Trauma Literature Research Articles

Chronic knee pain following infrapatellar/suprapatellar magnetic intramedullary lengthening nails versus external fixators in limb length discrepancy: A retrospective review

Aims & objectivesPrior to the popularization of magnetic intramedullary nails (MILNs), gradual deformity correction using external fixation was the norm in limb lengthening. Trauma literature has shown MILN via a suprapatellar approach (SP) to be associated with less knee pain than either an infrapatellar entry (IP) or external fixation. Yet, no research has investigated chronic knee pain and MILNs. We assessed differences in chronic knee pain following lengthening via an IP or SP approach with an MILN versus external fixation. Materials & methodsWe reviewed 147 limbs (55 MILN/IP, 22 MILN/SP, 71 external fixator) in 124 patients who underwent tibial lengthening with ≥12 months follow-up between February 2012 and July 2020. Knee pain was assessed pre- and postoperatively at 6 and 12 months, with the Lysholm Knee Scoring Scale (LKSS) and numeric pain scale (0-10). Differences in knee pain outcomes were compared across methods, with subgroup analysis of MILN/SP and MILN/IP. ResultsMean LKSS was 96.3 for external fixation and 88.5 for MILN (P = .011). In the MILN subgroups, mean LKSS was 91.7 for IP and 85.3 for SP. The IP group reported a lesser mean pain score (0.6 versus 2.1) at 12 months. Bilateral nail recipients demonstrated no knee pain differences versus unilateral. At 12 months postoperative, external fixation had better knee outcomes. ConclusionTibial lengthening with external fixation was associated with less chronic anterior knee pain and better functional outcomes than MILN overall. In terms of MILN approach, IP surpassed SP on subjective pain scores. Larger tibial lengthening and knee pain studies are warranted.

Summary Paper of the Updated 2023 European Association of Urology Guidelines on Urological Trauma

ContextThe European Association of Urology (EAU) Guidelines Panel for Urological Trauma has produced guidelines in order to assist medical professionals in the management of urological trauma in adults for the past 20 yr. It must be emphasised that clinical guidelines present the best evidence available to the experts, but following guideline recommendations will not necessarily result in the best outcome. Guidelines can never replace clinical expertise when making treatment decisions for individual patients regarding other parameters such as experience and available facilities. Guidelines are not mandates and do not purport to be a legal standard of care. ObjectiveTo present a summary of the 2023 version of the EAU guidelines on the management of urological trauma. Evidence acquisitionA systematic literature search was conducted from 1966 to 2022, and articles with the highest certainty evidence were selected. It is important to note that due to its nature, genitourinary trauma literature still relies heavily on expert opinion and retrospective series. Evidence synthesisDatabases searched included Medline, EMBASE, and the Cochrane Libraries, covering a time frame between May 1, 2021 and April 29, 2022. A total of 1236 unique records were identified, retrieved, and screened for relevance. ConclusionsThe guidelines provide an evidence-based approach for the management of urological trauma. Patient summaryTrauma is a serious public health problem with significant social and economic costs. Urological trauma is common; traffic accidents, falls, intrapersonal violence, and iatrogenic injuries are the main causes. Developments in technology, continuous training of medical professionals, and improved care of polytrauma patients reduce morbidity and maximise the opportunity for quick recovery.

The Mindful Interactions (MI) tool: promoting student mental health in tertiary education

This conceptual paper introduces the Mindful Interactions (MI) tool designed to enable university teaching academics to promote student mental health and in so doing, impact positively on academic outcomes. The MI tool is comprised of three elements: understandings to provide theoretical guidance which inform pedagogy, practices to provide strategies for translating theory into practice, and guiding principles which provide a catalyst for critical reflexion, challenge existing beliefs, and create a shared vision from which to work. Relationships are at its core, acknowledging that university students report teacher-student relationships as key to their mental health. Issues related to university student mental health, of which psychological distress is an important component, have been well documented and exacerbated since the onset of COVID-19, increasing demands on universities to meet student mental health needs. It is contended in this paper that understanding the causes of psychological distress, particularly in relation to Adverse Childhood Experiences, offers an alternative lens through which to view student mental health. This lens suggests additional ways of thinking about how university teaching academics and universities might proactively respond to student mental health needs. Cultural Historical Activity Theory informed the theoretical framework for the study, whilst two ‘approaches’ (the ‘Three Pillars of Trauma-informed Care’ and ‘Trust Based Relational Intervention’) along with associated trauma literature underpinned the development of the MI tool.

