Journal of Trauma & Treatment

The Carotid-Cavernous Direct Fistula (CCF) is a high-flow injury resulting from the wall laceration of the cavernous segment of the internal carotid artery and its subsequent communication with the cavernous sinus [1]. The vast majority of direct CCF is traumatic but direct posttraumatic CCF represents a rare entity, occurring in only 0.17 to 1.01% of all Traumatic Brain Injury (TBI) [1,2]. Clinical presentation may involve impairment of cranial nerves III, IV, V and VI, causing paralysis on the extrinsic eye movement and diplopia, besides the emergence of headache, retro-orbital pain, chemosis and proptosis and even intracranial hemorrhage [2].

Degloving injury of penile and scrotal skin are uncommon events and are caused mainly by accidents with industrial machines and agricultural machine belts. Here we report a young male who presented shortly after an farm machinery injury to his genitalia resulting in a degloving injury of his penis and testicles. He was initially managed by debridement and dressing, followed by single staged reconstruction in the form of anteromedial thigh testis burial and skin graft over the penile shaft, which healed with satisfactory aesthetic results with normal voiding function and erection of penis. Literature described different modalities of treating such injuries which is mainly done through a multidisciplinary approach which wasn’t available at our setting.

The present study reports the cause of death of a 30 year old male victim of fire. Autopsy findings reveal gross laryngeal oedema with narrowing of the air passage. The burn injuries involved about 30% of the total body surface area. The signs of asphyxia were quite prominent on autopsy. The person suffered from inhalation injuries along with burn injuries. A thorough literature review brought forth the fact that, a timely intubation could have saved his life.

There frequently a violation happened on fresher entry in different environment and in post marital relationship where person’s desire (subconscious concept on individual practice), expectation and emotion about fundamental behaviour and extreme pleasure and satisfaction become questing on insecurity of trans-survival environment or TSE. Where non-cooperation or refusal on the partner’s request for work coordination or safe sex on using non-consensual force or roughness or unwanted sadistic behavioural or sexual acts, disregard for the counterpart’s feelings, aimed exerting control over the partner become a substance abuse that experienced an overwhelming amount of stress. Such an event or unforced situation that causes disruption on relationship and make great distress on personality adjustment or unpleasant experience that causes early traumatic disorder (ETD).

Background: Rupture of the tibialis anterior tendon is a rare lesion and only few reports are found in the literature. Another not so rare condition is a thromboembolic event following a lower limb surgical procedure or immobilization period. Although there is general agreement that patients undergoing major hip or knee surgery benefit from prophylactic anti-thrombotic therapy, currently there are no unanimously accepted recommendations for thromboprophylaxis in patients with isolated lower limb injury or surgery.

Purpose: The aim of this study is to provide a case report and a critical review of publications on the matter. Case Report: We herein report a case of a 38-year-old man, otherwise well, who sustained a small open wound anterior to the tibiotarsal joint caused by the tip of a knife. Ultrasound confirmed a complete anterior tibialis tendon rupture. Patient underwent to acute repair and was discharged with an ankle cast, with the guidance of full-time use. There was no recommendation of any type of mechanical or pharmacological thromboprophylaxis. Five days later he presented deep venous thrombosis. Treatment was conducted with enoxaparin (20 mg daily) for 3 months.

Discussion: Rupture of the tibialis anterior tendon is decidedly rare and often neglected. Acute repair may be attempted, since delayed tendon reconstruction has had less favorable functional results. Deep venous thrombosis is a potentially life threatening condition that can occur after lower limb injury or immobilization period. We performed a literature review but we cannot draw definite conclusions, given the paucity of high quality studies. In conclusion, there is a need for further research with deeper assessment of thromboprophylaxis indications and contraindications.

Nasal stent accomplishes multiple roles in rhinoplasty cases. Placement of nasal stent both pre-and post-surgical rhinoplasty is aimed at maintaining airway, tissue position and reduces tissue contracture during healing period. This article provides a simplified technique of nasal stent fabrication prior to surgical rhinoplasty in case of dog bite with an immediate approach.

