History Of Road Traffic Accident Research Articles

Assessment of Functional Outcome and Postoperative Complications in Proximal Humerus Fracture Patients Managed With Proximal Humerus Internal Locking System (PHILOS) Plating.

Proximal humerus fractures are primarily common in the oldage group. The appropriate approach to managing such displaced and comminuted fracture patterns is often questionable. Hence, this study was conducted to assess the functional outcome of proximal humerus fractures following treatment with a proximal humerus locking plate and to assess the frequency of complications in such patients. In this robust study, 33 cases of proximal humerus fractures underwent surgical management at a prestigious teaching hospital from February 2021 to August 2022 utilizing a proximal humerus internal locking system (PHILOS) plate. The NEER classification was employed to categorize the fractures, and the NEER score was used for functional assessment. It's crucial to note that individuals with pathological fractures, associated injuries in the ipsilateral limb,nerve injuries, and cases of open fracture were rigorously excluded from the study. The mean age was 47 ± 5.2 years. Based on NEER's classification, the distribution of fractures was as follows: two-part fractures accounted for 18.18% (n = 6) of cases, three-part fractures for 54.54% (n = 18) of cases, and four-part fractures for 27.27% (n = 9) of cases. A history of road traffic accidents and falls was reported in 54.54% (n = 18) and 45.45% (n = 15) of cases, respectively. Functional outcome assessment utilizing NEER's scorerevealed a minimum score of 48 and a maximum of 96, with an average score of 82.96 ± 12.73. Notably, 39% of patients demonstrated excellent results, 27% exhibited satisfactorily, 21% manifested unsatisfactorily, and 12.12% presented failure outcomes. Of the 33 operated cases, 81.8% (n = 27) exhibited no complications during follow-up. The predominant complication observed was shoulder stiffness (9.09%, n = 3), followed by Varus mal-union (6.06%, n = 2), and superficial surgical site infection (3.03%, n = 1), managed with debridement and antibiotics leading to subsequent resolution. Managing proximal humerus fractures has consistently posed a formidable challenge. Our study indicates that using the PHILOS plate represents a reliable option for addressing such fractures. This plate provides sturdy fixation, facilitates early mobilization, and culminates in exceptional functional outcomes.The insights gained from this study can inform clinical decision-making and guide orthopedic surgeons in selecting theappropriate treatment strategy for proximal humerus fracture patients.

Drying up the drip- A case report

Cerebral Venous sinus thrombosis is an uncommon entity, which is usually associated with thrombosis of the dural venous sinuses due to local and clotting mechanism abnormalities. CVT secondary to CSF rhinorrhea has been recorded in literature but the relationship is uncertain. Here we report a case of a 28yr old male with a past history of road traffic accident who presented with features suggestive of meningoencephalitis. He was diagnosed to have Cortical Venous Thrombosis, on further evaluation he was found to have CSF rhinorrhea.

Aortic Rupture Due to Blunt Force Trauma: A Case Report

Background: Aortic rupture is one of the most important life-threatening conditions. Aortic rupture can occur by several causes, including trauma and spontaneous rupture. Case Details: A 62-year-old man was brought for an autopsy examination in a mortuary with a history of road traffic accidents. As per history revealed by the police and relatives, the deceased was a retired army officer and was driving a car. Autopsy Finding: The deceased was an elderly male. On external examination, the deceased sustained multiple reddish abraded contusions over the chest and both sides of the chest. On opening the thorax, the following injuries were present. Fracture of sternum was present at junction of body and manubrium associated with extravasations of blood in surrounding area. Multiple fracture of bilateral ribs associated with extravasations of blood in surrounding area. Discussion: All aortic segments are prone to rupture following sudden blunt trauma. In various studies it is found that 92% of aortic rupture occur at isthmus followed by arch of aorta (4%) followed by ascending aorta (3%).

