Trauma Surgery Research Articles

Recent advancements and future directions in fracture related infections: A scoping review

Fracture-related infections (FRIs) are complex challenges in orthopedic and trauma surgery, driving ongoing advancements in diagnostics, therapeutics, and management strategies. This scoping review examines recent progress and future directions in FRI management. Diagnostic enhancements encompass standardized definitions, improved biomarkers, advanced microbiological techniques, and innovative imaging modalities. Promising future diagnostics may include point-of-care testing, advanced imaging with enhanced specificity, and machine learning algorithms. Advancements in implant technology emphasize materials science, surface modifications, and personalized 3D printing, enhancing durability and antimicrobial efficacy. Immunomodulatory therapies targeting T cell dysfunction offer potential in addressing FRI chronicity. Enzybiotics and phages present promising alternatives to combat antibiotic resistance, with enzybiotics demonstrating effectiveness against biofilm-associated infections. Patient optimization, multidisciplinary approaches and specialized reference centers play vital roles in comprehensive FRI management, particularly crucial in resource-constrained settings. Collaboration and investment in research and technology are imperative for harnessing the full potential of these advancements and improving global FRI management outcomes. Addressing these complexities necessitates a multifaceted approach integrating clinical expertise, technological innovation, and global cooperation to optimize patient care and mitigate the burden of FRI worldwide.

Antimicrobial resistance: Biofilms, small colony variants, and intracellular bacteria

Soft tissue and bone infections continue to be a serious complication in orthopedic and trauma surgery. Both can lead to a high burden for the patients and the healthcare system. Musculoskeletal infections can be induced by intraoperative contamination, bacterial contamination of open wounds or hematogenous bacterial spread. During the recent decades, advances were achieved in the understanding of pathogenesis and antibiotic resistance. Despite some progress in the diagnosis and advancing of therapeutic concepts, groundbreaking successful improvement of treatment concepts is still missing. Current therapy concepts are based on the two pillars consisting of surgical debridement with joint or bone reconstruction as well as prolonged antibiotic therapy. An improved understanding of both host and pathogen-related factors leading to treatment failure is essential in musculoskeletal infections. Therefore, this review aims to give an overview of pathogen-related pathophysiology in musculoskeletal infections. It describes defense strategies of pathogens such as (1) biofilm, its development, characteristics, and treatment options. In addition, (2) characteristics of small colony variants and (3) intracellular bacteria are highlighted. Lastly (4) an outlook for potential and promising future therapeutic strategies is provided.

The role of tranexamic acid for infection prevention after fracture fixation

Despite the measures employed, fracture-related infections remain a concern after fracture fixation worldwide. Recently, the role of tranexamic acid as a protective drug against postsurgical infections in joint replacement and orthopedic trauma surgery has been proposed, where tranexamic acid has been associated with less surgical wounds complications and infectious complications including periprosthetic joint infection. The mechanism through which tranexamic acid exerts a protective effect against peri-implant infection is still the subject of debate. Although some authors hypothesize an indirect effect inhibiting the formation of postoperative hematoma, there are several studies that show a direct antibacterial effect of the drug against the capacity of bacterial aggregation, even avoiding biofilm formation, favoring the immune response of the host and the action of antibiotics. The purpose of this narrative review is to show the current role of tranexamic acid in orthopedic trauma, specifically its relationship with the prevention of infections related to implants.

Impact of routine pre-operative risk assessment on patients undergoing emergency major abdominal surgery in a regional Victorian hospital.

Routine preoperative risk assessment (RPRA) using objective risk prediction tools may improve the perioperative outcomes of emergency major abdominal surgery (EMAS). This project aims to identify whether the introduction of RPRA with the 'National Emergency Laparotomy Audit (NELA) Calculator' as standard-of-care for EMAS at a regional Victorian hospital has improved postoperative outcomes, reduced unplanned postoperative critical care unit (CCU) admission rates, and impacted the 'no-lap' rate. An audit was performed including all adult general surgery patients who required EMAS at Bendigo Health between September 2017 and August 2022, including those palliated up-front. Patients requiring surgery for uncomplicated appendicitis, cholecystitis, trauma, and diagnostic laparoscopy were excluded. Patient demographics, preoperative NELA score, CCU admission data and postoperative outcomes were collected and compared between patients undergoing surgery before and after the introduction of RPRA. Six hundred and ninety-one patients were included in the analysis. Median NELA score was 5 (IQR 1.5-11.75). 2.60% of patients were palliated up-front and did not proceed to surgery. Among the 673 operative patients, 30-day mortality was 5.20%. Following the introduction of RPRA there was a significant reduction in the unplanned CCU admission rate, from 9.14% to 3.48% (P = 0.04). There was no change in postoperative mortality, severe complication rate or planned CCU admission rate. RPRA reduced rate of unplanned CCU admissions. Postoperative mortality and complication rates did not change following introduction of RPRA. RPRA appears useful in guidance of preoperative palliative decision-making, but further study is required to validate its use in this context.

23rd European Congress of Trauma and Emergency Surgery.

23rd European Congress of Trauma and Emergency Surgery.

