Direct Trauma Research Articles

Traumatic optic neuropathy with concealed CRAO following blunt trauma in a young male patient: A rare case report

Traumatic Optic Neuropathy (TON) is a condition which results from vulnerable nature of the optic nerve to direct and indirect trauma leading to functional impairment of vision. Several varieties of direct optic nerve injury may be identified: optic nerve avulsion, transection, optic nerve sheath haemorrhage, orbital haemorrhage, and orbital emphysema. Central retinal artery occlusion (CRAO) is the sudden blockage of the central retinal artery, resulting in retinal hypoperfusion, leading to rapidly progressive cellular damage, and vision loss. An embolism is the most common cause of CRAO. The degree of collateralization and the duration of retinal ischemia determines the retinal survival. There are only few reported cases of central retinal artery occlusion caused by blunt traumaWe report a case of traumatic optic neuropathy presenting along with central retinal artery occlusion following a high speed blunt trauma to eye in an otherwise healthy young male.

Tetrafocal (three osteotomies) and pentafocal (four osteotomies) bone transport using Ilizarov technique in the treatment of distal tibial defect—preliminary outcomes of 12 cases and a description of the surgical technique

ObjectiveTo evaluate the preliminary outcomes of tetrafocal (three osteotomies) and pentafocal (four osteotomies) bone transport using Ilizarov technique for the treatment of distal tibial defect and describe the surgical technique. MethodsA total of 12 eligible patients with distal tibial defect > 6 cm caused by direct trauma or posttraumatic osteomyelitis who were admitted to our institution from January 2017 to January 2019 were treated by tetrafocal or pentafocal bone transport using Ilizarov technique. Detailed demographic data, including age, sex, etiology, defect size, number of osteotomies (three or four), external fixation time (EFT) and external fixation index (EFI), were collected, and the bone and functional outcomes were evaluated by the Association for the Study and Application of the Method of Ilizarov (ASAMI) scoring system. Complications during the surgery and the follow-up period were recorded and evaluated by the Paley classification at a minimum follow-up of two years after removal of the fixator. ResultsThere were 9 men and 3 women with an average age of 37.4±7.8 years. The etiology included posttraumatic osteomyelitis in 8 cases and posttraumatic bone loss in 4 cases. The mean bone defect after radical debridement was 7.1±0.6 cm. Tetrafocal bone transport was applied in 9 cases, and pentafocal bone transport was applied in 3 cases. The average EFT and EFI were 5.2±0.8 months and 0.7±0.2 months/cm, respectively. The average time of follow-up after removal of the external fixator was 28.5±3.3 months without recurrence of osteomyelitis. The bone results were good in 7 cases, fair in 4 cases, and poor in 1 case, and the functional results were good in 5 cases, fair in 6 cases, and poor in 1 case. The most common complication was pin tract infection, which occurred in all cases, but there were no major complications, such as nerve or vascular injury. ConclusionTetrafocal and pentafocal bone transport using Ilizarov technique could be an alternative treatment option in selected cases with distal tibial defect > 6 cm. It could shorten the distraction period, fasten regeneration, and reduce the associated complications.

Lunar lenses - Acquired lens colobomas.

Acquired lens colobomas secondary to ocular surgeries are scarcely described in the literature. We describe two cases of acquired lens coloboma in two infants with glaucoma who underwent ocular surgery. The coloboma in the first case was likely because of direct trauma to the lens zonules during an optical iridectomy with a vitrectomy cutter, resulting in localized loss of zonules and consequently localized lens coloboma. The coloboma in the second case was noticed during examination under anesthesia after scleral buckling and cryopexy for retinal detachment. The cause for coloboma development in this case could be disruption of the lens zonules because of stretching of the globe after scleral buckle surgery or because of injury to zonules during scleral buckling and the cryopexy procedure.

