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  Most popular articles (Since September 05, 2017)

 
 
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REVIEW ARTICLE
Challenges to Use Response Time Standard in Assessing Emergency Medical Services in Iran: A Systematic Review
Seyyed Mohammad Reza Hosseini, Mohammadreza Maleki, Hasan Abolghasem Gorji, Davoud Khorasani-Zavareh, Masoud Roudbari
October-December 2017, 6(4):55-62
DOI:10.4103/atr.atr_29_17  
Response time (RT) accounts as a common tool for emergency medical services (EMS) assessment. While the national standard RT has been established in Iran since 2007, its application has hardly been put into scrutiny. This study aimed at investigating the use of RT standard in assessing EMS in Iran. This systematic review included papers focusing on prehospital EMS assessment published in Google Scholar, Scopus, Embase, PubMed, and the Persian databases of Magiran and SID. Selection criteria involved all English and Persian studies focusing on RT as an assessment of prehospital EMS in the context of Iran. Repetitious papers and those presented in conferences were omitted, which left 21 papers published from 2007 to mid-2016 for systematic review. A data collection form was designed. This provided both inclusive information about the papers and indicators used to report RT in each paper (i.e., mean and percentages of RT below 8 min) as well as the use of these indicators vis-a-vis that of the standard. From among the 21 papers focusing on RT, seven (33%) reported RT as percentages of operations performed in <8 min according to the national standard and compared the percentage with the national standard. A total of 18 (86%) reported the means of RT; nine studies compared mean and the national standard as expressed in percentage. Limited use of the national standard to report RT was identified as a challenge to EMS assessment. Further, the inconsistency that exists when comparing RT in terms of means and percentage is a challenge to the validity of judgments expressed in some previous studies. Employment of uniform methods to report and evaluate performance based on the national standard will lead to greater transparency in emergency operation performance.
  463 245 -
ORIGINAL ARTICLES
An Epidemiologic Study of Deceased Pedestrians in Road Traffic Accidents in Iran during 2012-2013
Jalil Hasani, Noushin Sadat Ahanchi, Abdolhalim Rajabi, Mohammadreza Ghadirzadeh, Seyed Saeed Hashemi Nazari
October-December 2017, 6(4):63-68
DOI:10.4103/atr.atr_57_17  
Background and Objectives: Due to the high rate of pedestrian deaths in traffic accidents and given that describing demographic profiles of pedestrian deaths and features of accident locations is an important factor in the prevention, management, and analysis of road traffic accidents, this study aimed at describing the demographic and personal patterns as well as environmental factors affecting the occurrence of road traffic accidents among pedestrians in Iran. Materials and Methods: This cross-sectional study was conducted on all pedestrian deaths caused by traffic accidents referred to the Forensic Medicine Organization in Iran from March 20, 2012, to March 19, 2013. In this study, demographic information as well as the information related to the accidents and other information including trauma location, the final cause of death, date of accident, date of death, time of death, and time of accident were examined. The information received from the Forensic Medicine Organization was first controlled and then analyzed using the Stata 11 software. Results: From a total of 4371 pedestrians died in 2012 due to traffic accidents, 3201 cases (73.2%) were males with a mean age of 48.1 ± 0.46 years, and 1170 cases (23.8%) were females with the mean age of 46.1 ± 0.77 years. In terms of age, education, and marital status, the highest frequencies of pedestrian deaths were, respectively, observed in the age group 65 years old and above (33.4%), the illiterate group (44.5%), and married people (67.9%). The highest and the lowest incidence rates of death were seen in Gilan (11 per 1000 people) and South Khorasan Provinces (2.4 per 100,000), respectively. Conclusions: Pedestrians as the most vulnerable people in traffic accidents comprise a large proportion of deaths and disabilities caused by road traffic accidents. It seems necessary to take some measures including paying special attention to physiological characteristics of the age group above 65 years old, doing close monitoring by the traffic police in October and the rush hours, and providing facilities for pedestrians to cross in busy locations of suburban areas.