DEMOGRAPHIC PROFILE OF DISABILITY ASSESSED PATIENTS IN TERTIARY CARE HOSPITAL IN PRATAPGARH DISTRICT OF UTTAR PRADESH

Objective: There is a lack of data regarding the demographic profile of acquired disability in hospital-admitted patients in Pratapgarh District. Therefore, the present study was conducted to know the demographic profile of disability-assessed patients in a tertiary care hospital of Pratapgarh district. Methods: The present study is a record-based retrospective study in which 490 patients assessed by the investigator for disability in selected tertiary care hospitals in Pratapgarh district of Uttar Pradesh between 2020 and 2023 were taken into consideration. Demographic parameters like age, gender, number of admissions, duration of hospital stay, etc. were recorded in a Microsoft Excel sheet. Data were analyzed by descriptive statistics using SPSS version 23.0 and presented as graphs. Results: Out of 490 cases, the majority (83.06%) were male, while 16.94% were female. The mean age of patients was 38.2±3.7 years. In the present study, males had a mean disability percentage of 28% (standard deviation, SD=24.9) and females had a mean disability percentage of 22% (SD=18.3). In the majority of patients (75.3%), one-time admission was observed. In the present study, the majority of cases (94.89%) had a history of road traffic accidents. About three-fourths of disabilities (75.51%) were found in brachial plexus injuries, followed by 46.94% of disabilities in spine injuries and 38.98% in head injuries. Conclusion: The present study will help treating doctors, especially orthopedic surgeons, insurance companies, and governments understand the magnitude of the problem. The treating doctor, especially orthopedic surgeons, will be in a better position to explain to patients about disability through its assessment, and the benefits will be available to patients in the form of certification.

COMPARISON AND FUNCTIONAL ANALYSIS OF SINGLE-BUNDLE ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION ALONE WITH LATERAL EXTRA-ARTICULAR TENODESIS AS AN ADJUNCT TO ANTERIOR CRUCIATE LIGAMENTRE CONSTRUCTION IN ANTEROLATERAL INSTABILITY

Objective: The aim of this study is to compare the functional outcome of ACLR alone, with patients who underwent ACLR with LET.ACL injuries rarely occur in isolation, and associated meniscal, chondral, and ligamentous lesions all influence the outcome of treatment Materials and methods: This prospective study conducted in 30 patients with ACL deficient knee with high grade pivot (grade-II &grade-III) Skeletally mature to 56 years of age , 2 or more of: competitive pivoting sport, Chronic ACL insufficiency, Revision ACLR and Generalized ligament laxity - Beighton score of 4 greater. Results: A total of 30 patients were evaluated in this study.15 cases were operated for ACLR and 15 cases for ACLR + LET. Most of the patients were in the age group of 21-30 with all male gender indicating ACL injuries are common in young males with history of road traffic accident (63.33%) at the time of injury. The mean operating time in our study (also the total tourniquet time) was 110 minutes (range 100 - 130 minutes). Instability was controlled well in ACLR + LET group .Two patients in ACLR+LET group have complained of instability episodes. Preoperatively, Grade 2 pivot shift was observed in 80% in control and 33.33% in other group. Grade 3 pivot shift on examination was found in 20% in control group and 66.66% in experimental group. Post-surgery patients who received ACLR alone had Grade 1 pivot in 60% , Grade 2 in 33.33% and Grade 3 in 6.67%. Combined group (ACLR+LET) had grade 1 in 33.33, Grade 2 in 60% and Grade 3 pivot in 66.66%. Regarding preoperative IKDC scores, patients treated with ACLR alone had 26.66% below 45, 40% between 45-55, 6.66% in 60-70,70-80 and in patients treated with both ACLR+LET had 6.66% in 40-50, 20% in 50-60,46.66% in 60-70, 26.66% in 70-80 before surgery. Post-surgery, patients in both groups had excellent scores (90-100 IKDC score). Conclusions: The combination of LET and intra-articular ACLR is effective in eliminating the high-grade pivot-shift phenomenon. Adding a lateral extra-articular tenodesis can improve patient outcome without the need for future revision ACL surgery and its obligatory intense postoperative rehabilitation, in moderately active patients.

