Management Of Injuries Research Articles

Epidemiology of High-Energy Distal Radius Fractures.

Background: High-energy distal radius fractures have not been as well studied as the more common osteoporotic fractures. Differences between these two groups of fractures have implications on the prevention and clinical management of such injuries. Methods: A retrospective review was conducted of all patients in our institution who presented with distal radius fractures within the period of a year. Demographic data, injury mechanism, fracture classification, associated injuries and work-related status were obtained and analysed. Results: High energy fractures made up 27.1% of the cases. Falls from height were the most common cause, followed by motor vehicle accidents. These high-energy fractures were more commonly seen in males, younger patients (average age 41 vs. 61 years), and in workplace accidents. These injuries were also more likely to be bilateral and associated with an additional ipsilateral upper extremity injury. The high-energy group was also more likely to have an AO type B fracture. Conclusions: A substantial proportion of distal radius fractures seen in our population are high-energy injuries. Their contrasting patient and injury profiles suggest that they should be considered separately from osteoporotic fractures. Level of Evidence: Level IV (Therapeutic).

The optimal management of blunt aortic injury in the young

BackgroundBlunt aortic injury (BAI) is relatively uncommon in the pediatric population. The goal of this study was to examine the management of BAI in both children and adolescents, using a large national dataset. MethodsPatients (1–19 years of age) with BAI were identified from the Trauma Quality Improvement Program (TQIP) database over 14-years. Patients were stratified by age group (children [ages 1–9] and adolescents [ages 10–19]) and compared. Multivariable logistic regression (MLR) analysis was performed to determine independent predictors of mortality in adolescents with BAI. ResultsAdolescents undergoing TEVAR had similar morbidity (16.8 vs 12.6 ​%, p ​= ​0.057) and significantly reduced mortality (2.1 vs 14.4 ​%, p ​< ​0.0001) compared to those adolescents managed non-operatively. MLR identified use of TEVAR as the only modifiable risk factor significantly associated with reduced mortality (OR 0.138; 95%CI 0.059–0.324, p ​< ​0.0001). ConclusionsBAI leads to significant morbidity and mortality for both children and adolescents. For pediatric patients with BAI, children may be safely managed non-operatively, while an endovascular repair may improve outcomes for adolescents.

Cognitive status, psychological state and needs of caregivers for elderly patients with home-induced pressure injuries: a qualitative study.

Aims/Background Pressure injury stands as a global healthcare concern, primarily affecting elderly individuals. As the ageing of the global population shows no signs of slowing down, both society and the families of the affected individuals continue to bear the brunt of the consequences of pressure injuries. The majority of pressure injury cases are managed at home, and the occurrence and progression of pressure injuries in the elderly are closely associated with informal caregivers. This study aims to qualitatively explore the cognitive status of caregivers for elderly patients with home-induced pressure injuries, as well as their psychological state and needs during the caregiving process. Methods This research is qualitative, descriptive, and phenomenological in nature. A purposive sampling method was used. Eighteen caregivers of elderly patients with pressure injuries were selected from Jiangnan University Medical Centre as interviewees from June 2023 to August 2023. Semi-structured interviews were utilised to collect data regarding the caregivers' cognition, psychological state, and care-related needs while caring for elderly patients with home-induced pressure injuries. The data were then organised and analysed using Colaizzi's phenomenological analysis method and NVivo 11.0. Results Through the analysis of interview data from caregivers of elderly patients with home-induced pressure injuries, three main themes and nine subthemes were identified. The data analysis also revealed that the caregivers surveyed lacked the crucial awareness of preventing pressure injuries and that their caregiving practices were not up to standards. During the caregiving process, they were challenged with substantial stress while also experiencing negative emotions such as anxiety or depression. They had a strong desire for persistent medical support to alleviate the psychological and emotional challenges. Conclusion The findings of this study establish a collaborative relationship network among the hospitals, family, medical staff, and caregivers in the management of pressure injuries, but with a special attention to the caregivers' needs for disease-related knowledge and psychophysical support. Such relationships streamline communication between medical staff, patients, and their caregivers, facilitating the adoption of active and correct methods by caregivers to prevent and care for pressure injuries. This can positively impact the quality of care for pressure injuries, further improving the life quality of patients and their caregivers, controlling the incidence of pressure injuries, and reducing readmission rates.