  375 98 -
Analysis of Direct Medical Expenses Resulting from Road Traffic Injuries in the City of Tabriz
Narges Shadkam, Alireza Mahboub-Ahari, Mohamad Asghari Jafarabadi, Ali Imani
October-December 2017, 6(4):69-75
DOI:10.4103/atr.atr_31_17  
Background: Road crashes as a major global public health problem cost 3% of most countries and 5% of low- and middle-income countries' gross domestic product (GDP). The World Health Organization has predicted that without sustained action, road traffic crashes will become the seventh leading cause of death by 2030. Objectives: The aim of this study was to analyze the death rate, severity of injuries, and direct medical costs caused by road traffic injuries (RTI) in the city of Tabriz in 2014. Methods: Trauma injury admissions due to RTI in Imam Reza Hospital in Tabriz City were investigated in terms of etiology and the direct medical costs during 2014–2015. Data were collected using a researcher-made checklist after being confirmed by relevant experts in terms of face validity. All information on direct medical costs are extracted from several sources including hospitals, database of the Ministry of Health and Medical Education, disaster and emergency medical management center, and public and private physiotherapy clinics across the city. Results: Review of the hospital records showed that the mean age of the patients (67.9% males and 32.1% females) was 34 ± 17.3 years. In addition, 79.2% of the patients were treated on an outpatient basis, and 20.8% were treated on a hospitalization basis (hospitalization or death). The mean times of inpatient and outpatient hospitalization for injuries were 3 h and 6.7 ± 5.3 days, respectively. Total direct medical costs were 11.631 dollars, of which 8% was for hospital costs, 9.7% for prehospital costs, and 2.3% for physiotherapy costs. Chest and lower part injuries had highest medical costs. From etiological standpoints, the greatest reason of being injured and hospitalization is multiple injuries and bruises, and the prominent cause of death was blow to the head and neck (70%). Conclusions: The results of the present study showed that direct medical costs in Tabriz during 2014–2015 were equal to 0.1% of GDP, which is a considerable amount. High economic and social costs of road accidents and their harmful physical and psychological effects on individuals and community require the attention of professionals and experts in the transportation industry and health-care system to determine appropriate strategies for interventions in reducing accidents' burden and injuries.
  299 72 -
The Epidemiology, Management, and Outcome of Field Hockey-related Fractures in a Standard Population
Greg A J. Robertson, Alexander M Wood, Stuart A Aitken, Charles M Court-Brown
October-December 2017, 6(4):76-81
DOI:10.4103/atr.atr_56_17  
Background: Field hockey is one of the most popular sports in the world, yet little is known about patient outcome following fracture injuries sustained during this sport. Objectives: The aim of this study is to describe the epidemiology, management, and outcome of field hockey-related fractures in a known UK population at all skill levels. Materials and Methods: All fractures sustained during field hockey from 2007 to 2008 within the adult Lothian population were prospectively recorded and confirmed by an orthopedic surgeon during treatment at the sole adult orthopedic center in the region. Nonresident individuals were not included in the study. Follow-up data were obtained in September 2010 to determine return rates and times to field hockey. Results: Nineteen fractures were recorded over the study period in 19 patients. Seventeen (89%) of the fractures were recorded in the upper limb, with 15 (79%) recorded in hand. Eighteen fractures (85%) in 18 patients (95%) were followed up at a mean interval of 31 months (range: 25-37 months; standard deviation [SD] 2.1 months). The mean time for return to field hockey from injury was 10.8 weeks (range: 3-26 weeks; SD 7.1 weeks). For patients with upper limb injuries, the mean time was 9.2 weeks (range: 3-20 weeks; SD 5.7 weeks), compared to 22 weeks (range: 18-26 weeks; SD 5.7 weeks) for patients with lower limb injuries. Eleven percent of the cohort did not return to field hockey. Seventy-eight percent of the cohort returned to field hockey at the same level or higher. Fifty percent had ongoing related problems, yet only 17% had impaired field hockey ability because of these problems. Fractures with the highest morbidity in not returning to field hockey were as follows: Metacarpal 14% and finger phalanx 13%. Conclusions: The significant majority of field hockey-related fractures are sustained in the upper limb, notably the hand. Around ninety percent of patients sustaining a fracture during field hockey will return to this sport at a similar level. While half of these will have persisting symptoms 2 years postinjury, only one-third of symptomatic patients will have impaired field hockey ability because of this.
