Journal of Trauma & Treatment

It is well evidenced that exposure to early psychological trauma in childhood or adolescence represents a substantial risk factor for an adult psychopathological development. In particular, so called type II trauma events, i.e. repeated or chronic interpersonal traumatic experiences like emotional, physical, sexual abuse, and physical, emotional neglect are associated with the development of a wide range of mental disorders.

Aim: To study the epidemiology of delayed union of long bones.

Introduction: In India, the availability of fracture healing therapies to the general public is limited. The infrastructure of the health system in India, involving both public and private sector does not provide adequate opportunity for rural and low-income inhabitants to access the needed care. Due to these reasons, majority of the global burden of injuries are borne by low and middle-income countries.

Material and methods: Patients getting admitted in AVBRH hospital above the age of 18 years of either sex with radiological features of delayed union. Study was a prospective, case control observational type carried out in a rural health setup at AVBRH. It comprised of 153 patients out of which 43 patients had delayed union of a long bone, 53 patients had non-union. These patients were compared with 57 patients that had postoperative fracture union which were included as a control group who had the same risk factors for delayed union.

Results: Aging, female gender, comminuted and segmental fractures, higher grades of soft tissue injury, smoking, and infection were found to be independent risk factors for delayed union in long bone fractures. Among the risk factors, smoking and infection can be controlled to decrease the prevalence of delayed union.

Conclusion: It is necessary that we create awareness about the importance of primary treatment like immobilization and wound debridement, as patients should reach as early as possible. Patient’s relative’s moral support is necessary in order to get early hospitalization so as to reduce the risk of delayed union among patients and so that appropriate modality of treatment (surgical and conservative) with use of bone regeneration substitutes such as bone grafting and PRP can be done to promote faster healing keeping infection in control.

The eggshell membrane has shown a positive effect on joint pain relief. In this study, several tests have been performed to measure the effect of Ovomet® supplementation on subjective perception and biomechanical variables to crossfiters before and after 50 days of administration.

Pain perception questionnaires were performed in order to assess and demonstrate the protective or potentiating of Ovomet® effect on athletes' joints. In addition, we measured biomechanical variables such as muscle strength and power in knee extension, linear stiffness of the Achilles tendon (AT) by ultrasound, muscle stiffness through sensor in two different manoeuvers.

Of all the biomechanical variables, the measurement of tendon stiffness by ultrasound, proves to be a useful tool to study the factors that can affect the joints, like our object of study, the effect of joint supplementation on athletes.

Traumatic brain injury (TBI) is a significant public health problem in all regions of the globe despite advancement in prevention and treatments. Its global incidence is rising and it is predicted to surpass many diseases as a major cause of death and disability by the year 2020. It is a leading cause of mortality, morbidity, disability, and socioeconomic losses in India as well. For reducing the burden of TBIs, India and other developing countries are facing the major challenges of prehospital care, prevention, and rehabilitation in their rapidly changing environments.

We all like to hear positive stories of bravery and heroism, especially those that have a good ending and outcome. These stories reassure us that amongst all the bad news and tragedy we see on a daily basis, there are people out there who act and behave selflessly in extraordinary situations and circumstances.

While programs using horses with war veterans proliferate few aim specifically at Moral Injury. Many believe that riding horses constitutes therapy for Post-Traumatic Stress Disorder. While there may be a benefit because the movement of the horse is regulating to the nervous system, this practice is contraindicated for warriors with Moral Injury which we see as separate and distinct from PTSD, and not a disorder. Our definition of Moral Injury is that it is an existential/spiritual crisis that is the result of having been trained to override the instinctual aversion to the taking of human life.

It can also be the consequence of having perpetrated acts during combat operations, necessary at the time for survival, that damage one’s conscience or moral compass. To the extent that warriors may have both PTSD and Moral Injury, the latter requires a different clinical approach. Warriors who attend Trauma and Resiliency Resources Inc.’s Warrior Camp® program do not ride nor do they have access to halters, lead lines or other instruments of domination or control.

