Minor Trauma Research Articles

HAS THE FREQUENCY OF DENTAL TRAUMA AND MOUTHGUARD USE IN ELITE HANDBALL PLAYERS CHANGED SINCE 2005?

Background: The study on the incidence of dental trauma and the use of mouthguards in 2005 revealed that handball players in Turkey do not use mouthguards. This current study evaluates the changes up to 2021 and evaluates today's athletes' attitudes toward using mouthguards.Methods: The data were collected from 68 professional handball players through a questionnaire. The same questions of the 2005 study were asked concerning the incidence of dental trauma and mouthguard use. In addition, today's handball players' attitudes toward using mouthguards were also investigated. The data were analyzed with Minitab 17. Independent samples t-tests were used to compare quantitative data. Fisher's exact test was used for ratio comparisons (percentage), and the Pearson Chi-Square test was used to distribute categorical data. The statistical significance level was taken as p<0.050.Results: This study shows that the athletes have experienced minor dental trauma since 2005. However, the difference is not statistically significant (p=0.291). Moreover, there was no statistically significant difference between the distribution of dental injury types in the avulsion, crown fracture, and dislocation between 2005 and 2021 (p=0.431). While 77.4% of the athletes were aware of mouthguards in 2005, this rate has increased to 100% in 2021 (p<0.001). No mouthguard use was reported in the 2005 study, while 29% of the participants in 2021 reported mouthguard usage (p<0.001). The main reason for not wearing a mouthguard for the 2005 participants was lack of information, while in 2021, it was fear of speaking or breathing difficulties (p<0.001)Conclusions: Dental trauma remains a severe problem for handball players. It is pleasing that professional handball players in Turkey have started to use mouthguards. Dentists and sports managers should work together to reduce the frequency of dental trauma and prevent possible adverse effects.

Imminent Perforation of a Post-Traumatic Scleromalacia

Scleromalacia is a degenerative thinning of scleral tissue. Their general causes are dominated by inflammatory rheumatism and systemic vasculitis. The traumatic cause is very rare. We report a rare case of scleromalacia following a minor trauma with localized hernia of the uveal tissue covered by an intact conjunctiva.

Oral health status in patients with inherited epidermolysis bullosa: a comparative multicenter study.

Epidermolysis bullosa (EB) is a rare genetic mucocutaneous disorder characterized by epithelial fragility leading to blister formation on skin and mucous membranes with even minor mechanical trauma. Most EB oral health publications give fragmented information, focusing on only one oral health aspect or one EB type. The aim of this study was to expand the knowledge of the overall oral health status of individuals with dystrophic, junctional, and simplex EB. A comparative multicenter study, including a control group, and based on questionnaires and clinical examinations, was undertaken in three EB expert centers. Most EB (90.2%) participants brushed their teeth at least once a day despite the pain. The prevalence of enamel defects and caries experience did not differ between the 42 EB participants and the 42 age-/sex-matched healthy controls. Gingival inflammation unrelated to dental plaque accumulation was found in EB participants. Blisters, erythema, and erosion/ulceration mainly involved gingiva, buccal mucosa, lips, and palate, with different topographic patterns according to EB type. EB patients whatever the age showed a similar lesion distribution. Simplex and dystrophic EB patients under 12 years old displayed higher lesion severity than junctional EB ones. Only dystrophic type exhibited microstomia and ankyloglossia. Oral health status seemed to benefit from a close collaboration between dental practitioner and dermatologist, and from regular dental examination, starting at a young age and with a focus on prevention. The new appreciation of oral health involvement highlighted by this study is essential for EB patients care, regarding comorbidities and quality of life.

The Role of Ultrasound in Pediatric Skull Fractures: Determination of Fracture and Optic Nerve Sheath Diameter Measurements.

