Post Trauma Research Articles

Understanding nightmares after traumatic events in Detroit (UNiTED): prospective associations with interpersonal violence and posttraumatic stress disorder symptoms

ABSTRACT Background: Research suggests trauma-related nightmares (TRNs) during the acute aftermath of trauma may contribute to posttraumatic stress disorder (PTSD). However, it is unknown who is most vulnerable to TRNs, which is critical to identify at-risk patients toward whom early nightmare-focused treatments can be targeted to prevent PTSD. Objective: We tested trauma type (interpersonal violence [e.g. assault] vs non-interpersonal trauma [e.g. motor vehicle collision]) as a risk factor for TRNs in a predominantly low-income, Black, urban sample in Detroit, MI, USA. Method: We recruited patients from the intensive care unit following traumatic injury (N = 88; M age = 39.53 ± SD 14.31 years, 67.0% male, 67.0% Black, 47.7% annual income ≤ $20,000) and administered surveys at three post trauma timepoints: one week (T1), one month (T2; n = 61), and two months (T3; n = 59). Trauma type was assessed at T1 via electronic medical records. Participants reported the extent to which their dreams’ content was similar to the trauma for which they were hospitalized across T1-T3. Participants then completed the PTSD Checklist for DSM-5 at T3. Results: TRNs were more prevalent over time among patients exposed to interpersonal violence (80%) vs non-interpersonal trauma (48.7%, p = .005). Patients hospitalized for interpersonal violence faced greater odds for TRNs across timepoints relative to non-interpersonal trauma patients (Odds Ratio = 4.95, p = .021). TRNs, in turn, prospectively predicted PTSD symptoms such that TRNs at T2 presaged more severe PTSD at T3 (p = .040, η p 2 = .31), above and beyond T1 PTSD status. Conclusions: This prospective study provides first evidence that interpersonal violence exposure is a robust risk factor for TRNs, which prospectively contribute to PTSD symptom development. Early intervention on TRNs after interpersonal violence exposure may decrease PTSD risk. Future studies are encouraged to use ambulatory methods to capture nightmares sooner after they occur.

Pilot Study-Estimated VO2max via Modified Harvard Step Test (MHST) in Anterior Cruciate Ligament Injury Patients Undergoing Pre-Op Rehabilitation

Introduction: Anterior Cruciate Ligament (ACL) injury ranging from partial to full thickness tear causes much dysfunction physically and psychologically. It affects both daily & sporting activities with potential of creating long term complications such as post-traumatic osteoarthritis of knee, functional limitations, increase in body mass index (BMI) and loss of cardiorespiratory fitness. Cardiorespiratory fitness is an important indicator for functional and fitness capacity and VO2max is used to measure cardiorespiratory fitness. VO2max is the maximum rate of oxygen consumption during a vigorous exercise. Cardiopulmonary exercise testing is usually done on a treadmill with gaseous exchange system, a process that is time consuming, expensive and difficult to assess and not available in our public health setting. Modified Harvard step test is easy to do, cost friendly and allows mass testing to measure cardiorespiratory fitness (VO2max) however there are inadequate data on ACL injury and its influence on cardiorespiratory fitness using modified Harvard step test. Method: A prospective study was done using patients attending Sports Medicine Gym Hospital Tuanku Ja’afar 2023 and data from 20 patients who were undergoing pre-ACL reconstruction rehabilitation were evaluated. Patients were divided into two groups according to post trauma duration; (<6 months of injury and rehabilitation and >6 months injury and rehabilitation). Patients were required to do modified Harvard step test and translated into VO2max scores. Anthropometric data were also taken from patients. Results: The mean age for our study is 21.9±4.3 years. The mean VO2max for the entire participant was 43.2ml/kg/min. Mean VO2max for groups <6 months injury rehabilitation and >6 months injury rehabilitation was at 35.4±1.8 ml/kg/min and 49.0± 5.8ml/kg/min respectively. We report difference in both groups VO2max Conclusion: Cardiorespiratory fitness is often reduced during earlier phase of injury due to inability to perform aerobic exercises. Progressive rehabilitation can improve cardiorespiratory fitness, aid in patients return to sports and reduces morbidity post operatively. Modified Harvard step test is a reliable and cost-effective method to test VO2max. It is also important to increase cardiorespiratory fitness to maintain healthy BMI.