Our work at TRR is in accordance with the EAGALA model of Equine Assisted Psychotherapy. This method best suits warriors with Moral Injury because it allows for a more robust use of the horse’s capacity for nonjudgmental intuitive mirroring. In particular, a horse’s ability to intuitively target post-war attachment disruptions caused by morally injurious combat experiences is best employed when the veterans keep their feet on the ground.

The incidence of tibial shaft fracture that too distal end fracture is on the rise due to increased rate of road traffic accident by two-wheeler users, specially due to the traffic scenario in cities of our country. High speed vehicles, bad roads and rapid industrialization has further compounded the problems. In this prospective study, we studied 20 patients that suffered a distal tibial fracture. They were managed by intramedullary nailing with or without fixation of the fibula. Results were based on radiological and functional outcomes categorized by excellent, good, fair and poor. We evaluated the rate of fracture union and post-operative complications. 65% of the patients had an excellent outcome, 25% had good, 5 had fair and 5 had a poor outcome. 6 patients suffered complication. The average time to union was 15 weeks. Our study concluded the excellent outcomes that could achieved by intramedullary nail with the distal locking screw.

The present text aims to promote reflections about the trauma clinic. It is a treatment practice conceived within the psychological care of refugee immigrants, marked by the silencing that comes from the fixation in the traumatic moment. Such practice requires unconventional interventions that can symptomatize this deadly silence and convey the experience of loss produced by the trauma of displacement/uprooting. We propose a few questions regarding the ethos of the trauma clinic, at the same time as we present some Freudian indications for the understanding of the operation of this traumatic moment. Both authors authorize the publication of this study.

Admiral Horatio Lord Nelson, the greatest British naval hero, was fatally wounded during the Battle of Trafalgar. Conventional theory holds that he died mainly of an injury to a major blood vessel in the chest. However, a review of the empirical evidence-with the benefit of modern medical science-, suggests that the primary cause of death was a spinal neurogenic shock from transection of the mid thoracic spinal cord. These conditions do not necessarily exclude each other.

Aims: The purpose of this study was to predict the clinical course by intracranial pressure (ICP) or cerebral perfusion pressure (CPP) in the acute phase and prognosis in patients with severe head trauma who underwent therapeutic mild hypothermia (HT).

Methods: A consecutive 143 patients treated with HT for intracranial hypertension (ICH) in two trauma centers were included in this study. The pressure measured after computed tomography scanning was defined as the initial ICP or CPP. Outcome was assessed at 6 months according to the Glasgow Outcome Scale. ROC analysis was performed to clarify the threshold value of ICP/CPP predictive of ICP uncontrollable by HT.

Results: The cutoff value of ICP for uncontrollable ICP obtained from ROC analysis was 32.5 mmHg (sensitivity: 0.545, specificity: 0.875), and that for CPP was 56.5 mmHg (sensitivity: 0.813, specificity: 0.663). Fifty-three (96.4%) of 55 patients whose initial ICP was greater than 32.5 mmHg and 67 (95.7%) of 70 patients whose initial CPP was less than 56.5 mmHg had developed uncontrollable ICP.

Conclusion: The cutoff values predictive of ICP uncontrollable by HT from ROC analysis were 32.5 mmHg for ICP and 56.5 mmHg for CPP. For those patients with initial ICP greater than the cutoff value or an initial CPP less than the cutoff value, it may be harmful to prolong HT. The knowledge obtained from this study may be useful for considering the treatment strategy for severe traumatic brain injury.

The aim of this study was to examine the effect of trauma experience severity on borderline personality characteristics and to examine as well the mediation effect of self-esteem. To measure traumatic experience severity, the Trauma Experience Questionnaire-Revised (TEQ-R) was developed and validated. The TEQ-R, Rosenberg Self-Esteem Scale, and the personality assessment inventory-borderline features scale (PAI-BOR) were administered to 400 normal subjects. According to structural equation model analysis, trauma experience severity was positively associated with borderline characteristics, and the mediation effect of self-esteem was significant. Both trauma severity and borderline characteristics were negatively related to self-esteem. Thus, self-esteem seemed to have a buffering effect on the path between trauma and borderline personality.