The aim of the present study was to determine the accuracy of point-of-care ultrasound (POCUS) for detecting skull fractures and to evaluate sonographic measurements of optic nerve sheath diameter (ONSD) and ONSD/eyeball vertical diameter (EVD) ratios in children with head trauma. Children who presented with local signs of head trauma and underwent cranial computed tomography (CT) were enrolled. The suspected area was examined by POCUS to identify a skull fracture, and then the ONSD at 3 mm posterior to the globe and the EVD were measured. Ratios of ONSD measurement at 3 mm/EVD were reported. All ONSD measurements and ratios were calculated from cranial CT images. There were 112 children enrolled in the study. The sensitivity and specificity of POCUS for skull fractures was 93.7% (95% confidence interval [CI], 82.8-98.6) and 96.8% (95% CI, 89.1-99.6), whereas the positive predictive value was 95.7% (95% CI, 85.1-98.8), and the negative predictive value was 95.3% (95% CI, 87.3-98.4). There was high agreement between POCUS and CT for identifying skull fractures (κ, 0.90 [±0.04]). In the group without elevated intracranial pressure findings on CT, patients with space-occupying lesions (SOLs) had higher sonographic ONSD measurements and ratios (P < 0.001) compared with cases without SOLs. When used with clinical decision rules to minimize the risk for clinically important traumatic brain injury, POCUS seems to be a promising tool to detect skull fractures and calculate ONSD measurements and rates to predict the risk for SOLs and perform further risk stratification of children with minor head trauma.

Statistical and machine learning approaches to predict the necessity for computed tomography in children with mild traumatic brain injury.

Minor head trauma in children is a common reason for emergency department visits, but the risk of traumatic brain injury (TBI) in those children is very low. Therefore, physicians should consider the indication for computed tomography (CT) to avoid unnecessary radiation exposure to children. The purpose of this study was to statistically assess the differences between control and mild TBI (mTBI). In addition, we also investigate the feasibility of machine learning (ML) to predict the necessity of CT scans in children with mTBI. The study enrolled 1100 children under the age of 2 years to assess pre-verbal children. Other inclusion and exclusion criteria were per the PECARN study. Data such as demographics, injury details, medical history, and neurological assessment were used for statistical evaluation and creation of the ML algorithm. The number of children with clinically important TBI (ciTBI), mTBI on CT, and controls was 28, 30, and 1042, respectively. Statistical significance between the control group and clinically significant TBI requiring hospitalization (csTBI: ciTBI+mTBI on CT) was demonstrated for all nonparametric predictors except severity of the injury mechanism. The comparison between the three groups also showed significance for all predictors (p<0.05). This study showed that supervised ML for predicting the need for CT scan can be generated with 95% accuracy. It also revealed the significance of each predictor in the decision tree, especially the "days of life." These results confirm the role and importance of each of the predictors mentioned in the PECARN study and show that ML could discriminate between children with csTBI and the control group.

Serum Glial Fibrillary Acidic Protein in Detecting Intracranial Injuries Following Minor Head Trauma; a Systematic Review and Meta-Analysis.

Developing novel diagnostic and screening tools for exploring intracranial injuries following minor head trauma is a necessity. This study aimed to evaluate the diagnostic value of serum glial fibrillary acidic protein (GFAP) in detecting intracranial injuries following minor head trauma. An extensive search was performed in Medline, Embase, Scopus, and Web of Science databases up to the end of April 2022. Human observational studies were chosen, regardless of sex and ethnicity of their participants. Pediatrics studies, report of diagnostic value of GFAP combined with other biomarkers (without reporting the GFAP alone), articles including patients with all trauma severity, defining minor head trauma without intracranial lesions as the outcome of the study, not reporting sensitivity/specificity or any other values essential for computation of true positive, true negative, false positive and false-negative, being performed in the prehospital setting, assessing the prognostic value of GFAP, duplicated reports, preclinical studies, retracted articles, and review papers were excluded. The result was provided as pooled sensitivity, specificity, diagnostic score and diagnostic odds ratio, and area under the summary receiver operating characteristic (SROC) curve with a 95% confidence interval (95% CI). Eventually, 11 related articles were introduced into the meta-analysis. The pooled analysis implies that the area under the SROC curve for serum GFAP level in minor traumatic brain injuries (TBI) was 0.75 (95% CI: 0.71 to 0.78). Sensitivity and specificity of this biomarker in below 100 pg/ml cut-off were 0.83 (95% CI: 0.78 to 0.89) and 0.39 (95% CI: 0.24 to 0.53), respectively. The diagnostic score and diagnostic odds ratio of GFAP in detection of minor TBI were 1.13 (95% CI: 0.53 to 1.74) and 3.11 (95% CI: 1.69 to 5.72), respectively. The level of evidence for the presented results were moderate. The present study's findings demonstrate that serum GFAP can detect intracranial lesions in mild TBI patients. The optimum cut-off of GFAP in detection of TBI was below 100 pg/ml. As a result, implementing serum GFAP may be beneficial in mild TBI diagnosis for preventing unnecessary computed tomography (CT) scans and their related side effects.

