Trauma最新文献

{"title":"Surgical methods of treatment for tibial diaphyseal fractures","authors":"M.Yu. Stroiev, O. Karpinska","doi":"10.22141/1608-1706.1-2.25.2024.964","DOIUrl":"https://doi.org/10.22141/1608-1706.1-2.25.2024.964","url":null,"abstract":"Background. Bone fractures are a public health concern. In recent years, there has been an upward trend in body weight of people of all age groups. Obesity has long been thought to help protect against fractures, but recent studies have shown that for every 5 cm increase in waist circumference, the risk of any fracture is 3 % higher. The purpose: according to the meta-analysis of modern medical literature, to determine the main directions of surgical treatment for long bone fractures, their advantages, and disadvantages, including in overweight patients, the features of diaphyseal fracture fixation in overweight patients. Materials and methods. A meta-analysis of special literature from scientific databases was conducted: Cochrane Library, Scopus, National Library of Medicine — National Institutes of Health, ReLAB-HS Rehabilitation Resources Repository. One hundred and thirty articles were analyzed, from them 31 were selected, which, in our opinion, reflect the purpose of the study. Results. All methods of surgical fixation of fractures have their advantages and disadvantages. The frequency of nonunions caused by intramedullary fixation of the femoral shaft can reach 10 %, and varus/valgus and rotational deformities and shortening can also be observed. But the use of locking screws prevents the occurrence of most complications. When fixing the fractures with plates, the main complications are related to superficial and deep infections, which were more often observed in overweight patients. The analysis demonstrated that in overweight and obese patients, the main complicating factor is not the method for fixing the fracture zone, but factors related to the health of the patient himself. So, despite the fact that the results of treatment of fractures in patients with normal weight and obesity did not have a statistically significant difference, an increase in cardiovascular complications, exacerbation of chronic respiratory diseases was observed. Moreover, it is the presence of concomitant diseases that often makes surgical intervention impossible. Conclusions. There is a large amount of research on surgical methods of fixing tibial diaphyseal fractures, but data on the choice of fixation method in overweight and obese patients as a separate approach were not found. There are data on complicating factors of excess weight in the treatment of fractures and surgical interventions. Systematic studies related specifically to the algorithm for choosing the method of fracture fixation and complications have also not been found.","PeriodicalId":515287,"journal":{"name":"Trauma","volume":"31 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140966629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A keystone speciality: The role of anaesthesia in trauma systems","authors":"Laura Hobbs, Neil Shorney, Rowan Burnstein, Saleyha Ahsan, Michael Bath, Sara Halimah, Tom Bashford","doi":"10.1177/14604086241245600","DOIUrl":"https://doi.org/10.1177/14604086241245600","url":null,"abstract":"","PeriodicalId":515287,"journal":{"name":"Trauma","volume":"25 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140975857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preservation of neurologic function in the setting of penetrating-knife spinal cord injury with dural involvement and concurrent lung injury","authors":"A.S. Levy, Connor Berger, Vignessh Kumar, Abbasali Badami, Ian Côté","doi":"10.1177/14604086241241857","DOIUrl":"https://doi.org/10.1177/14604086241241857","url":null,"abstract":"Penetrating spinal cord injuries present unique clinical scenarios with high variability in presentation and management. These injuries are rare, accounting for 0.8% of annual penetrating spine injuries in the United States, with knives being the most common penetrating object. Retention of the knife blade further complicates management, with greater risk of infection and progressive neurologic injury. Given the rarity and variability of such injuries, preferred management for penetrating-knife spinal cord injuries (PKSCI), especially those with retained knife blades, remains contested. Furthermore, the management of PKSCI with concurrent lung injury is poorly described within the literature. Here we discuss a unique case of a neurologically intact adult male who suffered a large lower thoracic PKSCI with complete dural transection and lung involvement. The patient arrived with the blade in situ while maintaining full neurologic function. Emergent imaging revealed the blade trajectory passing through the T8 lamina exiting the spinal canal at the costovertebral junction with involvement of the lung parenchyma and