  293 56 -
The Effects of Mindfulness-based Stress Reduction on Emotional Regulation and Psychological Well-being of Iranian Veteran's Homemakers with Secondary Posttraumatic Stress Disorder
Abdollah Omidi, Mahboobeh Shabanzadeh Fini, Hossein Akbari, Goodarz Akasheh
October-December 2017, 6(4):82-86
DOI:10.4103/atr.atr_4_18  
Background: Problems of emotional regulation and lack of social skills in veterans' families are very common and like psychological complications have unpleasant consequences for them. Therefore, effective and helpful interventions and therapies are highly important. Objectives: The current study aimed at evaluating the effect of mindfulness-based stress reduction (MBSR) on the improvement of emotional regulation and psychological well-being in veterans' homemakers with secondary posttraumatic stress disorder. Patients and Methods: In the current study, the permuted blocked randomization method was used. Participants were selected from veterans' homemakers referred to the counseling center of veterans in Kashan city (Iran) in 2015. They were randomly assigned into two groups (30 controls and 31 cases). The case group underwent the MBSR treatment. Results: Results showed no significant difference between the two groups at the baseline (P < 0.05). No significant difference was observed in the total score of MBSR on emotional regulation between the groups. However, the difference between pre- and post-test of rejection of emotional response subscale was significant. In addition, the total score in the psychological well-being at pre- and post-test was significant. Conclusions: It seems that MBSR significantly affects the psychological well-being, but it has no effect on the emotional regulation except the subscale of emotional response rejection.
  259 78 -
CASE REPORTS
Different Aspects of Penile Amputation; Surgery, Forensics, and Psychiatry (Case Report and Short Review)
Hamid Pakmanesh, Rayka Sharifian, Mahmoodreza Ashabyamin
October-December 2017, 6(4):101-104
DOI:10.4103/atr.atr_13_17  
Penile amputation (PA) is a rare genitourinary injury. Three main etiologies of PA consist of iatrogenic, accidental, and self-mutilation. Eighty-seven percent of the self-mutilated patients suffer from psychiatric disorders. Nowadays, microsurgical techniques with neurovascular anastomosis are the best approach for PA. This paper insists on psychiatric and legal consequences, which may involve health-care team. A 25-year-old male patient presented to our emergency department with self-inflicted PA. As he had a history of some psychiatric problems, psychiatric consultation was requested. The patient did not accept any surgical interventions. We informed his relatives completely; however, they did not agree with surgical intervention because they predicted that he might repeat amputation again. According to the forensic medicine specialist consultation, we took the coroner's warrant for emergency surgical intervention and transferred the patient to the operating room without any consent. Microsurgical penile replantation was performed. There was no leakage in retrograde pericatheter urethrography on the 3rd postoperative week, and the urethral catheter was removed. The patient was able to void normally, and cystostomy tube was removed at the same time. Consent for all medical procedures is an important part of national and international human right law and medical ethics. Physicians should inform patients about their problem and take a reliable consent. If the patient was unreliable for informed consent, relatives could do it. However, in an emergency, there is an exception in the law that let surgeons do the operation without consent for these cases.