Fracture lines and comminution zones of traumatic sacral fractures.

Sacral fractures are uncommon and understanding three-dimensional morphology is needed to obtain proper treatment. The purpose of this study was to identify the repeatable fracture patterns and comminution zones for traumatic sacral fractures and create fracture maps. Computerized tomography images of 72 patients with traumatic sacral fracture were included in the study. For each fracture, fracture lines were identified and digitally reduced. All fractures were superimposed over a template and fracture maps; comminution zones and heatmaps were created for each zone. There were 40 males and 32 females with a mean age of 46.5±19.9. Fifty-three (73.6%) patients sustained major trauma, and 19 (26.4%) had minor trauma. There were 37 (51.4%) Zone 1, 22 (30.6%) Zone 2, and 13 (18.1%) Zone 3 fractures. Each Denis zone showed certain fracture patterns. In Zone 1 fractures, most of the fracture lines were vertical and oblique (up to 45°) orientation on both sides. In Zone 2 fractures, fracture lines were concentrated on the S1 and S2 levels. Anterolateral and posterolateral parts of the sacrum were less affected in right-side fractures. In Zone 3 fractures, fractures were concentrated in S1, S2, and S3 levels around the sacral canal. The median sacral crest and midline remained mostly unaffected. Sacral fractures showed specific repeatable patterns for each zone. These findings may be helpful for pre-operative planning, placement of fixation material, design of new implants, and modification of current fracture-classification systems.

Sigmoid sinus thrombosis complicated with subdural subjacent hematoma after a minor trauma in a child - How to manage?

Sigmoid sinus thrombosis complicated with subdural subjacent hematoma after a minor trauma in a child - How to manage?

A Case of Congenital Mild Hemophilia Diagnosed After Wisdom Teeth Extraction.

Hemophilia A is a recessive congenital deficiency of factor VIII that is characterized by normal bleeding time, normal prothrombin time, and prolonged activated partial thromboplastin time. In moderate and severe cases, abnormal bleeding is observed even after minor trauma, and the diagnosis is usually made by the age of 5-6 years, whereas in mild cases, abnormal bleeding is detected after major trauma or surgery. Herein, we present a case of hemophilia A that was discovered due to difficulties with hemostasis after tooth extraction.

An Unusual Presentation of Lichen Striatus.

An Unusual Presentation of Lichen Striatus.

Kummell's Disease is Becoming Increasingly Important in an Aging Society: A Review.

Kummell's disease (KD) is referred to as delayed posttraumatic vertebral collapse, avascular necrosis of vertebrae, or ischemic vertebral collapse. KD is no longer rare in an aging society. It is mainly caused by minor trauma, and nonunion occurs secondary to avascular necrosis at the vertebral body fracture site, which can lead to vertebral kyphosis or intravertebral instability. Clinical symptoms of KD range from no symptoms to severe paralysis due to nerve injury. KD is considered a complication of osteoporotic vertebral compression fractures, and conservative treatment, including osteoporosis treatment, is important. Timely interventions such as vertebral augmentation or surgery, with active regular follow-up are necessary before the onset of neurological deficits due to osteonecrotic collapse in patients with suspected KD. In this study, we summarize the pathogenesis, diagnosis, and treatment of KD, which is showing increasing prevalence in an aging society. We have presented a literature review and discussed clinical guidelines and therapeutic strategies to reduce the morbidity and mortality associated with KD.