associated pneumorrhachis and pneumothorax. The patient was brought to the operating room where the blade was removed under direct visualization, the dura was repaired, and pneumothorax was stabilized. We describe in this case the choice of imaging, method of blade removal, cerebrospinal fluid leak management, dural repair, and concurrent lung injury management that afforded a favorable, ASIA class E outcome with complete preservation of neurologic function.","PeriodicalId":515287,"journal":{"name":"Trauma","volume":"48 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140709906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bimanual expression and removal of corneal embedded intraocular end-on foreign body","authors":"A. Bhayana, Priyanka Prasad, Pradeep Venkatesh","doi":"10.1177/14604086241241855","DOIUrl":"https://doi.org/10.1177/14604086241241855","url":null,"abstract":"","PeriodicalId":515287,"journal":{"name":"Trauma","volume":"5 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140743561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How to prevent road traffic accidents leading to passenger vehicle drowning","authors":"Ali Davoudi Kiakalayeh, Reza Mohammadi, Shahrokh Yousefzade chabok, Sajad Davoudikiakalayeh","doi":"10.1177/14604086241245592","DOIUrl":"https://doi.org/10.1177/14604086241245592","url":null,"abstract":"","PeriodicalId":515287,"journal":{"name":"Trauma","volume":"10 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140745294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multifunctional capabilities of СО2 for providing pharmacodynamics of carboxytherapy","authors":"V. Shtroblia, S.S. Filip, R. Lutsenko","doi":"10.22141/1608-1706.4.24.2023.962","DOIUrl":"https://doi.org/10.22141/1608-1706.4.24.2023.962","url":null,"abstract":"Background. To identify potential opportunities for carboxytherapy, it is necessary to assess the importance of various signaling mechanisms of sensitivity to СО2 and summarize the knowledge about the cellular and molecular mechanisms underlying the beneficial and safe effects of carboxytherapy. High level of СО2 activates the mechanisms that convert hypoxia into the mode of survival and physiological homeostasis. The balance between the pro-inflammatory and anti-inflammatory phases in inflammation also shifts towards homeostasis when tissue СО2 level increases, which is very important for wound and fracture healing. The physiological properties of СО2 provide oxygenation, enhancement of angiogenesis, mitochondrial biogenesis, blood flow in tissues, anti-inflammatory effect, and reduction of oxidative stress. These pro-perties of СО2 determine the potential use of carboxytherapy as a therapeutic approach in tissue hypoxia, to accelerate tissue repair and reduce inflammation. Methods. Тhe search for scientific information on the possibilities of СО2 in medicine was conducted in the PubMed and Google Scholar electronic databases. Results. Literature data on СО2 studies aimed at the mechanisms of pharmacological action of carboxytherapy were found, which have been investigated in animal models in vivo and in research with human participants. Conclusions. This review presents the scientific evidence supporting the clinical benefits of therapeutic exposure to СО2 (carboxytherapy).","PeriodicalId":515287,"journal":{"name":"Trauma","volume":"9 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140432349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The value of the posterior ligamentous complex in traumatic injury of thoracolumbar junction. Part 2. Diagnostic methods","authors":"O. Nekhlopochyn, V. Verbov, I. Cheshuk, M. Vorodi, I.M. Ivanovich","doi":"10.22141/1608-1706.4.24.2023.960","DOIUrl":"https://doi.org/10.22141/1608-1706.4.24.2023.960","url":null,"abstract":"The posterior ligamentous complex (PLC) of the spinal motion segment consists of the supraspinous, interspinous ligaments, ligamentum flavum, and facet joint capsules. The state of this functional combination of ligamentous structures is considered a critical predictor of stability in traumatically injured spine. Despite the practical importance of the PLC concept, it has mainly been used for theoretical evaluation of spinal stability models for a long time. Literature analysis reveals a lack of consensus regarding diagnostic criteria for PLC injuries and their clinical significance. The results of some studies are conflicting. This review attempts to organize information on diagnostic methods for assessing the status of different elements of the PLC in traumatic injuries of the thoracolumbar junction. Currently, there is no universally accepted criteria to help verify PLC injuries. Many signs have diagnostic value, which can be categorized as direct or indirect based on the visualization method. Direct signs are based on the analysis of images that characterize specific anatomical structures. Indirect