Trauma Department Research Articles

Road Traffic Accidents, Climbing Frames, or Trampolines: What Harms Children in the 2020s?

Background In the modern Western world, activities and the daily routine of children have changed over time. Detailed analyses of the mechanisms of injuries and current fracture patterns in children are rare. The aim of the study was to elicit and investigate the most dangerous leisure and sporting activities leading to fractures in children today. Materials and methods This is a retrospective study focusing on children that were treated in a level-one trauma center in Germany between 2015 and 2020. All children who were 14 years of age or younger and suffered a traumatic injury treated in our emergency department were included in this study. From the database, mechanisms of injury, type of injury, age, and gender were analyzed. Results The study included 12508 patients, including 7302 males and 5206 females. Among the 10 most common mechanisms of injury were collisions (8.6%), falls (7.7%), injuries while playing (6.1%) or while running or walking (5.9%), soccer (5.9%), bicycle accidents (3.8%), and trampoline falls (3.4%). Road traffic accidents involving passengers or pedestrians caused 3.3% of the injuries but were the most common cause of death. The most common mechanisms of injury causing a fracture were falls, playing soccer, and bicycle accidents. Sorting the mechanisms of injury by the percentage that caused a fracture, the most dangerous activities were falling from heights above 2 meters, skiing and snowboarding, climbing and bouldering, skateboarding, and horseback riding. In the five-year study period, four out of six children died due to road traffic accidents. Conclusion Injured children must be provided with the best quality of care 24/7 in orthopedic trauma departments and have to be kept as a focus in the training of orthopedic trauma surgeons. Road traffic accidents are still the main cause of death in children, but they are overall less common. Falls and sports activities are the most likely to cause a fracture.

VENOUS THROMBOEMBOLISM WITH THE USE OF ASPIRIN VERSUS ENOXAPARIN AS PROPHYLACTIC AGENTS AFTER HIP ARTHROPLASTY

Objective: To assess how often venous thromboembolism (VTE) occurs in patients on low dosage aspirin versus enoxaparin for VTE prevention after hip arthroplasty. Methodology: This quasi-randomized controlled trial was conducted at the Department of Trauma & Orthopedics, Lady Reading Hospital, Peshawar. The study was conducted over a period of 6 months. Lottery method was used to collect data and the patients were divided into two groups. The chi-square test was used to compare the frequency of VTE between groups. Effect modifiers such as age, gender, and BMI were managed through stratification. The post-stratification chi-square test was used to determine whether there is a relationship between these impact modifiers and study results. P-value 0.05 was used to define a significant difference. Results: A total of 74 patients undergoing total/partial hip arthroplasty in orthopedics surgery were observed, which were divided in two equal groups. Patients in Group A were managed by aspirin (75mg/day) and Group B patients received enoxaparin (0.5mg/kg). Group A had 2(5.4%) patients with VTE in follow-up and 35(94.6%) patients had observed no VTE. Group B had VTE in 4(10.8%) patients and no VTE in 33(89.2%) patients which shows that VTE was high in group B as compared to group A. The difference was insignificant with p-value=0 .337. Incidence of VTE was seen to be higher in patients aged more than 50 years. Conclusion: The difference in incidence of VTE after hip arthroplasty with use of either Aspirin or Enoxaparin as prophylactic agents was statistically insignificant.

Screening and intervention for intimate partner violence at trauma centers and emergency departments: an evidence-based systematic review from the Eastern Association for the Surgery of Trauma

BackgroundIntimate partner violence (IPV) is a serious public health issue with a substantial burden on society. Screening and intervention practices vary widely and there are no standard guidelines. Our objective...