Hybrid interventions for atherosclerotic lesions of the lower limb arteries

Treatment of multilevel atherosclerotic lesions of the lower limb arteries is an acute problem in modern medicine. There is no a single treatment algorithm. Hybrid technologies are one of the possible treatment options. There are reasonable assumptions that these technologies can at least partially solve this problem. Minor trauma is an undoubted advantage of hybrid technologies. Therefore, these approaches are advisable in severe patients with various comorbidities and contraindications for traditional methods. Therefore, analysis of hybrid methods is of great interest for cardiovascular surgeons. Hybrid method is now recognized as one of the most effective and minimally traumatic treatment for patients with atherosclerotic lesions of the lower extremities.

Giant Cell Tumor of FDP Tendon Sheath in Young: A Rare Case Report

Introduction: Giant cell tumor of the tendon sheath of the hand (GCTTS) is a benign tumor of unknown cause. The clinical diagnosis is supported by pre-operative imaging. The standard of care is surgical resection along with histological confirmation. It appears as a palpable enlargement that is painless. Although pre-operative imaging and fine-needle aspiration cytology (FNAC) corroborate its suspicion, histology following surgical resection is mostly responsible for establishing its diagnosis. Due to its rarity, a case of GCT of the flexor tendon sheath of the right index finger is reported here. Case Report: We give an example of a patient with giant cell tumor (GCT) of the flexor digitorum profundus tendon sheath in a male patient who is 18 years old. On examination, a 1.8 × 1.2 × 1.0 cm swelling was seen covering an adjoining tendon on the palmar surface of the right index finger at the middle phalanx. The swelling was well-defined, had a smooth surface, was consistently firm, and could be easily pushed in a sideways direction. An isolated soft-tissue shadow was visible in the affected area of the hand’s X-ray, but there was no bone involvement. As a professional shooter, the patient utilizes his right index finger as a trigger finger. Conclusion: In adults with hand soft-tissue tumors, GCTTS should be considered as a possible differential diagnosis, especially when there’s any evidence of repeated inconsequential minor trauma. The patient should be monitored to find and treat recurrences. Keywords: Giant-cell tumors, FDP tendon, GCTTS.

Клинические и фенотипические признаки недифференцированной дисплазии соединительной ткани при интрамуральной миоме матки как маркеры прогнозирования инфертильности

Objective. To examine associations between clinical and phenotypic signs of undifferentiated connective tissue dysplasia (UCTD) and uterine leiomyoma, as well as fertility and infertility in case of intramural uterine leiomyoma. Patients and methods. In this retrospective cross-sectional study, 400 patients were included and divided into two groups. The study group consisted of 370 patients with intramural leiomyoma, including 240 infertile and 130 fertile patients (70 women in the first trimester of pregnancy and 60 women delivered less than 12 months ago, in whom leiomyoma was diagnosed before and/or during pregnancy). The control group consisted of 30 patients without leiomyoma and infertility who referred for a preventive examination. Results. The frequency of clinical and phenotypic signs of UCTD was significantly higher (2.5-fold) in patients with leiomyoma compared to healthy controls. A number of UCTD signs were significantly associated with infertility in intramural leiomyoma (De Quervain syndrome, mitral valve prolapse, hematomas due to minor trauma, hyperpigmentation, history of uterine appendage torsion, scoliosis, varicose veins, iron-deficiency anemia). Based on the findings, significant diagnostic coefficients and informativeness coefficients for several UCTD signs, expressed in rounded scores, were obtained using mathematical calculations, which allows their use as prognostic criteria for fertility/infertility in intramural leiomyoma. The identified clinical symptoms are apparently both systemic (manifested as UCTD signs) and localized (leiomyoma formation and infertility). Conclusion. A high frequency of the combination of clinical and phenotypic signs of UCTD with infertility in intramural uterine leiomyoma was established. The present study allowed us to determine significant signs of UCTD, the presence of which is associated with a high risk of infertility. The results of the study and the risk score can be used to assess potential fertility in intramural leiomyoma in patients of reproductive age and to choose treatment tactics. Key words: uterine leiomyoma, undifferentiated connective tissue dysplasia, infertility, infertility risk prediction

Letter to the Editor: Commentary on Progression of Ossification of Posterior Longitudinal Ligament After Anterior Cervical Discectomy and Fusion in Military Patients Exposed to Minor Trauma (Korean J Neurotrauma 2022;18:254-267).

