Local Trauma Research Articles

Case Study: The Application of Extracorporeal Shockwave Therapy (ESWT) and Active Finger Blocking Exercise on Movement and Function of Fingers Disorders Caused by Trigger the 4th Finger Dextra

Background: Trigger finger also referred to as stenosing tenosynovitis. It is a traumatic condition that involves the formation of nodules in the tendons of flexor digitorium muscle due to a combination of repetitive finger movements or local trauma and impaired healing, as a result of which the affected finger is locked in either a flexed or extended position thereby impeding movement. Objective: This case study was aimed to determine the effect of extracorporeal shockwave therapy, and active finger blocking exercise in one women patient, aged 47 years old with diagnosed of trigger the 4th finger dextra. Methods: This case studies have been carried out 6 times for 2 weeks in one women patient, by evaluating the degree of pain by using the Visual Analogue Scale (VAS), Joint Range of Motion (RoM) by using a goniometer and functional activity ability hands with the Disability of the Arm, Shoulder and Hand (DASH) questionnaire. Results: There was a decrease in the motion pain degree from VAS 7 to VAS 4, and the degree of tenderness pain from VAS 5 to VAS 2. There was an increase active flexion-extension movement of the 4th finger dextra from (S)=25°-0°-50° to (S)=40°-0°-75°, while passive movement from (S)=30°-0 °-60° to (S)=40°-0°-75°. There was a decrease in the value of hand disabilities based on the results of the DASH questionnaire from 24% to 21%. Conclusion: The application of extracorporeal shockwave therapy and active finger blocking exercise can reduce the pain, increase the range of motion and functional abilities patient diagnosed Trigger the 4th Finger condition.

998 Distal Radius Fractures – Assessing Time to Surgery

Abstract Background The British Orthopaedic Association Standards for Trauma (BOAST guidelines) recommend that intra-articular distal radius fractures should be operated within 3 days and extra-articular fractures within 7 days of a decision to operate (1). Aim The objectives of this audit were to assess compliance with BOAST guidelines for operative management of distal radius fractures within a local trauma unit. Method Three audit cycles were completed between 2018 and 2021 over 3 -4-month periods. The second and third cycles were completed after elective orthopaedic cases were moved to an elective orthopaedic centre, and commencement of a weekly half day dedicated hand trauma list. All skeletally mature patients with acute distal radius fractures were included. Results Despite the addition of a dedicated hand trauma list and elective services moving to a dedicated site, compliance with BOAST guidelines remained almost unchanged. Compliance was at 100% for extra-articular fractures. However, for intra-articular fractures, compliance only slightly improved from 50 % to 53.3%. The average time to surgery improved from 4.25 days to 3.66 days for intra-articular fractures. Average time to surgery for extra-articular fractures was 3 days. Proposed reasons for delay included lack of trauma theatre time, prioritisation of other urgent cases such as femur fractures and lack of appropriate surgeon. Conclusions No distinction was being made to prioritise intra-articular distal radius fractures over extra-articular fractures for surgery. Trauma and Orthopaedic (T&O) staff have been educated and changes made to the T&O department’s trauma database to resolve this.

Idiopathic Palatal Fistula of the Left Soft Palate.

Palatal fistulas, often congenital or trauma-induced, are occasionally encountered in the field of plastic surgery. We report a case of a non-medial 3mm soft palate fistula in a 43-year-old woman, with no apparent trigger or history of local trauma or infection. The fistula, extending 2cm toward the lateral pharyngeal wall, was surgically removed under general anesthesia as it was impacting the patient's quality of life. The lumen was stained, and the fistula was removed in one mass. The excised tissue was covered with stratified squamous epithelium and was surrounded by adherent tonsil tissue. No recurrence was observed postoperatively. Despite an initial suspicion of a congenital cause, the fistula's lateral extension and histology suggested a possible origin from the second pharyngeal pouch. To date, there are no reports of fistulas opening on the soft palate. Therefore, this presents an exceptionally rare instance of a soft palate fistula.

