Editorials
Amir Khorram-Manesh
Volume 5, Issue 1 , January 2017, Pages 1-3
Editorials
Ali Razmkon
Volume 5, Issue 1 , January 2017, Pages 4-5
Review Article
Sanjay Meena; Pankaj Kumar Sharma; Samarth Mittal; Jyoti Sharma; Buddhadev Chowdhury
Volume 5, Issue 1 , January 2017, Pages 6-12
Abstract
Introduction: Modified Stoppa approach was introduced as an alternative to ilioinguinal approach for management of anterior fractures of acetabulum in order to reduce complications of the latter. However, the efficacy of either approach over other is not well established. The aim of this meta-analysis ...
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Introduction: Modified Stoppa approach was introduced as an alternative to ilioinguinal approach for management of anterior fractures of acetabulum in order to reduce complications of the latter. However, the efficacy of either approach over other is not well established. The aim of this meta-analysis is to compare the efficacy of modified stoppa and ilioinguinal approach in the management of acetabular fractures in terms of a) quality of reduction achieved b) complication rates c) functional outcomes d) operative time e) intra-operative blood loss.Methods: Databases of PubMed, EMBASE and Cochrane registry of controlled trials were taken into consideration for studies on modified Stoppa approach versus Ilioinguinal approach group for the treatment of anterior acetabular fractures. Dichotomous variables were presented as risk ratios (RRs) /Odds Ratio (OR) with 95% confidence intervals (CIs), and continuous data was measured as mean differences, with 95% CIs.Result: Four studies involving 375 patients were included in this meta-analysis. Out of those 375 patients, 192 were managed with ilioinguinal approach and 183 were managed with modified Stoppa approach. Anatomical reduction was significantly higher in Stoppa group (p=0.052, RR=1. 19 (1.02, 1.37), p=0. 90, I2=0%). The complication rate was significantly higher in the Ilioinguinal approach as compared with the Stoppa approach (p=0.01, RR 0.63 (0.44 to 0.91), p=0.73 (I2= 0%). The operative time was significantly shorter with modified Stoppa approach (MD = -48.79 (-80.29 to -17.30), p=0.002). No significant differences were found between the two groups in terms of their functional outcomes (p=0.63, RR 0.96 (-0.80 to 1.15), p=0. 56, I2=0%) and blood loss (MD= -212.89 (-476.27 to 50.49) p=0. 06, I2=71%).Conclusion: Anterior acetabular fractures, if operated with the modified Stoppa approach were found to have better reduction and lower complication rates with less operative time, when compared to ilioinguinal approach. No significant difference in terms of blood loss was found in both the groups. Further higher quality randomized controlled trials are needed to verify our results.
Hamid Reza Eftekharian; Homa Ilkhani pak
Volume 5, Issue 1 , January 2017, Pages 13-17
Abstract
Objective: To evaluate the effects of intravenous ketorolac on early postoperative pain in patients with mandibular fractures, who underwent surgical repair.Methods: This prospective, randomized, placebo-controlled clinical trial was conducted in Shahid Rajaei Hospital, affiliated with Shiraz University ...