The protective role of two oxindole derivatives is mediated by modulating NLRP3/caspase-1 and PI3K/AKT pathways in a preclinical animal model of hepatic ischemia reperfusion injury

AimHepatic ischemia reperfusion injury (HIRI) is a leading cause of mortality post liver transplantation, hypovolemic shock and trauma. In this study, we tested, on molecular bases, the possible protective role of two different derivatives of 2-oxindole in a preclinical model of HIRI in rats. Main methodsHIRI was operated in male Wistar albino rats and prophylactic treatment with oxindole-curcumin (Coxi) or oxindole-vanillin (Voxi) was carried out before the operation. The biochemical and histopathological investigations, in addition to the mechanistic characterizations of the effect of the tested drugs were performed. Key findingsHIRI was assured with elevated liver enzymes and marked changes in histopathological features, inflammatory response and oxidative stress. Pretreatment with Coxi and Voxi improved the hepatic histopathological alterations, reduced the elevated serum liver enzymes level and hepatic Malondialdehyde (MDA) content, increased the hepatic Superoxide Dismutase (SOD) activity and reduced Glutathione (GSH) content, downregulated the expression of TNF-α, IL-6, Nod-Like Receptor p3 (NLRP3), Cleaved caspase1, Cleaved caspase 3 proteins, alongside the expression level of IL-1β, ICAM-1, VCAM-1 and BAX genes, attenuated NF-кB p-P65 Ser536 and Myeloperoxidase (MPO)-positive neutrophils, and activated the PI3K/AKT pathway. SignificanceCoxi and Voxi have promising hepatoprotective activity against HIRI in rats through ameliorating the biochemical and histopathological alterations, attenuating inflammatory and oxidative stress status by modulating the inflammatory TNF-α/ICAM-1, the pyroptosis NLRP3/Caspase-1, and the antioxidant PI3K/AKT pathways.

Associations among meaning in life, coping, and distress in trauma-exposed U.S. military veterans.

Experiencing meaning in life may be particularly relevant following traumatic experiences as individuals who report meaning post trauma report less psychological distress. Engaging in avoidant coping, however, may be a sign of underlying psychological distress in the aftermath of traumatic experiences. We sought to examine associations among meaning in life, avoidant coping, and psychological distress in a sample of trauma-exposed veterans. Secondary cross-sectional analyses were conducted on data from veterans exposed to a traumatic event(s) who experienced clinically meaningful guilt (N = 145). Questionnaires on meaning in life, avoidant coping, and psychological distress were administered, and structural equation modeling was used to test direct effects. Path analysis revealed that greater meaning was associated with lower depression, anxiety, and posttraumatic stress symptomatology, while higher avoidant coping was associated with greater depression, anxiety, posttraumatic stress, and somatization symptomatology. Participants who report more meaning in life and report lower avoidant coping post trauma may experience less psychological distress. If replicated longitudinally, results could suggest cultivating meaning in life and reducing avoidant coping may decrease psychological distress. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Pre-clinical evaluation of 99mTc-labeled chalcone derivative for amyloid-β imaging post-head trauma.