Generation and content validation of physical and vocational rehabilitation in paraplegics: An interview guide

BACKGROUND: As the mainstay treatment for paraplegics is rehabilitation, patient satisfaction and experience are important predictors of the care being provided. To understand whether the current arrangements of rehabilitation services are sufficient to help an individual with paraplegia return to a productive life. Patient-centered interview guides to explore their rehabilitation experience are lacking, which calls for a generation of the same. OBJECTIVE: To generate and validate an interview guide (PVR-PIG), which aims at understanding and exploring the experience of physical and vocational rehabilitation for individuals with paraplegia. METHODS: After an extensive literature search, an initial 27-item interview guide was formulated under three domains: general experience and expectations from rehabilitation care; physical rehabilitation experience, barriers, and facilitators; and vocational rehabilitation. Later, it was sent for content validation to a multidisciplinary expert panel with prior experience in spinal cord injury (SCI) management. RESULTS: After suggestions were received from nine experts with an average of 14 years of experience in dealing with SCI, a 15-item interview guide was finalized, with a scale-level and item-level content validity index of 0.897 and 0.78–1, respectively. CONCLUSION: The generated interview guide (PVR-PIG) aimed to explore physical and vocational rehabilitation experiences in paraplegics was found to be valid.

CNS and Thorax Injury and Associated Risks Factors in Equestrian Sports.

Equestrian sports continue to gain popularity in the United States and are associated with a high injury rate, especially involving the central nervous system and thorax. Due to this high rate of injury and the potential for long-term consequences associated with participation, an understanding of the unique risks of this sport is needed. To describe severe injury in equestrian sports and review the role that protective gear plays in injury mitigation. The PubMed Database was searched using the search terms "equestrian" and "horse" combined with "spinal cord injury," "head injury," "traumatic brain injury," "experience levels," and "demographics." A total of 53 papers were selected based on their relevance of epidemiology, risk factors, and management of injuries sustained during equestrian activities. Case studies, randomized controlled trials, prospective studies, and retrospective studies were all included for further review. Systematic review. Level 4. None. Injuries to the thorax, including fractures, pneumothoraces, internal organ contusions, and crush injuries, have been cited in multiple national and international trauma registries as the most prevalent injury location in equestrians; however, head and neck injuries, high cervical spine fractures, and closed head injuries are reported to be associated with the highest rates of mortality. Helmets provide protection against skull fracture and traumatic brain injury. Vests were not associated with diminished rates of spinal cord injuries; however, they may provide protection to the thorax. Riding experience also plays a role in reducing the prevalence of injury. Equestrian-related activities are associated with a high risk of injury despite protective measures. Protective gear can mitigate some injury risk but does not protect against spinal injury. Continued investigation into improving protective equipment, rider education, and preventative strategies to mitigate this risk is needed.

Identification and verification of disulfidptosis-related genes in sepsis-induced acute lung injury.