Tibiotalocalcaneal Arthrodesis with Hybrid Nail-Plate Constructs: A Novel Technique for Treatment of Unstable Ankle & Hindfoot Deformities

Category: Ankle; Hindfoot Introduction/Purpose: Tibiotalocalcaneal (TTC) arthrodesis is a treatment option for several pathologies of the hindfoot and ankle. Traditional fixation options include intramedullary nailing or plate-screw constructs. In certain patients, for example when bone quality or post-operative compliance are of concern, more robust fixation may be desired. Charcot neuroarthropathy (CN) patients in particular often have complex deformities, poor bone quality, and impaired sensation. New trauma literature shows hybrid nail-plate constructs (NPCs) may permit early weight bearing in osteoporotic distal femur fractures. We report early results of TTC arthrodesis using NPCs in patients with complex deformities of the ankle and hindfoot. Methods: Patients undergoing TTC arthrodesis via intramedullary nail fixation plus plating by a single surgeon from September 2020 to December 2022 were included in our study. Indications included CN, post-traumatic deformities, and advanced arthritis. Age, comorbidities, Hemoglobin A1c, presence of an ulcer, implants, bone graft used, and postoperative complications were retrospectively recorded. Results: Fifteen patients met inclusion criteria. Six patients had CN; eight patients had post-traumatic complications; and one patient had an arthritic cavovarus deformity. Average age was 55 years (range 31-72). Eleven patients were treated with a lateral TTC locking plate; three were treated with an anterior tibiotalar arthrodesis plate; and one was treated with a 3.5mm reconstruction plate. All patients were treated with a TTC arthrodesis nail. In all cases, cellular bone matrix was used; in fourteen cases, autograft was also used. Average follow-up was 35 weeks (min. 12). Three patients underwent below-knee amputation, two for infection and the other for hardware failure. Two others required postoperative debridements but subsequently cleared their infections. Twelve patients have a stable, non-infected, ulcer free foot at latest follow-up. Conclusion: TTC arthrodesis can be used for a variety of indications, and many of these patients present complex challenges. Patients with CN in particular often have severe deformities and poor bone quality. Hybrid fixation methods provide added stability in complex cases, possibly allowing for more powerful deformity correction and earlier weight-bearing. We report a 80% favorable outcome rate in our case series, with major complications confined to patients with significant medical comorbidities (poorly controlled diabetes, peripheral vascular disease). We believe that TTC arthrodesis with hybrid nail-plate constructs represents an attractive solution to complex ankle and hindfoot deformities.

The trauma and fragmentation narrative in Amy Tan’s The Kitchen God’s Wife and Toni Morrison’s Beloved

Trauma theory, which emerged in the early 1990s, unveiled the deep-rooted violence characterising modern civilisation. As an essential subset of trauma studies, trauma literature acts as a testament to victims’ experiences. A narrative technique pivotal to this literature is the fragmented narrative, mirroring both the inherent nature of trauma and its external portrayal. This technique aptly captures the often-ineffable nature of traumatic experiences. This research scrutinises the application of fragmented narrative in two seminal works: Amy Tan’s The Kitchen God’s Wife published in 1991 and Toni Morrison’s Beloved published in 1987. Through a lens focused on mother-daughter dynamics and trauma representation, the study illuminates the novels’ shared themes of motherhood and the agonising internal battles of trauma-afflicted mothers. Tan and Morrison, using fragmented narrative, vividly depict their protagonists’ harrowing traumas, and offer invaluable insights into the experiences of marginalised communities. The emphasis on trauma literature is pivotal, both for a comprehensive understanding of traumatic events and the advancement of trauma research. This underscores the paramountcy of acknowledging personal and communal traumas and championing a humane approach to trauma victims.