The Effect of Mandibular Impacted Third Molar on Fracture of Mandibular Angle and Condyle: An Observational Study

Objective: The factors that may increase the risk of mandibular angle fractures are the abrupt change in angulation and its association with impacted teeth. Condyle, a common mandibular fracture site, is spared if the impact is absorbed in the angle. The study aimed to determine the relationship between the status of impacted mandibular third molars and mandibular angle and condylar fractures in patients with a history of road traffic accidents, within the age group of 18 to 50 years. Methods: In this observational study, 136 patients were examined clinically to diagnose mandibular angle and/or condylar fractures which were confirmed using an orthopantomogram. The status of the mandibular third molars was assessed radiographically. Results: Among the 173 fracture sites detected, 43 were diagnosed at the angle and 130 at the condyle. The demographic assessment demonstrated an age predisposition between 31 and 50 years (44%) in males and 21 and 30 years (47%) in females, with an overall peak incidence in the age group of 21 to 30 years (45%). There was a significant relationship between the status of impacted third molars and the occurrence of angle (P<0.01) and condylar fractures (P=0.05). The incidence of angle and condylar fractures in patients with/without associated impacted mandibular third molars were found to be 91% and 64% and 9% and 36%, respectively. Conclusions: The presence of impacted third molars had a significant relationship with the high incidence of angle fractures and the low incidence of condylar fractures. Knowledge about the common fracture patterns associated with impacted mandibular third molars would alert the clinician to contemplate fractures based on the anatomic distribution.

Management of Endo-Perio Lesion using Collagen Membrane: A Case Report

This case report describes the management of endo-perio lesion. A 40 year old patient reported with pain and discolored tooth with history of road traffic accident a year ago. Intraoral examination of tooth 11 revealed the presence of restorative material and a sinus tract opening with probing depth of 6mm. Following full mouth scaling, access opening and biomechanical preparation was done during which intra-canal irrigant was seen oozing through the sulcus of tooth 11. Multiple RVGs were taken as there was difficulty in negotiating the canal which suggested the presence of communication. Surgical intervention was carried out were root perforation was noted. Canal was negotiated and perforation was repaired using biodentine. Collagen membrane was placed as a barrier. Patient was recalled after 2 weeks, 1 month and at 3months. At the end of three months there was complete reduction in probing depth with satisfactory soft tissue healing. Proper diagnosis of the endo-perio lesion is the key to success. The multidisciplinary approach with accurate diagnosis contributed to the favorable therapeutic outcome.

Cross-sectional Observational Study on the Demography of the Neurosurgical Emergency Admissions in a Year 2014 at Gurayat General Hospital, Saudi Arabia

Gurayat General Hospital is a 350 bed secondary referral hospital of Kingdom of Saudi Arabia. This is one of the busiest hospitals in Al-Jouf region. Trauma is very common in this city and the ER department is mostly overwhelmed by Neurosurgical emergency patients. The aim the study was to evaluate the age sex, types of injuries and causes of injuries of the neurosurgical emergency patients. This was a cross-sectional descriptive observational study. Ethical approval was achieved from proper authority. Good Clinical Practice (GCP) ICH E6 protocol was followed in order to ensure safety and efficacy. Data was collected from the log book of the ER department. Data were transferred to a spreadsheet to make a master sheet. Valuables of individual columns were analyzed and tabulated. Comparison was performed between the result of this study and other international studies. About 7.3% of all ER admissions were for the Neurosurgical cases. Among the Neurosurgical cases (n=3588) there was clear predominance of male gender (81%). Majority (45%) of the Neurosurgical patients were from children and teen age group. Nearly 50% of the patients reported to ER with the history of Road Traffic Accident (RTA). Head injury was the commonest (61%) type of injury. Approximately 45% patients were admitted in to general ward whereas 42% patients were discharged from ER after providing primary treatment. When the results of this study were compared to the results of the other international studies fair similarities were observed.