The commonly performed circumcision of male infants has been searched with reference to the traumatic lesion called epidermoid cyst. A recent report emphasized with a 10-year-old boy its rarity in the world literature. Therefore, a series of 9 patients, which I documented between 1977 and 1996 from among an ethnic group in Nigeria, is presented. It accrued beneficially from the analysis of a histopathology data pool.

Background: CT analyses of occipital condyle fractures (OCF) have been based on low case numbers so far, and prospective studies on fracture morphology are not available yet.

Methods: Over a period of five years, all OCF were prospectively assessed, and the patients were followed-up clinically and radiologically after one year post trauma.

Results: 31 patients were assessed of whom 27 had unilateral OCFs and 4 had bilateral OCFs; a total of 5 patients (16.1%) with OCF died due to the severity of associated injuries. Coronary CT reconstructions either showed horizontal or vertical fracture lines, with the latter extending into the joint (14 versus 17 patients). Mortality was 37.5% in patients with horizontal fractures (due to associated cerebral injuries) and 0% in patients with vertical fractures with joint involvement. The outcome at the time of clinical follow-up was also significantly worse with horizontal fractures.

Conclusions: OCFs per se are generally considered to be benign injuries. However, fracture morphology is an indicator for the clinical course: Due to related severe intracerebral injuries, horizontal fractures – when compared to vertical fractures – are associated with higher morbidity, significantly higher mortality, and significantly worse outcome

Non-surgical cancer treatments are often limited by the presence of side effects and oral mucositis is the most common of these. The current model of mucositis involves a complex mechanism of molecular, cellular, and tissue based changes. A variety of assessment tools exist to monitor symptoms during treatment and multidisciplinary approach is vital to prevent mucositis. Patients require support to deal with the symptoms of mucositis without losing their quality of life. Some agents and protocols may be helpful in the treatment, but most pharmacological approaches remain controversial.

Background: Citicoline is a neuroprotective/neurorestorative drug used in several countries for the treatment of traumatic brain injury (TBI). After the publication of the controversial COBRIT trial, the use of citicoline has been questioned in this use, so it has been considered necessary to undertake a systematic review to evaluate if citicoline is effective in the treatment of patients with traumatic brain injury.

Methods: A systematic search was performed on Medline, Embase, and Ferrer databases to identify all published, unconfounded, comparative clinical trials of citicoline in acute phase head injured patients. Results: 12 controlled trials enrolling 2706 patients were identified. Under the random-effects model, the metaanalysis shows an 1.815 (IC 95% 1.302; 2.530) in favour of citicoline in the rates of independence, using as a measure the Glasgow Outcome Scale. The effect of citicoline has been diluted across time in parallel with the improvement of the standard of care of this kind of patient, as demonstrated by the cumulative meta-analysis technique.

Conclusion: Formal meta-analysis of comparative trials of citicoline in TBI shows a beneficial treatment effect, without safety concerns.

Introduction: The acute respiratory distress syndrome (ARDS) was proposed as an acute onset respiratory failure with PaO2/FiO2 ratio <200 (regardless of positive end-expiratory pressure (PEEP) level), bilateral infiltrates on chest X-ray and pulmonary artery occlusion pressure below 18 mmHg. The main therapeutic management of ARDS is based on the concept of protective lung strategy ventilation. Some authors reported about increase in oxygenation in the prone position (PP) in both direct types of ARDS; however, the clinical significance of it still remains questionable. We review and analyze potential clinical benefits of using the prone position in trauma critically ill patients with severe ARDS.

Methods: This is an observational, retrospective study provided in university teaching hospital from January 2006 and June 2012. In this study, we retrospectively examined clinical data of 33 trauma and 56 non-trauma critically ill adult patients suffering from severe ARDS and managed by application of prone positioning (PP) during General Intensive Care Unit (GICU) stay.