Value of indomethacin suppository for preoperative analgesia and anti-inflammation in laparoscopic appendectomy: a protocol of prospective, double-blinded, single-centre, randomised controlled trial in China

IntroductionPostoperative pain has always been a problem for patients and surgeons. Local inflammation, surgical trauma and pain in the body can cause a systemic stress response and immune imbalance, which...

Non-tuberculous mycobacterial skin and soft tissue infections in the Northern Territory, Australia, 1989-2021

BackgroundA previous review demonstrated that the majority of NTM infections in the Northern Territory (NT) are pulmonary in nature [1], however skin and soft tissue (SST) are likely the next most common sites of disease. The current epidemiology of NTM SST infections across the NT is not known. We aimed to establish the current and historical incidence rates, and the organisms involved. MethodsAll NTM cases reported to the Centre for Disease Control in Darwin from 1989-2021 were retrospectively reviewed. Results226 NTM notifications were reviewed. 73 (32%) cases were SST infections. The incidence of SST cases increased over the study period. Female cases were more common (p=0·002). Disease occurred across a wide age range (1-85 years). Only 16% of cases occurred in Aboriginal individuals which may reflect immunological factors requiring further investigation. Many cases had no clear provocation, but localised skin trauma was the most common risk factor. The most common organism identified was M. fortuitum (41%). Diagnosis was often delayed, with a median time to diagnosis of 69 days (IQR=31-149). Most cases (60%) underwent surgical intervention with adjunctive anti-mycobacterial medical therapy. ConclusionNTM SST incidence rates increased over the study period. NTM SST infections are a rare but important differential diagnosis for non-healing cutaneous wounds.

BH05 Successful treatment of acrodermatitis continua of Hallopeau with methotrexate

Abstract A 39-year-old woman was referred with a 3-month history of brittle nails, painful fingertips and psoriasiform plaques affecting her torso and limbs. She had a past medical history of macrocytic anaemia secondary to dietary B12 and folate deficiencies, which required inpatient transfusions. She had no previous dermatological concerns, and there was no history of infection or trauma to the affected sites. On examination of her hands and feet, there was evidence of nailbed pustulation, subungual hyperkeratosis, onychodystrophy, anonychia of multiple nails and dactylitis, consistent with acrodermatitis continua of Hallopeau (ACH) with associated psoriasis. At diagnosis, the patient’s Dermatology Life Quality Index (DLQI) was 16, she had a Psoriasis Area and Severity Index (PASI) score of 18 and a Psoriasis Epidemiology Screening Tool (PEST) score of 4. Nail fungal culture was negative. Plain radiographs of the hands and feet demonstrated a flexion deformity of the left fifth finger distal interphalangeal joint, with otherwise normal bone texture, alignment and joint spaces. The patient was initially treated with potent topical corticosteroids and vitamin D analogues, with little improvement. The patient was commenced on 15 mg subcutaneous methotrexate (MTX), with close monitoring of serum and red cell folate given her background of folate deficiency, which was being actively replaced. Within 3 months of starting MTX monotherapy, the patient’s hands had dramatically improved with skin and fingernail changes largely resolved, and an improvement in manual dexterity (DLQI 11, PASI 3, PEST 5). MTX was increased to 20 mg once weekly and the patient was also started on sulfasalazine 500 mg twice daily by her rheumatologist for psoriatic arthritis. ACH is a chronic pustular eruption initially affecting distal phalanges with gradual proximal progression and the potential development of generalized pustular psoriasis. ACH is considered a variant of palmoplantar pustulosis, commonly affecting adult females with localized trauma and infection as possible triggers. Given the rarity of ACH, the evidence base for therapy is limited to case reports and series, with no standardized treatment guidelines. Topical therapies include corticosteroids, calcineurin inhibitors and vitamin D analogues. Local phototherapy and systemic therapy with acitretin, MTX and ciclosporin have been described, with wide-ranging results. In severe cases such as this, patients typically receive biologic therapy, with variable responses reported with tumour necrosis factor-α inhibitors, anti-interleukin (IL)-6 therapy, and anti-IL-12/IL-23 and anti-IL-17 therapy. We present a rare case of severe ACH and psoriasis, treated with MTX monotherapy, which was not only clinically effective but also cost-effective.