Difficult Tracheostomy in Calcified Tracheal Rings - Surgical Case Series

Background: Surgical airway management in an acute setting of road traffic accident can be difficult, even in the context of an anatomically normal airway. Tracheostomy, as a surgery is dependent on the exposure and removal of upper tracheal rings. When these rings are found calcified, it leads to further difficulties or complications in management, at times even resulting in surgical emphysema. Methods: A series of 6 adults, all males, aged between 32-45 years, presented to us individually between Nov 2021 to Nov 2022, with history of road traffic accidents causing poly trauma and requiring immediate airway stabilization. Results: None of them had prior history of neck trauma or endotracheal intubation or chronic cough. Chest x ray was normal in all of these individuals. Elective tracheostomy under general anesthesia was performed on day 5 of endotracheal intubation. During the procedure of conventional tracheostomy, after retracting the thyroid isthmus upwards, and prior to making a tracheal window, tracheal rings 3 and 4 were found to be calcified, which prolonged the time taken to remove a piece of cartilage. Conclusion: A junior surgeon needs to be well versed with the surgical anatomy of the region, the surgical procedure and management of possible complications with confidence and ease. A lack of knowledge amongst junior medical staff coupled with unskilled assistance when managing such cases lead to increased operative times and hence complications. Keywords: Tracheostomy, Calcified tracheal rings, adult, surgical

Neglected fracture shaft femur presenting with pseudoaneurysm: a case report

A pseudoaneurysm is a collection of blood leaking from a damaged arterial wall. Development of the false aneurysm is due to either initial injury of the vessel or is a complication of internal fixation of the femoral fracture. Femoral artery pseudoaneurysms (FAPs) may close spontaneously if the tear is small enough to allow for clotting and sealing. On the other hand, rupture of the aneurysm can trigger thrombosis, distal embolization and compression of adjacent structures. We present a case of left superficial femoral arterial pseudoaneurysm in a 36-year-old male with fracture of left femoral shaft. A 36-year-old male with history of road traffic accident presented to our institute with pain and swelling in left thigh. Patient was investigated and diagnosed with fracture left femoral shaft with a pseudoaneurysm of the left superficial femoral artery (SFA). Stenting was done for SFA followed by open reduction and internal fixation of the femoral shaft fracture. Such cases require multidisciplinary approach and a proper planning with involvement of different medical specialities to achieve optimal results and to minimise any intraoperative and post operative complications.

A Case Report of A Mid-Front Head Injury Using Starry Sky Surgical Approach of the Face

A 20-year-old male was referred to the Department of oral and maxillofacial surgery, Trinity Hospital, Aizawl-Mizoram on July 4th,2022 with a history of Road traffic accident (RTA). The patient was unconscious and was taken to the operation theatre and had multiple facial injuries. A frontal bone fracture with frontal sinus injury was noticed and a starry sky approach was used under GA. Overall, the starry sky approach shows very less scars and very less complications and proves to be the right approach in frontal bone fracture involving the midline.

Which is better?? e-Fast or contrast enhanced computed tomography in blunt abdominal trauma: An observational study in tertiary care center

Background: Blunt Abdominal trauma is one of the most common causes among injuries caused mainly due to road traffic accidents and assaults. The rapid increase in number of motor vehicles and its aftermath has caused rapid increase in number of victims to blunt abdominal trauma. Motor vehicle accidents account for 75 to 80% of blunt abdominal trauma. Blunt injury of abdomen is also a result of fall from height, assault with blunt objects, industrial mishaps, sport injuries, bomb blast and fall from riding bicycle. Due to the delay in diagnosis and inadequate treatment of the abdominal injuries, most of the cases are fatal. The knowledge in the management of blunt abdominal trauma has progressively increased. The reason for this could be due to the interval between trauma and hospitalization, inadequate and lack of appropriate surgical treatment, delay in diagnosis, post-operative complications and associated trauma especially to head, thorax and pelvis.Aims and Objectives: To study the sensitivity of eFAST in comparison with CECT in blunt injury abdomen patients.Material and Methods: All the patients brought to emergency department with the history of road traffic accident, fall from height, assault with blunt objects, industrial mishaps, sport injuries, bomb blast and fall from riding bicycle are included in the study. eFAST was done in the resuscitation area for all the patients. After admission all the patients with eFAST positive were on close observation for to proceed with CECT Abdomen and Pelvis or to operate the patient.Results: A total of 50 cases of blunt injury abdomen presenting in our trauma care setup were included in our study. Of these cases 44 cases (88%) were males and 06 cases (12%) were females. The age group spectrum studied was comprised of 16 years to 72 years and the mean age of the study group was 37.22 years. 40 patients were operated for haemoperitoneum and other 10 patients were managed conservatively.Conclusion: CECT is the gold standard technique for evaluating of blunt injury patients because it is highly sensitive and panoramic compared with eFAST. However eFAST can help us in assessing the severity of the trauma and helps in decision making for emergency laprotomy.