A CASE STUDY OF AGNI KARMA IN STANYA GRANTHI WITH SPECIAL REFERENCE TO GYNECOMASTIA

Gynecomastia is the benign enlargement of male breast glandular tissue and is the most common breast condition in males. It is usually caused by increased estrogen activity, decreased testosterone activity, or the use of numerous medications. Granthi is a pathological condition of vitiated Doshas in Mamsa, Rakta, Meda, and other structures, resulting in a knot like elevated abnormal growth. In Granthi doshas (vata, pitta, kapha), the mamsa and asruk, meda and sira cause an elevated swelling which is rounded and knotted. Granthi, as explained by Acharya Sushruta, is of 5 types, and by Acharya Vagbhata, is of 9 types. Agnikarma acts on multiple levels in the body. It is mainly done in Vata-Kapha diseases because it has vikasi, tikshna and ushna properties by which it removes strotorodha. A 26-year-old male patient presented with complaints of enlargement of the left breast associated with pain. There was no history of direct trauma or use of any hormonal pills. Based on clinical examination, the patient was diagnosed with a case of Stanya Granthi (gynecomastia). After careful review, the patient was treated with Agnikarma (Once weekly for five weeks) and Samshamana chikitsa. After five weeks of treatment patient’s breast lump was softened, mildly reduced in size, and there was a significant improvement in pain. It was concluded that Agnikarma could be done in Stanya Granthi (Gynecomastia) along with Samshamana chikitsa as an effective treatment modality.

Epithelial Ingrowth Under LASIK Flap After a Massive Shockwave From the Port of Beirut Ammonium Nitrate Explosion

PURPOSE: To present a case of epithelial ingrowth under a laser in situ keratomileusis (LASIK) flap as a direct result of a pressure shockwave without direct blunt trauma to the eye. METHODS: Case report RESULTS: A 27-year-old woman developed epithelial in-growth under the LASIK flap interface after a massive shock-wave trauma to the eye caused by the 2020 Port of Beirut explosion. No flap dislocation, folds, or tears had been noted on examination after the trauma. Observation with close follow-up was elected. The vision and area of ingrowth remained stable over 1 year of follow-up. CONCLUSIONS: Pressure shockwave from an immense blast can mimic direct blunt trauma in eyes after LASIK and can result in epithelial ingrowth. Treatment should be tailored to vision, flap condition, and progression. [J ournal of Refractive Surgery Case Reports. 2022;2(2):e26–e28.]

An Infrapatellar Fat Pad Tear in a High School Football Player: A Case Report

Objective: To present a clinical case exploring the occurrence and management of a tear to the infrapatellar fat pad IFP of a high school football player. Background: Acute tears to the IFP are rare. Typically, the IFP becomes impinged (i.e., Hoffa’s disease) through a fall, direct knee trauma, or surgical complications, and requires conservative treatment. Treatment: A 15-year-old high school football player reported to the athletic training clinical complaining of right knee discomfort and the inability to fully flex the knee. The patient stated that during a field goal attempt he missed the ball and hyperextended his right knee. Hoffa’s disease and impingement of the IFP have been well documented, but these injuries have a different mechanism of injury. Uniqueness: More common injuries to the IFP occur because of microtraumas (i.e., Hoffa’s disease) or direct trauma to the knee (i.e., IFP impingement) in older populations. For this patient, the mechanism of injury was non-contact and minimal swelling, and no visual deformity or discoloration were present to suggest an injury. Additionally, the patient was able to complete functional movements with complaining only of “weird tightness” in the knee during extension. Conclusion: Due to the similarity of multiple knee pathologies, unknown mechanisms of injury need to be considered when evaluating the knee structure. Further examination is needed to determine demographic data and the probability of a non-contact injury is to the IFP, especially in pediatric patients.

Surgical management of isolated humeral trochlear fracture: A rare case report

IntroductionIsolated humeral trochlea fracture is a rarely reported entity, because theoretically it inaccessible to direct trauma. The mechanism of this injury is still under speculation, also consistent with the limited information available, and a medical consensus on the management does not exist. We report the case of a patient with an isolated trochlea fracture and discuss the underlying mechanisms and the clinical, radiological and therapeutic features of this injury. This work will significantly advance our understanding of this particular fracture.Case presentationA 19-year-old man received an elbow injury after a fall. An anteroposterior radiograph showed an irregularity of the medial joint space, and an intra-articular half-moon-shaped fragment that had moved up and forward at lateral view radiograph. A computed tomography scan confirmed an isolated fracture of the trochlea. Open reduction and internal fixation were performed, resulting the good outcome.DiscussionIsolated trochlear fracture in adults is rare and usually associated with capitellar fracture and/or elbow dislocation. The mechanism of injury behind distal humeral fractures is under speculation with reported in the literature are the result of both high-energy and low-energy traumas. Radiographs and CT scan can be used as the modality for imaging studies, but diagnosis is based on the results of a CT scan.ConclusionAn isolated fracture of the trochlea is rare. The mechanisms that generate this fracture are complex. As with other front-line fractures of the humeral distal end, we recommend open reduction and internal fixation for displaced fracture.