107-LB: Clinical Performance of Extended Mio 30 Infusion Set

Objective: Medtronic Mio™ 30 infusion set (M30IS) is a single use IS for pump users with pre-loaded inserter, a 30° insertion angle, and labeled for 3-day use. The M30IS wear duration is impacted by initial local trauma caused by insertion and sustained inflammation by cannula & insulin infusion (insulin aggregates & other impurities in the infusate), with the latter being predominant. An extended Mio™ 30 infusion set (EM30IS) was developed by improving insulin formulation stability in the fluid path. This study reports on the performance of the EM30IS in persons with T1D during an early feasibility trial (ClinicalTrials.gov: NCT05544643). Method: This is a X over study of EM30IS and M30IS on 21 subjects with type 1 diabetes. Each subject wore both sets 4-5 times each on a preferred site that was continuously infused with insulin lispro or aspart subcutaneously via a Medtronic 780G pump for 3 days (M30IS), 7 days (EM30IS) or until failure. Endpoints of safety and effectiveness (failure rate due to unexplained hyperglycemia <16%) were evaluated. Exploratory analyses related to performance and glycemic control were also evaluated. Results: The EM30IS survival rate at 6 days (70%) was comparable to M30IS survival rate at 3 days (63%). Glycemic control outcomes were equivalent (see Table 1) and there were no episodes of EM30IS-related severe hypoglycemia or DKA. Conclusion: The EM30IS was safe and its performance at 6 days was equivalent to the performance of M30IS at 3 days. Disclosure O. Cohen: Employee; Medtronic. Y. Cohen: None. S. Chattaraj: Employee; Medtronic. G. Zhang: Employee; Medtronic. E. Anselmo: Employee; Medtronic. A. Tirosh: Advisory Panel; Medtronic. Research Support; Medtronic. Speaker's Bureau; Medtronic. Advisory Panel; Novo Nordisk. Speaker's Bureau; Novo Nordisk. Advisory Panel; Sanofi. Speaker's Bureau; Sanofi. Research Support; Sanofi. Advisory Panel; Eli Lilly and Company. Speaker's Bureau; Eli Lilly and Company. Funding Medtronic

Merging of two level-1 trauma centers in Amsterdam: premerger demand in integrated acute trauma care

PurposeAvailability of adequate and appropriate trauma care is essential. A merger of two Dutch academic level-1 trauma centers is upcoming. However, in the literature, volume effects after a merger are inconclusive. This study aimed to examine the premerger demand for level-1 trauma care on integrated acute trauma care and evaluate the expected demand on the system.MethodsA retrospective observational study was conducted between 1-1-2018 and 1-1-2019 in two level-1 trauma centers in the Amsterdam region using data derived from the local trauma registries and electronic patient records. All trauma patients presented at both centers’ Emergency Departments (ED) were included. Patient- and injury characteristics and data concerning all prehospital and in-hospital-delivered trauma care were collected and compared. Pragmatically, the demand for trauma care in the post-merger setting was considered a sum of care demand for both centers.ResultsIn total, 8277 trauma patients were presented at both EDs, 4996 (60.4%) at location A and 3281 (39.6%) at location B. Overall, 462 patients were considered severely injured patients (Injury Severity Score ≥ 16). In total, 702 emergency surgeries (< 24 h) were performed, and 442 patients were admitted to the ICU. The sum care demand of both centers resulted in a 167.4% increase in trauma patients and a 151.1% increase in severely injured patients. Moreover, on 96 occasions annually, two or more patients within the same hour would require advanced trauma resuscitation by a specialized team or emergency surgery.ConclusionA merger of two Dutch level-1 trauma centers would, in this scenario, result in a more than 150% increase in the post-merger setting’s demand for integrated acute trauma care.