Sepsis-induced acute lung injury (ALI) is a common and serious complication of sepsis that eventually progresses to life-threatening hypoxemia. Disulfidptosis is a newly discovered type of cell death associated with the pathogenesis of different diseases. This study investigated the potential association between sepsis-induced acute lung injury and disulfidptosis by bioinformatics analysis. In order to identify differentially expressed genes (DEGs) linked to sepsis, we screened appropriate data sets from the GEO database and carried out differential analysis. The key genes shared by DEGs and 39 disulfidptosis-related genes were identified: ACSL4 and MYL6 mRNA levels of key genes were detected in different datasets. We then used a series of bioinformatics analysis techniques, such as immune cell infiltration analysis, protein-protein interaction (PPI) network, genetic regulatory network, and receiver operating characteristic (ROC), to investigate the possible relationship between key genes and sepsis. Then, experimental verification was obtained for changes in key genes in sepsis-induced acute lung injury. Finally, to investigate the relationship between genetic variants of MYL6 or ACSL4 and sepsis, Mendelian randomization (MR) analysis was applied. Two key genes were found in this investigation: myosin light chain 6 (MYL6) and Acyl-CoA synthetase long-chain family member 4 (ACSL4). We verified increased mRNA levels of key genes in training datasets. Immune cell infiltration analysis showed that key genes were associated with multiple immune cell levels. Building the PPI network between MYL6 and ACSL4 allowed us to determine that their related genes had distinct biological functions. The co-expression genes of key genes were involved in different genetic regulatory networks. In addition, both the training and validation datasets confirmed the diagnostic capabilities of key genes by using ROC curves. Additionally, both in vivo and in vitro experiments confirmed that the mRNA levels of ACSL4 and MYL6 in sepsis-induced acute lung injury were consistent with the results of bioinformatics analysis. Finally, MR analysis revealed a causal relationship between MYL6 and sepsis. We have discovered and confirmed that the key genes ACSL4 and MYL6, which are linked to disulfidptosis in sepsis-induced acute lung injury, may be useful in the diagnosis and management of septic acute lung injury.

Can Radiological Imaging Accurately Predict the Length of the Ureteral Defect/Stricture Following Ureteral Injury?

The incidence of ureteral injury is increasing due to extensive application of the endourological procedures. In the present study, we evaluated the accuracy of imaging studies in predicting length of defect in patients with ureteral injury. We reviewed data of all consecutive patients who underwent endourological management for ureteral injury in our institution from Jan 2020 to Jan 2023, to assess the accuracy of radiological evaluations in determining the length of ureteral defect. We compared the radiological imaging results with intraoperative findings to determine its diagnostic accuracy. We report data on accuracy of preoperative imaging and outcomes of endourological management in 5 patients who presented with apparently long ureteral defects in preoperative radiological evaluations following ureteral injury. The mean age was 42[30.5-42.5]. three of five were male. The mean time from injury to ureteroscopic management was 12.5±7.5 days. The mean follow up time was 7.3±2.2 months. Our experience showed that radiological evaluations have the potential to overestimate the length of defect. Radiological evaluations following ureteral injury have the potential to overestimate the length of defect and therefore endoscopic evaluations and intraoperative imaging studies are necessary to accurately determine the length of defect and appropriate management. However, endourological management is safe and efficient in treating patients with short segment ureteral defect/injury.

Outcomes of Patients With Traumatic Brain Injury Transferred to Trauma Centers

Wide variations exist in traumatic brain injury (TBI) management strategies and transfer guidelines across the country. To assess the outcomes of patients with TBI transferred to the American College of Surgeons (ACS) level I (LI) or level II (LII) trauma centers (TCs) on a nationwide scale. In this secondary analysis of the ACS Trauma Quality Improvement Program database (2017 to 2020), adult patients with isolated TBI (nonhead abbreviated injury scale = 0) with intracranial hemorrhage (ICH) who were transferred to LI/LII TCs we re included. Data were analyzed from January 1, 2017, through December 31, 2020. Outcomes were rates of head computed tomography scans, neurosurgical interventions (cerebral monitors, craniotomy/craniectomy), hospital length of stay, and mortality. Descriptive statistics and hierarchical mixed-model regression analyses were performed. Of 117 651 patients with TBI with ICH managed at LI/LII TCs 53 108; (45.1%; 95% CI, 44.8%-45.4%) transferred from other centers were identified. The mean (SD) age was 61 (22) years and 30 692 were male (58%). The median (IQR) Glasgow Coma Scale score on arrival was 15 (14-15); 5272 patients had a Glasgow Coma Scale score of 8 or less on arrival at the receiving trauma center (10%). A total of 30 973 patients underwent head CT scans (58%) and 2144 underwent repeat head CT scans at the receiving TC (4%). There were 2124 patients who received cerebral monitors (4%), 6862 underwent craniotomy/craniectomy (13%), and 7487 received mechanical ventilation (14%). The median (IQR) hospital length of stay was 2 (1-5) days and the mortality rate was 6.5%. There were 9005 patients (17%) who were discharged within 24 hours and 19 421 (37%) who were discharged within 48 hours of admission without undergoing any neurosurgical intervention. Wide variations between and within trauma centers in terms of outcomes were observed in mixed-model analysis. In this study, nearly half of the patients with TBI managed at LI/LII TCs were transferred from lower-level hospitals. Over one-third of these transferred patients were discharged within 48 hours without any interventions. These findings indicate the need for systemwide guidelines to improve health care resource use and guide triage of patients with TBI.