Aβ42 plaque formation is one of the preliminary pathologic events that occur post traumatic brain injury (TBI) which is also among the most noteworthy hallmarks of AD. Their pre symptomatic detection is therefore vital for better disease management. Chalcone-picolinic acid chelator derivative, 6-({[(6-carboxypyridin-2-yl)methyl](2-{4-[(2E)-3-[4-(dimethyl amino)phenyl]prop-2-enoyl]phenoxy}ethyl)amino}methyl)pyridine-2-carboxylic acid, Py-chal was synthesized to selectively identify amyloid plaques formed post head trauma using SPECT imaging by stable complexation to 99mTc with > 97% efficiency without compromising amyloid specificity. The binding potential of the Py-chal ligand to amyloid plaques remained high as confirmed by in vitro binding assay and photophysical spectra. Further, the Py-chal complex stained amyloid aggregates in the brain sections of rmTBI mice model. In vivo scintigraphy in TBI mice model displayed high uptake followed by high retention while the healthy rabbits displayed higher brain uptake followed by a rapid washout attributed to absence of amyloid plaques. Higher uptake in brain of TBI model was also confirmed by ex vivo biodistribution analysis wherein brain uptake of 3.38 ± 0.2% ID/g at 2min p.i. was observed for TBI mice model. This was followed by prolonged retention and more than twofold higher activity as compared to sham mice brain. This preliminary data suggests the specificity of the radiotracer for amyloid detection post head trauma and applicability of 99mTc labeled Py-chal complex for TBI-induced β-amyloid SPECT imaging.

Characteristics of traumatic major haemorrhage in a tertiary trauma center

BackgroundMajor traumatic haemorrhage is potentially preventable with rapid haemorrhage control and improved resuscitation techniques. Although advances in prehospital trauma management, haemorrhage is still associated with high mortality. The aim of this study was to use a recent pragmatic transfusion-based definition of major bleeding to characterize patients at risk of major bleeding and associated outcomes in this cohort after trauma.MethodsThis was a retrospective cohort study including all trauma patients (n = 7020) admitted to a tertiary trauma center from January 2015 to June 2020. The major bleeding cohort (n = 145) was defined as transfusion of 4 units of any blood components (red blood cells, plasma, or platelets) within 2 h of injury. Univariate and multivariable logistic regression analyses were performed to identify risk factors for 24-hour and 30-day mortality post trauma admission.ResultsIn the major bleeding cohort (n = 145; 145/7020, 2.1% of the trauma population), there were 77% men (n = 112) and 23% women (n = 33), median age 39 years [IQR 26–53] and median Injury Severity Score (ISS) was 22 [IQR 13–34]. Blunt trauma dominated over penetrating trauma (58% vs. 42%) where high-energy fall was the most common blunt mechanism and knife injury was the most common penetrating mechanism. The major bleeding cohort was younger (OR 0.99; 95% CI 0.98 to 0.998, P = 0.012), less female gender (OR 0.66; 95% CI 0.45 to 0.98, P = 0.04), and had more penetrating trauma (OR 4.54; 95% CI 3.24 to 6.36, P = 0.001) than the rest of the trauma cohort. A prehospital (OR 2.39; 95% CI 1.34 to 4.28; P = 0.003) and emergency department (ED) (OR 6.91; 95% CI 4.49 to 10.66, P = 0.001) systolic blood pressure < 90 mmHg was associated with the major bleeding cohort as well as ED blood gas base excess < -3 (OR 7.72; 95% CI 5.37 to 11.11; P < 0.001) and INR > 1.2 (OR 3.09; 95% CI 2.16 to 4.43; P = 0.001). Emergency damage control laparotomy was performed more frequently in the major bleeding cohort (21.4% [n = 31] vs. 1.5% [n = 106]; OR 3.90; 95% CI 2.50 to 6.08; P < 0.001). There was no difference in transportation time from alarm to hospital arrival between the major bleeding cohort and the rest of the trauma cohort (47 [IQR 38;59] vs. 49 [IQR 40;62] minutes; P = 0.17). However, the major bleeding cohort had a shorter time from ED to first emergency procedure (71.5 [IQR 10.0;129.0] vs. 109.00 [IQR 54.0; 259.0] minutes, P < 0.001). In the major bleeding cohort, patients with penetrating trauma, compared to blunt trauma, had a shorter alarm to hospital arrival time (44.0 [IQR 35.5;54.0] vs. 50.0 [IQR 41.5;61.0], P = 0.013). The 24-hour mortality in the major bleeding cohort was 6.9% (10/145). All fatalities were due to blunt trauma; 40% (4/10) high energy fall, 20% (2/10) motor vehicle accident, 10% (1/10) motorcycle accident, 10% (1/10) traffic pedestrian, 10% (1/10) traffic other, and 10% (1/10) struck/hit by blunt object. In the logistic regression model, prehospital cardiac arrest (OR 83.4; 95% CI 3.37 to 2063; P = 0.007) and transportation time (OR 0.95, 95% CI 0.91 to 0.99, P = 0.02) were associated with 24-hour mortality.ResultsEarly identification of patients at high risk of major bleeding is challenging but essential for rapid definitive haemorrhage control. The major bleeding trauma cohort is a small part of the entire trauma population, and is characterized of being younger, male gender, higher ISS, and exposed to more penetrating trauma. Early identification of patients at high risk of major bleeding is challenging but essential for rapid definitive haemorrhage control.