Proposing the FLOCK Score as a Triage Tool and Outcome Predictor in the Older Age Trauma Population

It is well known both anecdotally and quantitatively that older age patients greater than 65 years are a particularly vulnerable population in medicine. This characterization holds true in the trauma literature where older age patients incur a disproportionate percentage of injury related mortality among other poor outcomes [1].

An introduction to directed acyclic graphs in trauma research.

Directed acyclic graphs (DAGs) are visual representations of the presumed causal structure of an empirical research data set. They are important tools for researchers but have been used rarely in the psychological trauma literature. The purpose of this article is to explain what DAGs are and why (and how) they are useful for trauma researchers. We first describe the utility of DAGs for making causal assumptions explicit, identifying causal effects, and preventing bias. Basic definitions and rules governing the use of DAGs are presented using a hypothetical DAG. We explain why conditioning on a variable, for example, by controlling for it in a multivariable model, can in some circumstances actually introduce bias and not prevent it. We also provide references for topics related to DAGs that are beyond the scope of this introductory article. DAGs are illustrated using the example of the effect of posttraumatic stress disorder (PTSD) on Parkinson's disease. We demonstrate that a multivariable model controlling for all covariates that are being considered introduces bias and would make it impossible to identify the causal effect of PTSD on Parkinson's disease. DAGs can help trauma researchers to understand when they can and when they cannot draw causal conclusions based on research data. This introduction to DAGs should help readers understand their use in the articles on marginal structural models, causal mediation analysis, and instrumental variable methods in this special section, Causal inference and agent-based modeling in trauma research. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

문화기억과 트라우마의 문학적 재현

The “nation narrative” that literature evokes after the war is reproduced again in literature. The memory of war reproduced in literature functions as a kind of window to approach the truth of history by adding fictional imagination to the fragmented and blurred personal narrative. Memory and trauma can be considered through historical historical historical research of war, but it can be dealt with from a macroscopic and international perspective centered on grand discourses or national narratives, which can make it far from restoring the war experience and understanding of individual subjects. In addition, there may be limitations in drawing out private memories suppressed by the dominant ideology of the time. However, through the author's empirical consideration, the appearance of war reborn in the space of literary works allows us to imagine the narrative of microscopic and individual subjects that cannot be captured from a macroscopic and international perspective. Here, through the novel War Trash, we will examine the traces of memories and trauma that war engraves on individuals, and through this, we will move on to the problem of the memory of war and the reproduction of trauma in literature. Through the difference between the meaning of war in a realistic space and the meaning of it when it moves to the space of literature, it is expected to provide implications for the movement and change of narrative subjects, diversification of perspective on narrative objects, and hidden problems that can be discussed today.

A Critical Study on Trauma Literature and the Concept of Soul Mate in Paulo Coelho’s Brida

The Brazilian author Paulo Coelho was born in 1947 in the city of Rio de Janerio .Before dedicating his life completely to literature, he worked as theatre director and actor, lyricist,and journalist. His novel Brida is chosen for study .It illustrates the concept of Soul mate very strongly .Besides this novel is analysed in view of trauma literature .The field of trauma studies in literary criticism has gained significant attention in 1996 with the publication of Cathy Caruth’s Unclaimed Experience :Trauma,Narrative,and History and Kali Tal’s Worlds of Hurt:Reading the Literatures of Trauma.A theoretical trend was introduced by scholars like Caruth,who pioneered a psychoanalytic post structural approach that suggests trauma is an unsolvable problem of the unconscious that illuminates the inherent contradictions of experience and language. Paulo Coelho’s third novel, Brida, tells the story of a young woman on a quest for knowledge and fulfillment. As the novel begins, Brida seeks out two teachers. The first is Magnus, who teaches her about the tradition of the sun, in addition to helping her conquer her fears. In Brida, the Magus sees his soul mate essentially the other half of his own soul. The second teacher is Wicca, who instructs Brida in the knowledge and rituals of the tradition of the moon. While practicing these rituals, studying tarot cards, and dancing to the sound of the world, Brida begins to understand that she is a witch. While the spiritual aspects of the novel are most profound, Paulo Coelho’s protagonist also struggles with the more visceral challenges of the heart.