Understanding fluid dynamics and renal perfusion in acute kidney injury management.

Acute kidney injury (AKI) is associated with an increased risk of morbidity, mortality, and healthcare expenditure, posing a major challenge in clinical practice, and affecting about 50% of patients in the intensive care unit (ICU), particularly the elderly and those with pre-existing chronic comorbidities. In health, intra-renal blood flow is maintained and auto-regulated within a wide range of renal perfusion pressures (60-100 mmHg), mediated predominantly through changes in pre-glomerular vascular tone of the afferent arteriole in response to changes of the intratubular NaCl concentration, i.e. tubuloglomerular feedback. Several neurohormonal processes contribute to regulation of the renal microcirculation, including the sympathetic nervous system, vasodilators such as nitric oxide and prostaglandin E2, and vasoconstrictors such as endothelin, angiotensin II and adenosine. The most common risk factors for AKI include volume depletion, haemodynamic instability, inflammation, nephrotoxic exposure and mitochondrial dysfunction. Fluid management is an essential component of AKI prevention and management. While traditional approaches emphasize fluid resuscitation to ensure renal perfusion, recent evidence urges caution against excessive fluid administration, given AKI patients' susceptibility to volume overload. This review examines the main characteristics of AKI in ICU patients and provides guidance on fluid management, use of biomarkers, and pharmacological strategies.

Solid Metal Chemical and Thermal Injury Management.

Solid metals may create a variety of injuries. White phosphorous (WP) is a metal that causes both caustic and thermal injuries. Because of its broad use in munitions and smoke screens during conflicts and wars, all military clinicians should be competent at WP injury identification and acute therapy, as well as long-term consequence recognition. English-language manuscripts addressing WP injuries were curated from PubMed and Medline from inception to January 31, 2024. Data regarding WP injury identification, management, and sequelae were abstracted to construct a Scale for the Assessment of Narrative Review Articles guideline-consistent narrative review. White phosphorous appears to be ubiquitous in military conflicts. White phosphorous creates a characteristic wound appearance accompanied by smoke, a garlic aroma, and spontaneous combustion on contact with air. Decontamination and burning prevention or cessation are key and may rely on aqueous irrigation and submersion or immersion in substances that prevent air contact. Topical cooling is a key aspect of preventing spontaneous ignition as well. Disposal of all contaminated clothing and gear is essential to prevent additional injury, especially to rescuers. Long-term sequelae relate to phosphorous absorption and may lead to death. Chronic or repeated exposure may induce jaw osteonecrosis. Tactical Combat Casualty Care recommendations do not currently address WP injury management. Education and management regarding WP acute injury and late sequelae is essential for acute battlefield and definitive facility care. Resource-replete and resource-limited settings may use related approaches for acute management and ignition prevention. Current burn wound management recommendations should incorporate specific WP management principles and actions for military clinicians at every level of skill and environment.