Usability of a mHealth Solution using Speech Recognition for Point-of-care Diagnostic Management

The administrative burden for physicians in the hospital can affect the quality of patient care. The Service Center Medical Informatics (SMI) of the University Hospital Würzburg developed and implemented the smartphone-based mobile application (MA) ukw.mobile1 that uses speech recognition for the point-of-care ordering of radiological examinations. The aim of this study was to examine the usability of the MA workflow for the point-of-care ordering of radiological examinations. All physicians at the Department of Trauma and Plastic Surgery at the University Hospital Würzburg, Germany, were asked to participate in a survey including the short version of the User Experience Questionnaire (UEQ-S) and the Unified Theory of Acceptance and Use of Technology (UTAUT). For the analysis of the different domains of user experience (overall attractiveness, pragmatic quality and hedonic quality), we used a two-sided dependent sample t-test. For the determinants of the acceptance model, we employed regression analysis. Twenty-one of 30 physicians (mean age 34 ± 8 years, 62% male) completed the questionnaire. Compared to the conventional desktop application (DA) workflow, the new MA workflow showed superior overall attractiveness (mean difference 2.15 ± 1.33), pragmatic quality (mean difference 1.90 ± 1.16), and hedonic quality (mean difference 2.41 ± 1.62; all p < .001). The user acceptance measured by the UTAUT (mean 4.49 ± 0.41; min. 1, max. 5) was also high. Performance expectancy (beta = 0.57, p = .02) and effort expectancy (beta = 0.36, p = .04) were identified as predictors of acceptance, the full predictive model explained 65.4% of its variance. Point-of-care mHealth solutions using innovative technology such as speech-recognition seem to address the users’ needs and to offer higher usability in comparison to conventional technology. Implementation of user-centered mHealth innovations might therefore help to facilitate physicians’ daily work.

Остеопороз в ракурсе оказания профильной травматолого-ортопедической помощи при низкоэнергетических переломах проксимального отдела бедренной кости

Introduction The low detection rate of osteoporosis and the lack of treatment in the elderly can contribute to a higher rate of low-energy fractures, poor results of surgical treatment and mortality. The purpose of the work was to evaluate the frequency of detection and treatment of osteoporosis before the fracture and during specialized trauma and orthopaedic care provided for a low-energy fracture of the proximal femur in the elderly. Material and methods A retrospective analysis of 209 medical histories of individuals aged 60 years and older who received treatment for a low-energy fracture of the proximal femur in 2 randomly selected trauma departments and a telephone survey of the patients performed at 3-8 months were produced. Availability of the diagnosed osteoporosis and the treatment before and during fracture repair were identified. Results The diagnosed osteoporosis was established in 5.2 % prior to fracture occurrence and in 16.7 % after the fracture occurrence. In both cases, the condition was treated with colcalciferol, calcium and pathogenetic therapy used in some cases. Discussion Diagnosis and treatment of osteoporosis in the elderly remained low before a lowenergy fracture of the proximal femur and during trauma and orthopaedic treatment. Conclusion The initiation and treatment of osteoporosis during the trauma and orthopaedic management of a low-energy fracture should be considered as a component of the high-quality specialized care.

Transformation of Emergency &amp; Trauma Department in Response to COVID-19 Pandemic

Objectives: COVID-19 pandemic has caused tremendous impact on Emergency &amp; Trauma Department (ETD) worldwide including ETD Hospital Taiping (HTPG). It is a large department with approximately 200 staff and a daily admission load that achieves an average of 250-300 patients per day, with an expected load increment during festivals and weekends. This article illustrates reorganizing strategies of ETD HTPG in setting up system and rules implementation in response to COVID-19 pandemic since the year 2020. Methods: This is a descriptive report on the transformation of dedicated facilities to cope with COVID-19 pandemic since the year 2020. Plan-DO-Check-Act (PDCA) has been implemented to improve the systems. The report is written based on the actual clinical needs, development and advancement of emergency medical services in ETD HTPG. Results: Elimination of COVID-19 pandemic virus is impossible in the near future in a start year of 2020. Isolation has turned out to be the next crucial step in controlling the pandemic. The creation of Triage Isolation Booth (TIB) has reduced transmission risks while allowing staff to carry out their usual triage process. Three emergent clinical areas were formed in an ad-hoc manner to cater to the pandemic, namely Respiratory Zone, Influenza-Like Illness (ILI) &amp; COVID Zone in addition to basic 3 zones of red, yellow and green. New norms, rules and regulations are adapted to all ETD staff, patients and visitors. Conclusion: This article is meant to share our initiative and strategies in handling and managing COVID-19 cases with multiple challenges and limitations of resources in ETD HTPG. As a point of success of these strategies, we have recorded only 3 isolated positive cases among ETD staff in the year 2020. To date, the system is being practiced and revised from time to time to achieve better performance for patients’ needs. International Journal of Human and Health Sciences Supplementary Issue: 2023 Page: S21