Letter to the Editor: Commentary on Progression of Ossification of Posterior Longitudinal Ligament After Anterior Cervical Discectomy and Fusion in Military Patients Exposed to Minor Trauma (Korean J Neurotrauma 2022;18:254-267).

The Importance of Headgear During Scooter Riding in the Pediatric Population, and Suggesting Recommendations.

The authors analyzed the characteristics of pediatric patients who visited trauma center due to injuries sustained while riding scooters and suggested recommendations on our concerns about pediatric scooter use. From January 2019 to June 2022, we collected data for those who visited due to accidents while riding scooters. And, the analysis was conducted by dividing it into pediatric (younger than 12 years) and adult (older than 20 years) patients. There were 264 children (<12 years), and 217 adults (>19 years). We observed 170 head injuries (64.4%), in the pediatric population and 130 head injuries (60.0%) in the adult population. There were no significant differences between pediatric and adult patients for all three injured regions. Among pediatric patients, only 1 reported the use of protective headgear (0.4%). The patient suffered a cerebral concussion. However, 9 of the pediatric patients who did not wear protective headgear suffered major trauma. Among 217 adult patients, 8 (3.7%) had used headgear. 6 suffered major trauma and 2 suffered minor trauma. Of the patients who did not wear protective headgear, 41 suffered major trauma and 81 suffered minor trauma. Since there was only one patient in the pediatric group who wore headgear, no statistical inferences could be calculated. In the pediatric population, the head injury rate is as high as in adults. We were unable to statistically support the significance of headgear in the current study. However, in our general experience, the importance of headgear is overlooked in the pediatric population compared to adults. It is necessary to encourage the use of headgear actively publicly.

Evaluation of Fine Needle Aspiration Cytology versus Culture for Laboratory Diagnosis of Subcutaneous Mycosis

Introduction: Subcutaneous swellings are commonly seen in clinical practice having varied pathology from epidermal inclusion cyst to malignancy. Subcutaneous mycosis is a fungal infection of subcutaneous tissue and dermis which is more prevalent in workers of rural, tropical, and subtropical regions. The subcutaneous infection mostly occurs due to minor trauma which goes unnoticed. Fine Needle Aspiration Cytology (FNAC) followed by microbiological analysis is a cost-effective and simple procedure and can be considered as one of the main modalities for early diagnosis. Moreover, it gives an early presumptive identification of fungus, which helps the clinician in a timely therapeutic approach. Aim: To study the efficacy of FNAC in the diagnosis of subcutaneous mycosis in comparison with culture method. Materials and Methods: A cross-sectional study, including clinically diagnosed cases of subcutaneous mycosis was evaluated between the periods of March 2019 to February 2021 in a tertiary care hospital in Northern Odisha. FNAC samples from all the cases of subcutaneous mycosis were studied cytologically and microbiologically. Cases were analysed and further evaluated on the basis of their age, sex, detailed clinical history, and presentation. FNAC showed the presence of fungal elements in 20 cases. Microbiological evaluation of these samples was carried out. Results: Out of the total 50 cases of subcutaneous mycoses, male (16): female (4) ratio was 4:1 and the commonest age group affected was 20-60 years of age (75%). The most common site of involvement was the lower limb (60%) followed by upper limb (30%). Almost all the cases were from rural areas with a history of trauma present in 11 cases (55%). Out of 50 clinically diagnosed cases, cytological examination revealed fungal element in 20 (40%) cases. The most common cytological diagnosis was abscess with neutrophilic infiltration seen in 13 cases (65%) followed by granuloma in 7 cases (35%). All the 20 samples were further evaluated in conventional methods like KOH mount and culture. Fungal agents were isolated in 13 (65%) cases. Cladosporium spp. was the commonest isolate in 5 cases (25%). Conclusion: Subcutaneous mycosis is a rare disease. FNAC can be used as a rapid and cost-effective screening tool in the diagnosis of such cases as it is more sensitive. Though culture is the gold standard test, it is less specific.