TNFα-dependent mTOR activity is required for tenotomy-induced ectopic ossification in mice.

Ectopic ossifications often occur in skeletal muscles or tendons following local trauma or internal hemorrhage, and occasionally cause severe pain that limits activities of daily living. However, mechanisms underlying their development remain unknown. The right Achilles tendon in 8-week-old female or male mice was dissected. Some mice were injected intraperitoneally either with phosphate-buffered saline, dimethyl sulfoxide, cimetidine, rapamycin, celecoxib or loxoprofen for 10 weeks. One week after surgery, immunohistochemical analysis was performed for mTOR, TNFα or F4/80. Ten weeks after surgery, ectopic ossification at the tenotomy site was detected by 3D micro-CT. Ectopic ossification was seen at dissection sites in all wild-type mice by dissection of the Achilles tendon. mTOR activation was detected at dissection sites, and development of ectopic ossification was significantly inhibited by administration of rapamycin, an mTOR inhibitor, to wild-type mice. Moreover, administration of the histamine 2 blocker cimetidine, which reportedly inhibits ectopic ossification in tendons, was not effective in inhibiting ectopic ossification in our models. TNFα-expressing F4/80-positive macrophages accumulate at dissection sites and that ectopic ossification of the Achilles tendon dissection was significantly inhibited in TNFα-deficient mice in vivo. Ectopic ossification is significantly inhibited by administration of either celecoxib or loxoprofen, both anti-inflammatory agents, in wild-type mice. mTOR activation by Achilles tendon tenotomy is inhibited in TNFα-deficient mice. The TNFα-mTOR axis could be targeted therapeutically to prevent trauma-induced ectopic ossification in tendons.

Vertical Rectus Abdominis Myocutaneous Flap for Reconstruction of Forequarter Amputation Defect after Shoulder Soft Tissue Sarcoma Resection: Technical Consideration

Summary: Forequarter amputations in advanced local malignancy or trauma cases often leave a large defect that is challenging to reconstruct. Options for defect closure are varied. A vertical rectus abdominis myocutaneous (VRAM) flap could be an alternative to close a significantly large defect, which is relatively easier than the more technically demanding free flap. This case presents a 64-year-old man with a soft tissue sarcoma in the left shoulder that was treated by forequarter amputation and subsequent defect closure using a VRAM flap. The VRAM flap was initially used to reconstruct the chest and abdominal walls. There have been no reported uses for the shoulder defect. The repair site defect was viable even with a less aesthetic donor site, and all of the defects were closed without any signs of infection. The VRAM flap is a good option for a large defect closure at the shoulder region, particularly after forequarter amputation.