signs allow for the assessment of the PLC considering the state and location of adjacent, primarily bony, structures. The review examines the diagnostic capabilities of visualization methods such as spondylography, spiral computed tomography, magnetic resonance imaging, and ultrasound with identification of their main advantages and disadvantages. It is found that the broader capabilities of magnetic resonance imaging in visualizing soft tissue structures do not significantly improve diagnostic quality. Spiral computed tomography remains the leading method, both for evaluating bone traumatic changes and determining indirect signs of PLC injury. The development and clinical verification of spiral computed tomography characteristics for assessing the status of the ligamentous apparatus are important tasks in improving the quality of care for patients with thoracolumbar junction injuries.","PeriodicalId":515287,"journal":{"name":"Trauma","volume":"3 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140432640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extracorporeal shock wave therapy: options in chronic osteomyelitis (literature review)","authors":"G.I. Gertsen, Yu. K. Remenyuk, M. V. Sikorska, H.H. Bilonozhkin","doi":"10.22141/1608-1706.4.24.2023.961","DOIUrl":"https://doi.org/10.22141/1608-1706.4.24.2023.961","url":null,"abstract":"The use of extracorporeal shock wave therapy under experimental conditions has shown the effectiveness of the method in soft tissue and skeletal infections. In vitro, an energy-dependent effect of shock waves on reducing the viability of Staphylococcus aureus and other pathogenic flora was revealed. For the manifestation of the antibacterial activity of shock waves towards pathogenic bacteria of the typical flora in chronic osteomyelitis, at least 1,000 pulses were required, and for its almost complete eradication (99 %), 4,000 pulses were applied at an energy flux density of 0.59–0.96 mJ/mm2. Most authors confirm the isolated (without antibiotics) antibacterial effect of shock waves in vitro, although there are opposite opinions. It is known that pathogenic bacteria, including Staphylococcus aureus, form protective biofilms on infected soft, bone tissues, implants. Due to this, the emerging infection is difficult to treat for a number of reasons — the biofilm prevents the penetration of antibiotics and immune cells. In vitro studies have shown that shock waves destroy biofilms of pathogenic bacteria and create conditions for a joint bactericidal effect with antibiotics. In vivo observations under the conditions of modeling experimental osteomyelitis in animals have demonstrated bacteriologically that extracorporeal shock wave therapy, when used alone, does not have an antibacterial effect, however, a lower degree of osteomyelitis was detected morphologically. The authors stated the synergism of shock waves with antibiotics in the treatment of chronic osteomyelitis in animals, up to the bactericidal effect. Studies on the impact of shock waves on biofilms of pathogenic bacteria typical for soft tissue infections, chronic osteomyelitis, both in vivo and in vitro, showed that after the application of the method, the pathogenic flora becomes susceptible to antibiotic therapy. The currently widespread opinion about the contraindication of extracorporeal shock wave therapy in the presence of infection in the body, due to the risk of exacerbation of the inflammatory process, the likelihood of bacteremia, sepsis, and foci of secondary infection, has not been confirmed in the experimental studies in vivo. Many research have shown the absence of similar or other complications in animals after the use of shock waves. The analysis of the presented data indicates the need for further study of the mechanism of extracorporeal shock wave effect on chronic osteomyelitis, possible complications associated with the use of the method, as well as its approbation in the clinic.","PeriodicalId":515287,"journal":{"name":"Trauma","volume":"14 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140433281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of using H. Kitaoka (AOFAS) scale, FFI (Italian version), Roles and Maudsley score, VAS in patients with flatfoot","authors":"A.P. Liabakh, O. Turchin, V.M. Pyatkovskyi","doi":"10.22141/1608-1706.4.24.2023.958","DOIUrl":"https://doi.org/10.22141/1608-1706.4.24.2023.958","url":null,"abstract":"Assessment of the functional capacity of the foot requires adequate tools depending on a specific nosology. Objective: to investigate the possibility of using evaluation scale of H. Kitaoka (American Orthopaedic Foot and Ankle Society (AOFAS)), Foot Function Index (FFI) (Italian version), Roles and Maudsley score, visual analog scale (VAS) in patients with flatfoot. Materials and methods. Clinical and X-ray examinations of 63 patients (78 feet) who had flatfoot were performed. Their