Pancreatic and Duodenal Injuries: Experience at A Single Trauma Centre

Background: Pancreatic and duodenal injuries are uncommon due to relative protection by their posterior anatomical position and have an incidence of less than 1% of all hospital admissions for trauma. Auckland City Hospital is a tertiary referral hospital in New Zealand with Trauma and Hepatopancreatobiliary units and admits approximately 384 patients with major trauma per year, predominantly from blunt mechanisms. This study is used to assess the incidence, diagnosis and clinical management of pancreatic and duodenal injuries in trauma patients at a single trauma centre. Method: A retrospective study was undertaken using data from a prospectively collected trauma registry. Inpatient notes including all patients admitted from 2007 to 2020 were reviewed. Pancreatic and duodenal injuries were graded using the American Association for the Surgery of Trauma (AAST) organ injury scale (OIS) grading system. Investigations including radiology and biochemistry and clinical management were noted. Results: A total of 45 trauma patients admitted to Auckland City Hospital had sustained pancreatic or duodenal injuries. Six patients had combined pancreaticoduodenal injuries, 16 had duodenal and 23 had pancreatic injuries. Grade I organ injuries were the most common in pancreatic (19/29) and duodenal injuries (9/22). Majority of patients underwent laparotomy (33/45) for associated haemodynamic instability. All organ specific indications for surgery occurred in Grade II and higher injuries. 10/45 patients were managed non-operatively, of which the majority had Grade I or II organ injuries (9/45). 3/45 patients died. Conclusion: The incidence of pancreaticoduodenal injuries is rare (45 patients in 13 years) and in keeping with trauma literature. In our series, haemodynamically stable patients with Grade I - II pancreatic and Grade I - II (non-laceration type) duodenal injuries did not require operative management. Endoscopic pancreatic stenting may facilitate selective non-operative management in some patients with pancreatic injury or complications.

Visible wounds of invisible repression: A perspective on the importance of investigating the biological and psychological impact of political repression.

Exposure to psychological trauma is a well-accepted risk factor for the development of mental and somatic diseases. However, chronic stressors not fulfilling the criteria of traumatic experience can have similarly adverse health consequences. While the harmful impact of chronic stressors is generally recognized among researchers, there is a lack of acknowledgment within clinical, political, and societal entities. This becomes evident in the experiences of victims of political repression in the former German Democratic Republic (GDR), an authoritarian state in East Germany. Repression in the GDR included covert measures, such as "Zersetzung" (engl: disintegration), consisting of wiretapping, spreading rumors, or provoking failure in professional and social domains. It aimed to systematically undermine the psychosocial integrity of individuals, inducing anxiety, social isolation, and confusion. This article integrates findings on repression in the GDR with existing trauma and chronic stress literature. "Zersetzung" shares key features with severe psychosocial chronic stressors. Like trauma, experiencing "Zersetzung" likely dysregulated the biological stress systems, thereby predisposing victims to the health consequences they frequently experience to the present day. Certain severe chronic stressors, such as "Zersetzung," do not appear to differ in their negative health consequences from Criterion A traumatic events. Identifying the biological and psychological impact of political repression techniques is essential, not only for public acknowledgment, and proper health care of victims of GDR repression, but also for those individuals suffering from similar repression methods today. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Measures of trauma exposure and trauma response: A scoping review.

In contrast to the vast clinical, theoretical, and empirical literature on the impact of trauma, relatively few studies have reviewed the trauma measures that researchers and clinicians can choose to use in their work. This scoping review aimed to catalog all trauma measures (trauma exposure and its subjective responses) that have been published in the peer-reviewed literature, developed for use with adult populations. Through a systematic search of the literature and the screening of 19,631 abstracts, a total of 363 unique trauma measures were identified. Most of these measures were developed for assessment purposes rather than for clinical screening or diagnostic purposes. Most of these measures are patient-self-report measures that assess trauma exposure in the patients' lifetime, or subsequent symptoms, particularly cognitive impairments. Complications in the trauma literature are highlighted, including the use of very similar abbreviations of measures, substantial discrepancies regarding the definition of trauma, and the general assumption that a potentially traumatic event inevitably leads to traumatic distress rather than a path of resilience.