Profil primljenih pacijenata na Odeljenje vitreoretinalne hirurgije i očne traume na Univerzitetskoj očnoj klinici - dvogodišnja retrospektivna studija

Introduction/Aim: Vitreoretinal diseases can lead to permanent vision loss. The aim of our study was to present the frequency, demographics and treatment options of the patients hospitalized and treated at the tertiary healthcare Department of Vitreoretinal Surgery and Eye Trauma in a two-year period. Material and Methods: The retrospective study was conducted at the Clinic for Eye Diseases, University Clinical Center of Serbia in Belgrade, Serbia in the period between November 30, 2020 and December 4, 2022. |Data on demographics, seasonality and treatment methods were collected from "Heliant" healthcare software and subsequently interpreted. Results: During the study period, a total of 1295 patients were hospitalized. Cataract was the most common reason for hospitalization (n=355, 27.4%), followed by ocular trauma (n=303, 23.4%) and rhegmatogenous retinal detachment (n=287, 22.2%). The majority of patients with eye trauma (n=125, 41.2%, p&lt;0.001) were between 19 and 44 years old. Male predominance was found in ocular trauma (n=261, 86.1%, p&lt;0.001), and also in patients hospitalized for rhegmatogenous retinal detachment surgery (n=166, 57.8%, p&lt;0.001) and surgery due to complications of proliferative diabetic retinopathy (n=41, 71.9%, p&lt;0.001). Patients aged between 45 and 64 years were at the highest risk (n=136, 47.4%, p&lt;0.001) and vitrectomy was performed more often as a treatment of rhegmatogenous retinal detachment (n=193, 67.2%, p&lt;0.001). Rhegmatogenous retinal detachment most commonly occurred in autumn (n=103, 35.9%, p&lt;0.001). Conclusion Further studies focusing more on some of the pathologies included in this study may be beneficial for a better understanding of epidemiology, preventive measures, and optimal treatment methods.

Development and Evaluation of a Web-Based Application for Trauma Nursing Documentation in Thailand: A Feasibility Study.

Electronic nursing documentation has advantages for monitoring and improving the quality of trauma nursing documentation. However, electronic nursing documentation has rarely been implemented in Thailand. This study aimed to assess the feasibility and nursing satisfaction of a web-based trauma nursing documentation application. A descriptive cross-sectional survey design was used to assess the feasibility and nursing satisfaction with a web-based trauma nursing documentation application. The application was based on literature review, Advanced Trauma Life Support principles, and the North American Nursing Diagnosis Association. The survey was administered to trauma and emergency department registered nurses in a hospital in Thailand from November 2021 to January 2022. Patient data were also extracted from the web application system for analysis. A total of 59 nurses piloted the web-based application on 79 trauma patients. Of 59 nurses, 45 (76.3%) were female, 44 (74.6%) had worked in the emergency department for more than 5 years, and 49 (83.1%) had no prior experience with using web-based applications. The nurses were satisfied with the application (M = 3.51, SD = 0.62), and they suggested that it was feasible to apply in practice (M = 3.46, SD = 0.79). These preliminary data demonstrate that implementing a web-based application for trauma nursing documentation in the emergency department is feasible and satisfactory to nurses.

