; possible explanations and theoretical implications are discussed.

Objectives: Trauma is the leading cause of death in children. Abdominal trauma with Injuries to the liver, spleen and kidneys are common in children and many of these injuries nowadays are treated non-operatively, where as Pancreatic injuries are uncommon and its management still controversial. The aim of this study is to report the outcome of management in a series of children with pancreatic injury.
Methods: Ten Children less than 10 years of age treated at our institution with pancreatic injury between the period of May 2000 and May 2010 and reviewed retrospectively. 8 cases admitted from the emergency room and two cases referred from another facility. Diagnosis made on clinical suspicion, biochemistry tests and radiological confirmation (ultrasound and CT scan). Management was started according to the grade of Injury.
Results: Seven boys and three girls aged between 2.5 and 10 years sustained pancreatic injuries: three cases had grade I Pancreatic injury (minor contusion), three cases with grade II (major contusion without duct injury or tissue loss), two with grade III (distal transection and duct injury), one case with grade IV (proximal transection) and one case with pancreatic transaction and extensive duodenal injury (grade IV with associated injury). Grade I and II injuries were successfully managed without surgery. Children with grade III injuries were treated conservatively, but each developed a symptomatic pseudo cyst that failed to resolve with percutaneous drainage and underwent spleen-sparing distal pancreatectomy. The child with grade IV transected pancreatic neck was treated by Roux-en-Y jejunostomy drainage and the last case with the Grade IV and associated duodenal injury treated with Whipple procedure. Amylase level was normal in Grade I and II injuries and increased as the grade of injury is higher. All children made a full recovery. Median follow up was 45 days.
Conclusion: Pancreatic injuries in children are uncommon and its management still controversial, some Institutions prefers conservative management, whereas others hold on the surgical option. Level of amylase is correlated with the severity of the injury when pancreatic injury is diagnosed. The management of pancreatic injuries in children depends on the grade of injury, presence of associated injuries and Hospital expertise.

Background: This study compares patient operated by thoracoscopy and thoracotomy in patients with
penetrating chest wounds with massive hemothorax, hemodynamically stable.
Materials and methods: Retrospective study Cross sectional, type III level of evidence.45 patients were included in the study. In 24 of them were approached by thoracoscopy and the remaining 21 by thoracotomy and compared morbidity, hospital stay, operative time, complications and conversion rate in patients with penetrating trauma massive hemothorax managed by thoracotomy hemodynamically stable with those managed by thoracoscopy during the period from September 1, 2008 until September 30, 2011 operated by the Department of General Surgery and Thoracic Surgery Hospital Santa Clara, Bogota, Colombia.
Results: Thoracoscopy is associated with reduced blood loss, less operative time, shorter hospital stay by filing a conversion rate of 12.5% video assisted surgery procedures and a lower rate of complications.
Conclusions: Thoracoscopy represents a therapeutic option and a safe approach in the right hands to the chest injured patients with massive hemothorax, hemodynamically stable.

Sexual violence in prisons constitutes an act of torture which has been used to a widespread in war situations as in former Yugoslavia and Chechnya. However, especially in Islamic countries sexual violence to men has been neglected because of cultural based stigma of the issue. Sexual torture has serious mental, physical and sexual health consequences. This paper describes the physical long-term effect of anal torture in an adult man in prison. Examination was performed following the Istanbul Protocol guidelines. A prolonged relaxation time of the anus as a sign of sphincter insufficiency could be an evidence of traumatic damage of anal sphincter by such kind of torture.

Losing hopes and dreams regarding a person diagnosed with schizophrenia-a first psychotic episode, emotional tribulation, going between remission and relapse, the risk of self-inflected wounds and of  aggressiveness against people around, are experiences which families have to face. Intrinsic family characteristics determine the way family members react to illness, with clear repercussions on both the family and the evolution of first - episode psychosis. We shall next present the various family characteristics that might influence the evolution of a psychotic episode, as well as the results of some studies that show the efficiency of family interventions in the evolution of a first psychotic episode in schizophrenia.