Papillary Endothelial Hyperplasia

A man in his 30s had a unilateral mass of the epididymis. There was no prior history of local trauma, and ultrasonographic imaging did not reveal the presence of any other testicular abnormality. A 1.4-cm unilocular cystic lesion was excised. Histopathologic examination showed the presence of blood vessels with organizing thrombi adjacent to the epididymis (Figure 1A, B ). On microscopic examination, several foci of proliferative clusters of cells with epithelioid to vaguely spindled morphology were identified (Figure 1C, D). What is the lineage of the epithelioid cells, and is this lesion benign or malignant?a.Vascular lineage, malignant (angiosarcoma)b.Carcinoma, malignantc.Vascular lineage, benign (papillary endothelial hyperplasia)d.Melanoma, malignant Answer: c. Vascular lineage, benign (papillary endothelial hyperplasia) The images show the presence of an intravascular lesion with organizing thrombus that is broken down into collagenized clumps admixed with hemorrhagic material (Figure 2A, B ). These collagenized clusters are lined by vascular endothelial cells, and immunohistochemistry for ERG and CD31 confirms vascular lineage (Figure 2C, D). These findings are consistent with papillary endothelial hyperplasia.1Akdur N.C. Donmez M. Gozel S. Ustun H. Hucumenoglu S. Intravascular papillary endothelial hyperplasia: histomorphological and immunohistochemical features.Diagn Pathol. 2013; 8: 167Crossref PubMed Scopus (51) Google Scholar Papillary endothelial hyperplasia is thought to represent breakdown of intravascular thrombi with accompanying ingrowth of vascular endothelial cells along the edges of thrombotic material. In late stages, as in this case, these lesions may impart an appearance of a papillary lesion with an anastomotic network of vascular endothelial cells that is frequently misinterpreted as an angiosarcoma. However, in contrast to angiosarcoma, these lesions are almost always exclusively intravascular and lack infiltrative growth. Infrequently, papillary endothelial hyperplasia may be recognized in an extravascular location secondary to rupture or as part of organization of an extravascular hematoma. These lesions exhibit minimal nuclear pleomorphism, mitotic activity, or necrosis. Finally, papillary endothelial hyperplasia has an excellent prognosis and does not recur when completely excised.

Myositis Ossificans of the Breast Mimicking Breast Cancer: A Case Report

Myositis ossificans (MO) is an uncommon tumor characterized by a rapidly growing mass following a history of local trauma. Few cases of MO affecting the breast have been reported, and some were misdiagnosed as primary osteosarcoma of the breast or metaplastic breast carcinoma. The following case report presents a patient with a growing breast lump whose core biopsy result was suspicious for breast cancer. MO was diagnosed after analysis of the mastectomy specimen. This case highlights the importance of MO as a differential diagnosis of a growing soft-tissue mass after trauma to avoid unnecessary overtreatment. Keywords: Myositis Ossificans, Osteosarcoma, Breast Cancer, Mastectomy, Heterotopic Ossification © RSNA, 2023

Injuries related to sauna bathing

PurposeAwareness of well-being and health issues have contributed to increased popularity of sauna bathing. However, little is known about potential risks and injuries. The aim of this study was to identify the causes for injuries, the affected body regions and to define recommendations for prevention. MethodsA retrospective chart data analysis was conducted among patients treated for an injury related to sauna bathing at the local trauma centre of the Medical University of Innsbruck between January 1, 2005 and December 31, 2021. Patients’ demographics, the cause for the injury, the diagnosis, the body region of the trauma and the treatment methods were collected. ResultsTwo hundred and nine patients with injuries related to sauna bathing (83 female [39.7%] and 126 male [60.3%]) were identified. Fifty-one patients showed more than one injuries leading to a total of 274 diagnosis: contusions/distorsions (113; 41.2%), wounds (79; 28.8%), fractures (42; 15.3%), ligament injuries (17; 6.2%), concussions (15; 5.5%), burns (4; 1.5%) and brain bleeding (3; 1.1%). The most common cause for an injury was a slip/fall (157; 57.5%) followed by dizziness/syncope (82; 30.0%). Interestingly, head and face injuries were mostly caused by dizziness/syncope, whereas slip/fall was the leading cause for injuries of foot, hand, forearm and wrist. Nine patients(4.3%) needed surgical treatment mainly due to fractures. Eight patients got injured by wood splinters. One patient sustained grade IIB-III burns lying unconscious with an alcohol intoxication of 3.6‰ in the sauna. ConclusionThe main causes for injuries during sauna bathing were slip/falls and dizziness/syncopes. The latter one might be prevented by improved of the personal behaviour (e.g. drink enough water before and after each sauna bathing), whereas slip/falls might be prevented by the revision of safety regulations, particularly the obligation to wear slip resistant slippers. Thus, everyone himself as well as the operators can contribute to reduce injuries related sauna bathing.

Atypical Presentation Delays Treatment of Pediatric Testicular Torsion.