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Objective: To evaluate the effects of intravenous ketorolac on early postoperative pain in patients with mandibular fractures, who underwent surgical repair.Methods: This prospective, randomized, placebo-controlled clinical trial was conducted in Shahid Rajaei Hospital, affiliated with Shiraz University of Medical Sciences during a 1-year period from 2015 to 2016. We included a total number of 50 patients with traumatic mandibular fractures who underwent surgical repair. Patients with obvious contraindications to ketorolac such as asthma, renal dysfunction, peptic ulceration, bleeding disorders, cardiovascular disease, mental retardation, or allergy to ketorolac or NSAIDS, were excluded. The patients were randomly assigned to receive intravenous ketorolac (30 mg) at the end of operation in post anesthesia care unit immediately upon the onset of pain (n=25), or intravenous distilled water as placebo (n=25). Postoperative monitoring included non-invasive arterial blood pressure, ECG, and peripheral oxygen saturation. The postoperative pain was evaluated by a nurse using visual analog scale (VAS) (0–100 mm) pain score 4 hours after surgery and was compared between the two study groups.Results: Overall we included 50 patients (25 per group) in the current study. The baseline characteristics including age, gender, weight, operation duration, anesthesia duration and type of surgical procedure were comparable between two study groups. Those who received placebo had significantly higher requirements for analgesic use compared to ketorolac group (72% vs. 28%; p=0.002). Ketorolac significantly reduced the pain intensity 30-min after the operation (p<0.001). There were no significant side effects associated with ketorolac.Conclusion: Intravenous single-dose ketorolac is a safe and effective analgesic agent for the short-term management of mild to moderate acute postoperative pain in mandibular fracture surgery and can be used as an alternative to opioids.
Mehrzad Banihashemi; Azam Safari; Navid Nezafat; Mahmoodreza Tahamtan; Manica Negahdaripour; Negar Azarpira; Younes Ghasemi
Volume 5, Issue 1 , January 2017, Pages 18-23
Abstract
Objective: To evaluate the effect of fibrin perihepatic packing on controlling liver hemorrhage and liver wound healing.Methods: In this animal experimental study, 20 adult male Sprague Dawley rats, weighing 200-220 g, were included. Stab wound injury was created by number 15 scalpel, so that bilateral ...
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Objective: To evaluate the effect of fibrin perihepatic packing on controlling liver hemorrhage and liver wound healing.Methods: In this animal experimental study, 20 adult male Sprague Dawley rats, weighing 200-220 g, were included. Stab wound injury was created by number 15 scalpel, so that bilateral liver capsules and liver tissue were cut, and acute bleeding was accrued. The animals were divided into 2 study groups: control (with a primary gauze packing treatment) and test group (with fibrin packing treatment). Serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total serum bilirubin (TSB) levels were measured as a liver function test during the treatment period. Blood loss was calculated for estimation of hepatic hemorrhage during surgery. After four weeks, the liver wound repair was evaluated by sampling and Hematoxylin and Eosin staining (H&E).Results: In the test group, all of animals were alive (mortality rate= 0%). Significantly, ALT and AST levels were raised after surgery, followed by a decrease ALT (p=0.783) and AST (p=0.947) to the normal level during 4 days. Estimated blood loss was 2.89 ± 0.73 mL (about 19.65% of estimated blood volume). Hematocrit levels returned to the normal level (p=0.109) after 48 hours. In the control group, the mortality rate was 50% during 12h after surgery. ALT (p=0.773) and AST (p=0.853) were decreased to normal level during 6 days, and estimated blood loss was 4.98 ± 0.77 mL (about 32.98% of estimated blood volume) in the remaining animals. Moreover, hematocrit levels returned to the normal level (p=0.432) after 72 hours. Estimated blood loss in the test group was significantly less than control group (p<0.001). Total serum bilirubin levels were not significantly different from the normal level, before and after surgery in both groups. Histopathology sections from the post-hepatectomy specimens showed that the site of the previous incision was completely repaired, and a dense fibrous septum was observed in both groups.Conclusion: The fibrin dressing was effective in preventing blood loss and saving lives after a liver stab injury and major internal bleeding in the animal model of rat.
Hossein Hodjati; Ahmad Hoseinzadeh; Seyed Masoud Mousavi; Seifollah Dehghani Nazhavi; Viginda Kumar; Maryam Sehhatpour
Volume 5, Issue 1 , January 2017, Pages 24-28
Abstract
Objective: To evaluate the feasibility and results of using serosal patch of small bowel for repair and replacement of inferior vena cava (IVC) after resection of a part of infra-renal IVC in an animal model, as it may be encountered in extensive tumors of retroperitoneal and trauma patients.Methods: ...