Karakteristik Klinis Pasien Laserasi Kelopak Mata Akibat Trauma di Pusat Mata Nasional Rumah Sakit Mata Cicendo

Introduction : Trauma of eyelids due to sharp object, blunt object, road traffic accidents etc. are the major causes resulting in injuries to eyelids. A good identification and prompt treatment can improve the outcome of palpebral laceration. Purpose : To describe clinical characteristics of eyelids laceration due to trauma without involvement of lacrimal system and other orbital Methods : A retrospective descriptive cross sectional study was conducted. Data is taken from medical records of patients diagnosed as eyelid laceration from January 2016 to November 2020. Age, gender, laterality, first reference, place, onset, cause, site of trauma, depth, outcome, complication and System for Peri-Ocular Trauma (SPOT) classification was reviewed. Results : This study comprised of total 157 patients. Most of them were males 119 (75.80%) with median of age 24. The main mechanism of injury was direct trauma 88 (56.05%). The location where the injury occured was road side accidents 81 (51.59%). Superior eyelid was the most affected 96 (61.15%). Subcutaneus tissue as wound base 68 (43.31%) and affected to margin of eyelid 36 (22.92%). Hypertropic scar was the most complication found in 40 (25.47%). The most common SPOT type injury were Type IA. Conclusion : Eyelids laceration due to trauma is common in male productive age, mainly affecting superior palpebra, mostly because of road side accidents. Hypertropic scar was most complication beside traumatic ptosis, lagophthalmos and lid margin notching. The SPOT classification can simplify a recording of palpebral injuries.

Splenic trauma after colonoscopy: Management and treatment

Colonoscopy is an increasingly used diagnostic-therapeutic technique. Although it is a safe procedure, it is not exempt from complications, which are rare but potentially serious. We present the case of a 54-year-old woman who came to the emergency room for abdominal pain after a diagnostic colonoscopy, with anemia in blood test. In CT angiography, was detected a grade III splenic injury according to the classification of the American Association for Surgery of Trauma (AAST), without active bleeding. Due to clinical stability, a non-operative management was decided, with good evolution. Possible causes of splenic rupture are direct trauma to the spleen or excessive traction on the colonic mucosa during biopsy. Symptoms usually appear in the first 24-72 hours after the procedure and are usually abdominal pain and peritoneal irritation, as well as anemia. Abdominal CT is recommended as the imaging test of choice (Figure 1). Treatment of these patients can be extrapolated to management for traumatic splenic injuries. Based on the AAST classification, hemodynamically stable patients may benefit from non-operative management, although in grades IV and V an angiography would be recommended to rule out active bleeding and perform prophylactic angioembolization. Therapeutic angioembolization would be indicated in stable patients with active bleeding. In the case of instability or signs of peritonism, urgent laparotomy is the treatment of choice. Some authors recommend performing control CT for the diagnosis of associated non-hemorrhagic vascular lesions, such as pseudoaneurysms. In conclusion, post-colonoscopy splenic rupture is a serious but infrequent complication, whose treatment will be determined by the stability of the patient and the presence of active bleeding in an imaging test.

Implementasi Hue Saturation Value (HSV) Untuk Identifikasi Fraktur Tulang

Fracture or fracture is a break in the continuity of the bone, most of the fractures occur as a result of trauma, some fractures occur secondary to a disease process such as osteoporosis which causes pathological fractures. The cause of fracture is trauma, which is divided into direct trauma, indirect trauma, and minor trauma. The problem in this research is that the system can be designed to work properly to perform image processing which has shortcomings in the advantages of detection of edge images on bone invoices. Hue is a color known to humans such as red and green, colors that are captured by the human eye based on the wavelength produced. Saturation represents the purity level of the color or the amount of white light mixed with the hue. Each pure color has a saturation value of 100%. Edge detection serves to identify the outline of an object against an overlapping background. Color segmentation is the separation of segments in an image based on the colors contained in the image.