Results: We found no difference in demographic data and in the rate of complications between both study groups after application of PP. The trauma patients with severe acute lung injury demonstrated remarkable improvement in lung compliance (from 18.72 ± 9.52 to 29.285 ± 6.26, p<0.05,) and significant decreases in peak inspiratory pressure (PIP) in the prone position (from 33.48 ± 9.52 cm H2O to 21.06 ± 7.06 cm H2O, p<0.05) The mortality rate was lower in trauma group patients treated by PP (p<0.005) than in non-trauma ICU population.

Conclusions: Our study showed clinical benefit by application of PP in the treatment of severe ARDS in posttrauma critically ill patients.

Introduction: Foreign bodies in ear, nose, throat or neck are common otolaryngologic emergencies. Removal of foreign bodies from the neck usually needs surgery. Reports of foreign bodies in the neck are caused by extraluminal migration of the foreign bodies from the upper aerodigestive tract, external traumas or iatrogenic factors.In the present report; we describe an unusual foreign body: “a Schanz screw” in the neck due to ortopedic surgery performed for traumatic fragmental clavicle fracture. Case report: 51-year-old male patient who was wounded in a car crash presented to an orthopedics clinic with a right fragmental clavicle fracture. There were no pathological findings in other system examinations. He had undergone surgery where his right clavicle had been fixated with a Schanz screw. After 3 months later the x-ray showed that the screw fixed the right clavicle had been displaced to the paravertebral space. Extraction was successful by unscrewing the screw along the direction of the skin of the shoulder with no immediate squeal. Conclusion: This case is not only informative for the orthopaedists performing surgery for clavicle fractures but also highlights the importance of imaging and planning external approach for otorhinolaryngologists, considering extracting a metallic foreign body deep in the soft tissue of the neck

We report a case of a trauma patient with Bilateral Adrenal Hemorrhage (BAH) associated with Heparin Induced Thrombocytopenia (HIT). An 80-year-old man was brought to our hospital after falling from a height of 3 m. His vital signs were stable, and whole body Computed Tomography (CT) showed that he had right multiple rib fractures, hemothorax, and pelvic fracture. The patient subsequently underwent Transcatheter Arterial Embolization (TAE) for the pelvic fracture hemorrhage treatment. Then, the patient was admitted to the intensive care unit and was transfused 2 units of red cell concentrate and 2 units of fresh frozen plasma.

On Day 3, we started with the subcutaneous injection of unfractionated heparin (15,000 units per day) to prevent Deep Vein Thrombosis (DVT). On Day 6, the patient vomited and had fever (39°C) with a confused mental status. His systolic blood pressure suddenly dropped to 90 mmHg. Abdominal CT scan demonstrated BAH (Figure 1) and laboratory findings exhibited a platelet count of 50 × 103 mm−3 (which was 160 × 103 mm−3 5 days earlier). We suspected HIT leading to BAH and stopped heparin injection; we subsequently started anticoagulation therapy with argatrovan (continuous infusion: 0.5 μg/BW kg/min) and checked heparin antibody. As the patient was in a shock status, we diagnosed adrenal insufficiency and started the administration of steroids. Subsequently, the patient gained consciousness, his other symptoms regressed, and his platelet count gradually increased. Later, heparin antibody was found to be positive, and the diagnosis of HIT was confirmed.

Objective: The aim of this study was to investigate the use of intraoperative scrotal Doppler ultrasound (SDU) in cases of testicular torsion with questionable viability.

Methods: Eighty-two patients with unilateral testicular torsion were included. Surgical exploration was performed as soon as possible and hot packs were applied. If testicular color improved, the gonad was preserved and if it remained black, orchiectomy was carried out. In equivocal cases, we used SDU to assess testicular blood flow intraoperatively. The cases that showed an evidence of arterial flow to the affected testis underwent orchiopexy, otherwise orchiectomy was done. All cases were followed up for six months.