A curious case of idiopathic eosinophilic pleural effusion post swimming pool diving

Eosinophilic pleural effusion is defined as pleural effusion with &gt;10% eosinophil count. Even though the mechanism underlying eosinophilic pleural effusion is poorly understood, it is considered to be caused by pleural fluid sequestration of bone marrow-derived eosinophils. Even though there is a wide spectrum of diseases recognized to be associated with eosinophilic pleural effusion, including pleural irritation, trauma (hemothorax, pneumothorax, thoracic surgery), malignancy, parasitic infection, drug/toxin-induced and pulmonary embolism; almost 25% of cases remain idiopathic. We herein report a curious case of eosinophilic pleural effusion, which has developed post blunt trauma to the chest, sustained after diving into a swimming pool. The patient was extensively evaluated for possible etiologies but was found negative for any underlying known pathology that could lead to eosinophilic pleural effusion.

An unusual case of multiple skin abscesses caused by methicillin-resistant &lt;i&gt;Staphylococcus aureus &lt;/i&gt;in a 6-year-old boy

This report is a rare case of a 6-year-old child presenting with multiple skin abscesses resulting from a methicillin-resistant Staphylococcus aureus (MRSA) infection post blunt trauma to the pelvic region. Staphylococcus aureus poses challenges due to its antibiotic resistance. The child’s condition, marked by sepsis and extensive abscesses, prompted a multidisciplinary approach involving antibiotic therapy and surgical interventions. The MRSA strain exhibited resistance to various antibiotics, emphasizing the importance of individualized treatment as per the case. The case underlines the complexities of managing multi-site MRSA infections and emphasizes the significance of accurate diagnosis, appropriate antibiotic selection, and surgical intervention for successful outcomes.

(131) Microsurgical Denervation of the Spermatic Cord for Chronic Scrotal Pain: Results from a Prospective Case Series

Abstract Introduction Microsurgical spermatic cord denervation (MSCD) is one of the lines of management of chronic scrotal pain refractory to conservative lines of therapy, however, it has not been fully adopted by different centres. Other procedures such as epididymectomy, orchidectomy and vasectomy reversal are being offered instead. Objective To evaluate the safety and efficacy of microsurgical denervation of the spermatic cord in the management of chronic scrotal pain refractory to conservative lines of therapy. Methods Twenty consecutive patients were prospectively enrolled for MSCD over a 24-month period. These patients underwent MSCD after exclusion of any correctable cause of chronic scrotal pain (CSP) and/or poor response to medical treatment. Efficacy of the technique was evaluated by the degree of pain improvement using the Visual Analogue Scale (VAS). Safety was assessed by reporting any intra- or post-operative complications. Results The mean age of the studied population was 51.7 (36–78) years. The mean pain duration was 4.2 (1–20) years. In 8 patients (40%), the aetiology of the chronic pain was idiopathic, 5 patients (25%) the pain occurred after previous scrotal surgery (vasectomy in 2 patients, AUS in 2 and an epididymal cyst excision in 1 patient), 4 patients (20%) post scrotal trauma and 3 patients (15%) post epididymo-orchitis. Ten patients (50%) had complete pain resolution, 8 (40%) had a partial resolution of their pain, the pain remained the same in a one patient (5%), and one patient (5%) had resolution of the scrotal pain but developed pain at the incision site following MSCD. The VAS pain score significantly improved from a mean of 9.7 to 3.7 postoperatively. (p=0.0029). No significant complications have been encountered in this case series. Conclusions Microsurgical denervation of the spermatic cord is a safe and reliable option that should be more widely adopted to treat men with chronic scrotal pain refractory to conservative treatment. Disclosure No.

