आघात एवं उपचार जर्नल

The aim is to investigate the effects of Zhuang Jin Xu Gu Decoction (ZJXG Decoction) on femoral fracture healing in rats. Femur fractures were generated in fifty male adult Wistar rats by cutting femur transversely at middle point. ZJXG Decoction was administered orally after surgery for 7-14 d. Radiological evaluation or X-ray imaging analysis indicated that the fibrous callus tissue at the femoral fracture-end increased and the fracture line became fuzzy at 7-14 d following treatment with ZJXG Decoction. Hematoxtlin-Eosin (HE) staining showed that the fibrous-granular tissue at the fracture-end changed gradually to fibrous, cartilaginous and osseous callus tissues. immunohistochemical staining and Enzyme Linked Immunobsorbent Assay (ELISA) results showed that BMP-7 in the fibroblasts and osteoblasts of callus and its serum level increased significantly 7-14 d following treatment with ZJXG Decoction. It is concluded that ZJXG Decoction could enhance the fracture healing by up-regulating the expression of BMP-7 in fibroblasts and osteoblasts of callus in rats.

Study Background: Quality of life survey conducted after the surgical stabilisation of traumatic thoracic and lumbar vertebral fractures in geriatric patients.

Methods: Over a period of 5 years, 42 patients at an age of more than 65 years underwent surgical stabilisation due to an unstable traumatic fracture of the thoracic or lumbar spine. Initially, retrospective empiric data collection was conducted, followed by a prospective radiological and clinical follow-up, including VAS and SF-12.

Results: It was possible to conduct a postoperative radiological and clinical follow-up in 31 out of 42 patients (74%) after a mean period of 27.3 months. In 11 out of 42 patients (26%), clinical outcome data were collected by relatives. The mean age at the time of surgery was 71.4 years (range 65 to 87 years), and the injury had almost exclusively been stabilised by using a dorsal internal fixator. The surgical revision rate was 12% (5 out of 42 patients), and postoperative 1-year mortality was also 12% (5 out of 42 patients). At the time of the follow-up, a significant loss of correction was observed in lateral x-ray images when compared to immediate postsurgical results. Quality of life (as measured by SF-12) was significantly reduced at the time of the follow-up compared to a healthy reference population. A significant postoperative decline was also observed with regard to homecare nursing and level of care categories. On the other hand, none of the patients lived in a nursing home, and 35 out of 42 patients (83%) were satisfied or very satisfied with the surgical treatment (as measured by a summary measure).

Conclusions: The surgical treatment of traumatic vertebral fractures in geriatric patients resulted in high subjective patient satisfaction post surgery. However, quality of life (SF-12) after an average period of 27.3 months post surgery was still significantly reduced when compared to a healthy reference population.

In life-threatening poly trauma, there is no defined therapeutic guidelines. We present optimal therapeutic strategy of life-threatening unstable pelvic fractures with traumatic aortic injury. Two cases of identical life-threatening poly trauma, unstable pelvic fractures with traumatic aortic injury, were taken to our emergency and critical care center. They were performed radical treatment for the unstable pelvic fractures before performing radical surgery for the aortic injury. The radical treatment for the unstable pelvic fractures included preventive TAE, which was performed regardless of the presence of extravasation. In the period leading up to the surgery for aortic injury, we conducted strict medical management of blood pressure and pulse using beta blockers and calcium channel blockers. By means of this strategy, we were able to perform early (18 hours after the accident in case 1, 14 hours after the accident in case 2), safe blood vessel prosthesis implantation for aortic injury with the use of a cardiopulmonary bypass without difficult-to-control massive hemorrhaging due to intra-operative use of heparin. Their postoperative progresses were favorable, and they continued recovering until they could resume activities of daily living with complete independence without obvious complications resulting from TAE. In cases of life-threatening pelvic fracture with concomitant traumatic aortic injury that require surgery with the use of cardiopulmonary bypass, early and safe operation on the aorta is made possible by performing pre-operative preventive TAE, regardless of the presence of extravasation. We consider this strategy will contribute to improved survival rates.

Our experience shows that 44% of severe brain trauma is annually caused in traffic accidents . This is similar to the findings of other authors , noting that in economically developed countries this percentage decreases slightly from year to year. According to the WHO report for 2008 in Europe there were 120,000 deaths and 2.4 million injured in traffic accidents. In most of the examined 49 countries, a significant number of victims were young population aging roughly from 15 to 30 . There are several kinds of measures in dealing with trauma caused by traffic.