average age was 42.5 ± 2.0 (9–72) years. X-ray and clinical indicators were used: horizontal and vertical talo-metatarsal angles (TMA), angle of valgus deviation of the calcaneus, body mass index. The assessment of the functional state of the foot was carried out according to the H. Kitaoka (AOFAS) scale, FFI (Italian version), Roles and Maudsley score, VAS. The strength of the relationship between indicators was studied ­using Pearson’s pairwise correlations; a correlation regression analysis was performed on models where the indicators of rating scales were the dependent variables. Results. There was an inverse correlation between the foot function score (AOFAS) and the age and TMA, a direct correlation between the FFI and the age and body mass index, a direct dependence of functional insufficiency (Roles and Maudsley score) and pain level (VAS) on age. A sufficient degree of correlation (0.5–0.75) was found between the applied scales. Conclusions. Sufficient criterial and construct validity of the AOFAS scale, FFI (Italian version), Roles and Maudsley score, VAS was found when used in patients with flatfoot. The use of selected scales is an adequate tool for assessing functional capacity in patients with flatfoot.","PeriodicalId":515287,"journal":{"name":"Trauma","volume":"14 78","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140432681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Study of the stress-strain state in models of various options for osteosynthesis of tibial bones with diaphyseal fractures in the middle third in children with osteogenesis imperfecta and incomplete growth Part 1. Compression","authors":"M. Korzh, S. Khmyzov, E. Katsalap, M. Karpinsky, O. Yaresko","doi":"10.22141/1608-1706.4.24.2023.959","DOIUrl":"https://doi.org/10.22141/1608-1706.4.24.2023.959","url":null,"abstract":"Background. Osteogenesis imperfecta is accompanied by multiple fractures of skeletal bones, the development of progressive deformations of the long bones of the limbs and, as a result, the inability to stand and walk. At present, the most promising means for stabilizing bone fragments are intramedullary fixators of various designs. Installation of internal fixators without the possibility of their lengthening during the skeletal growth leads to an increase in the frequency of repeated surgical interventions due to the need for their replacement. The purpose was to investigate the stress-strain state of the lower leg models under the influence of compressive load in conditions of fracture of both bones in the middle third and their osteosynthesis using intramedullary rods of various designs in children with osteogenesis imperfecta and incomplete growth. Materials and methods. A mathematical modeling of osteosynthesis of tibial bones with a fracture in the middle third in children with osteogenesis imperfecta was performed in two options: 1 — using a rod without rotational stability; 2 — a rod with rotational stability of the structure. During the research, the stress-strain state of the model was studied under the influence of vertical compressive load. Results. Under compressive loads, the use of a rod with rotational stability does not lead to any significant changes in the stress-strain state of the model compared to tibial osteosynthesis with a rotationally unstable rod. This can be explained by the fact that before resisting the loads acting along the longitudinal axis of the rods, both rods are unstable, so all loads are carried by the bone structures. This is a “fee” for the opportunity to “grow”. The presence of rotational stability of an intramedullary rod does not have a significant effect on the stress distribution in the models under compressive loading. But it should be noted that when using a rotationally stable rod, the stresses in the distal tibia are slightly reduced, and what is especially important, in the fracture zone too. Thus, a growing rod with a locked rotational movement creates more favorable conditions for the fusion of tibial fractures in the middle third, which is of great importance in the treatment of children with osteogenesis imperfecta. Conclusions. Under the influence of compressive loads, the presence of rotational stability of an intramedullary rod does not provide significant advantages from the point of view of stress distribution in the model of a tibial fracture in the middle third. However, due to the presence of a movable support at the distal end of the tibia, even with a vertical compressive load, a small torque can occur between the bone fragments, which should block the rod with a locked rotational movement. This is the cause for a decrease in the stress in the distal fragment of the tibia.","PeriodicalId":515287,"journal":{"name":"Trauma","volume":"28 116","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140432851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}