Model Terapi Latihan Pasca Cedera Ankle pada Atlet Taekwondo Klub KBTC

This research aims to create and develop a form of exercise therapy after ankle injury that can help recovery. Activities that have been carried out using the RND method will produce a product in the form of a model of exercise therapy after ankle injury. Subjects who were targeted in research on the development of post-injury exercise therapy models for KBTC club taekwondo athletes. Of the ten steps of Sugiyono's research model, this research only reaches the sixth stage, namely: (1) potential and problems, (2) data collection, (3) initial product design, (4) design validation, (5) design revision, (6) Product trial. The results of this action research will produce a complete exercise therapy design product that is more specific to the sport of taekwondo.In this study, researchers collaborated with experts in the field of physiotherapy, experts in injury management as expert judgment. The validation test used in this study used an expert justification test, where the exercise therapy model after ankle injury used 14 validated models.This post-ankle injury exercise therapy model can also be used as reference material for other researchers in post-ankle injury exercise therapy in KBTC club athletes. The results of this research can be concluded that after going through validation tests with expert justification, 14 models of post-ankle injury training therapy models were produced for KBTC club taekwondo athletes.

Epidemiology of orthopedic injuries among inpatients admitted at a tertiary teaching and referral hospital in Kenya: a retrospective cross-sectional study

BackgroundOrthopedic injuries are serious and continue to be a concern for healthcare systems worldwide. Approximately 90% of the estimated traumatic injuries occur in low- and middle-income countries. In Kenya, there is a dearth of information on orthopedic injury patterns that could be used to prioritize injury prevention measures and to help hospital management teams allocate resources appropriately. The purpose of this study was to determine the epidemiology of orthopedic injuries admitted to Kenyatta National Hospital.MethodsThis was a retrospective cross-sectional study. Overall, 720 charts were reviewed. Data were analyzed using frequency distribution, pearson chi-square test and logistic regression.ResultsOverall, 85% were aged 15–64 years. Approximately 80% were male, married or single. Patients with primary or secondary education composed 72%. Road traffic accidents (59.4%) and falls (24.7%) were the most common mechanisms of injury. A total of 99.9% of the inpatients were Kenyans. Open injuries were 40.1%. Lower limb (67.4%) and upper limb (26.9%) injuries were the most common. Inpatients aged 15–24 years were 74% less likely to have upper limb injuries than those aged 0–14 years (p = 0.023). However, those aged 15–24 years were 19.250 times more likely to have spine injuries than those aged 0–14 years (p = 0.008). Males were 68.6% and 51.2% less likely to have pelvic injury and comorbidities, respectively, than females (p < 0.001). Patients with secondary and tertiary education were 2.016 (p = 0.003) and 2.3 (p < 0.001) times more likely to have upper limb injuries, respectively, than those with no or preschool education. Similarly, those with tertiary education were 2.079 times more likely to have comorbidities than those with no or preschool education (p = 0.017).ConclusionMost of the inpatients with orthopedic injuries were young, male involved in Road traffic accidents and therefore Kenya National Transport and Safety Authority needs to enforce road safety measures to reduce road carnage. Those with higher education and children were more likely to have upper limb injuries. Females were more likely to have pelvic injuries and co-morbidities. Lower and upper limb injuries were the most common injuries and this should guide resource allocation in management of orthopedic injuries.

Clinical Applications of Artificial Intelligence in Occupational Health: A Systematic Literature Review.

To identify and critically analyze studies using artificial intelligence (AI) in occupational health. A systematic search of PubMed, IEEE Xplore, and Web of Science was conducted to identify relevant articles published in English between January 2014-January 2024. Quality was assessed with the validated APPRAISE-AI tool. The 27 included articles were categorized as follows: health risk assessment (n = 17), return to work and disability duration (n = 5), injury severity (n = 3), and injury management (n = 2). 47 AI algorithms were utilized, with artificial neural networks, support vector machines, and random forest being most common. Model accuracy ranged from 0.60-0.99 and AUC from 0.7-1.0. Most studies (n = 15) were of moderate quality. While AI has potential clinical utility in occupational health, explainable models that are rigorously validated in real-world settings are warranted.