The Palestinian Perspective: Understanding the Legacy of al-Nakba Through the Palestinian Narrative

The memories carried by the Palestinian people can be understood in two forms. First, there are the memories as a result of direct trauma recieved through displacement and death throughout the history of the Zionist colonial project. The Palestinian Nakba, as but one example, highlights the extent of such memories through the traumatizing military massacres and forced expulsion of over 750,000 Palestinians at the hands of Zionist militant groups. These direct memories are carried from generation to generation and transform into a looming sense of collective melancholy experienced by the later generations both in historical Palestine as well as those living in diaspora. There is a clear disconnect in historical academia as people try to understand the suffering of the Palestinians through questionable historical frameworks rather than a lens that accurately represents the memories and trauma of the Palestinians as they had and continue to experience. As a result, Palestinians today find their memories of trauma challenged and in some cases outright denied via these historical frameworks and atmospheres produced by the Israeli government. The question is then how could we be able to understand trauma and memory as it relates to the Paletsinians? Throughout this thesis we will explore several different forms of translating and transmitting Paletsinian memory.

Scapulothoracic Bursitis or the Snapping Scapula Syndrome May Mimic with Shoulder Pain

Background: The scapulothorasic joint plays an important role in overall shoulder function by providing a stable base for glenohumeral rotation. Snapping scapula syndrome, a likely under diagnosed condition, can produce significant shoulder dysfunction in many patients. Because the precise origin is difficult to understand, sometimes mimic with shoulder pain. Dysfunctioning of any of muscles, ligament, bursa may cause abnormal scapular motion and predispose to scapulothoracic joint disorders. Accurate recognition of the syndrome may lead to prompt and long-term relief of symptoms by conservative or noninvesiveintervension treatment.Results:The causes of scapulothoracic bursitis and crepitus include direct or indirect trauma, overuse syndromes, glenohumeral joint dysfunction, boney abnormalities, muscle microtrauma or atrophy or fibrosis, and idiopathic causes. Scapulothoracic bursitis and crepitus remain primarily clinical diagnoses. However, imaging studies or local injections may also be helpful. The initial treatment of scapulothoracic bursitis and scapulothoracic crepitus should be conservative. Intevension procedure is best for treating modalitis for scapulothoracic dysfunction, most reports have demonstrated well to excellent outcomes in a significantly high percentage of patients.Conclusions:Clearly, the best initial approach to these conditions is a conservative treatment like nonsteroidal antiinflammatory drugs plan that combines scapular strengthening, postural reeducation, and core strength endurance. If an appropriate trial of nonoperative management proves unsuccessful, local non invesiveintervension can produce good results.

Persistence of headache and its relation to other major sequelae following traumatic brain injury at 2-8years after deployment-related traumatic brain injury in veterans of Afghanistan and Iraq wars.

This study deals with headache in relation to other major sequelae of traumatic brain injury (TBI) in veterans of Iraq and Afghanistan wars over 8years after experiencing a deployment-related TBI (DTBI). TBI occurred in 14%-23% of veterans deployed to the Iraq or Afghanistan campaigns. This study evaluates sequelae of TBI (STBI) over 1-8years after a DTBI. This is a secondary, cross-sectional analysis of previously collected data, which was taken from review of medical records of the first 500 veterans with a DTBI seen in the TBI clinic of the Oklahoma City Veterans Health Center. This report deals with five of the most common STBIs and represents the presence and severity of, or absence of, the particular symptom at the time of a patient's initial visit to the clinic. All subjects were evaluated between June 1, 2008, and April 30, 2011. The STBI used here include: headache, dizziness, balance, coordination difficulties, and difficulty with decisions. In the TBI clinic, the burden of these symptoms was evaluated with a Likert Scale of none, mild, moderate, severe, or very severe. For this report, the scale was compressed into three categories: none, mild/moderate, and severe/very severe. Data were complete for age at TBI and mechanism of TBI in 500 subjects, for symptom severity in 497 subjects, for TBI severity in 491 subjects, and for presence of prior TBI in 496 subjects. For the 497 subjects with complete symptom severity data, headache was seen in 476 (95.8%) and absent in 21 (4.2%). Regarding headache severity, 236 (47.5%) reported mild/moderate and 240 (48.3%) reported severe/very severe headache burden. For other sequelae, including severity of dizziness, balance, and coordination problems, these symptoms were absent in 85 (17.1%), 85 (17.1%), and 106 (21.3%) patients, respectively; of mild/moderate severity in 356 (71.6%), 355 (71.4%), and 321 (64.6%) patients; and of severe/very severe intensity in 56 (11.3%), 57 (11.5%), and 70 (14.1%) patients. Difficulty with decisions, which was used as an indication of cognitive difficulty, was noted in 429 (86.3%) of the subjects, of which 252 (50.7%) noted mild/moderate and 177 (35.6%) severe/very severe intensity. To evaluate changes over time, the subjects were divided into 2-year cohorts of 1-2, 3-4, 5-6, and 7-8years since DTBI. Comparing symptom burden within these four 2-year cohorts, there was no statistically significant change in symptom burden analyzing by time interval from DTBI to TBI clinic evaluation. For analysis by severity of the DTBI in 491 subjects with complete data, categories were constructed based on alteration of consciousness (AOC) or duration of loss of consciousness (LOC) as follows: AOC (264/491 [53.8%]); LOC <1min (95/491 [19.4%]); LOC, 1-30min (115/491 [23.4%]); and LOC >30min (17/491 [3.5%]). The proportion of subjects with severe/very severe symptom intensity increased as the severity of the DTBI increased (from p=0.043 to p=0.001). Additional evaluations included groupings by age at DTBI (20-29, 30-39, and ≥40years), by presence or absence of a TBI prior to the DTBI, and by causation of the DTBI (blast or direct head trauma). No significant differences were observed with any of these comparisons. For veterans experiencing a DTBI, these TBI-related sequelae persist with little improvement over time up to 8years. A trend toward symptoms becoming worse as DTBI severity increased was observed. Headache was the most frequent sequela of TBI, occurring in 96% of the patients with almost half of these reporting severe/very severe intensity of headache burden. The basis for the prolonged persistence of these STBI is not known.