Surgical Management of Unstable Superior Femoral Epiphysiolysis with Great Displacement

Introduction: Superior femoral epiphysiolysis (SFE) is a most progressive but sometimes abrupt displacement of the femoral head relative to the superior femoral metaphysis through the cervicocerebral growth plate of the femur. The displacement of the femoral head is most often downward and backward. It is a typical pathology of the pubescent adolescent, most often overweight. It occurs on average at the age of 12 years in girls and 14 years in boys. Unstable forms with large displacements have a high risk of femoral head necrosis and chondrolysis. Although in situ fixation is the generally accepted treatment for minor SFE, the treatment of more severe cases remains controversial. When the extent of the displacement makes it impossible to pass a screw between the femoral neck and the femoral head, the only option is to reduce the displacement. This reduction must be gentle, progressive and limited to the minimum necessary for osteosynthesis. Objective: The aim of the work was to evaluate the results of the technique of progressive reduction of epiphyseal displacement by transtibial traction followed by percutaneous fixation of the femoral head by screw. Patients and Method: This was a retrospective descriptive study over a 10-years period from January 1, 2013 to December 31, 2022. It focused on the surgical treatment of unstable upper femoral epiphysiolysis with large displacement in the orthopaedic trauma department of the University Hospital of Kati. All patients operated on in our department for large displacement SFE were included in this study. Cases of secondary large displacement upper femoral epiphysiolysis and patients who had already undergone surgery on the proximal femur were excluded. Continuous progressive traction on the Boppe splint through a pin under the anterior tibial tuberosity was performed for 15 days in all patients. The hip was flexed to 45° and the knee to 35°. Fixation was performed with one or two screws. No contralateral preventive fixation was performed. Minimum follow-up was one year. Functional outcome was assessed by the Postel Merle d’Aubigné score. Anatomical outcome was assessed by the quality of reduction, the occurrence or non-occurrence of femoral head necrosis, and chondrolysis. Results: We identified nine patients with a mean age of 12.8 years and extremes of 9 and 17 years. There were three boys and six girls. Trauma was mentioned in four cases. The cause was idiopathic in five cases. Functional impotence was complete in all patients. The slippage was acute on a chronic background in all patients. The left side was affected in 7 cases and the right side in 2 cases. The patients were overweight in 7 cases. The patient’s weight was within the normal range in two cases. At final follow-up, all nine patients were asymptomatic. Anatomically, all nine patients had a femoral head free of avascular necrosis. In eight patients, the posterior tilt was absent, identical to that obtained after the traction period. Only one patient had a moderate posterior tilt with a neck uncovering of less than 25%. Functionally, the PMA score was very good in eight cases and good in one case. Conclusion: This study shows that the treatment of acute and unstable forms of upper femoral epiphysiolysis by progressive reduction with transtibial traction can lead to satisfactory results. Reduction in large displacement forms should be gentle, progressive and limited to the minimum necessary for osteosynthesis. Magnetic resonance imaging examination is an essential and indispensable prognostic element. Indications for preventive fixation should be selectively reserved for specific cases.

Results the use of minimally invasive surgical methods for the treatment of patients with polytrauma in the Fergana branch of the Rncemp

Retrospective analysis of the anatomical and functional outcomes of surgical treatment of 1024 patients with polytrauma was performed in the trauma department of the FBRSCEMA for the period from 2005 to 2020. High-tech methods of minimally invasive osteosynthesis have been increasingly used in recent years in order to improve the results of treatment of patients with polytrauma. 1340 operations were carried on 1024 (76.4%) patients. The share of minimally invasive surgical interventions was 83.4% (854 operations). In comparison with traditional osteosynthesis, the introduction of new minimally invasive osteosynthesis technologies provides the possibility of earlier performing of surgical fixation of bone fragments, reduces the likelihood of postoperative complications due to minimal surgical trauma, creates optimal conditions for accelerating the healing of fractures, provides early support for the limb and the ability to start an early stage development of movements in the joints of the injured limbs.

Functional Outcome of Open Latarjet Procedure for Recurrent Anterior Shoulder Dislocation