Lower Extremity Traumatic Wound Management: Relative Significance of Negative Pressure Wound Therapy in the Orthopedic Setting.

Significance: Lower extremity traumatic wounds are associated with numerous perioperative challenges. Their etiologies determine the characteristics and extent of the injury. The timing of subsequent surgical intervention and wound healing optimization after lower extremity trauma are integral to successful perioperative lower extremity wound management. Recent Advances: Managing trauma to the lower extremities uses a multidisciplinary surgical approach. The objective of this review is to summarize lower limb trauma assessment, advancements in lower extremity trauma management, and the clinical applications of advanced wound care in lower limb traumatic wounds. The advent of lower limb reconstruction and the development of advanced wound care modalities have helped to improve the management of these complex injuries. Critical Issues: The extensive involvement of bone, soft tissues, nerves, and blood vessels of severe lower extremity trauma wounds presents a challenge for clinicians in both the acute care setting and during patient rehabilitation. If not properly managed, these injuries may be subject to a decline in limb function and may possibly result in limb loss. To reveal developing limb-threatening conditions, serial examinations should be performed. Future Directions: The majority of lower limb traumatic wound will benefit from the perioperative administration of an appropriate negative pressure wound therapy (NPWT)-based system, which can help to promote granulation tissue and remove wound exudate before definitive closure and/or reconstruction. NPWT should be included as an important adjunct in the surgical management of lower limb traumatic wounds.

Pediatric head injury guideline use in Sweden: a cross-sectional survey on determinants for successful implementation of a clinical practice guideline

BackgroundThe Scandinavian Neurotrauma Committee guideline (SNC-16) was developed and published in 2016, to aid clinicians in management of pediatric head injuries in Scandinavian emergency departments (ED). The objective of this study was to explore determinants for use of the SNC-16 guideline by Swedish ED physicians.MethodsThis is a nationwide, cross-sectional, web-based survey in Sweden. Using modified snowball sampling, physicians managing children in the ED were invited via e-mail to complete the validated Clinician Guideline Determinants Questionnaire between February and May, 2023. Baseline data, data on enablers and barriers for use of the SNC-16 guideline, and preferred routes for implementation and access of guidelines in general were collected and analyzed descriptively and exploratory with Chi-square and Fisher's tests.ResultsOf 595 invitations, 198 emergency physicians completed the survey (effective response rate 33.3%). There was a high reported use of the SNC-16 guideline (149/195; 76.4%) and a strong belief in its benefits for the patients (188/197; 95.4% agreement). Respondents generally agreed with the guideline's content (187/197; 94.9%) and found it easy to use and navigate (188/197; 95.4%). Some respondents (53/197; 26.9%) perceived a lack of organizational support needed to use the guideline. Implementation tools may be improved as only 58.9% (116/197) agreed that the guideline includes such. Only 37.6% (74/197) of the respondents agreed that the guideline clearly describes the underlying evidence supporting the recommendation. Most respondents prefer to consult colleagues (178/198; 89.9%) and guidelines (149/198; 75.3%) to gain knowledge to guide clinical decision making. Four types of enablers for guideline use emerged from free-text answers: ease of use and implementation, alignment with local guidelines and practice, advantages for stakeholders, and practicality and accessibility. Barriers for guideline use were manifested as: organizational challenges, medical concerns, and practical concerns.ConclusionsThe findings suggest high self-reported use of the SNC-16 guideline among Swedish ED physicians. In updated versions of the guideline, focus on improving implementation tools and descriptions of the underlying evidence may further facilitate adoption and adherence. Measures to improve organizational support for guideline use and involvement of patient representatives should also be considered.

Surgery for subaxial cervical spine injuries: which is better: anterior, posterior, or anterior-posterior combined approach?: a systematic review and meta-analysis.