Supercutaneous Plating Technique: A Case Report of Locking Plate Used as an External Fixator

Introduction: Open fracture is one of the most common and challenging healthcare problem in orthopedic practice1.Despite improvements in implant design, management of open fractures remain a challenge for the orthopedic surgeon. Locked compression plates (LCP) have advantages of angular stability from the locking-head mechanism and less irritation when compared with traditional external fixators due to their low profiles. Here is a case report of the same. Case Report: A 50-year-old lady, a municipal worker by occupation, came to casualty with alleged history of road traffic accident and injury to right thigh and knee. Plain radiograph of of right femur with knee revealed a supracondylar fracture of right femur. As a definitive treatment, patient underwent open reduction and supercutaneous plating. Skin grafting was done for the external wound over distal thigh. The External fixation plate for right distal knee was removed after 6 weeks and knee ROM of 0 to 100 degree flexion was achieved by one year. Conclusion: Open fractures can be treated by external fixation using the LCP plates, which are safe, reliable and have acceptable functional outcomes with minimal complication rates. Its advantages also include ease of performing surgery and ease of removing plate after fracture healing. Keywords: Supercutaneous plating, LCP- locking compression plate, External fixator

Super Selective Angioembolization for Posttraumatic ArterioCavernosal Fistula Presenting with Nonischemic Priapism

Arteriocavernosal fistula generally occurs from penetrating injury and is rarely secondary to blunt trauma. Patients typically present with a painless partial erection following some type of genitoperineal trauma; the resultant arterial damage leads to an arterial-lacunar fistula and occasionally, to an associated pseudoaneurysm. The case reported in this article is unique in a way that the patient presented after 4 months yet super selective angioembolization of the feeder artery yielded promising results. A 24-year-old man was reported to the outpatient department of our center with a history of road traffic accidents and subsequent perineal injury 4 months back. The patient had complaint of inability to get full rigid erection and persistent partial erection of penis for 4 months since the trauma. On clinical examination, the patient had a partial detumescent penis and normal testes. Doppler ultrasonography revealed extravasation of blood from the lacerated cavernosal artery as a characteristic color blush that extended into the erectile tissue. Magnetic resonance imaging of the perineum suggested the possibility of left-sided posttraumatic arteriocavernous fistula. Diagnostic angiogram of left iliac artery demonstrated arteriocavernous fistula, and selective arterial embolization of feeding artery left cavernosal artery was performed with metallic coils. Procedure was uneventful. Complete detumescence was achieved in the immediate postoperative period. Super selective angioembolization of the feeder’s vessel remains the treatment of choice even in patients with long-standing fistula and priapism secondary to it.

A Descriptive Cross-Sectional Study on Clinical Profile and Outcome of Delirium in Trauma Patients in the Semi-Closed Intensive Care Unit of a Medical College

Introduction: Delirium in trauma patients is common and underdiagnosed.
 Objectives: This study aimed to identify the risk factors and outcome of delirium in trauma patients in a mixed semi-closed intensive care unit.
 Methodology: This descriptive cross-sectional study was done on 77 patients of age 18 years or more admitted for more than 24 hours with the history of road traffic accidents, falls, drowning, physical assaults, and self- inflicted violence in a level three intensive care unit of the National Medical College for six months. The whole sampling method was used in our study and all cases during a given time were included in the study. The Confusion Assessment Method-ICU and Richmond Agitation Sedation Scale were used to diagnose delirium and level of arousal respectively. All data was transferred to the excel sheet and transferred to a statistical package for the social sciences-16. The Chi-square test and Fisher’s exact probability test were used to detect the difference between groups in the univariate analysis, as appropriate. The variables were analyzed using binary logistic regression. Any variables which had P<0.2 after the univariable risk regression and all other potential variables associated with the delirium were included for the multivariable risk regression. The level of significance was P<0.05.
 Result: Of the 77 ICU admissions 17(22.1%) developed delirium. Hyperactive delirium was the most common motor subtype 9(52.9%). The mean duration of delirium was 3.69±4.06 days. Age, hypertension, blood transfusion, and orthopedic trauma were identified as risk factors for delirium. Delirious patients had a longer length of stay in the ICU (7.0 ±4.6 vs 4.5±4.1 days) with no impact on the duration of mechanical ventilation, mortality, reintubation, and unplanned extubation.
 Conclusion: Age, hypertension, blood transfusion and orthopaedic trauma were identified as the risk factor for delirium in trauma patients that should be identified early to prevent complications such as longer length of stay in the ICU, longer duration of mechanical ventilation, mortality, reintubation and unplanned extubation.