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Objective: To evaluate the feasibility and results of using serosal patch of small bowel for repair and replacement of inferior vena cava (IVC) after resection of a part of infra-renal IVC in an animal model, as it may be encountered in extensive tumors of retroperitoneal and trauma patients.Methods: Five healthy sheep of both sexes were prepared. After general anesthesia and laparotomy, a defect with 1 cm width and 4cm length was made on anterior aspect of infra-renal IVC, and then an adjacent loop of small bowel was brought and sutured continuously to cover the defect of IVC as a patch graft. The observation period was two months.Results: Three of five IVCs were macroscopically patent without stenosis and thrombosis. Pathologic assay revealed complete endothelialization of serosal surface of the patch of small bowel loop. One of IVCs was completely occluded in gross evaluation and fibrous formation in pathologist review. The sheep had no sign of venous hypertension and edema of limbs. One sheep died at the night of first operation due to internal bleeding.Conclusion: Serosal patch of small bowel is an accessible and feasible alternative in repair and reconstruction of IVC especially when there is restriction for use of prosthetic material in a contaminated space of abdomen.
Marjan Jeddi; Mohammad Hossein Dabbaghmanesh; Alireza Kharmandar; Gholamhossein Ranjbar Omrani; Marzieh Bakhshayeshkaram
Volume 5, Issue 1 , January 2017, Pages 29-35
Abstract
Objective: To determine the prevalence of fractures and associated risk factors in healthy Iranian children and adolescents.Methods: In this cross sectional population based study, 478 healthy Iranian children and adolescents aged 9–18 years old participated. Baseline data and bone mineral content ...
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Objective: To determine the prevalence of fractures and associated risk factors in healthy Iranian children and adolescents.Methods: In this cross sectional population based study, 478 healthy Iranian children and adolescents aged 9–18 years old participated. Baseline data and bone mineral content and density have been determined. One questionnaire was completed for all individuals including previous history of fracture, its location, and level of trauma. Albumin, calcium, phosphorus, alkaline phosphatase, and vitamin D levels were measured.Results: We found a prevalence of 12.9% for fracture. (34.5% for girls and 65.5% for boys); about 71% suffered long bone fracture with distal forearm as the most common site. Totally 58% of the boys and 54% of the girls had fracture with low-energy trauma. The fracture group had lower bone mineral apparent density in the lumbar spine (0.19±0.04 vs. 0.20±0.03, p=0.04), lower serum albumin (4.6±0.5 vs 4.8±0.4, p=0.02), and higher serum alkaline phosphatase level (446±174 vs. 361±188, p=0.02) compared with non-fracture subjects. By logistic regression analysis, we found a significant association for sex, and bone mineral content of the lumbar spine with fracture (p=0.003, p=0.039).Conclusion: Compared to other studies, our subjects had lower rate of fracture. We found an association between low bone density and fracture in children and adolescents. This finding has important implications for public health. Further research may contribute to recognition of preventive measures.
Swagat Mahapatra; Vineet Thomas Abraham
Volume 5, Issue 1 , January 2017, Pages 36-41
Abstract
Objective: To evaluate and report the functional results of surgical management of intercondylar fractures of the humerus in adults using a novel dual plating technique.Methods: A total number of 60 patients with Riseborough and Radin type II, III, and IV intercondylar humerus fractures were operated ...
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Objective: To evaluate and report the functional results of surgical management of intercondylar fractures of the humerus in adults using a novel dual plating technique.Methods: A total number of 60 patients with Riseborough and Radin type II, III, and IV intercondylar humerus fractures were operated with open reduction through a Trans-olecranon approach and internal fixation using two plates in inverted-Y configuration. Patients were followed for 6 weeks, 3 and 6 months were evaluated using the Mayo Elbow performance score and Quick-DASH score.Results: There were 50(83.33%)men and 10 (16.67%)women with mean age of 34.9 ± 12.63 years. 63.3% of the cases were following Motor vehicle accident and rest following fall. The right upper limb was more commonly affected than the left side. Riseborough and Radin type II fractures accounted for 3.33% of cases; type III fractures accounted for 50% of cases and type IV accounted for 46.67%. Excellent to Good results were seen in almost 80% of cases as per the Mayo Elbow performance score at 6-month follow-up. Quick-DASH scores for the series at 6-month follow-up was on average of 15.96 ± 9.92.Conclusion: Dual plating in inverted Y configuration offers a reliable fixation, which permits early mobilization and good functional outcome.