  199 27 -
ORIGINAL ARTICLES
Alcohol abuse in subjects developing or not developing posttraumatic stress disorder after trauma exposure
Marcella Brunetti, Giovanni Martinotti, Gianna Sepede, Federica Vellante, Federica Fiori, Fabiola Sarchione, Massimo di Giannantonio
July-September 2017, 6(3):8-14
DOI:10.4103/atr.atr_12_17  
Background and Objectives: The complex relation between trauma and alcohol abuse is still far to be recognized. Traumatic experiences can prompt and facilitate an excessive use of alcohol. On the other hand, alcohol use may increase the possibility to be involved in traumatic events or reduce post-trauma resilience. This study aimed to explore alcohol use and abuse in a sample of traumatized participants, with or without posttraumatic stress disorder (PTSD). Methods: Thirty-five outpatients with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) diagnosis of PTSD and 35 outpatients with trauma exposure who did not develop PTSD were recruited. The clinical assessment of the participants comprised the following scales: The Structured Clinical Interview for DSM-IV, the Clinician-Administered PTSD Scale, and the Alcohol Use Disorders Identification Test (AUDIT). Results: Correlation analysis conducted on all participants showed a significant positive correlation between the AUDIT score and trauma load. When considering the two groups separately, the same correlation reached statistical significance in the PTSD group only. Analysis of beta-coefficients of regressions confirmed a significant influence of trauma load on the AUDIT score. Conclusion: A greater use of alcohol significantly correlated with trauma load only in the PTSD group. This data indicates that trauma itself is not sufficient to determine drinking problems, whereas PTSD symptoms may lead to alcohol use. A circular relation, rather than a linear one, can therefore be considered when traumatic experiences and alcohol use are taken into account. Specifically, traumatic experiences could cause the PTSD development, which could, in turn, lead to alcohol use or abuse as a self-medication. Such outcome could develop in alcohol use disorder that, circularly, enhances the risk of traumatic experiences. Hence, in the clinical evaluation of PTSD patients, a deep investigation of drinking patterns is highly recommended.
  168 23 -
REVIEW ARTICLE
Prevalence of drug-resistant Pseudomonas aeruginosa in Iranian burned patients: A meta-analysis
Samira Tarashi, Mohsen Heidary, Hossein Dabiri, Mohammad Javad Nasiri
July-September 2017, 6(3):1-7
DOI:10.4103/atr.atr_22_17  
The increasing prevalence of drug-resistant Pseudomonas aeruginosa in burned patients is one of the main public health problems worldwide. Although drug-resistant P. aeruginosa in burn units is frequent in some countries and unusual in others, the level of this conditions is not precisely known in Iran. Imipenem is one of the most potent agents against P. aeruginosa. Imipenem resistance is a major obstacle to treatment of P. aeruginosa infections. We aimed to determine the true prevalence of imipenem-resistant P. aeruginosa in Iranian burned patients according to the Preferred Reporting Items for Meta-Analyses statement. Moreover, resistance to several potent anti-P. aerugi nosa drugs were indicated according to the Clinical and Laboratory Standards Institute guidelines for the disc diffusion method. Several databases including Web of Science, Scopus, PubMed, Scientific Information Database, Magiran, Iranmedex, and science direct were searched to get studies addressing drug-resistant P. aeruginosa in Iranian burned patients from March 2006 to May 2015. A total of 34 reports available from different areas of Iran were included in the current study. The meta-analyses showed that 54.9% of P. aeruginosa were resistant to imipenem. The most common resistance was seen against ceftazidime (66.9%), followed by ciprofloxacin (52.9%) and cefepime (52.3%). It is necessary to know the epidemiology of drug-resistant P. aeruginosa because it can promote control strategies for decreasing their prevalence. The high incidence of drug-resistant P. aeruginosa in Iran emphasizes the need for precise drug susceptibility testing, continuous monitoring of drug resistance, especially in burn units, use of sensitive methods for the laboratory diagnosis, and close relation between physician and laboratories.
