Journal of Trauma & Treatment

An extraordinary case of trans-orbital penetrating injury is presented. A 42-year-old male was surprised while he was stealing into an apartment. While he was trying to escape through the window, he fell on a rod of the fence with not severe ocular and cerebral complications. We describe a unique presentation of a trans-orbital penetration injury that had a good outcome and not severe ocular and cerebral complications. After being transported at the S.M. Goretti Hospital in Latina, the rod was removed outside the operating room and the CT scan was performed. Patient underwent urgent surgery after stabilization of vital parameters.

Objective: To explore the anterior/posterior decompression, bone graft, internal fixation combined with postoperative early stimulation in the treatment of cervical spine trauma complicated with spinal cord injury treatment. 

Methods: From 2005 January to 2014 December, 40 patients with cervical spine fracture, dislocation of injury associated with spinal cord injury were treated with anterior/posterior decompression, bone graft, internal fixation operation combined early electrical stimulation after operation.

Results: 40 cases were followed up from 12 months to 6 years. Bone graft healed well, no case of plate and screws loosening, rupture and other complications, symptoms of spinal cord injury improved satisfactorily. Preoperative spinal cord injury Frankel grade: A grade 24 cases, B grade 4 cases, C grade 5 cases, D grade 7 cases, postoperative recovery to B grade 2 cases, E grade 26 cases. According to the Japanese Department of orthopedics Society (JOA) criteria score, postoperative improvement rate was 89.26%.

Conclusion: Anterior/posterior spinal canal decompression, bone graft, early internal fixation operation combined with postoperative early electrical stimulation in the treatment of patients with cervical spine injury associated with spinal cord injury, can prevent or alleviate the secondary spinal cord injury and other complications, provide effective fixation spinal segmental stability, promote the recovery of spinal cord function, achieve a satisfactory effect.

Blunt thoracic trauma is among the major causes of mortality in setting of acute trauma. Early mortality in chest trauma is often preventable; however, chest trauma can lead to delayed complications. Extra pleural hematoma is among one of them. Owing to the scarcity of literature present on the extra pleural hematoma and its management after blunt thoracic trauma, we, hereby, report a case of 50 year old man who sustained bilateral multiple rib fractures with no hemothorax after blunt thoracic trauma. Patient developed large radio-opaque shadow in right hemithorax four days after injury which later was diagnosed as extra pleural hematoma and was successfully managed with limited thoracotomy.

Approximately 1.6-3.8 million mild traumatic brain injuries occur each year as a direct result of sports participation [1-6]. Football, particularly at the high school level, is the most common sport associated with these injuries [2]. As a collision sport, helmets are an important protective device [4]. Age, condition, and fit of football helmets are important factors in optimizing their protective properties. We hypothesized that due to inconsistent staffing, a lack of resources, and decreased general awareness of the problem, high school athletic programs have suboptimal supervision and care of their helmet inventory thereby decreasing head-trauma related safety for their athletes. Further to this point, we hypothesized that helmets in private schools and suburban areas will be newer, better conditioned, and better inspected than helmets in rural and inner city areas. We undertook this study to investigate the current status of helmet testing, maintenance, and fitting in a cohort of high schools in Middle Tennessee.

Chylothorax most commonly occurs after thoracic surgery; blunt thoracic trauma is a rare cause of chylothorax. A 50yr old female presented to our emergency department with history of road traffic injury. On primary assessment the vital parameters were normal and she had a laceration of nasal bridge and lip, with fractures of nasal and right forearm bones. CT scan confirmed fracture of nasal bone, spinous process of D4 vertebrae and bilateral radius. Repair of lip laceration along with open reduction and internal fixation (ORIF) for bilateral radii and nasal bone fracture were done emergently. Patient was allowed orally after 6 hours and recovery seemed to be uneventful. However, patient started complaining of chest heaviness with difficulty in breathing on second post-operative day. On Ultrasound Chest and CT evaluation a radiological diagnosis of traumatic hydrothorax with mediastinal & retroperitoneal lymphangiectasias was made. Intercostal drains placed bilaterally showed chylothorax. Patient was kept nil per oral and on parenteral nutrition, micronutrient supplementation and adequate analgesia. Empiric antibiotic therapy was started. Intercostal drain output and lipid levels of contents decreased with this regime, gradually enteral fat-restricted diet was started with medium chain triglycerides and patient was allowed full orally from day 6. Chest drain was removed on day 11 and patient discharged on day 12.