Investigating the effects of frailty on six-month outcomes in older trauma patients admitted to UK major trauma centres: a multi-centre follow up study

BackgroundPre-injury frailty is associated with adverse in-hospital outcomes in older trauma patients, but the association with longer term survival and recovery is unclear. We aimed to investigate post discharge survival and health-related quality of life (HRQoL) in older frail patients at six months after Major Trauma Centre (MTC) admission.MethodsThis was a multi-centre study of patients aged ≥ 65 years admitted to five MTCs. Data were collected via questionnaire at hospital discharge and six months later. The primary outcome was patient-reported HRQoL at follow up using Euroqol EQ5D-5 L visual analogue scale (VAS). Secondary outcomes included health status according to EQ5D dimensions and care requirements at follow up. Multivariable linear regression analysis was conducted to evaluate the association between predictor variables and EQ-5D-5 L VAS at follow up.ResultsFifty-four patients died in the follow up period, of which two-third (64%) had been categorised as frail pre-injury, compared to 21 (16%) of the 133 survivors. There was no difference in self-reported HRQoL between frail and not-frail patients at discharge (Mean EQ-VAS: Frail 55.8 vs. Not-frail 64.1, p = 0.137) however at follow-up HRQoL had improved for the not-frail group but deteriorated for frail patients (Mean EQ-VAS: Frail: 50.0 vs. Not-frail: 65.8, p = 0.009). There was a two-fold increase in poor quality of life at six months (VAS ≤ 50) for frail patients (Frail: 65% vs. Not-frail: 30% p < 0.009). Frailty (β-13.741 [95% CI -25.377, 2.105], p = 0.02), increased age (β -1.064 [95% CI [-1.705, -0.423] p = 0.00) and non-home discharge (β -12.017 [95% CI [118.403, 207.203], p = 0.04) were associated with worse HRQoL at follow up. Requirements for professional carers increased five-fold in frail patients at follow-up (Frail: 25% vs. Not-frail: 4%, p = 0.01).ConclusionsFrailty is associated with increased mortality post trauma discharge and frail older trauma survivors had worse HRQoL and increased care needs at six months post-discharge. Pre-injury frailty is a predictor of poor longer-term HRQoL after trauma and recognition should enable early specialist pathways and discharge planning.

Apexification with mineral trioxide aggregate on post trauma right maxillary central incivus teeth

Apexification with mineral trioxide aggregate on post trauma right maxillary central incivus teeth

Complete major pancreatic duct disruption complicated by pancreatico-atmospheric fistula following blunt upper abdominal trauma

Pancreatic injury post blunt abdominal trauma is exceedingly rare. When complete major pancreatic duct (MPD) disruption occurs, a disconnection between the pancreas and the duodenum can take place, ultimately leading to fistula formation. We describe a case of MPD disruption following blunt abdominal trauma, complicated by a fistula between the pancreas and an open abdomen (pancreatico-atmospheric fistula). Although the fistula was managed using standard methods for treating pancreatic fistulas, wound care was a significant challenge in this case where the fistula exteriorized into an open abdomen.