Early Complications of Modified Tension-Band Wiring (MTBW) in the Treatment of Close Patellar Fractures

Introduction: Patella fracture account for 1 Percent of all skeletal fracture, Patella fractures are problematic because the loss of the extensor mechanism of the knee, loss of articular congruity and stiffness of the knee joint. The surgical goals are anatomic reconstruction of the articular surface and stable fixation to allow early motion. Modified tension band wiring MTBW (MTBW) is the procedure of choice for patellar fracture these days because of the dramatic decrease in post-operative complications with this procedure.The complications noted in the early post-operative period are infection,loss of reduction, prominence of hardware, and knee stiffness. Objective: To determine the frequency of early post-operative complications following modified tension band wiring MTBW for closed patellar fractures. Methods: This study was conducted in the department of orthopedic surgery, Lady Reading Hospital, Peshawar from June 2010-september 2011. Through a descriptive cross sectional study, a total of hundred patients of closed patellar fractures were selected in a consecutive manner from the OPD and ER department. All patients were subjected to modified tension band wiring MTBW under G/A by an expert orthopedic surgeon and data was also collected at 1st week, 1st month, 3 months and 6 months regarding early post-operative complications like loss of reduction, infection, prominence of hardware and stiffness. Results: Total patients were hundred. There were 60 (60 Percent) males and 40 (40 Percent) were females. Mean age of the patients was 43.82 years + 14.3SD years (range 20-85 years). 74 (74 Percent) were presented with history of road traffic accident. Overall complication rate by the end of 6 months was a total of 25 Percent with of 21 Percent patients with infection, 11 Percent had developed stiffness, 6 Percent with hardware prominence and only 4 Percent with loss of reduction. Conclusion: The frequency of early post-operative complication following modified tension band wiring MTBW for closed patellar fractures was higher than previously reported and further research work should be carried out to identify the factors responsible for it. Keywords: Developed Stiffness, Closed Fracture Patella, Modified Tension Band Wiring MTBW, Early Post-Operative Complications, Hardware Prominence,

Case Report on Right Chronic Dacryocystitis with Lacrimal Sac Abscess

Background: Dacryocystitis of the lacrimal sac, can be acute or chronic. Chronic dacryocystitis is prevalent, but acute dacryocystitis is uncommon, and it's usually caused by a nasolacrimal duct obstruction. Traumatic injury, infections, inflammations, and neoplasms are all possible causes of nasolacrimal duct obstruction (NLDO). Whatever causes NLDO, it leads to the stalling of tears, the accumulation of mucoid secretions, and the desquamation of cells, providing an ideal environment for bacterial infections and the development of dacryocystitis. Case presentation: A 23 years old male came to the ENT department with the chief complaint of right eye watery discharge for 1 year, and right lower eyelid swelling with pain over the right side of the face for 1 month. The patient had a history of road traffic accidents one year ago. For that, he underwent open reduction and internal fixation. But after 9 months, he was having a history of right frontozygomatic suture region infected plate for which he underwent surgery of infected Removal with right orbital volume correction. He had a history of 2 units of blood transfusion with no allergic reaction. On arrival, a physical examination of the eye was carried out which shows swelling over the right eyelids along with tenderness. The Contrast Enhanced Computed Tomography of paranasal sinuses was done along with the dacryocystography under local anesthesia after that he has undergone through Dacryocystorhinostomy under general anesthesia and later he was treated with antibiotics, analgesics, and antacids.Conclusion: It is an inflammation of the tear-producing gland. Chronic dacryocystitis has 2 types namely, primary and secondary types. The primary variety, which affects 80% or more of women, is widespread and distinguished by a strong sex preference. The most significant contributing component to its cause appears to be heredity. The prevalence of the second variant is uncommon and roughly equal in both sexes. It is brought on by an illness or injury to the nearby parts. An external dacryocystorhinostomy is the best method of treatment for this condition.