Repair of facial trauma such as that sustained during a high-speed motor vehicle accident, as described in this patient report, can be functionally and esthetically challenging. Here, successful post-surgical management of wound breakdown following a zygomaticomaxillary complex fracture repair included use of a self-adhesive hydrogel wound dressing.

Dental traumatic injuries are the most uninvited emergencies causing panic, emotional, aesthetic, functional and psychological disturbances. Avulsion being the most common injury, it deals with exarticulation or total luxation of the tooth out of its socket as a result of sports injuries or fights. While in-vitro studies have shown that teeth can be kept in conditioned media for up to 96 hours and still present optimal healing, clinically emphasis on the extra-oral time and viability of the PDL cells decide the prognosis for the avulsed tooth. Transport or storage media for the tooth is of critical importance for survival of these PDL cells for successful replantation. This article highlights the different storage media available for an avulsed tooth and the most suitable ones to be used depending on their ease of availability for the general population.

Background: Assessment of lower extremity alignment is important. The malalignment test is generally assessed two-dimensionally on plain radiographs. In patients with complex deformities, the key points are set inaccurately on Roentgenogram images, leading to problems with both accuracy and reproducibility. Computed tomography (CT) is the current gold standard for evaluating femoral torsion measurements. However, CT images vary depending on slice orientation during scanning, images of flexion deformities are affected by the orientation of the CT slice, making accurate evaluation impossible should a flexion deformity be present. For this reason, three-dimensional preoperative analysis is required. We report a case in which three-dimensional preoperative analysis was used for a patient with leg deformity after injury to the distal femoral epiphysis, with good results.

Methods: CT scanning was used to establish a preoperative plan and produced a surface morphology model from CT axial data. Free software was then used to create mirror images of the affected and unaffected sides from these data. The mirror image of the unaffected side was then positioned in three-dimensional space, and vectors were set. The fragment proximal to the osteotomy plane was defined as the reference fragment (RF) and the distal fragment as the corresponding fragment (CF), with the functional axis of the unaffected side forming the helical axis (HA). The amount of deformity correction of the CF required was then calculated automatically in terms of the two parameters of rotation and translation in three dimensions by shifting the CF along the HA. A Taylor spatial frame (TSF) was used to perform gradual correction surgery.

Results: The rotational deformity was corrected, a 20-mm medial shift and 12-mm posterior shift persisted. Correction was carried out a second time to correct this deformity.

Conclusion: Three-dimensional analysis of long-bone may prove useful for the correction of long bones deformities in the legs when complex deformity is present.

Objectives: Tube thoracostomy is a common procedure performed after chest trauma. The current practice is to insert the tube in the 3rd, 4th, or 5th intercostal space (ICS) at the anterior axillary line. In this study we compared the outcome of tubes inserted at lower spaces versus the standard (higher) location.

Methods: Patients receiving a chest tube after chest trauma were identified using the trauma registry at a Level 1 trauma center from July 2009 to December 2011. Each tube inserted was categorized as either “High” (3rd-5th ICS) or “Low” (6th-7th ICS) placement. Patient records were reviewed for demographics, Injury Severity Score (ISS), chest tube interval (CTI), length of hospital stay (LOHS), interventions (including thoracoscopy and thoracotomy), and mortality.

Results: There were no differences between both groups regarding age, ISS, interventions or mortality. However, patients receiving chest tubes in the 3rd through-5th ICS (High group) demonstrated significantly lower CTI and LOHS when controlling for age and ISS. (Multi-linear Regression, F-Value=3.14 and 9.44; p=0.027 and <0.0001, respectively)

Conclusion: Low thoracotomy placement tubes are as safe as High placement with no difference in outcome in terms of morbidity and mortality. However, patients with low placement reported longer CTI and a longer LOHS.

Traumatic intracranial aneurysm is rare and mostly due to blunt head injury. High mortality rate up to 50% is reported in the literature. Early diagnosis and appropriate management is essential for this fatal disease. We present a rare case of pseudoaneurysm over left-side posterior communicating artery after traumatic head injury. Avulsion of the posterior communicating artery was noted intra-operatively and then clipping of the proximal stump was arranged. There was no delayed hemorrhage after the operation. After review of the literature, there is no definite management for this kind of traumatic intracranial pseudoaneurysm. Here, we present the fourth case of posterior communicating artery traumatic pseudoaneurysm, which presents appropriate outcome after surgical intervention of clipping proximal stump of the avulsed artery.