Dreaming of space: a premonition of Ernest Hemingway

ABSTRACT This article concentrates on the cultural mythology of Ernest Hemingway implicitly inscribed into Aleksei Uchitel’ and Aleksandr Mindadze’s Dreaming of Space (2005). This film offers a presentiment of Hemingway as a symbolic representative of the unattainable West and the life that existed just beyond the reach of most Soviet citizens. In so doing, it engages with the Soviet lost generation, those released from Soviet prison camps after Iosif Stalin’s death. Technological advancement would not result in a progressive, modern Soviet state and this lost generation remained, in the words of Nancy Condee, ‘somnambulants and post trauma casualties’ of Stalin’s terror. Ultimate freedom was only realised by leaving the USSR, a pursuit that had inherent risk. The premonition found in Dreaming of Space is not actually of Soviet scientific and cultural superiority, but of the desire for liberation from the USSR. Certainly, Hemingway was an important part of that counter-culture response.

Acute muscle wasting rate assessment and long-term mortality in critically ill trauma.

To evaluate the relationship between acute muscle wasting rate and long-term mortality in critically ill trauma. A single-center, retrospective study was conducted in critically ill trauma. Patients with Computed Tomography scans including the L3 vertebra within 24 hours and at 1 week after trauma were recruited. Acute muscle wasting rate was defined as the mean percent variation per day of skeletal muscle index in the first week after trauma. Multivariate logistic regression analysis and receiver operating characteristic curve analysis were performed to determine whether acute muscle wasting rate could help predict hospital malnutrition and 1-year mortality. Skeletal muscle index was 49.3±10.7 cm2/m2 at baseline and decreased to 45.1±9.6 cm2/m2 (p<0.001) at 1 week and 39.8±10.8cm2/m2 (p<0.001) at 1 month after trauma. A sustained decrease of skeletal muscle index was observed from baseline up to 6 months (33.7±8.4cm2/m2, p<0.001) post trauma, and lasted for 1 year (37.7±5.6cm2/m2, p=0.004). Logistic regression analysis showed that acute muscle wasting rate was an independent risk factor for hospital malnutrition and 1-year mortality. Every 1% absolute increase of acute muscle wasting rate was associated with 1.82-fold higher odds of 1-year mortality in critically ill trauma. The area under curve of acute muscle wasting rate was 0.813 for hospital malnutrition prediction and 0.715 for 1-year mortality prediction. Acute muscle wasting rate was independently associated with higher 1-year mortality and hospital malnutrition in critically ill trauma.

Prolonged course of brain edema and neurological recovery in a translational model of decompressive craniectomy after closed head injury in mice.

The use of decompressive craniectomy in traumatic brain injury (TBI) remains a matter of debate. According to the DECRA trial, craniectomy may have a negative impact on functional outcome, while the RescueICP trial revealed a positive effect of surgical decompression, which is evolving over time. This ambivalence of craniectomy has not been studied extensively in controlled laboratory experiments. The goal of the current study was to investigate the prolonged effects of decompressive craniectomy (both positive and negative) in an animal model. Male mice were assigned to the following groups: sham, decompressive craniectomy, TBI and TBI followed by craniectomy. The analysis of functional outcome was performed at time points 3d, 7d, 14d and 28d post trauma according to the Neurological Severity Score and Beam Balance Score. At the same time points, magnetic resonance imaging was performed, and brain edema was analyzed. Animals subjected to both trauma and craniectomy presented the exacerbation of the neurological impairment that was apparent mostly in the early course (up to 7d) after injury. Decompressive craniectomy also caused a significant increase in brain edema volume (initially cytotoxic with a secondary shift to vasogenic edema and gliosis). Notably, delayed edema plus gliosis appeared also after decompression even without preceding trauma. In prolonged outcomes, craniectomy applied after closed head injury in mice aggravates posttraumatic brain edema, leading to additional functional impairment. This effect is, however, transient. Treatment options that reduce brain swelling after decompression may accelerate neurological recovery and should be explored in future experiments.

Noise-induced damage in the zebrafish inner ear endorgans: evidence for higher acoustic sensitivity of saccular and lagenar hair cells.