Surface Electromyography-Driven Therapeutic Gaming for Rehabilitation of Upper Extremity Weakness: A Pilot Study.

In patients with severe upper extremity weakness that may result from peripheral nerve injuries, stroke, and spinal cord injuries, standard therapy in the earliest stages of recovery consists primarily of passive rather than active exercises. Adherence to prescribed therapy may be poor, which may contribute to suboptimal functional outcomes. The authors have developed and integrated a custom surface electromyography device with a video game to create an interactive, biofeedback-based therapeutic gaming platform. Sensitivity of the authors' custom surface electromyography device was evaluated with simultaneous needle electromyography recordings. Testing of this therapeutic gaming platform was conducted with a single 30-minute gameplay session in 19 patients with a history of peripheral nerve injury, stroke, spinal cord injury, and direct upper extremity trauma, including 11 patients who had undergone nerve and/or tendon transfers. The device was highly sensitive in detecting low levels of voluntary muscle activation and was used with 10 distinct muscles of the arm, forearm, and hand. Nerve and tendon transfer patients successfully activated the donor nerve/muscle and elicited the desired movement to engage in gameplay. On surveys of acceptability and usability, patients felt the system was enjoyable, motivating, fun, and easy to use, and their hand therapists expressed similar enthusiasm. Surface electromyography-based therapeutic gaming is a promising approach to rehabilitation that warrants further development and investigation to examine its potential efficacy, not only for building muscle strength and endurance but also for facilitating motor relearning after nerve and tendon transfer surgical procedures. Therapeutic, IV.

Immediate Interventions After Surgery to Reduce Readmission for Upper Extremity Infections.

Upper extremity infections (UEIs), commonly caused by intravenous drug use and direct trauma to the hand, can be devastating. Many studies support hand therapy postoperatively to improve outcomes. This population of patients often experience increased returns to the emergency department (ED) for treatment, repeat surgery, poor function, and increased hospital expenditure.This is a 2-phase study to investigate and intervene on the care pathway for patients undergoing surgery for UEI at a single urban university hospital. For the first 6-month phase, all patients with UEI requiring surgery received the standard of care, including written discharge instructions, a scheduled follow-up, and a determination for hand therapy based on evaluation. During the second phase, over the following 6 months, all patients with UEI requiring surgery received an intervention before discharge, in addition to standard of care, including a scripted educational session on the importance of hand therapy by a resident physician, home exercise program instructions, and a referral to hand therapy before discharge. Outcome measures were assessed for 6 months. Outcome measures included follow-up, hand therapy attendance, ED visits for the same complaint, readmissions, and reoperations.Forty-seven patients were in the first control group without intervention and 41 patients were in the second intervention group. Of the control group, 43% attended a follow-up appointment, 2% attended hand therapy, and 45% presented to the ED, resulting in a total of 167 visits. Eleven presented to the ED and were readmitted for complications from surgery, all 11 required a second operation. In the intervention group, 54% attended a follow-up appointment (P = 0.044), more patients attended hand therapy (22% P = 0.013), and 24% presented to the ED (P = 0.047), resulting in 40 ED visits.Seven were readmitted for complications from surgery and 4 required a second operation (P = 0.1). Early, simple intervention and education prove to be an effective method to decrease emergency department burden and healthcare expenditure for treatment of a challenging population. Although additional education and referral to hand therapy utilization do not change operation rates, it decreased returns to the ED, readmissions, and increased follow-up.

