आघात एवं उपचार जर्नल

Duodenal intramural hematoma is a rare condition, mostly described in children and young adults that can be a complication of duodenal biopsy, especially in patients with predisposing hemorrhagic diathesis. It can determine secondary pancreatitis because of ampullary hematoma. Noonan Syndrome (NS) is an autosomal dominant disorder characterized by short stature, typical facial dysmorphisms, congenital heart defects and other anomalies such as bleeding problems which have been reported in up to 55% of patients. We herein report a case of duodenal hematoma with pancreatitis developed after endoscopic biopsy in a boy who was initially suspected of having celiac disease on the base of his short stature and growth retardation. Afterwards a more careful past medical history collection and objective examination revealed characteristic features of NS which could have been picked-up in advance, thus avoiding an investigation, such as the duodenal endoscopic biopsy, which in NS patient is potentially more risky.

Purpose: Pelvic fractures are uncommon in children. They rank second to those of the skull in terms of complication. The present study retrospectively evaluates 200 multi-trauma patients. Mode of injury, type of fracture, associated lesions, morbidity and mortality were assessed. Methods: Fractures were classified according to the tile pelvic fractures classification and injury severity was classified according to the Modified Injury Severity Scale (MISS) and Pediatric Trauma Score (PTS). The type of fracture correlated with injury severity and complications. The greatest morbidity and mortality was found in patients with completely unstable pelvic fractures. Results: In the pre-hospital stage at the site of the accident, the PTS demonstrated to be a very useful tool to assess injury severity of the patient, to decide on the first treatment measures, and to evaluate the degree of complexity of care the patient needs. The MISS showed to have good predictive value for injury assessment during the in-hospital stage Conclusions: Pelvic fractures are rare in children. Early stabilization with external fixation is the gold standard for the management of patients with fractures of the pelvic ring. In the pre-hospital stage at the site of the accident, the PTS demonstrated to be a very useful tool to assess injury severity of the patient, to decide on the first treatment measures, and to evaluate the degree of complexity of care the patient needs. The MISS showed to have good predictive value for injury assessment during the inhospital stage and is, together with the tile classification, useful for the staging of associated injury and the degree of morbidity and mortality. Adequate treatment of this type of fracture allows to minimize sequelae in the growing skeleton. Correct orthopedic treatment is important in the majority of these lesions.

Periprosthetic fractures after total knee arthroplasty occur as a result of low energy trauma usually compounding some surgical pitfalls and patient related factors [1,2]. Patient and technique related predisposing factors are osteopenia, osteolysis, malalignment, anterior femoral notching, poor flexion (stiff knee), corticosteroid use, rheumatoid arthritis, myasthenia gravis and cerebral palsy [1,3]. The reported periprosthetic fracture incidence ranges from 0.3 to 2.5 percent [1,4]. But unfortunately an increase of periprosthetic fracture incidence would be inevitable due to increased life expectancy and osteoporotic patient numbers [3,5-7].

Purpose: The purpose of this prospective study was to assess the results of immediate radial nerve palsy associated with closed humeral shaft fractures treated by the closed interlocking intramedullary nail without radial nerve exploration.

Methods: Eighteen patients suffered from immediate radial nerve palsy associated with closed humeral shaft fractures treated by closed interlocking intramedullary nail, without exploration of the radial nerve.

Results: Patients were followed up for a mean of 18 months (range from 12 to 24 months). All the cases had united in a good alignment within 12 weeks. Full clinical and electrodiagnostic radial nerve recovery as regarding the range of shoulder, elbow, wrist and hand movements occurred at 6 months examination.

Conclusion: Closed interlocking nailing for immediate radial nerve palsy associated with closed humeral shaft fractures, provides immediate stability and can be done with a closed technique, brief operative time and minimum violation to the radial nerve, with early return of optimal extremity function.

Background: The most common cause of death and disability after severe trauma in childhood is traumatic brain injury (TBI). Of all trauma deaths, 25% are caused by head injury.

Objectives: The complex pathobiology of traumatic brain injury (TBI) offers numerous targets for potential neuroprotective agents. We evaluate the clinical benefit after creatine administration in children and adolescents.

Methods: A prospective, randomized, comparative, open – labeled pilot study of the possible neuroprotective effect of creatine was carried out on 39 children and adolescents, aged between one to eighteen years old, with (TBI). The creatine was administered for 6 months at a dose of 0.4gr/kg in an oral suspension form every day. For categorical variables, we used the χ² test (Chi-square test) to identify differences between controls and cases . Statistical significance was defined as a p-value<0.05 and not statistically significant if p-value >0.1.

Results: The administration of creatine to children and adolescents with TBI improved results in several parameters, including duration of post-traumatic amnesia (PTA), duration of intubation, intensive care unit stay. Significant improvement was recorded in the categories of dysarthria (p<0.001) and lingual problems of understanding (p<0.001) aspects in all patients. No side effects were seen due to creatine administration.

Conclusions: More specific examinations for in vivo evaluation of creatine must be performed, in order to draw conclusions for the optimal duration and manner of creatine supply, as well as its possible role for the prevention of TBI complications, in double blind studies.

Introduction: Fixation of trochanteric femoral neck fractures can be problematic. The tip apex distance (TAD) is a simple measurement that predicts screw cut-out in the femoral head from fractures treated with a fixed angle sliding hip screw device. By assessing whether the measurements in our centre were comparable to published results, we wanted to assess our proficiency in fixing these injuries as well as the general usefulness of this measurement in day to day practice. Methods: A retrospective review was conducted of 102 consecutively treated trochanteric fractures over a 12 month period, with 11 patients excluded. Three observers (n=3) used a standardised method to measure the TAD (from 2 orthogonal projections with a correction for magnification). The stability of the fracture patterns with the accuracy of reduction were measured according to published criteria. Results: 91 fractures were sustained in 90 patients, with one patient being treated for bilateral hip fractures. The mean tip apex distance was 19.06 mm ±0.77 mm (±95% CI). Assessing the inter-observer variability, the standard deviation between the 3 observers was 1.99mm, equivalent to 10% of the mean TAD. 12 out of 91 sliding hip screw devices (13.1%) had a TAD greater then 25mm, predictive of a higher extrusion rate. Conclusions: Measurement of the TAD can provide a reliable method to examine the adequacy of screw placement in the femoral head. Our results compare favourably to those published and we have found a similar level of inter-observer variability, confirming the usefulness of this measurement in assessing the quality of fixation and its reproducibility. By determining which patients have an increased risk of failure of fixation by screw cut-out we have been able to offer targeted surveillance rather than routinely following up all patients: bringing back those with a high TAD for x-ray follow up.

Polytrauma patients are at high risk to die due to acute physiological deterioration after a high injury load within the first hours. Trauma scores such as ISS, NISS and APACHE II and laboratory parameters were collected at admission. The aim of this study was to evaluate the independent predictors of early death of the polytrauma patient.

Long bone fractures in children can be due to accidental or nonaccidental injury. Fractures, along with soft tissue injuries, are the main physical signs of child abuse. The identification of non-accidental nature of fractures in children remains a major diagnostic challenge for clinicians [1]. The clinical situation is sensitive due to child protection issues and the impact of an incorrect judgement on the child and the family unit. Away from the clinical setting, the evidence for the judgement on child abuse must also withstand scrutiny in the court of law. There can also be waste of considerable resources in the investigation of a misjudged non-accidental injury. It is important to be aware of the variation in clinical traits of fractures from accidental and non-accidental injuries.