The three otolithic endorgans of the inner ear are known to be involved in sound detection in different teleost fishes, yet their relative roles for auditory-vestibular functions within the same species remain uncertain. In zebrafish (Danio rerio), the saccule and utricle are thought to play key functions in encoding auditory and vestibular information, respectively, but the biological function of the lagena is not clear. We hypothesized that the zebrafish saccule serves as a primary auditory endorgan, making it more vulnerable to noise exposure, and that the lagena might have an auditory function given its connectivity to the saccule and the dominant vestibular function of the utricle. We compared the impact of acoustic trauma (continuous white noise at 168 dB for 24 h) between the sensory epithelia of the three otolithic endorgans. Noise treatment caused hair cell loss in both the saccule and lagena but not in the utricle. This effect was identified immediately after acoustic treatment and did not increase 24 h post-trauma. Furthermore, hair cell loss was accompanied by a reduction in presynaptic activity measured based on ribeye b presence, but mainly in the saccule, supporting its main contribution for noise-induced hearing loss. Our findings support the hypothesis that the saccule plays a major role in sound detection and that the lagena is also acoustically affected, extending the species hearing dynamic range.

The Role of the Teacher in Reducing Post Disaster Trauma in Early Childhood

Natural disasters often occur in Indonesia, taking a toll. It is undeniable that anyone can become a victim of natural disasters, including early childhood. One of the impacts caused by the victim is a traumatic feeling that can occur at any time. Early childhood education teachers need to have a role as counselors in helping children who experience symptoms of trauma. Teacher skills are needed in aspects of learning in schools. This paper intends to reveal the role of teachers in reducing trauma after natural disasters in early childhood. The results of community empowerment through group play therapy training then carried out a pre-post test. The results showed that there were differences in knowledge related to the group play therapy method before and after.&#x0D; Keywords: group play therapy, post disaster trauma, early childhood teacher

Fat embolism as a complication of lower extremity long-bone surgery

Introduction Fat embolism syndrome (FES) is a formidable complication that occurs with extremity long-bone fractures. Overall, the mortality of FES is estimated to be 10–36 % depending on the severity of the injury. Early detection of complications, selection of optimal methods for fracture fixation and for anesthesia that would prevent FES are essential.The objective was to assess the incidence of clinical manifestations of FES in patients with lower extremity long-bone fractures, determine the optimal methods of prevention, methods of anesthesia and surgical intervention in the management of the patients.Material and methods The study included 355 patients with lower extremity long-bone fractures treated between 2020 and 2021 at the Trauma Department, State Budgetary Healthcare Clinical N.I. Pirogov Hospital No. 1. Patients were grouped according to different parameters including frequency of occurrence of FES depending on the length of the preoperative period: patients with a long and short preoperative period; treatment strategy: patients treated surgically or conservatively; preoperative use of prophylaxis: patients receiving and not receiving "Essentiale"; anesthetic aidused: general or spinal anesthesia.Results Of the 355 patients examined, FES was detected in 8 patients with fractures of the lower extremities, one patient died. FES developed mainly in the first 72 hours of injury. FES occurred in less than 12 hours (n = 1), in 12-24 hours (n = 2), in 24-48 hours (n = 2), in 48-72 hours (n = 3).Discussion FES developed in patients with a delayed operative period and in patients treated conservatively. The prophylaxis policy suggests timely diagnosis using Schonfeld's scoring system for FES and taking "Essentiale" early post trauma. Patients who underwent surgery with spinal anesthesia showed a decreased incidence of FES as compared with patients operated on using general anesthesia.Conclusion There is a high incidence of FES. Hepatoprotectors can be used on the first days after injury to prevent FES. Osteosynthesis under spinal anesthesia is the preferred method of treatment.