Electric scooters as a silent source of danger in increasing use among young people: a single-center in-depth accident analysis.

The reasons for the increase in accidents involving shared stand-up e-scooters in recent years may be the wide-spread use of e-scooters among young people, especially in metropolitan areas with heavy traffic, non-compliance with traffic rules, and insufficient legal regulations. In this study, we analyzed in detail the typical features of rider-sharing e-scooter-related injuries brought to the emergency department of our hospital in the light of current literature. The clinical and accident characteristics of 60 patients with surgical requirements who were brought to the emergency department of our hospital due to e-scooter-related accidents between 2020 and 2020 were analyzed using statistical methods ret-rospectively. The majority of the victims were university students and the number of victims of the male gender was slightly higher and the mean age was 25.3±13.0 years. Most e-scooter accidents occur on weekdays. Most of the e-scooter-related accidents happen on weekdays and are non-collision type accidents. The majority of e-scooter-related accident victims were in the minor trauma group (injury severity score <9), predominantly had extremity and soft-tissue injuries and needed radiological examination (44 patients, 73.3%), and only eight victims (13.3%) required surgical operation and also all of the e-scooter victims were discharged fully healed. Among the more common collision-free e-scooter-related accidents that have a lower trauma severity score or cause minor soft-tissue injury, mono-trauma occurs more commonly than multisystem trauma; likewise, radius and nasal-weighted monofractures occur more commonly than multiple fractures, according to this study. Besides, effective measures and legal regulations should be put in place to prevent e-scooter-related accidents.

Association of Actinomyces Israelii with Pyogenic Granuloma - A RT-QPCR Study

Background Pyogenic granuloma is a benign vascular non-neoplastic inflammatory lesion that may be re-active to trauma hormonal changes and chronic local irritation. Occasionally they occur as a result of the invasion of microorganisms secondary to minor trauma. Actinomyces species are one of the normal habitants of the oral cavity that tend to penetrate submucosal tissues when there is a disruption in the mucosal barrier and cause pathology. Actinomyces israelii a gram-positive rod-shaped bacterium is an opportunistic pathogen that is difficult to culture. Molecular analyses a polymerase chain reaction and DNA sequencing will identify bacterial species and strains that are difficult or impossible to grow in artificial culture media.Methodology A total of 15 paraffin-embedded pyogenic granuloma samples were taken. All samples were subjected to molecular analysis using real-time polymerase chain reaction with forward and reverse primers of Actinomyces israelii.Result Out of 15 samples 13 samples 86.7 had expressed Actinomyces israelii gene sequence with good mean CT value suggesting that Actinomyces israelii have an association with pyogenic granuloma. There was a weak negative correlation r - 0.022 between age and CT value and the correlation was found to be statistically insignificant p0.943.Conclusion The anterior region of the oral cavity is more prone to trauma and thereby might act as a source for breaking the mucosal barrier which can be a route for microorganisms to establish their association with pyogenic granuloma. These microorganisms may play a role in recurrence. Identification of the causative organisms of irritation could serve as a tool for the radical treatment of pyogenic granulomas.

Lumbar Plexus Palsy Caused by Massive Psoas Hematoma Related to Vertebral Compression Fracture in a Patient with Liver Cirrhosis.

Osteoporotic vertebral compression fractures (VCFs) are common injuries in elderly patients and are usually stable because only the anterior column is involved. However, neurological deterioration may complicate osteoporotic VCFs, and most of them are related to canal invasion. Liver cirrhosis (LC) and its related complications have been identified as risk factors for an increased bleeding tendency, which, in turn, is associated with increased morbidity and mortality risks. We herein present a rare case of an osteoporotic VCF and a massive psoas hematoma that resulted in lumbar plexus palsy in a patient with LC after a stable-type spinal injury. To our knowledge, this is the first reported case of lumbar plexus palsy attributed to a liver-cirrhosis-related massive psoas hematoma and a stable VCF after minor trauma. This case highlights the potential risk of severe neurological deficits related to this type of common and seemingly trivial injury. The possible pathophysiological mechanisms are discussed and the relevant literature is reviewed.