OBJECTIVES To find the functional outcome of the open Latarjet method for recurrent anterior shoulder dislocation. METHODOLOGY The current retrospective study was conducted at the Orthopedic and Trauma Department of the Khyber Teaching Hospital in Peshawar from September 2020 to August 2021. A total of 31 patients were included in the study, of which 29 were males and 2 were females. A detailed medical history was obtained through physical examination, and all necessary laboratory tests were requested. AP and axillary views of plain X-ray radiographs were taken. We used a CT scan on all the patients to calculate the humeral and glenoid bone loss. We had all patients undergo an MRI to rule out soft tissue pathology. Six months after surgery, the outcome was graded using the Constant Murley Score on a good, good, fair, and poor scale. RESULTS In this study open Latarjet procedure was done in 31 patients with 29 males (93.4%) and two females (6.45%). The right-sided shoulder was involved in 24 (77.14 %) patients, while the left shoulder was involved in 7 patients (22.58%). A bipolar lesion in the shoulder with bone loss was seen on the glenoid side at 17.5% (range 10-25%), and the humeral side was 22.5%. Follow-up was done for six months in which 22 patients had a very good outcome (70.96%), six patients had a good outcome(19.35%), two patients had a fair outcome(6.45%), and one patient had a poor outcome(3.22%). There were no major complications seen like graft fractures, graft malposition, neurovascular compromise, and hardware breakage CONCLUSION Recurrent anterior shoulder instability can be effectively treated with open Latarjet with excellent functional outcomes and a very low complication rate and recurrence.

A Clinical Audit of Orthopaedic Operation Note Documentation and Digitalization of the Operative Note Template: A Quality Improvement Project.

Background Good communication between a surgical team and other colleagues is vital, and the medium of communication is often the operative note. It is essential to ensure continuity of care between the operating team and other colleagues; also, it provides a medicolegal record of patientcare. It checks all the four main domains of good surgical practice guidelines set by the Royal College of Surgeons (RCS) of England. The aims of this project wereto evaluate the quality of operation notes against the set parameters by the RCS and to improve qualityof the operative notes using information technology (IT) service software update to provide operative note digitalization. Methods This was a retrospective andprospective closed-loop audit, in which the operative notes were analysed for the Trauma and Orthopaedics speciality. Three separate cycles of audits were completed. In the the first cycle, data were collected retrospectively from all the operative notes, from June 1, 2020, to June 15, 2020; then, data were collected prospectively after making interventionsto establish digitalization of the operative notes. The secondcycle was completed from February 14 to 21, 2021, and from March 1 to 7, 2021. The third cycle was completed from August 1 to 31, 2021.All data were collected in Excelusing a checklist that evaluated 34 parameters. These parameters were based on the recommendations of RCSGood Surgical Practice guidelines.All trauma and orthopaedic patients were included regardless of the type of procedure. There were no exclusion criteria in place. Results An overall increase from 9.5% to 66.7% in typed operative notes was achieved with the introduction of the templated operative note documentation service. There was a 40% reduction in the use of handwritten operative notes. Concerns regarding legibility were reduced in view of the digitalization of the operative notes. The firstcycle of the audit, in terms of the parameters yielded, found that the operative notes were missing 10 important parameters, independent of the author grade; these were recorded in less than 10% of the operative notes. The secondcycle, in terms of the parametersyielded, found that the operative notes were missing four important parameters, independent of the author grade; these were recorded in less than 10% of the operative notes. The thirdcycle of the audit, in terms of the parameters yielded, found that the operative notes were missing three important parameters.Specific documentation for 12 different parameters improved over the course of the three Plan-Do-Study-Act (PDSA) cycles. Conclusion Royal College of Surgeons guidelines and integration withITservices significantly improved the quality and legibility of operative notes that were being documented in the trauma and orthopaedics department. Structured document standards and good integration with a computer-based IT servicehelpprompt surgeons to document in a better and easy way, thereby leading to improved clinical documentation.

Making a move: Using simulation to identify latent safety threats before the care of injured patients in a new physical space.