Both anterior and posterior approaches have shown insignificant differences in good clinical outcomes with one over another advantages and disadvantages. This review aimed to provide evidence for the best management of subaxial cervical spine injuries and discuss the clinical outcomes and complications. Clinical studies of anterior versus posterior and anterior versus anterior-posterior (combined) approaches to subaxial cervical spine injury were searched electronically from PubMed, Medline, ScienceDirect, Cochrane Library, and other Internet databases. Clinical improvement, complication rates, and mortality rates showed no significant differences with an odds ratio of 1.09 (95% confidence interval [CI], 0.79-1.49; p=0.61) for the anterior versus posterior approach and an odds ratio of 1.05 (95% CI, 0.35-3.18; p=0.93) for the anterior versus the combined approach. Surgical duration and blood loss were significantly different between the anterior and posterior groups with a mean difference of -42.84 (95% CI, -64.39 to 21.29; p<0.0001); -212.91 (95% CI, -417.60 to 8.22; p=0.04), respectively, whereas the length of hospitalization did not (p=0.16). No difference was found between the groups when compared by clinical improvement and complication rate. Meanwhile, the anterior approach was superior to the posterior approach in terms of surgical duration, blood loss, and hospitalization length.

Protective Effects of Aqueous-Ethanol Leaf Extract of Justicia Carnea Lindl. and Silymarin on Thioacetamide-Induced Hepatorenal Injury in Rats

Background and Purpose: Liver and kidney injuries pose significant global health risks and are often linked to oxidative stress and inflammation. Thioacetamide (TAA) is a hepatorenal toxin widely used in experimental models. Justicia carnea, has been used traditionally for treating liver disorders and silymarin, a flavonoid complex derived from Silybum marianum, is renowned for its hepatoprotective effects. This study investigated the potential protective effects of aqueous-ethanol leaf extract of J. carnea and silymarin on TAA-induced hepatorenal injury in rats.Methods: Six groups (n=5) of male Wistar rats were used in the experiments. Group A (control) received 10 mL/kg of distilled water; group B was administered TAA at a dosage of 300 mg/kg; group C received TAA (300 mg/kg) along with 50 mg/kg of silymarin; groups D, E, and F were administered 300 mg/kg of TAA and subsequently treated with 200, 400, and 600 mg/kg of the extract, respectively. TAA was administered intraperitoneally while silymarin and the extract were administered orally. Treatment was daily for 14 days after which sera and livers from the rats were assayed for enzymes, albumin, bilirubin, urea, creatinine, electrolytes, and antioxidants.Results: Exposure to TAA significantly elevated liver enzyme markers: alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP), and bilirubin but reduced albumin levels. TAA exposure also led to increased urea, creatinine, sodium, potassium, and chloride levels and caused a significant decrease in antioxidant enzymes: catalase (CAT), superoxide dismutase (SOD), reduced glutathione (GSH) but increased malondialdehyde (MDA) levels in liver homogenates. However, treatment with silymarin and doses of extract significantly ameliorated hepatorenal function parameters and improved the antioxidant status of the liver in the experimental animals.Conclusion: These findings suggest that both silymarin and J. carnea aqueous-ethanol extract possess hepatoprotective and renoprotective properties, highlighting their potential as therapeutic agents in the management of hepatorenal injuries.

Reconstruction after inappropriate lower limb open degloving injury management resulting in the necrotic wound: a case report

Background: Trauma with shear mechanisms, which are typically the result of after trauma regarding traffic incidents, is the primary cause of degloving injuries. The condition is typified by the avulsion of skin and subcutaneous tissue, resulting in a deficiency in coverage and, in extreme situations, the loss of the limb involved. Case Presentation: A 58-year-old male was struck by a car and sustained a direct blow to his right lower leg from a rubber tire. The patient was hospitalized and did primary wound closure. A week later, the patient sought a second opinion in a different hospital due to necrotic tissue formation in his lower limb due to previous primary closure disregarding tissue vitality through split-thickness skin excision (STSE). Conclusion: This case reported management of necrotic tissue and reconstruction defect closure by skin graft through surgical cleaning and debridement. After establishing a viable grafting bed, split-thickness skin grafts were applied as covering.

