Elevation Of Depressed Fracture Research Articles

Epidemiology of surgically managed traumatic brain injury patients

Traumatic brain injury (TBI) constitutes a major health and socioeconomic problem throughout the world TBI is called the ‘silent epidemic’ because problems resulting from TBI are often not immediately visible and TBI patients are not very vociferous. Epidemiological studies of TBI are essential to the targeted prevention and effective treatment of brain-injured patients. Epidemiology analysis of surgically managed traumatic brain injury patients was done. Mean age was 35.9 years. Males were more commonly (80%) involved than females (20%). In 57.5% of cases, falls were responsible for TBI and in 42.5% of cases, Road traffic accidents were responsible. Edh was the most common type of TBI in (50%). Chronic SDH occurred in 25% of cases. Acute SDH and Contusions were both seen in 13.75% of cases. Depressed fractures occurred in 6.25% of cases and ICH occurred in 1.25% of cases. Craniotomy was the most common (42%) surgical procedure performed, followed by burrhole drainage (22.5%). Decompressive craniectomy was done in 18.75% of cases and elevation of depressed fracture was performed in 6.25% of cases. Traumatic brain injury (TBI) constitutes a major health and socioeconomic problem throughout the world. People of all ages are affected by it. Males are more commonly involved as compared to females. Timely hospitalisation and surgical management whenever indicated improves the survival.

Pediatric Head Injury: A Study of 120 Cases

Objectives: This study aimed to evaluate incidence, mode, and severity of injury, treatment options and to determine the outcome in pediatric age group patients with head injury.
 Patients & Methods: 120 pediatric patients with a head injury, with ages up to 15 years or less, were included. Detailed history, general and neurological examination including GCS were noted. The CT scans were conducted and the patients managed as per said protocol. Various surgical procedures were performed including craniotomies and evacuation of hematoma, the elevation of depressed fractures and repair of the dura, decompression craniotomies, and evacuation of Subdural collections and contusions.
 Results: 60.1% of patients were boys and 39.16% were girls. In the majority (63%) of the children, the ‘fall’ was reported. The majority of children (68.3%) in our study had a mild head injury with GCS 13 – 15. 35.83% patients had normal CT scans, and 23.33% had isolated skull fractures. 68.75% patients were with a severe head injury and had a poor outcome. A poor outcome was noted in patients having brain edema, subdural hematoma, and brain contusions.
 Conclusion: Head injury in the pediatric age group still continues to be a significant cause of mortality and morbidity. The outcome is directly being related to the severity of injury i.e., GCS. Falls and RTAs are the most common causes and preventive measures in different forms need to be addressed.

Surgical management of TBI

Traumatic brain injury is a leading cause of death & disability all over the world. The early diagnosis via CT Brain & the active medical management has improved tremendously in the last decade. With the use of assisted ventilation & the intracranial monitoring the out come of severe traumatic brain injury has improved & the number of survival has increased & the disability has lessened. The active surgical treatment of traumatic brain injury has added a lot to the out come starting with the intracranial monitoring, removal of surgical intracranial haematomas, Elevation of depressed fractures & the decompressive craniectomy are the key to success in the management of TBI. I am going to talk about the evidenced base approach to all surgical procedures in the management of TBI with emphasis on personal experience in Dubai.

Evaluation of neurotrauma in motorcycle-related accidents at a tertiary hospital in Egypt

Background Although traffic laws in Egypt obligate drivers to wear helmets, they are not strictly followed, resulting in an increased incidence of neurotrauma during accidents. Objective The aim of the present study was to evaluate head and spine injuries as a result of motorcycle accidents in 1 year. Patients and methods This study was conducted in the Neurosurgical Emergency Department of Cairo University Hospitals. Only motorcycle-related neurotrauma patients were included. Demographic data, types of lesions inflicted, operations and procedures carried out, hospital stay, and outcome were investigated by analyzing admission files and operation records. The results were then compared with the published literature. Results Out of 117 patients, there were 93% males and 7% females. The age group 20–40 years represented 61.5% of the cases. Extradural hematoma was present in 42 (36%) cases, fissure fracture and base of skull fracture in 64%, brain contusion in 29%, and spine fracture in four (0.034%). Helmeted drivers represented only 9.5% of the patients. Thirty-nine percent of patients had other associated injuries than of head and spine. Operations were performed on 45 (38.5%). Nearly half of the operation procedures comprised evacuation of extradural hematoma. Others included elevation of depressed fracture, frontal sinus repair, decompressive craniotomy, and spinal fixation surgeries. Hospital stay ranged from 2 to 28 days with an average of about 4.5 days; furthermore, 22.2% of the victims became handicapped and dependent. Conclusion Following safety measures during motorcycling significantly reduces morbidity and mortality at time of accidents. Although these patients have a short median hospital stay but surgery rates are obviously high. Follow-up for victims may reveal other potential burdens and help in the reintegration of society.