Nasrin Mehri; Homayoun Sadeghi-Bazargani; Abdolrasoul Safaiean
Volume 5, Issue 1 , January 2017, Pages 42-46
Abstract
Objective: To determine the epidemiological and clinical characteristics of hand and finger amputations in patients referring to a single center in northern Iran.Methods: This was a cross-sectional study conducted on 200 traumatic hand amputees hospitalized in Shohada Hospital in Tabriz, Northwestern ...
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Objective: To determine the epidemiological and clinical characteristics of hand and finger amputations in patients referring to a single center in northern Iran.Methods: This was a cross-sectional study conducted on 200 traumatic hand amputees hospitalized in Shohada Hospital in Tabriz, Northwestern Iran during a 1-year period in 2014. Data were collected through prospective interviews for variables such as demographic characteristics, accident time; exact anatomical site of amputation; reasons for amputation; amputation mechanism; and having attention deficit symptoms as well as activities causing attention deficit prior to the accident.Results: The vast majority of cases were men and women accounted for only 7.5% of injured cases. In 60.5% of cases, the accident occurred on the fingers of their active hand and fingers accounted for almost 95% of accidents. 85.8% of accidents occurred at work. 63.7% of accidents occurred in the evening. 63.67% of accidents occurred in the evening. Among hazardous occupations, agricultural occupations ranked the first followed by sugar cut and pressing jobs. It was found that 10% of the victims were injured while responding a mobile phone call and 3% of the victims reported that they were listening to music through headphones before the accident. Five percent of the participants reported a quarrel with a colleague and 11.5 % of them reported a quarrel with their employer prior to the accident.Conclusion: Amputations are of much importance in men working in given jobs such as agricultural and pressing. Distraction caused by mobiles, music and personal relations with others is considered of importance to be prevented during job. Risk levels for potential risk indicators need to be assessed through controlled studies.
Marjan Hosseinpour; Abdollah Mohammadian-Hafshejani; Mohammad Esmaeilpour Aghdam; Mahdi Mohammadian; Farzad Maleki
Volume 5, Issue 1 , January 2017, Pages 47-52
Abstract
Objective: To investigate trend and seasonal pattern of occurrence and mortality of motorcycle accidents in patients referred to hospitals of Isfahan.Methods: This cross-sectional study was carried out using traffic accidents data of Isfahan province, extracted from Ministry of Health (MOH) database ...
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Objective: To investigate trend and seasonal pattern of occurrence and mortality of motorcycle accidents in patients referred to hospitals of Isfahan.Methods: This cross-sectional study was carried out using traffic accidents data of Isfahan province, extracted from Ministry of Health (MOH) database from 2006 to 2010. During the study period, 83648 people injured due to motorcycle traffic accidents were referred to hospitals, all of them entered in the study. Logistic regression model was used to calculate the hospital mortality odds ratio, and Cochrane-Armitage test was used for assessment of linear trend.Results: During the study period, the hospital admission for motorcycle accident was 83,648 and 89.3% (74743) of them were men. Mean age in accidents time was 26.41±14.3 years. The injuries and death sex ratio were 8.4 and 16.9, respectively. Lowest admission rate was during autumn and highest during summer. The injury mortality odds ratio was 1.01 (CI 95% 0.73-1.39) in the Spring, 1.34 (CI95% 1.01-1.79) in summer and 1.17 (CI95% 0.83-1.63). It was also calculated to be 2.51 (CI95% 1.36-4.64) in age group 40-49, 2.39 (CI95% 1.51-5.68) in 50-59 and 4.79 (CI95% 2.49-9.22) in 60-69 years. The mortality odds ratio was 3.53 (CI95% 2.77-4.5) in rural place, 1.33 (CI95% 1.15-1.54) in men, and 2.44 (CI95% 2.09-2.85) in the road out of town and village. In addition, trend of motorcycle accidents mortality was increasing (p<0.001).Conclusion: Motorcycle accidents injuries are more common in men, summer, young age and rural roads. These high risk groups need more attention, care and higher training.