In today's rapidly changing health care environment, hospitals are expanding into newly built spaces. Preserving patient safety by identifying latent safety threats (LSTs) in advance of opening a new physical space is key to continued excellent care. At our level 1 pediatric trauma center, the hospital undertook a 5-year project to build a critical care tower, including a new emergency department with five trauma bays. To allow for identification and mitigation of LSTs before opening, we performed simulation-based clinical systems testing. Eight simulation scenarios were developed, based on actual patient presentations, incorporating a variety of injury patterns. Scenarios included workflow and movement from the helipad and squad entrance as well as to radiology, the operating room, and the pediatric intensive care unit. A multiple resuscitation scenario was also designed to test the use of all five bays simultaneously. Multidisciplinary high-fidelity simulations were conducted in the new tower. Key trauma and emergency department stakeholders facilitated all sessions, using a structured framework for systems integration debriefing framework and failure mode and effect analysis to identify and prioritize LSTs, respectively. Eight sessions were conducted for 2 months. A total of 201 staff participated, including trauma surgeons, respiratory therapists, nurses, emergency physicians, x-ray technicians, pharmacists, emergency medical services, and operating room staff. In total, 118 LSTs (average of 14.8/session) were identified. Latent safety threats were categorized. An action plan for mitigation was developed after applying failure mode and effects analysis prioritization scores (based on severity, probability, and ease of detection). Systems-focused trauma simulations identified a large number of LSTs before the opening of a new critical care building. Identification of LSTs is feasible and facilitates mitigation before actual patient care begins, improving patient safety. Therapeutic/Care Management; Level IV.

Sensitivity, Specificity, and Cut-off Point of the Mini-Mental State Examination in Patients With Mild Traumatic Brain Injury

Background and Aim: Most patients suffering from traumatic brain injury (TBI) are those with mild injuries (mTBI). However, due to the absence of symptoms in brain imaging until long after the injury, the manifestations of cognitive impairments remain undiagnosed. Therefore, cognitive screening is considered a key measure in these patients. One of the common screening tools for evaluating cognitive impairments is the mini-mental state examination (MMSE) test. The present study aimed to determine the cut-off point, sensitivity, and specificity of the MMSE test in mTBI patients. Methods and Materials/Patients: In this observational and cross-sectional-analytical study, the statistical population included all patients with mTBI who were injured in the 1st half of 2022. The case group included 79 mTBI patients admitted to the trauma, neurosurgery, and intensive care unit (ICU) departments of Poursina Hospital in Rasht City, Iran, in the 1st half of 2022, who had been referred to the same hospital and Velayat specialized clinic for rehabilitation and re-visit, and the control group included 79 normal healthy individuals. Both groups were cognitively evaluated by the MMSE test on two occasions with an average time interval of 2-3 weeks. Results: The results of the discriminant analysis showed a cut-off point of 27 to 28 as the probable point of cognitive impairment. Also, to identify the cognitive impairment in mTBI patients, this test reported low sensitivity of 0.43-0.58 and a moderate specificity of 0.69-0.80 in two tests. Conclusion: In screening for possible mild cognitive impairment in mTBI patients, the MMSE is relatively useful and should not be used solely to replace a comprehensive neuropsychological evaluation with diagnostic purposes.

IMPLEMENTATION OF THE ELDER MISTREATMENT EMERGENCY DEPARTMENT TOOLKIT AT LYNDON B. JOHNSON HOSPITAL

Abstract Lyndon B. Johnson Hospital (LBJ) has the busiest Level III trauma and emergency department (ED) in Texas. Located in the busiest Houston zip code for Adult Protective Services reports, LBJ staff routinely assess older adults for mistreatment with no formal screening and response protocol. An ED-wide staff assessment revealed formal training needs for elder mistreatment (EM) detection, management, and reporting. Between October and December 2019, 55% of ED bedside nurses were trained along with 75% of charge nurses, and 12 clinical and nurse case managers, resulting in improved knowledge regarding EM screening and response best practices. In January 2021, LBJ staff implemented the Elder Mistreatment Screening and Response Tool (EM-SART). This resulted in 1,218 complete screens, 23 cases of suspected EM (2%), and 4 confirmed EM cases. Despite the pandemic and other challenges, LBJ staff demonstrated resilience and dedication, and reported EM training, screening, and response protocol efficacy.

Removal of Metal Fixators after Consolidation of Bone Fractures: To Do or Not to Do? (Literature Review)

Summary. Removal of metal fixators today is one of the most common surgical interventions in developed countries. According to many European researchers, surgeries performed to remove metal fixators account for almost 30% of all planned surgical interventions and 15% of the total number of surgeries performed in trauma departments. This certainly indicates the great social significance of the problem. An analytical review of the literature has shown that the surgery of removing metal fixators in the consolidation of bone fractures is not a routine procedure; it requires experience and training of the surgeon. The problem of removal of metal fixators in some individual cases and localizations is not completely solved and requires further clinical and experimental studies.