Complicated head trauma from machete wounds: the experience from a tertiary referral hospital in Jamaica

There have been limited reports on machete wounds to the cranium. This study was carried out to document the injury profile in a series of patients who have sustained cranial injuries from machete wounds in this setting. Between 1 January 1998 and 1 January 2008, demographic and clinical data were retrospectively collected from all patients treated with complicated head injuries from machete wounds with at least one of the following clinical or radiological features: a recorded Glasgow Coma Score < 8 at any point during admission; compound skull fractures; protruding brain matter; cerebrospinal fluid (CSF) leaks; intra-cranial bleeding; parenchymal contusions; lacerations and/or oedema. The data were analysed using the SPSS version 12.0. Of the 40 patients with complex injuries to the cranium, there was a 6:1 male preponderance with a mean age of 32.5 ± 13.7 years (Mean ± SD). The injuries included open skull fractures in all the 40 (100%) patients, depressed skull fractures in 20 (50%) patients, CSF leaks in 4 (10%) patients, protruding brain matter in 4 (10%) patients, cerebral contusions in 3 (7.5%) patients and extra cranial injuries in 16 (40%) patients. Tetanus prophylaxis and intravenous antibiotics were administered to all patients, and phenytoin was required in 16 (40%) cases. There were 37 (92%) patients requiring operative intervention at a mean of 10.4 h after presentation (SD ± 18.1; Median 6). The operative procedures included elevation of depressed fractures in 20 (54.1%) patients, dural repair in 10 (27.0%) patients and intra-cranial debridement in 7 (18.9%) patients. There were three deaths (7.5%), and seizures were recorded in 5 (12.5%) cases with no reports of infectious morbidity. Eighty percent of patients had a normal Glasgow outcome score on discharge. Complicated machete head trauma is uncommon at this health care facility in Jamaica. We achieved a satisfactory outcome with aggressive management consisting of prompt assessment of the extent of injury, appropriate antibiotics, anticonvulsants for those with seizures or cortical injury and early operation to decrease the risk of complications.

Moderate head injury: a guide to initial management.

The purpose of this study is to determine the initial treatment of patients who appear to have sustained moderate head injuries when first evaluated. The authors reviewed the records of 341 patients whose initial Glasgow Coma Scale (GCS) scores ranged from 9 to 12, as well as another 106 patients with GCS scores of 13. All patients underwent cranial computerized tomography (CT) at the time of admission. In 40.3% of these patients the CT scans were abnormal (30.6% had intracranial lesions), and 8.1% required neurosurgical intervention (craniotomies for hematoma in 12, elevation of depressed fractures in five, and insertion of intracranial pressure monitors in 19). Four patients died of their intracranial injuries. A similar incidence of lesions found on CT and at surgery suggests that an initial GCS score of 13 be classified with the moderate head injury group. Skull fractures were found to be poor indicators of intracranial abnormalities. These results suggest that all patients with head injury thought to be moderate on initial examination be admitted to the hospital and undergo urgent CT scanning. Patients with intracranial lesions require immediate neurosurgical consultation, surgery as needed, and admission to a critical-care unit. Scans should be repeated in patients whose recovery is less rapid than expected and in all patients with evidence of clinical deterioration; this was necessary in almost half of the patients in this group, and 32% were found to have progression of radiological abnormalities on serial CT scans.

Posterior table fractures of the frontal sinus: I. An experimental study.

Experiments using cats were performed to examine the natural history of posterior table fractures of the frontal sinus and the methods available for treatment. Elevation of depressed fractures and obliteration by either fat or osteoneogenesis and fibrosis were the modalities of treatment used. Comparisons were made with untreated controls. Fascia reinforcement of the dura and plugging of the nasofrontal duct were variables. The nasofrontal duct is critical in the natural history of these injuries. All fractures of the posterior table heal if drainage into the nose is maintained. Fractures which are elevated heal by bony union with associated mucosal and dural healing. Loose fragments of the posterior table heal if left in place. Mucoceles form if the nasofrontal duct is obstructed, if mucosa is inadequately removed during obliteration and, in some instances, where islands of mucosa are isolated by mucosal laceration. Viable adipose tissue in the sinus prevents significant ingrowth of mucosa from the nasofrontal duct. Growth of mucosa into fracture lines was not a problem. Both adipose transplants and intrasinus fascia reinforcement appeared to contribute to well defined posterior table healing.

Surgical repair of the anterior fossa because of rhinorrhea, aerocele, or meningitis.

✓ The authors report their experience with 52 patients requiring specific anterior fossa repair only and 47 in whom repair was conducted during elevation of depressed fractures. The incidence of rhinorrhea, aerocele, and meningitis is related to the site of dural defect repaired at operation.