The aim of the study is to identify patient- and care-related factors associated with time to treatment for acute testicular torsion and the likelihood of testicular loss. Data were retrospectively collected for patients 18 years and younger who had surgery for acute testicular torsion between April 1, 2005, and September 1, 2021. Atypical symptoms and history were defined as having abdominal, leg, or flank pain, dysuria, urinary frequency, local trauma, or not having testicular pain. The primary outcome was testicular loss. The primary process measure was time from emergency department (ED) triage to surgery. One hundred eleven patients were included in descriptive analysis. The rate of testicular loss was 35%. Forty-one percent of all patients reported atypical symptoms or history. Eighty-four patients had adequate data to calculate time from symptom onset to surgery and time from triage to surgery and were included in analyses of factors affecting risk of testicular loss. Sixty-eight patients had adequate data to evaluate all care-related time points and were included in analyses to determine factors affecting time from ED triage to surgery. On multivariable regression analyses, increased risk of testicular loss was associated with younger age and longer time from symptom onset to ED triage, while longer time from triage to surgery was associated with reporting atypical symptoms or history.The most frequently reported atypical symptom was abdominal pain, in 26% of patients. These patients were more likely to have nausea and/or vomiting and abdominal tenderness but equally likely to report testicular pain and swelling and have testicular findings on examination. Patients presenting to the ED with acute testicular torsion reporting atypical symptoms or history experience slower transit from arrival in the ED to operative management and may be at greater risk of testicular loss. Increased awareness of atypical presentations of pediatric acute testicular torsion may improve time to treatment.

Less Is Better: Full-Incision Double-Eyelid Blepharoplasty with Rapid Recovery.

Full-incision double-eyelid blepharoplasty is effective, but postoperative complications, such as local trauma and persistent tissue swelling, are major concerns. Because tissue swelling is caused by the obstruction of blood and lymphatic flow, the authors modified the conventional full-incision method to minimize the trauma as much as possible. Twenty-five patients underwent the modified procedure. There was minor swelling immediately after the surgery, which subsided 1 to 5 days after the surgery. No patient reported loss of the double eyelid crease. Only 2 patients underwent a second operation because of a low crease. Satisfactory results were obtained in 92% of patients (23 of 25). According to our understanding of this technique, less trauma is the key to obtaining better results under certain conditions.

PERIPHERAL OSSIFYING FIBROMA- A CASE REPORT

Peripheral ossifying broma (POF) is a reactive soft tissue growth that is usually seen on the interdental papilla and reactive in nature. It is considered a metaplastic process which involves the periodontal ligament in response to local irritants or trauma, such as biolm, calculus, unsatisfactory restorations, and poorly adapted prostheses. Here presenting a case of 34-year-old female patient with diagnosis and management of peripheral-ossifyingbroma with 6 month follow up.

Endoscopic management of tracheoesophageal prosthesis-induced esophageal mucosal bridge.

Esophageal mucosal bridge (EMB) is a rare, often incidental finding encountered during esophagogastroduodenoscopy (EGD). It can be of congenital origin, or occur secondarily to local esophageal trauma, radiation therapy, and various inflammatory conditions involving the esophageal mucosa [1]. While mostly asymptomatic, EMB can often result in dysphagia by causing luminal obstruction. We present a case of symptomatic EMB secondary to long-standing tracheoesophageal voice prosthesis (TEVP) that was successfully treated with endoscopic resection using a scissor-type dissection knife.

Development of hemodynamically relevant acquired arterio-venous fistulae in patients with venous malformations.