Case Report
Christian David Weber; Philipp Kobbe; Christian Herren; Andreas H. Mahnken; Frank Hildebrand; Hans-Christoph Pape
Volume 5, Issue 1 , January 2017, Pages 53-57
Abstract
While blunt trauma of the head and neck are a common pattern of injury, significant problems related to the prompt diagnosis and optimal management of traumatic artery injuries have been reported in the literature. While patients with major artery injuries might develop hemorrhagic shock very rapidly, ...
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While blunt trauma of the head and neck are a common pattern of injury, significant problems related to the prompt diagnosis and optimal management of traumatic artery injuries have been reported in the literature. While patients with major artery injuries might develop hemorrhagic shock very rapidly, patients with blunt cerebrovascular injuries (BCVI) can present asymptomatic, but complications like basilar territory infarction, cortical blindness and death may occur. We report the life- and limb-saving management in a 57-year-old hemodynamically unstable trauma patient. The individual developed hemorrhagic shock, and other major complications, including cortical blindness, related to a posterior circulation stroke. Full recovery was achieved by immediate endovascular prosthesis for subclavian artery (SA) rupture and stenting of a traumatic vertebral artery occlusion. Endovascular and alternative treatment options are discussed and the management of subsequent sequelae associated with aggressive anticoagulation in trauma patients is reviewed, including intracranial, abdominal and other sites of secondary hemorrhage.
Case Report
Mehdi Ayaz; Reza Moein
Volume 5, Issue 1 , January 2017, Pages 58-62
Abstract
Mucormycosis is a rare opportunistic fungal infection that can implicate cranial sinuses, brain, lungs, gastrointestinal tract and skin. Although it can occur in patients with competent and incompetent immunity such as patients with diabetes mellitus, lymphoma, leukemia and burns, but it has an aggressive, ...
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Mucormycosis is a rare opportunistic fungal infection that can implicate cranial sinuses, brain, lungs, gastrointestinal tract and skin. Although it can occur in patients with competent and incompetent immunity such as patients with diabetes mellitus, lymphoma, leukemia and burns, but it has an aggressive, malignant and lethal course in patients with incompetent immunity. To enforce the importance of burn in patients with underlaying diseases such as diabetes, we are going to report a rare case of diabetic burnt patient complicated by right upper extremity myocutaneous mucormycosis. We selected this case to emphasis the importance of underlying disease (diabetes mellitus) with cutaneous burn, aggressive treatment of fungal infection in these patients and referring such case to burn center to prevent catastrophic results. A 50-year-old woman was introduced to us after several days of medical and surgical care of right upper extremity and trunk split-thickness burn. Due to gross muscle necrosis of right upper extremity and poor general condition of the patient, she was taken to the operating room that led to right upper extremity amputation and several times of aggressive debridement to save her life. Pathologic report was indicative of mucormycosis. We can conclude from this case that: 1) Burn, even partially thickness and with little body surface area, should be referred to burn center for better care 2) No response to usual medical treatment should make us more sensitive to consider the unusual causes of infection such as fungi 3) Suspected dead tissues should be excised aggressively especially if suspiciousness to wound sepsis and fungal infection is present especially in an immunocompromised patient.
Letter to the Editor
Biplab Mishra
Volume 5, Issue 1 , January 2017, Pages 63-66