  131 23 -
ORIGINAL ARTICLES
A new prehospital score to predict hospitalization in trauma patients
Shahrokh Yousefzadeh-Chabosk, Zahra Haghdoost, Zahra Mohtasham-Amiri, Ali Davoudi-Kiakalayeh, Alireza Razzaghi, Ehsan Kazemnegad-Leili, Leila Kouchakinejad
July-September 2017, 6(3):25-30
DOI:10.4103/atr.atr_4_17  
Background: Prehospital scores are used for determining the prognosis of trauma severity in trauma patients. Objectives: This study aimed at developing a new prehospital score for emergency medical service (EMS) staff to predict hospitalization in trauma patients transferred to the hospital. Patients and Methods: This study was a diagnostic test evaluation conducted on data of 1185 traumatic patients transferred through EMS to Poursina Hospital of Rasht between March 2012 and March 2013. Data were collected using a questionnaire with two parts. The first part included data on demography, injury, and type of interventions performed at the scene of the accident. The second part consisted of initial evaluations (Glasgow coma scale (GCS), oxygen saturation (O2S), pulse rate (PR), systolic blood pressure (SBP), the ability to walk, and outcome (hospitalization, nonhospitalization). The questionnaire was filled out by EMS staff at the scene or during transfer to the hospital with respect to clinical observations. Data were analyzed using the logistic regression model. The Hosmer–Lemeshow test was also used to examine the good fit of model. Results: A total of 1185 patients were evaluated using prehospital data. Of seven variables evaluated by the scoring system, only four variables were identified in the regression analysis as predictors of hospitalization including age, SBP, O2S, and walking ability. Sensitivity, specificity, and positive and negative likelihood ratios were 0.67, 0.68, 2.09, and 0.48, respectively. Conclusions: The GOMAAPS (GCS, O2S, mechanism of injury, age, ability to walk, PR, and SBP) score serves as a guide for the EMS staff at the scene to be understood of the necessity of transfer and predicting hospitalization.
  128 16 -
Explorative Analysis of Motorcyclists' Injury Severity Pattern at a National Level in Iran
Ali Tavakoli Kashani, Ahmad Mohammadian, Mohammad Mehdi Besharati
October-December 2017, 6(4):87-93
DOI:10.4103/atr.atr_38_17  
Objectives: This study aimed at examining the hidden patterns of motorcycle crashes and riders' injury severity at the national level in Iran. Methods: Hierarchical clustering (HC) and latent class clustering (LCC) techniques were used in combination to analyze riders' injury pattern in 6638 motorcycle crashes occurred in Iran during 2009–2012. First, the HC was performed to classify the provinces into homogeneous groups, based on the percentage of different crash factors in each province and a new variable called “province group” was added to the crash database as the output of the HC analysis. Next, the LCC was conducted to cluster the crash data and to investigate the riders' injury pattern across the country. Results: Among the six crash clusters identified by the LCC, Clusters 1 and 5, in which, respectively, 91% and 84%, of the riders were under 30 as well as Cluster 2, in which 65% of the riders were above 30 years had the highest percentages of injured motorcyclists (86%, 84%, and 88%, respectively). Cluster 5 had also the lowest percentage of helmet usage (about 5%) and licensed riders (5%). Moreover, Cluster 6 had the highest fatality rate among the six clusters. In this cluster, 73% of the crashes were occurred in nonresidential/agricultural land uses, and 94% were occurred in rural areas. Conclusions: Since a significant share of crashes in Cluster 5 was occurred in province Groups C and E; this might be regarded as an indication of weak law enforcement over helmet usage and licensure in these provinces. In addition, as the pattern of helmet usage was different among province clusters, future studies might be conducted regarding motorcyclists' helmet-wearing intentions among several provinces. Moreover, crashes occurred in rural roads, particularly in the vicinity of nonresidential or agricultural land uses were more severe and need special future attention.
  122 21 -
A Visco-hyperelastic model for prediction of the brain tissue response and the traumatic brain injuries
Hossein Ashrafi, M Shariyat
July-September 2017, 6(3):41-48
DOI:10.4103/atr.atr_9_17  
Introduction: Numerous geometrically simplified models may be found in the literature on simulation of the traumatic brain injuries due to the increased intracranial pressure induced by severe translational accelerations of the brain inside the cranium following the impact waves. While numerous researchers have utilized viscoelastic models, some have employed specific hyperelastic models for behavior analysis of the brain tissue. No research has been presented so far based on the more realistic visco-hyperelastic model. Materials and Methods: In the present research, a realistic finite element model and four visco-hyperelastic constitutive models (viscoelastic models on the basis of the polynomial, Yeoh, Arruda-Boyce, and Ogden hyperelastic models) are employed to accomplish the outlined task. Therefore, the main motivation of the present research is checking the accuracy of the modeling procedure rather than presenting clinical results. In this regard, a realistic skull-brain model is constructed in CATIA computer code based on the magnetic resonance imaging scans and optimized in the HYPERMESH finite element software. Results: Influence of the contact and nonlinear characteristics of the brain tissue are considered in the simulation of the relative motions in LS-DYNA software to predict time histories of the acceleration and the coup and countercoup pressures by means of ANSYS finite element analysis software. Discussion: Comparing results of the four proposed visco-hyperelastic constitutive models with the available experimental reveals that employing Arruda–Boyce or Ogden-type viscoelastic models may lead to inaccurate or even erroneous results.