Positioning the Catheter Tip Anterior or Posterior to the Saphenous Nerve in Continuous Adductor Canal Block: A Mono-Centric Retrospective Comparative Study.

Ultrasound-guided continuous adductor canal block (cACB) is a conventional choice in patients undergoing total knee arthroplasty (TKA) for the management of the postoperative pain. Thisstudy aimstocompare different catheter tip locations for cACB relative to the saphenous nerve (anteriorly vs posteriorly) in terms of efficacy and complications. At the department of Surgical Sciences, Orthopedic Trauma and Emergencies of the University of Naples Federico II (Naples, Italy), between January 2020 and November 2021, retrospective comparative study was executed. Patients planned for TKA were included in the study if they met the follow inclusion criteria: patients undergone TKA; aged 50-85 years; body mass index (BMI) of 18-35 kg/m2; American Society of Anesthesiologists (ASA) physical status classification from I to III; subarachnoid technique for anesthesiology plane; continuous adductor canal block performed by an anesthetist with considerable experience. Patients were assigned to receive cACB with the catheter tip located anteriorly (Group 1, G1) or posteriorly to the saphenous nerve (Group 2, G2). Postoperative pain, ambulation ability, episodes of pump block and rate of catheter dislodgement and leakage were evaluated and analyzed. Altogether, 102 patients were admitted to the study (48 in G1 and 54 in G2). After the first 8 postoperative hours, in G1 17 patients (35.4%) had a VAS greater than 4, while in group 2 only 3 patients (5.6%) had a VAS greater than 4 (p-value <0.01). All patients of both groups showed ambulation ability in the postoperative period. No episode of leakage was recorded. While the catheter displacement rate was similar in the two groups (2.1% for G1 vs 3.7% for G2; p-value >0.05), the episodes of pump block were significantly less in G2 than in G1 (3.7% vs 20.8%; p-value <0.01). In cACB for TKA, we found that positioning the catheter tip posteriorly to the saphenous nerve may lead to a greater postoperative analgesia and reduce the risk of pump block compared to placing the catheter tip anteriorly to the nerve.

Clinical profile and outcomes of trauma patients visiting the emergency department of a trauma center Addis Ababa, Ethiopia.

The term traumatic injury refers to physical injuries that present quickly and with a great deal of severity. These injuries can result from blunt, penetrating, and other causes. The best patients' outcomes are achieved when all parts of a trauma care system are in place. In low-resource settings, these facilities are scarce and their requirements high. Identifying patient profiles and evaluating these in relation to patient outcomes will help to guide interventions and monitor progress. This study aimed to examine the clinical profile and outcomes of trauma patients at ALERT Hospital, Ethiopia's busiest national trauma center. Aretrospective cross-sectional chartreview of 362 patients admitted fromJanuary 2019 to December 2019 at Alert Hospital trauma and emergency department was conducted. The male-to-female ratio was 2.5:1, with trauma more prevalent among those in the age group of 24-33. Comparatively more injuries 98 (27.1%) occur between 8 and 6 a.m. and 90 (24.9%) of patients were transported by ambulance to the hospital. Among patients referred to the hospital, 247 (68.2%) patients received pre-hospital treatment. Interpersonal Violence (IPV) accounts for 31.8% of all accidents, followed by Road Traffic Accidents (RTA), which account for 30.7%. The Kampala Trauma Severity score (KTS) II showed mild trauma (82.3%), moderate trauma (11%), and severe trauma account (6.6%). A total of 44.2% of the victims suffered soft tissue injuries and 24% suffered extremity fractures, with 11.3% sustaining polytrauma. The mortality rate was 3.6%, with RTA, head injury, polytrauma, the severity of the injury, and patients with CPR were statistically associated factors. IPV and RTA were the two most frequent causes of injuries, with most trauma victims being young. A great deal of emphasis needs to be given to preventing injury and improving prehospital emergency services.