Comparative analysis of effect of submucosal dexamethasone and methylprednisolone injection on post-operative sequelae after third molar surgery in a randomized double blind manner

Background: Postoperative oedema is a consequence of tissue injury during surgery and the raising of muscular attachments, and appears as a result of direct trauma to blood and lymph vessels. Postoperative pain is a common phenomenon after surgery, due to surgical trauma and the release of pain mediators. After surgical extraction of impacted lower third molars, the pain is most intense 3-5 hours following extraction, just after the cessation of local anesthesia. Several methods of controlling the immediate inflammatory response associated with the third molar surgery abound in the literature. Aim of the study: To compare the effect of submucosal dexamethasone and methylprednisolone injection on post-operative sequelae after third molar surgery in a randomized double blind manner. Materials and methods: 45 Subjects for the present study were selected and divided into 3 groups of 15 patients each (group I- submucosal dexamethasone, group II sub-mucosal methylprednisolone, group III – submucosal placebo, normal saline) from amongst the patients who reported to OPD, at random basis irrespective of side, age, caste, creed, gender and socioeconomic status. Study was carried out in those patients who required surgical removal of impacted mandibular 3rd molars.

A case series of new radicular pain following the insertion of spinal cord stimulator.

Although spinal cord stimulation (SCS) is a safe procedure, equipment-related, biological and neurological complications have been observed in previous research, particularly case reports. No reports of new neuropathic pain in the absence of neurological deficit or positive MRI findings have been described. We detail three cases of new-onset radicular pain in the L5/S1 dermatome following insertion of SCS. This was a retrospective case series of three patients. Details of clinical background, indications for SCS and events occurring during insertion and further management were recorded. All three cases were technically difficult and required multiple epidural entry levels, with repeated passage of the electrode into and within the epidural space. All cases involved accessing epidural space T12/L1 and L1/L2. A possible explanation for the new-onset radicular pain could concern oedema to the conus medullaris, resulting from repeated passage of the electrode at the T12/L1 level. Alternative explanations could be direct trauma to transiting nerve roots, neuroplastic changes resulting in peripheral and central sensitisation and immune-mediated nerve injury. MRI imaging should be analysed prior to the SCS procedure to identify the level of the conus medullaris, with the aim of avoiding repeated passage of electrodes at that level. Unintended neurological adverse events should be discussed with patients during the consent process. Careful patient selection and psychological screening may also help identify patients who may be unlikely to respond to SCS therapy. Further reporting of new radiculopathic pain following SCS insertion is required to strengthen understanding of its potential causes.

ESIN in femur fractures in children under 3: is it safe?