  106 25 -
Intercostal nerves pulsed radiofrequency for intractable neuralgia treatment in athletes with sport trauma of the chest: A case-series study
Masoud Hashemi, Gholamreza Mohseni, Mohammad Hossein Ataei, Ali Zafari, Sohrab Keyhani, Seyyed Mohammad Jazayeri
July-September 2017, 6(3):37-40
DOI:10.4103/atr.atr_26_17  
Background: Athletes with trauma to the chest could be injured and suffer from an acute disturbing chest wall pain due to intercostal neuralgia. Pulsed radiofrequency (PRF) is an emerging safe therapy in many neurologic pain syndromes. Objectives: This study aimed to determine the effect of PRF on intercostal neuralgic pain in athletes complaining of severe chest pain and limited range of motion. Materials and Methods: This case-series study was conducted on athlete patients who suffered from severe chest pain that has limited their function. Eighteen athletes who were absent from physical training and sports activity due to intercostal neuralgia in their current season were admitted to our pain clinic. Intercostal nerve PRF was used to treat patients. Pain scale and return to sports activity were measured after PRF. Results: The mean time of absence from sports activity was 1.3 ± 0.6 weeks. The mean score of pain severity (numeric rating scale [NRS]) was 8.46 ± 1.85. In this study, 16 of 18 (88%) patients had effective pain relief (NRS <3) after PRF therapy. Besides, the NRS scores reduced by at least 90% in 16 of 18 (88%) patients as compared to the baseline. The mean NRS score was followed-up for 4 weeks. The scores significantly decreased at 1 (P = 0.001), 2 (P = 0.0015), and 4 (P = 0.0002) weeks following PRF compared to pre-PRF time. Conclusions: Pulsed radiofrequency is a suitable therapy for athletes with intercostal nerve entrapment pain, which provides adequate and quick pain relief, thus enabling them to resume their sport activities.
  99 21 -
CASE REPORT
Isolated open total talar dislocation: A case report and literature review
Sylvain Steinmetz, Niccolo Rotigliano, Philippe Zermatten
July-September 2017, 6(3):49-52
DOI:10.4103/atr.atr_18_17  
Open total talar dislocation without associated fractures is an extremely rare injury. There are scant reports in the literature. Accordingly, there is no consensus about the appropriate treatment of the extruded talus. We present the case of a 33-year-old man who sustained an isolated open total talar dislocation focusing on its management and outcome and review the literature. Open total talar dislocation is a terrible injury and its treatment is demanding. Early reimplantation of the talus appears to be a relatively risk-free and feasible procedure. Talectomy should be considered as a salvage procedure.
  100 19 -
CASE REPORTS
A Unique Case of Gossypiboma following Treatment of the Orbitozygomatic Complex Fracture
Saeed Nezafati, Seyed Ahmad Arta, Masoomeh Amani, Farzin Ahmadpour
October-December 2017, 6(4):98-100
DOI:10.4103/atr.atr_37_17  
Transmaxillary approach to the orbital floor has been used successfully to treat the blowout fracture by antral packing to support the orbital floor. However, antral packs are associated with a high incidence of infection and persistent oroantral fistula. A 30-year-old man with a history of the orbitozygomatic complex fracture 8 years ago presented with a persistent facial wound on the right side of the cheek. The patient underwent an exploratory surgery under general anesthesia, and the maxillary sinus was approached through the Caldwell-Luc operation and a long 2-m nasal tampon was found in the sinus. Foreign bodies including gossypibomas are rare, hard to diagnose, and mostly asymptomatic and in chronic cases do not reveal specific radiological and clinical signs for differential diagnosis. Therefore, in the evaluation of the soft-tissue lesions in patients with a history of a prior operation, it is wise to consider foreign bodies in the differential diagnosis.