Venous malformations tend to retain their slow-flow behavior, even in progressive disease or regression following therapy. The aim of this study is to analyze the development of acquired hemodynamic relevant arterio-venous fistulae in patients with slow-flow malformations. This study is a retrospective analysis based on a consecutive local registry at a tertiary care Interdisciplinary Center for Vascular Anomalies. Patients with venous malformations and development of secondary arterio-venous fistulae were included. Indications for therapy of the vascular malformation were based on patients' symptoms and complications. The following endpoints were of clinical interest and were assessed: origin of development of arteriovenous fistula, development of secondary comorbidities as a result of the vascular malformation. For analysis we focused on descriptive statistics. Out of 1213 consecutive patients with vascular malformations, in 6 patients perfusion changed from slow flow to arterio-venous fast-flow patterns. Four patients developed the fistula after local trauma in the area of the malformation, the other 2 patients developed the fistula due to progression of the disease and recurrent thrombophlebitis. These 2 patients had no trauma or interventions at the time of arterio-venous fistula development. Acquired arterio-venous fast-flow fistula in patients with slow flow vascular malformation is very rare and might be a result of local trauma or the progression of the disease with recurrent thrombophlebitis. Specific evidence-based treatment options for these patients do not exist.

Characteristics and Clinical Outcomes of Elderly Patients with Trauma Treated in a Local Trauma Center

Purpose: This study aimed to investigate the characteristics of elderly patients who visited a non-regional trauma center to examine the effects of old age on the clinical outcomes of patients.Methods: The medical charts of 159 patients with trauma who visited the National Health Insurance Service Ilsan Hospital between March 2020 and February 2022 were retrospectively analyzed.Results: Of the 159 patients, 41 were assigned to the elderly patient group (EPG) and 118 were assigned to the non-elderly patient group (NEPG). The average age of patients in each group was 75.5 and 38.2 years in the EPG and the NEPG, respectively. Comparing the injury mechanism between the two groups, pedestrian traffic accidents (TA) were the most common (24.4%), followed by slipping (19.5%), motorcycle TA, and bicycle TA (14.6%) in EPG. In the NEPG, motorcycle TA (28.0%) was the most common, followed by car TA (27.1%), and fall injury (16.9%), with a significant difference between the two groups (&lt;i&gt;p&lt;/i&gt; &lt; 0.001). The significant differences between the two groups were the injury severity score (ISS; &lt;i&gt;p&lt;/i&gt; = 0.004), severe trauma (&lt;i&gt;p&lt;/i&gt; = 0.045), intensive care unit admission (&lt;i&gt;p&lt;/i&gt; = 0.028), emergency operation (&lt;i&gt;p&lt;/i&gt; = 0.034), and mortality (&lt;i&gt;p&lt;/i&gt; = 0.013). The statistically significant risk factors for mortality were old age (&lt;i&gt;p&lt;/i&gt; = 0.024) and chest injury (&lt;i&gt;p&lt;/i&gt; = 0.013).Conclusion: Patients in the EPG compared with the NEPG group showed different injury mechanisms. The EPG has a higher severity and mortality rate than the NEPG.

Pyogenic granuloma in a 6-year-old boy - a rare case report

The gingiva, also known as the gums, is the pink-coloured keratinized mucosa that surrounds and protects the teeth. Gingival enlargement or gingival overgrowth, a common trait of gingival disease, is characterized by an increase in the size of gingiva. Irritation fibroma is an exophytic soft tissue mass in the oral mucosa. Indeed, it is not a real neoplasm, but a focal hyperplasia of fibrous connective tissue induced by local trauma or chronic irritation. Pyogenic granuloma is one of the inflammatory hyperplasia seen in the oral cavity, majority are found on the marginal gingiva with only 15% of the tumours on the alveolar part. It predominantly occurs in the second decade of life in young females, male to female ratio is 1:99, and size of lesion varies in diameter from few millimetres to several centimetres. This article presents a case of pyogenic granuloma in an 6year old boy who presented with a gingival overgrowth in his mandibular left buccal surface region i.r.t 31 including marginal and attached gingiva. He had discomfort during mastication, interferes with occlusion there was episode of bleeding during brushing. The lesion was excised and histopathological report confirmed the diagnosis. Case was followed up for six months and no recurrence of the lesion. Etiological factors, clinical features, differential diagnosis and different treatment options are discussed based on the review of current literature available.