Топографическая анатомия плечевого сплетения и возможности эндоскопического доступа (кадаверное исследование)

Relevance The brachial plexus is a complex anatomical structure the passes through three narrow anatomical spaces including the interscalene space, the space between the first rib and the clavicle (thoracic aperture), the space between the anterior chest wall and the pectoralis minor muscle. Compression of the brachial plexus and the vascular band can occur at the sites. Endoscopic approach to the brachial plexus is a promising surgical trend to allow neurolysis and decompression of the plexus with minimal trauma and blood loss and a good cosmetic result. The purpose was to explore topographic anatomy of the brachial plexus and surrounding structures and determine the possibility of endoscopic approach to the brachial plexus. Material and methods The shoulder and neck were dissected in 5 fresh cadavers. The study was performed at Trauma and Orthopaedics department of the Russian Peoples Friendship University and Department of pathological anatomy at the Buyanov’s Moscow State City Hospital between 2021 and 2022. Results The pectoralis minor muscle was detached from the coracoid process to endoscopically approach to the subclavian part of plexus. The lateral aspect of the subclavian muscle was detached from the clavicle to endoscopically approach to the thoracic aperture. Portals were produced at the supraclavicular fossa to endoscopically approach to the supraclavicular part of the plexus in the interscalene space considering the topographic anatomy of the jugularis external vein and accessory veins. The mean distance from the coracoid tip to the penetration point of the musculo-cutaneous nerve to the conjoint tendon was 3 cm. The mean distance between the anterior chest wall and the clavicle (width of thoracic aperture) was 1.86 cm. The mean distance between the sternal end of the clavicle to the point of passage of the subclavian artery under the clavicle was 5.7 cm. The mean width of the interscalene space was 1.4 cm. Discussion Aspects of topographic anatomy of the brachial plexus were examined in cadaveric studies of Sidorovich R.R. (2011), Chembrovich V.V. (2019), Anokhina Z.A. (2021), but endoscopic approach to the brachial plexus and possibility with endoscopic surgery were not discussed in the studies. Foreign cadaveric studies of Akaslan I. (2021), Koyyalamudi V. (2021), Costabeber I. (2010), Akboru (2010) were performed to examine topographic anatomy of the brachial plexus. The only study reporting the possibility of endoscopic approach to the brachial plexus and endoscopic anatomy was performed by Lafosse T. (2015). Our cadaveric series reported the possibility of endoscopic approach to the brachial plexus at the three levels for the first time in Russian literature. Conclusion Topographic anatomy of the supraclavicular and infraclavicular portions of the brachial plexus was examined in our series. The study showed the possibility of endoscopic approach to the brachial plexus at the interscalene space, thoracic aperture and subclavian area.

Magnetic resonance imaging (MRI) findings after knee, foot, and ankle traumas.

The aim of this study is to investigate the demographic and clinical characteristics of knee and ankle traumas that could not be detected in the first post-traumatic evaluation and diagnosed within 15 days after the follow-up examination and to discuss the results we obtained with current data. Patients admitted to the emergency department trauma department between January 1, 2017, and December 31, 2018, were retrospectively analyzed. Applications due to traffic accidents and all traumas except knee and ankle trauma were excluded from the study. Medical records were used to reveal the demographic characteristics of the cases, clinical findings, mechanisms of injury, additional injuries, and interventions in the emergency room. The mean age of 2,039 patients included in the study due to knee, foot, and ankle trauma was 35.69±12.01, and the median value was 36 (age range 11-71). The patients were divided into 2 groups knee trauma and ankle trauma and statistical evaluations were made. Of the patients evaluated for knee trauma (n=1,157), 463 (40%) were female and 694 (60%) were male. Of the patients evaluated for ankle trauma (n=882), 397 (45%) were female and 485 (55%) were male. It is evident that knee, foot, and ankle traumas after simple falls and sports injuries are frequently encountered by emergency physicians. It is known that post-traumatic ligament injury, bone contusion, intraarticular fluid/hematoma formation, and fractures that cannot be detected by radiographs can be overlooked in emergency departments where patient density is high.