“This Ain’t the Way It’s S’posed to Be”: Negotiating Trauma Through Postmemory and Implication in Yaa Gyasi’s Homegoing

ABSTRACT This paper examines how the negotiation of the traumas of slavery and its legacies in Yaa Gyasi’s Homegoing (2016) deviates from traditional trauma literature in terms of its form and content. Gyasi’s novel is shown to be structured as a postmemorial family saga, allowing it to highlight the transgenerational and transtemporal effects of trauma in a way that differs markedly from the modernist aesthetics prescribed by traditional trauma theory. Homegoing features a confrontational approach, as it represents trauma directly and explicitly, whilst positioning the reader and several characters as implicated subjects. The novel moreover shows itself attuned to the complexities of trauma by featuring cases of insidious trauma and emphasising how traumas may be rooted in structural issues.

Injury patterns and outcomes in motorcycle passengers.

Contemporary trauma literature on injuries to motorcycle passengers is scarce. The aim of this study was to examine the injury patterns and outcomes of motorcycle passengers with regard to helmet use. We hypothesized that helmet utilization affects both injury type and outcomes. The National Trauma Data Bank was queried for all motorcycle passengers who were injured in traffic accidents. Participants were stratified according to helmet utilization into helmeted (HM) and nonhelmeted (NHM) groups. Univariate and multivariate analyses were performed to compare the injury patterns and outcomes between the groups. A total of 22,855 patients were included for analysis, of which 57.1% (13,049) used helmet. The median age was 41years (IQR 26-51), 81% were female, and 16% of patients required urgent operation. NHM had higher risk of major trauma (ISS > 15: 26.8% vs 31.6%, p < 0.001). The most frequently injured body region in NHM was the head (34.6% vs 56.9%, p < 0.001), whereas in HM patients was the lower extremities (65.3% vs 56.7%, p < 0.001). NHM patients were more likely to require admission to the ICU, mechanical ventilation, and had significantly higher mortality rate (3.0% vs 6.3%, p < 0.001). The strongest predictors of mortality were GCS < 9 on admission, hypotension on admission, and severe head injury. Helmet utilization was associated with decreased odds of death (OR 0.636; 95% CI 0.531-0.762; p < 0.001). Motorcycle collisions can lead to significant injury burden and high mortality in motorcycle passengers. Middle-age females are disproportionally affected. Traumatic brain injury is the leading cause of death. Helmet use is associated with decreased risk of head injury and death.

Presence of Permanent Pacemakers: Implications for Elderly Patients Presenting with Traumatic Injuries

BackgroundThe presence of permanent pacemakers (PPM) is common among the elderly population. Trauma literature has shown that the inability to augment cardiac output by at least 30% after injury portends...

The post-traumatic growth approach to psychological trauma.

The post-traumatic growth approach to psychological trauma.

Severely injured patients: modern management strategies.

Management of severely injured patients remains a challenge, characterised by a number of advances in clinical practice over the last decades. This evolution refers to all different phases of patient treatment from prehospital to the long-term rehabilitation of the survivors. The spectrum of injuries and their severity is quite extensive, which dictates a clear understanding of the existing nomenclature. What is defined nowadays as polytrauma or major trauma, together with other essential terms used in the orthopaedic trauma literature, is described in this instructional review. Furthermore, an analysis of contemporary management strategies (early total care (ETG), damage control orthopaedics (DCO), early appropriate care (EAC), safe definitive surgery (SDS), prompt individualised safe management (PRISM) and musculoskeletal temporary surgery (MuST)) advocated over the last two decades is presented. A focused description of new methods and techniques that have been introduced in clinical practice recently in all different phases of trauma management will also be presented. As the understanding of trauma pathophysiology and subsequently the clinical practice continuously evolves, as the means of scientific interaction and exchange of knowledge improves dramatically, observing different standards between different healthcare systems and geographic regions remains problematic. Positive impact on the survivorship rates and decrease in disability can only be achieved with teamwork training on technical and non-technical skills, as well as with efficient use of the available resources.