  93 22 -
A Very Rare Cause of Shoulder Weakness: Concurrent Traumatic Neuropathies of Accessory, Long Thoracicus, and Suprascapular Nerves
Halil Onder, F Gokcem Yildiz, Gulay Nurlu, Kubilay Varli
October-December 2017, 6(4):94-97
DOI:10.4103/atr.atr_61_17  
Accessory nerve is one of the most sensitive cranial nerves to injury, and its injuries are usually caused by iatrogenic interventions. As many other causes can mimic its clinical presentation, careful physical examination should be performed while evaluating a patient suspected of accessory neuropathy. In this report, we aimed to illustrate a very rare case with concurrent traumatic cranial neuropathies of accessory nerve, suprascapular nerve, and long thoracicus. A 16-year-old boy was admitted with complaints of shoulder weakness and pain following a trauma of strain injury. He had first taken the misdiagnosis of brachial plexopathy; however, after a detailed physical examination and electrophysiological study, the diagnosis of concurrent traumatic neuropathies of accessory, suprascapular, and long thoracicus nerves was made. In our opinion, during evaluation of these rare traumatic neuropathies, detailed clinical evaluations combined with detailed electromyography investigations may give crucial data for the proper diagnosis.
  93 17 -
ORIGINAL ARTICLES
Sport and physical activities in total ankle replacement: Mobile- and fix-bearing
Federico Giuseppe Usuelli, Cristian Indino, Luigi Manzi, Camilla Maccario, Riccardo D'Ambrosi, Christopher Edward Gross
July-September 2017, 6(3):31-36
DOI:10.4103/atr.atr_14_17  
Background: The number of total ankle replacements (TARs) is rapidly increasing in consequence of the availability of new designs allowing to save the range of motion and to preserve against adjacent joints degeneration. This study aimed to compare participation in sports 12 months after TAR with either mobile-bearing or fix-bearing prosthesis. Materials and Methods: One hundred and seventeen primary TARs were performed (77 Hintegra, 40 Zimmer Trabecular Metal Total Ankle). We retrospectively assessed pain and function using the visual analogue scale (VAS) pain scale, American Orthopedic Foot and Ankle Society (AOFAS), Short-Form Health Survey (SF-12 divided into Mental (MCS) and Physical (PCS) score) obtained preoperatively, 6 and 12 months postoperatively. Activity levels were determined using the Halasi ankle activity scale and the University of California at Los Angeles (UCLA) score obtained preoperatively and 12 months after the surgery. Radiographic examination included plain radiographs with full weight-bearing taken preoperatively and 12 months postoperatively. Results: All patients showed a significant improvement for AOFAS, VAS, and SF-12 scores (P < 0.05). The Halasi activity scale and UCLA score were 4.2 ± 1.2 and 6.6 ± 1.8, respectively, for the fix-bearing group and 3.7 ± 1.5 and 6.3 ± 2.3 for the mobile-bearing 12 months after the surgery. In our series, jogging, dancing, and skiing represented the three most frequent sports. In the fix-bearing group, 60% of the patients practiced sport 1 year after surgery and 49.4% in the mobile-bearing group. The fix-bearing prosthesis had a quicker recovery and better functional outcomes within the first 6 months after the operation. At 1 year, there was not a significant difference in return to sport and physical activities between patients treated with a mobile-bearing implant and a fix-bearing implant. Conclusions: At 1 year, both fixed and mobile bearing present significant improvements in functional and recreational scores, with neither prove superior.
