Journal of Trauma & Treatment

The frequency of hip fractures are increasing in the globally. Cemented implants offer less pain and improved mobility post operatively. To date there has been no comparison between The Exeter Trauma Stem (ETS), which is a monoblock single size stem versus the Joint Replacement Instrumentation (JRI), a modular cemented hip used in the treatment of intracapsular fracture neck of femur fractures. It was postulated that the monoblock single size stem would be more difficult to insert in smaller femoral canals, and as such would have a greater tendency to lengthen the leg and greater incidence of calcar fractures. Over a 2 year period we have reviewed, the operative complications and radiological outcomes of the JRI hip hemiarthroplasty stem with a matched group of ETS implants. The study
highlights the one-size-fits-all ETS system is more likely to be placed longer than a modular JRI system (p=0.01). There was no statistical difference in calcar fractures between the two prostheses. There were 40/99 JRI implants (40%) patients which required a smaller prosthesis than the ETS, these patients may have been over lengthened if the ETS was used. Careful radiographic pre-operative evaluation is required in order to avoid over lengthening the ETS prosthesis in patients with a narrow canal. A modular prosthetic design offers a valuable alternative to such a scenario.

Background: Femoral neck fracture or Subcapital fracture of the hip is one of the most common fractures at old age. There is a debate about the use of monopolar monoblock prosthesis for the treatment of those fractures. This paper is a retrospective examination of the functional and ambulation outcome of patients after partial hip replacement with cementless Austin Moore prosthesis.

Methods: Between 2002-2009, 320 patients with femoral neck fracture were treated by hip hemiarthroplasty with cementless Austin Moore prosthesis in our department. All patients had displaced femoral neck fractures. The anterolateral approach was used for all operations. Seventy nine patients who underwent 84 hip hemiarthroplasty with cementless Austin Moore prosthesis agree to participate and were enrolled to this study. (Five patients had bilateral femoral neck fracture at separate occasions during the study period). All patients were followed at the out patients clinic and filled a questionnaire about functional and ambulation before fracture and after rehabilitation period. The functional outcome was divided into four levels, Poor Fair Good and Excellent functional ability. The scale of ambulation ability was 1-7 in which 1 is ambulation with no means and 7 is bed or chair ridden. Results: The average functional score before the fracture was 22.87 and 10.43 after surgery. The average ambulation ability before the fracture and after rehabilitation was (1.62) (4.29) respectively. Out of the 320 patients, three prosthetic hip dislocated (0.94%), four were (1.25%) infected and five (1.56%) experienced a periprosthetic fracture.

Conclusion: Our study reveals that only small number of patients achieved good or excellent functional and ambulation score. The decline in functional and ambulation ability was statistical significant. We showed a relatively low incidence of complications.

The management of polytrauma is based on the principle that the care provided to trauma patients in the first few hours can be absolutely critical in terms of predicting long term recovery and that good trauma care involves getting the patient to right place in right time for the right treatment. Managing critically injured patients are challenging. It is very important to assess the overall severity in terms of site and extent of injury. Earlier radiographs, conventional CT scanners and focused assessment with sonography for trauma (FAST) used to be very useful adjuncts in management of polytrauma. Nowadays with the advent of state of art multidetector CT (MDCT) scanners the scenario has improved. Most of the centers dealing with trauma have a clear protocol of MDCT for management. There are concerns regarding cost, radiation and whether “CT first protocol” should be employed. Here we review the role of MDCT in assessment of patients with polytrauma and its current status.

This article aims to review the available studies on the prevalence of Posttraumatic Stress Disorder (PTSD) in patients following treatment in an intensive care unit (ICU) and the impact of various factors on the development of PTSD. A systematic review of the databases PubMed, PsycINFO, and PILOTS was conducted.

Fifty-four articles were included. The mean point prevalence of PTSD/clinically significant PTSD symptoms (PTSS) was 17% (N=7943). Consistent risk factors were pre-ICU psychopathology and traumatic and/or frightening memories from ICU. Less consistent risk factors were younger age, female gender, lower educational level, higher number of biographical risk factors, administration of benzodiazepines, and sedation practice. Severity of illness was not a predictor. Post ICU PTSD/PTSS was associated with lower health related quality of life (HRQOL), comorbid anxiety, and depression.

It is concluded that post-ICU PTSD is common and that health care professionals should be aware of potential risk factors and early signs of PTSD and monitor the patients’ need for intervention. Future research should focus on on estimating potential psychological risk factors, and attempt to explain the relation between potential person and treatment related risk factors, as well as their contribution to the development of PTSD.

Bonfield CM, Grandhi R, Okonkwo DO (2014) Charcot Spine after Remote Cervical Spine Injury. J Trauma Treat 3:191.

Shoulder injuries within the collision sport of rugby not only result in significant time loss from competition but also have a high reoccurrence rate. Rehabilitation of these athletes forms a critical element in both returning them to sport and reducing the risk of further injury. This review outlines the problems which clinicians encounter in managing these athletes and strategies to overcome them.

Traumatic pneumatocele is rare. It usually regresses spontaneously with conservative treatment. In rare cases, it can get complicated and surgical intervention may be  necessary. A 21 year old male patient was taken to the hospital following a fall on an object with a sharp tip. His vital signs were stable. On X-ray and chest-CT he had a
pneumatocele area including the injury tract and a low percentage pneumothorax in the right lung. The patient was hospitalized for follow-up and was treated conservatively. After 3 days, he was discharged without any complication.

Accidents and trauma are one of the world's most serious but neglected health problems. The fast moving transportation systems, unprecedented and unplanned urbanization and changing social patterns have contributed to the global increase in the incidence of trauma. Traffic accidents are an endemic disease which affects mainly the young adults in the economically productive age groups and are the leading cause of death in persons under 44 years of age. Globally, 26% of all deaths in the age group of 15-44 years are due to injuries. The national vital registration system registers around 18 million deaths annually due to injuries worldwide. In Developing countries, trauma is a major problem, due to a very high incidence of vehicular accidents, other accidental injuries, crime and violence. Rising population, urbanization, industrialization and a drastic rise in vehicular transport has contributed to an annual increase in road traffic accidents by 3% in India alone. An accident death is reported every 1.9 minutes in India; in 1997, 10.1% of all deaths in India were due to accidents and injuries. Despite of this, trauma care is still at a developmental stage in our country. Thus, there is a growing population of traumatized patients requiring highly sophisticated and specialized care. Because most of these patients are young adults, with no underlying illness, there is a great concern to save these patients