Orthoplastics Management of Open Lower Limb Fractures at a Major Trauma Centre: Audit of Adherence to BOAST4 Guidelines

IntroductionThe British Orthopaedic Association Standards for Trauma and Orthopaedics (BOAST) guide the optimal management of open lower limb fractures. Adherence of the newly established Orthoplastic service at the Major Trauma Centre covering the Southeast of England was audited in relation to these standards. Materials and methodsAudit standards were produced. Data were collected using hospital records and the Trauma Audit and Research Network database. All open lower limb fractures managed between August 2020-August 2022 were included. Data collected included patient and injury demographics, and information related to initial and definitive management. ResultsOverall, 133 patients were identified, 70 men and 63 women, with an average age of 58 years. Women had a higher average age (69 years) and ASA grade (71% ASA 3 or higher). Low-energy injuries occurred in 69% of women compared to 78% of high-energy injuries in men (p<0.001). Among them, 108 (81%) were debrided within 24 h. The average time to first debridement was 18.78 h, and 95 (75%) were definitively closed within 72 h, 76 with primary closure, 7 with split-thickness skin graft, 7 with local flap and 36 with free flap. Overall, the post-operative infection rate was 13% with 94% of these fractures definitively closed within 72 h. ConclusionMost open lower limb fractures occurred in older women with higher ASA grade, from low-energy mechanisms. Most injuries were definitively managed as per the BOAST guidelines, but further efforts are required to improve the adherence to initial debridement targets, including training, appropriate resource allocation and implementation of procedures and proformas to guide injury management and improve documentation.

Utilizing Augmented Reality to Evaluate Service Member Team Performance.

Decision-making is a complex process that relies on situational awareness and experience to create a potential list of actions while weighing the risks and benefits of each action. There is a paucity of data evaluating decision-making for individual service members (SM) during the performance of team-based military-relevant activities. Understanding individual performance and decision-making within the context of a team-based activity has potential to aid in the detection and management of mild traumatic brain injuries and assist with safe and timely return-to-duty decision making. The aim of this project was to evaluate cognitive and motor performance in healthy SM during an augmented reality military specific, team-based activity. Data from 110 SMs from Fort Moore Georgia were analyzed for this project. Service members completed 3 augmented reality room breaching and clearing scenarios (Empty Room, Civilian/Combatant, and Incorrect Position of a unit member) with 3 avatar team members. Participants wore a Microsoft HoloLens 2 (HL2) device and used a replica M4 weapon (Haptech Defense Systems) during scenarios. Three-dimensional position data from the HL2 headset was used to compute temporal measures of room breaching and clearing events while the number and timing of weapon discharge was monitored by the M4. Temporal outcomes included time to enter room, time to fire first shot, time in fatal funnel, and total trial time while motor outcomes were distance traveled and average movement velocity. Pairwise comparisons between the Incorrect Position scenario and the Civilian/Combatant scenario demonstrated no difference in time to enter the room (2.36 seconds in both scenarios). Time to fire the first shot in the Civilian/Combatant scenario was longer (0.97 seconds to 0.58 seconds) while time in fatal funnel (2.58 seconds to 3.31 seconds) and time to trial completion (7.46 seconds to 8.41 seconds) were significantly longer in the Incorrect Position scenario. Reaction time to fire the first shot, time in the fatal funnel, and total trial time reflect a change in information-processing and decision-making capabilities during military specific, ecological, team-based scenarios when altering the environment inside of the room and modifying avatar movements. Future studies are planned to evaluate the effects of mild traumatic brain injury on specific aspects of military team performance.