  86 15 -
Optimization of trauma care: A two-tiered inhospital trauma team response system
Annelieke Maria Karien Harmsen, Georgios Fredericus Giannakopoulos, Kaoutar Azijli, Tessa Biesheuvel, Leo Maria George Geeraedts, Frank Willem Bloemers
July-September 2017, 6(3):15-19
DOI:10.4103/atr.atr_17_17  
Background: To improve utilization of resources and reduce overtriage, two-tiered trauma team activation (TTA) system was implemented. The system activates a complete or selective trauma team (CTT, STT). Activation is based on the mechanism of injury (MOI), prehospital vital signs and injuries. Objectives: The objective was to evaluate the feasibility, effectiveness and safety of the implementation of a two-tiered system and whether the triage is done according to the TTA criteria. Methods: A prospective observational study was performed at the emergency department (ED) of a Level I trauma center. Data were collected on TTA criteria, patient demographics, MOI, prehospital vital signs, imaging modalities and blood gas analysis in the ED and inhospital data. Results: In 3 months, 186 patients were presented to the trauma resuscitation room. Thirty-four patients were excluded, 152 patients were included for analysis. Median age was 48 years (range 1–93), 64% were males. In 73%, the CTT was activated, in 27% the STT, the STT was upgraded three times. Seventy-nine patients had to be admitted, the median length of stay was 5 days (range 1–62). Thirty-eight patients needed Intensive Care Unit (ICU) admission; the median ICU stay was 3 days (range 1–33). Three patients died in the resuscitation room, in total, nine patients died. Overtriage was 29% and undertriage 7%. No significant difference was found for mortality, duration of hospital admission or ICU admission across the four groups (correct activation STT, undertriage, overtriage, and correct activation CTT). Conclusions: This TTA system identifies those patients in need of a CTT adequately with an undertriage percentage of 7%, indicative of improved care for the severely injured and a more appropriate use of resources. With this model, the overtriage is set to an acceptable percentage of 29%.
  84 15 -
Femoral diaphyseal fractures in young adults: Predictors of complications
Nicholas David Clement, Nick J. A. Beresford-Cleary, A. Hamish R. W. Simpson
July-September 2017, 6(3):20-24
DOI:10.4103/atr.atr_11_17  
Background: Intramedullary nailing is an accepted method of management for femoral diaphyseal fractures. There are, however, risks associated with surgery such as nonunion, infection, and venous thromboembolism (VTE). Objectives: Our objective was to identify independent predictors of complications following intramedullary nailing of femoral diaphyseal fractures in young adults. Patients and Methods: During a 3-year period, 59 patients (aged 13–55 years) underwent intramedullary nailing for high energy femoral diaphyseal fracture. These patients were identified from a radiographic database. Patient demographics, socioeconomic status, smoking status, alcohol intake, diagnosis of diabetes, intravenous drug use, fracture comminution, and if it was open were recorded retrospectively. Complications assessed were nonunion, deep infection, VTE, amputation, and revision of the nail. Results: Univariate analysis identified that socioeconomic status, excess alcohol intake, intravenous drug use, fracture comminution, and an open fracture were predictors of complications. Logistic regression analysis identified that intravenous drug use (P = 0.036) and open fractures (P = 0.05) were significant independent predictors of nonunion. There was a trend toward significance (P = 0.07) for excess alcohol intake as a predictor of deep infection. Fracture comminution (P = 0.015) was an independent predictor of VTE. Logistic regression analysis failed to identify any significant independent predictors of amputation or revision after adjusting for confounding variables. Conclusions: Intravenous drug use, open fractures, and fracture comminution are independent predictors of nonunion and/or VTE. These patient factors could be used to identify those at risk of nonunion and VTE who may benefit from early preventative measures.
  85 14 -
LETTER TO EDITOR
Tetanus after Trauma: Still Existed Problem in Tropical Country
Viroj Wiwanitkit
October-December 2017, 6(4):105-105
DOI:10.4103/atr.atr_59_17  
  75 18 -
Challenges of impalement injuries
Mahir Gachabayov
July-September 2017, 6(3):53-54
DOI:10.4103/atr.atr_23_17  
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