Posttraumatic Tension Pneumocephalus Causing Atropine-Resistant Bradycardia

AbstractPneumocephalus is a serious complication following brain trauma. Tension pneumocephalus (TP) is entrapment of a large volume of air in the cranial vault causing mass effect on the brain parenchyma. It is the intracranial counterpart of tension pneumothorax and if neglected, can be life threatening. TP should be timely differentiated from benign pneumocephalus owing to its various nonspecific and lethal complications. Our patient is a 37-year-old male with a history of road traffic accident who presented to our hospital with headache and nasal discharge for the last two days. Computed tomography showed multiple skull fractures and extensive pneumocephalus. His preoperative heart rate was 38 beats per minute that was resistant to pharmacological interventions and required a temporary pacemaker for surgery. He underwent uneventful craniotomy for dura repair and was discharged home with no neurological deficit.

The Outcome of Trauma Patients in the Mixed Semi-closed Intensive Care Unit

INTRODUCTIONNepal due to its geographical condition, inadequate resuscitation on time, and lack of full-time intensivist in a trauma team is a cause of trauma-related morbidity and mortality. MATERIAL AND METHODSIt was a prospective, descriptive observational cross-sectional study in a level three intensive care unit of National Medical College for six month. All patients >18 years with a history of road traffic accidents, falls, drowning, physical assaults, and self-inflicted violence admitted to the mixed intensive care unit of a tertiary care hospital were included in this study. RESULTSOne hundred and ninety-one patients were included in this study. 152(79.5%) were males and 39(20.4%) were females. A road traffic accident was the most common mode of injury in 166(86.9%) patients. 178(93.1%) patients survived and went home, 10(5.3%) expired, 2(1%) left the hospital against medical advice (LAMA) and 1(0.5%) gave do not resuscitate orders (DNR). The mean days on the mechanical ventilator was 3.39±2.57 days. Mortality in an intubated patient was 8.6%. Mean LOS in the ICU was 4.28±4.12 days. SOFA and APACHE II scores were a good predictor of outcome, with the SOFA score being the most effective Injury severity score predicted mortality with a sensitivity of 88.9%, a specificity of 22%, with an AUROC curve of 0.543±0.092 with cut off score of 5.5. CONCLUSIONRaising public awareness, and strictly following the traffic rules can help in reducing the incidence of trauma. Trauma team consisting of full-time intensivists should be established to decrease the mortality in the intensive care unit.

Results of Conservative Management of CSF Rhinorrhea in Post Traumatic Patients

Objectives: We aimed to see the results of conservative management of CSF rhinorrhea in post-traumatic patients.
 Material and Methods: An observational study was conducted on 50 patients for 3 months from 1st November 2021 to 31th Jan 2022. Patients presented to neurosurgery unit II, PINS. All patients had a history of road traffic accidents (RTA).
 Results: The age range was 10 – 50 years. The mean age was 25 years. All patients were managed conservatively for one week. We advised complete bed rest to all patients for 2 weeks. Head ends of all patients were slightly inclined from 15 – 30 degrees to reduce pressure in basal cisterns. We gave acetazolamide, mannitol, antibiotics, and anti-epileptic medication to all patients. CSF rhinorrhea in our 43 (86%) patients was stopped completely. In our 5 (10%) patients, CSF rhinorrhea was cured completely after doing a lumbar puncture with drainage of CSF and with the placement of a lumbar drain at a rate of 10 ml per hour. In our 2 (4%) patients, CSF rhinorrhea was not cured. We have to do surgery either by trans cranial or endoscopic repair of CSF rhinorrhea.
 Conclusion: CSF rhinorrhea is best cured by conservative management except in 4% of cases.