Introduction: Bioceramic technology has been introduced recently in endodontics to benefit from the formation of hydroxyapatite during the setting reaction in the presence of tissue fluid and establish a chemical bond at the dentin interface.

Objectives: To evaluate some of physiochemical properties of new different Bioceramic (iRoot-SP, EndoSequence, Smartpastebio) versus mineral trioxide aggregate (MTA-Fillapex) root canal sealers. Adseal and ActiV-GP sealers were used as control. Methods: Standard discs (10 for each) were prepared and immersed in 20 ml deionized water. After 1, 7, 14 and 28 days, solubility, pH changes and released elements were calculated and statistically analyzed with ANOVA test.

Results: A significantly greater solubility and higher alkalinity were displayed by the tested sealers (in descending order) Smartpastebio, iRoot-SP, EndoSequence and MTA-Fillapex (P<0.05). Their solubility exceeded the acceptable limit (3%). Their maximum alkaline pH was exhibited after 7 days. Adseal and ActiV-GP exhibited initial neutral and acidic pH respectively. Finally both had neutral pH. EndoSequence exhibited the significantly greatest calcium release followed by iRoot-SP, Smartpastebio and MTA-Fillapex, whereas, ActiV-GP and Adseal exhibited the significantly lowest values (P<0.05). There was no silicon released from iRoot-SP, Smartpastebio and MTA-Fillapex. ActiV-GP exhibited the greatest silicon, aluminum and iron release. The greatest phosphorous, manganese and magnesium content was obtained by Adseal, MTA-Fillapex and EndoSequence respectively.

Conclusion: Under the condition of this study, the prolonged alkalinity of calcium silicate sealers was synchronized with their ongoing solubility. The higher calcium ions released indicated strong alkalinity. The inequality in aluminum, iron, manganese and magnesium released by the tested sealers may expect the variance in their behaviors.

The human body built with hard and soft tissue which has a fairly remarkable inherent capacity for regeneration; however, this regenerative capacity has its limitations, and defects larger than a critical size lack the ability to spontaneously heal. As such, the development and clinical translation of effective tissue regeneration modalities are paramount. One regenerative medicine approach that is beginning to gain momentum in the clinical setting is the use of platelet-rich plasma (PRP). PRP therapy is essentially a method for concentrating platelets and their intrinsic growth factors to stimulate and accelerate a healing response. While PRP has shown some efficacy in both in vitro and in vivo scenarios, to date its use and delivery have not been optimized for tissue regeneration. Issues remain with the effective delivery of the platelet-derived growth factors to a localized site of injury, the activation and temporal release of the growth factors, and the rate of growth factor clearance. This review will briefly describe the physiological principles behind PRP use and then discuss how engineering its method of delivery may ultimately impact its ability to successfully translate to widespread clinical use.

Background: Two fibrin sealant patch products (EVARREST™ and TachoSil™) are approved by the USFDA for use in surgical settings. While these products are among the most likely to be useful for trauma use, they are not approved for this use. There is a clinical need for trauma hemostats.

Methods: A well characterized animal model for severe soft tissue hemorrhage (partial nephrectomy) was combined with another well characterized model for dilutional and hypothermic coagulopathy. The two fibrin sealant patch materials available in the US were each applied to 12 animals. Animal assignment was randomized. If hemostasis could be achieved, the animals were resuscitated and survived for 48 hours.

Results: TachoSil™ was able to achieve hemostasis in 2 of 12 animals which survived to the scheduled necropsy date without significant pathology. For the two successful animals, the mean time to achieve hemostasis was 6.5 (+/-2.12) minutes, and 178.00 (+/-79.22) grams of blood were lost before hemostasis was achieved. EVARREST™ was able to achieve hemostasis in all 12 animals, and all animals survived to the scheduled necropsy date without significant pathology. The mean time to achieve hemostasis was 3.5 (+/-1.45) minutes, and 52.11 (+/-18.92) grams of blood were lost prior to achieving hemostasis.

Conclusions: When fibrin sealant patch products can achieve intraoperative hemostasis, animals can be resuscitated and survive without significant pathology. The two available products vary considerably in intraoperative efficacy.