Results: Mean patient age was 14.88 ± 4.46 years and the interval between the onset of symptoms and surgical intervention ranged from 5 to 56 hours. After complete detorsion of the affected testes, 25 testes were subjectively viable and orchiopexy was done. 29 patients had black gangrenous testes, and the decision of orchiectomy was easily justified for them. There were also 28 equivocal cases and SDU was applied to them. Out of them, 18 patients were found to be suitable for orchiopexy and the rest underwent orchiectomy. After six months, of the 18 equivocal cases who underwent testicular preservation, only five (27.8%) showed testicular atrophy.

Conclusion: The use of intraoperative SDU is helpful in decision making for equivocal cases of testicular torsion.

In many countries, a long-term registered electronic medical database has been established by public authorities, which could be used to investigate the epidemiology of orthopedic injuries or degenerative disorders. Three basic epidemiological study designs could be applied to a big-data for healthcare to study orthopedic medicine: crosssectional study, retrospective case-control study, and retrospective cohort study. From the viewpoint of epidemiology, nationwide descriptive estimations of orthopedic injuries or disorders presented as the point prevalence (or incidence) with the 95% confidence interval and subsequent analysis of risk factors (or prognostic factors) evaluated by various statistic methods are valuable to policymakers when considering the redistribution of medical and social resources.

Vegetative state (VS) is characterized by complete absence of behavioural evidence for self or environmental awareness. This is a case report of a traumatic brain injury (TBI) patient who was referred as a vegetative state. He was given medical, cognitive and physical therapy and recovered consciousness after 6 months. We thus concluded that patients with such a diagnosis should receive best medical, physical and cognitive care as some of them could show good recovery.

The osteotomy of the proximal tibia remains widely practiced by orthopedic surgeons in treating unicompartmental knee osteoarthritis. A retrospective study was carried out on a group of 15 patients who were operated in our Orthopedics and Traumatology Department over a period of six years. Patients underwent valgus closing wedge osteotomy of the proximal tibia in the treatment of femoro-tibial medial knee osteoarthritis. The purpose of this study was to evaluate the results and the medium-term survival of this series of 15 osteotomies. We recorded 13.3% of superficial infections of the surgical wound and 6.6% nonunion. Despite radiological signs of deterioration of the knees, the percentage excellent results in more than 10 years of follow up on the entire series were 66.6%.

This study demonstrated that, well performed, wedge closing wedge osteotomy of the proximal tibia significantly delays the age of the prosthetic knee replacement or even prevents the patient from a total knee replacement.

There frequently a violation happened on fresher entry in different environment and in post marital relationship where person’s desire (subconscious concept on individual practice), expectation & emotion about fundamental behaviour and extreme pleasure and satisfaction become questing on insecurity of Trans-Survival Environment or TSE. Where non-cooperation or refusal on the partner’s request for work coordination or safe sex on using nonconsensual force or roughness or unwanted sadistic behavioural or sexual acts, disregard for the counterpart’s feelings, aimed exerting control over the partner become a substance abuse that experienced an overwhelming amount of stress. Such an event or unforced situation that causes disruption on relationship and make great distress on personality adjustment or unpleasant experience that causes Early Traumatic Disorder (ETD).

From 1919 to his death, Sigmund Freud was treated for a maxillary jawbone cancer by two exceptional surgeons, the Austrian, Hans Pichler, and the American, Varaztad Kazanjian. Fleeing the Nazi regime, he went into exile in England where he died after numerous recurrences of the disease.

Clavicle fractures are very common and nearly all clavicle fractures heal with simple conservative methods. Clavicle fractures are also rather frequent in athletes as well as the ordinary young, active people because of simple falls and accidents. In this review, current treatment modalities for clavicle fractures in athletes and young active patients are given briefly. Those suggestions may also be beneficial for a person seeking for a faster recovery.