Blunt Traumatic Cerebrovascular Injury and Stroke: The Need for a High Index of Suspicion when Initial Vascular Imaging is Negative - A Single Center Case Series. (P14-5.019)

<h3>Objective:</h3> NA <h3>Background:</h3> Acute ischemic stroke (AIS) from traumatic cerebrovascular injury (TCVI) leads to approximately 4800 US strokes annually; often as sequelae of cervical arterial dissection. CT angiography (CTA) is typically used for screening, but this modality has limitations of low sensitivity, particularly for low-grade dissections. Our case series illustrates the importance of high index of suspicion in trauma patients to pursue further vessel imaging when there is unexplained AIS. <h3>Design/Methods:</h3> Case series. <h3>Results:</h3> Our series consists of 2 patients admitted to Trauma ICU following motor vehicle collisions. The 1st patient was a 22-year-old woman with left precentral gyrus infarction on diffusion-weighted MRI. Initial CTA showed dissection of cervical right internal carotid artery (ICA) which did not explain her infarction. Echocardiogram was also unrevealing so digital subtraction angiography was pursued, which revealed dissection of the left supraclinoid ICA not seen on CTA. The 2nd patient was a 15-year-old man with bilateral frontal infarctions on diffusion-weighted MRI. His initial CTA showed dissection of cervical left ICA. There was no explanation for his right frontal infarction on further workup so CTA was repeated after 4 days, which showed additional dissection involving the right cervical ICA not seen initially. Etiology of AIS in both cases was unexplained initially but repeat or alternate imaging helped unveil previously undetected ipsilateral dissections. <h3>Conclusions:</h3> Undetected traumatic dissection can result in devastating neurologic sequelae including further strokes and worsening dissection. It can also lead to unnecessary workup such as thrombophilia testing in younger patients. These patients are often hidden from the view of neurologists as they are typically managed by trauma surgeons and literature regarding TCVI is predominantly in surgical journals. We hope to increase awareness and emphasize the importance of a high index of suspicion to pursue further vessel imaging in unexplained stroke so that appropriate treatment can be initiated rapidly. <b>Disclosure:</b> Dr. Asif has nothing to disclose. Dr. Habib has nothing to disclose. Dr. Samkutty has nothing to disclose.

Nothing for us, without us: a review of the clinical literature and discursive evidence of interpersonal trauma in autistic women

PurposeFrom the authors’ personal and professional experiences, they have observed that autistic women are uniquely at risk of interpersonal trauma. Given the tendency for autistic women to be overlooked in research and practice, this study aims to rectify this by exploring the relevant literature and including the voices of autistic women throughout this paper.Design/methodology/approachThis study completed a literature review of quantitative and qualitative data relating to exposure to interpersonal trauma in autistic women. This study also reviewed relevant discursive evidence available on in memoirs and reports. This study also included dialogue between us as authors from an auto/“Autie”-ethnographic position.FindingsBoth clinical literature and discursive evidence support the idea that autistic women are uniquely at risk of interpersonal trauma, in particular, sexual victimisation. Explanatory factors are considered. Studies exploring rates of post-traumatic stress disorder (PTSD) were less consistent. Further evidence is required to better understand how autistic women experience and express PTSD and to inform assessment and treatment modifications.Originality/valueTo the best of the authors’ knowledge, this is the first paper to integrate clinical literature and discursive evidence on the topic of interpersonal trauma in autistic women. It provides useful insights into the experiences of autistic women in this space, directions for urgently needed future research and modifications to clinical practice.

Quality of the Parent-Child Relationship as a Moderator of Witnessing Violence and Youth Trauma Symptoms.

Traumatic event exposure affects two in every three adolescents in the United States and there is the potential for numerous deleterious effects including higher levels of youth depression, anxiety, posttraumatic stress symptoms, and emotional and behavioral problems. Witnessing violence is one of the more common experiences associated with trauma exposure. Despite the ample research on mental health outcomes associated with witnessing violence, less is known about the extent to which parent-child relationships play a role in youth mental health outcomes when youth are exposed to violence. With a clinically relevant, diverse sample of 806 youth ages 12years old who experienced maltreatment or were at risk of being maltreated, we tested hypotheses that the parent-child relationship quality would moderate the associations between witnessing violence and youth mental health outcomes. Results supported hypotheses for youths' symptoms of anxiety, depression, dissociation, and posttraumatic stress. The study contributes to the trauma literature by determining that the quality of the parent-child relationship moderated the effects of witnessing violence on trauma outcomes.