Efficacy of Enhanced Recovery after Surgery (ERAS) protocol in maxillofacial trauma: A randomized controlled trial

IntroductionEnhanced Recovery after surgery (ERAS) guidelines have been formulated in the literature for various different specialties but none is present for maxillofacial trauma patients. Hence, we have formulated ERAS protocol for maxillofacial trauma (ERAS-MT) patients and compared with the patients receiving the standard traditional care for post trauma outcomes. MethodologyA randomized controlled trial included 74 patients divided into two groups: Group 1 (ERAS group:37 patients) and Group II (Control group:37 patients). ERAS group were intervened according to the formulated ERAS protocol based on the previous literature and the control group received the standard of care. The both groups were compared for various post trauma outcomes. ResultsBaseline demographic data was non-significant between both the groups. There was significant decrease in pre-operative IV fluid use and total number of IV analgesics used till 72 h as well as in the immediate post operative period in the ERAS group(p = 0.001). ERAS group started oral feeds within 6 h and they were significantly compliant for oral carbohydrates in the pre-operative phase(p = 0.001). PONV episodes, swelling and infections were insignificantly less in the ERAS group(p > 0.05), however a significant difference was seen throat pain and decreased anxiety as well as Oral Hygiene Index(p = 0.001). At two weeks, a significant difference was seen in overall patient's satisfaction and cost analysis in the ERAS group (p = 0.001). ConclusionOur study suggested that ERAS protocol was associated with shorter hospital stay, early recovery with better overall satisfaction of the patients, lesser post-operative complications and significantly decreased cost analysis.

Poster 148: Preoperative Platelet Rich Plasma Injections Decreases Inflammatory and Chondrodegenerative Biomarkers in Patients with Acute Anterior Cruciate Ligament Tears and Reconstruction: A Pilot Study

Objectives: Post-traumatic osteoarthritis occurs at an alarming rate after ACL injury and surgery. The purpose of this study was to compare the effect of two, pre-operative PRP injections upon the progression of inflammatory and chondrodegenerative biomarkers to the natural progression before ACL reconstruction surgery. Our hypothesis was that pre-operative PRP injections would decrease the chondrotoxicity of the presurgery knee fluid. Methods: Participants were randomized to either a control or intervention group. Both groups received joint aspirations within the first 10 days following ACL injury (Time 1). In addition to joint aspiration at Time 1, the PRP group received a PRP injection at Time 1 and an additional PRP injection at a second visit 5-12 days after the initial visit. Synovial fluid samples were harvested in both groups at the time of ACL reconstruction (Time 2). ELISA was performed on all samples to detect cytokine levels of IL-1B, IL-10, IL-6, GM-CSF, IL-5, IFN-γ, TNF-⍺, IL-2, IL-4, and IL-8 Results: A total 24 participants were enrolled, final analysis was completed on 8 participants in the control group and 9 participants in the intervention group. The control group demonstrated a change in concentration (Δ1à2) between time 1 and time 2 that was not statistically significant for any cytokines p&gt;0.05, except for a statistically significant decrease in IL-8 (p=0.005). The intervention group demonstrated a decrease in all cytokine concentrations that was statistically significant for all cytokines p&lt;0.05, except for IL-8 (p=0.074). When comparing the control group to the intervention group at time 1, no significant difference was seen between cytokine concentrations (p&gt;0.05). Likewise, comparing the control group to the intervention group at time 2, no significant difference was seen between cytokine concentrations (p&gt;0.05). The magnitude of decrease was larger in the intervention group than the control group, but with comparison of means between groups there was not a statistically significant difference. The natural history for these biomarkers is a decrease but at a variable rate/amount. Preoperative intervention with PRP has the potential to consistently alter the concentration of chondrodestructive proteins. Conclusions: Intervention with aspiration and 2 injection series of PRP in the acute ACL injured knee resulted in greater reduction in effusion inflammatory markers than control. This may suggest a treatment modality to improve perioperative pain, function and possibly alter the course of post trauma arthritis in these patients, without the deleterious effect of steroid injection. Long term study and follow up is required to determine if intervention alters the natural history of post traumatic arthritis. [Table: see text][Table: see text]