BackgroundPediatric femur fractures are a major trauma in children. Different treatment algorithms have been developed but indications for surgical treatment, especially in very young patients, are still controversial. Literature recommends surgical stabilization with elastic-stable intramedullary nailing (ESIN) starting at the age of 3 and non-operative treatment in younger patients. This study sought to present the outcome of patients younger than 3 years of age treated with ESIN for femur fractures.Materials and methodsInclusion criteria were patients younger than 3 treated with ESIN in femur fractures. Patient demographics, fracture characteristics, mechanism of injury, outcomes and complications were recorded using charts and X-rays. Primary outcome measures were time to mobility, fracture consolidation and surgical-related complications.ResultsBetween 2010 and 2020, 159 patients were treated with ESIN in femur fractures in our institution. A total of 30 patients met the criteria. The mean age was 2.1 ± 0.7 years (13 months–2.9 years). Most common mechanism was fall from standing height (60%). Other mechanisms were motor vehicle accidents as a pedestrian (10%) or as a passenger (10%) as well as direct blow trauma (20%). Femoral shaft fracture was the most common injury (80%). 5 subtrochanteric and one distal metaphyseal femur fractures were found. Mean length of stay was 2.0 ± 1.3 days. Radiographic controls were performed on day 1, 14 and 6 weeks after surgery if not otherwise specified or if complications occurred. 4.6 ± 1.2 (n 2–7) X-rays were performed on average after surgery. First radiographic consolidation signs were seen after 2.4 ± 0.6 weeks. Only one child showed surgical-related complication with a leg length discrepancy of 1 cm. In 10% of the patients, shortening after surgery of 1.7 ± 1.4 mm (0.3–3.1 mm) occurred. One child initially treated with traction therapy showed skin irritations and was operated with ESIN. No non-union or ESIN-related complications were found. Mean follow-up was 5.1 ± 4.4 months (4–24 months). First independent mobilization was seen at an average of 3.4 ± 1.1 weeks (2–6 weeks) after surgery. Implant removal was performed after 3.2 ± 1.3 months (2–8 months). No refracture after implant removal occurred.ConclusionEarly results with ESIN show a reasonable and safe treatment option for femur fractures in toddlers and young children under the age of 3 with easy postoperative care, fast fracture union and early independent mobilization.

Chemical neurotoxicity to the inferior alveolar nerve—A rare sequela of endodontic treatment

AbstractAimDamage to the inferior alveolar nerve (IAN) during endodontic procedures is a rare complication. However, over‐ instrumentation and over‐filling during root canal treatment can cause injury through direct trauma, pressure or neurotoxicity from intra‐canal irrigants or root canal filling materials, particularly where the roots of mandibular molars or premolars are in close proximity to the IAN. This report describes the clinical presentation and management of a severe chemical injury to the right IAN following the endodontic treatment. We also provide practical considerations to help minimise such complications.MethodsA 27‐year‐old female developed immediate onset numbness and tingling to the right mental region following endodontic treatment of tooth 47. Radiographic examination confirmed widespread extrusion of root canal sealer within the marrow spaces of the right mandibular body extending centrally within the mandibular canal and perforating the lingual cortex.ResultsUrgent surgical exploration and decompression of the right IAN were undertaken, which revealed an avascular and fibrotic nerve with virtually no normal neuronal structure. There was evidence of foreign material both in contact with the epineurium and within the nerve trunk, much of which could not be eliminated. This severe chemical insult to the nerve resulted in irreversible anaesthesia in the right IAN distribution.ConclusionThis case highlights the diligence that is required when performing root canal treatment in high‐risk mandibular molar teeth, particularly in relation to confining materials within the canal space, accurate canal measurements and comprehensive radiographic evaluation both pre‐ and post‐operatively. Urgent specialist referral for the elimination of foreign material is essential to maximise the potential for nerve regeneration.

Posttraumatic stress symptom severity is associated with impaired processing of emotional faces in a large international sample.

Trauma exposure and posttraumatic stress symptoms (PTSS) are associated with biases in emotional face processing. Existing research has utilized a variety of methodological techniques to demonstrate hyperreactivity to threatening cues in posttraumatic stress disorder (PTSD; i.e., fearful faces), but studies to date have shown conflicting findings, including both increased and decreased time fixating on fearful faces. Moreover, the impact of PTSS severity on emotional face processing in the general population is unknown, as the generalizability of prior work is limited. The current study aimed to examine the associations between PTSS and sensitivity to detecting differences in fearful, angry, and happy faces in a large international sample. Participants were 1,182 visitors (M age = 31.13 years, SD = 13.57, range: 18–85 years) to TestMyBrain.org who completed three emotion sensitivity tasks and the PTSD Checklist for DSM‐5. The results indicated that higher PTSS scores were associated with poorer performance in detecting happiness, fear, and anger, ps < .001, with the largest effect for fear, f 2 = .06, controlling for age and gender. Participants who experienced more recent and more direct trauma exposure displayed higher levels of PTSS, with a small but significant effect whereby more direct trauma exposure was associated with higher (i.e., better) scores for anger and fear, f 2s = .02. Women showed heightened sensitivity to detecting fear compared to men, d = 0.17. The present findings underscore the value of citizen science initiatives that allow researchers to obtain clinical data from diverse samples with a high degree of PTSS variability.