Role of liver enzymes in patients with blunt trauma to liver on conservative management

Background: When blunt abdominal trauma occurs, the liver is the organ most often affected. The liver enzymes are often elevated in blunt trauma to the liver. However, the variation of liver enzymes among various grades of liver injury is not clear. The aim of our investigation is to determine the variation of liver enzymes across various grades of liver injury as well as whether it affects any change in management including surgical intervention. Methods: Our research was a prospective observational study. Patients of blunt abdominal trauma having a liver damage which was detected on a contrast CT scan and managed conservatively were included. They were categorized as per the AAST (American Association for the Surgery of Trauma) system. Various biochemical markers including liver enzymes were compared between the groups. Any change in management or need for intervention was found out. Results: A total of 35 patients has been included. Ages between 31 and 40 accounted for the majority of cases (34.3%). Our study showed male preponderance (85.7%). Most patients presented to the hospital within 24 hours of trauma (82.9%). Most of our patients had blood transfusions during their hospital stay (71.4%). AAST grade III injury was predominant (48.6%). Subgroup analysis between minor and major liver injury patients was done. No significant distinction was seen among the two groups concerning the assessed biochemical parameters. No significant variation was observed regarding the necessity for intervention. Conclusions: Liver enzymes can not be used to differentiate among various grades of liver injury. Patients who are managed conservatively can be managed so with close monitoring and supportive treatment without the need for any intervention. However, larger and randomized studies are needed to validate the results.

Case Report: Facial fracture sequelae: the importance of using a specific customized implant (PSI) for orbital reconstruction

The reconstruction of orbital fracture sequelae is a major challenge due to concerns regarding surgical approach and implant stability. Few anatomical sites of such minute size have presented with as much variation in treatment as the orbital floor fractures and related sequelae. Our patient developed sequelae of an orbital fracture over the last 3 years, presenting with dystopia, ophthalmoplegia, and diplopia in the supra- and lateroversion and aesthetic impairment. The variety of implant materials for reconstruction after orbital fractures is extensive, and the decision as to which material to use continues to be debated. The continuing development of computer-aided diagnosis and management and the construction of stereolithographic models offer comparable reproduction of anatomical detail. This technology is described in relation to the planning of trauma surgery and sequelae and the planning of ablative surgery for malignant neoplasms of the head and neck. The use of specific 3D printed titanium implants for bone defects was first reported in cranial reconstruction in 2012, and several studies have reported their use in orbital fractures. The advantages of this implant were increased stiffness, preventing shape loss during placement, a precise fit, and decreased surgical time. However, in the existing literature, the one-piece implant done in this way was a precise fit; therefore, it is possible that navigation between intraoperative anatomical landmarks is lost. However, in cases where reconstruction is difficult, such as extensive orbital wall fractures and large orbital sequelae, the 3D printed implant has been helpful in decreasing surgical time and can be accessed by a limited surgical approach with a precise fit. Our clinical case involved a 37-year-old male patient who experienced severe physical aggression in 2020, amid the COVID-19 pandemic. At the time, due to the overwhelming healthcare demands and resource constraints imposed by the pandemic, immediate surgical intervention for the correction of the fracture was not feasible. As a result of this delay, the patient developed sequelae of the orbital fracture over the last 3 years.

Sonographic anatomy of surgically acquired abdominal pseudohernia—A guide to the documentation of anterolateral integument denervation with ultrasound

AbstractIncisional hernia is a common clinical diagnosis when a patient presents with a post‐surgical abdominal wall bulge. Herniation is a complication that can result from a disruption to the anterior abdominal wall, however other differentials need to be considered to account for a localized prominence of the abdominal integument. One such differential is a pseudohernia; a bulging of an intact abdominal integument without protrusion of abdominal contents. This can occur as a direct consequence of operative trauma and subsequent denervation injury to abdominal wall musculature. Although surgical techniques have been refined to reduce the potential of segmental neuropathy, atrophy of the abdominal wall can be a long term sequalae that clinically mimics that of a hernia. Such an outcome can result from surgical approaches with a particular location and orientation leaving little option to avoid damage to nerves inherent to the area. Damage to these nerves can not only result in abdominal wall laxity but also to the development of further complications that can affect a patient's quality of life. The aim of this article is to increase sonographer awareness of postsurgical pseudohernia of the anterolateral abdominal wall as a differential to incisional hernia, and as such provide guidance on how to demonstrate this anomaly. Considering that pseudohernia and incisional hernia have differing management techniques, the sonographer can play a pivotal role in influencing patient management, negating the need for surgical hernia repair and advocate for a conservative management pathway.

Racial disparities persist in mortality after firearm assault injuries: A national analysis of the Trauma Quality Improvement Program database

ObjectivesIt is unclear whether improvements in the delivery of trauma care over the last decade have diminished racial disparities in mortality after firearm injuries. MethodsThe American College of Surgeons Trauma Quality Improvement Program was queried for patients (≥18 years old) who experienced penetrating firearm assault injuries between 2008 and 2018. Multivariable logistic regression was used to assess the association between mortality and race, controlling for demographics, comorbidities, shock index, injury severity score injury location, and hospital characteristics. ResultsThis retrospective cohort study included 261,116 patients who experienced firearm injuries secondary to assault between 2008 and 2018. Patients most frequently identified as Black (64.1%, n = 167,494), followed by White (16.3%, n = 42,649), Hispanic/Latino (15.7%, n = 41,044), and other racial groups (3.8%, n = 9,929). On multivariable logistic regression, Black patients (odds ratio, 1.53; 95% confidence interval, 1.45–1.62), and Hispanic/Latino patients (odds ratio, 1.11; 95% confidence interval, 1.03–1.19) were more likely to die after a firearm assault injury than White patients. Black patients were more likely to die in the emergency department (62.2%, n = 13,438) compared with White patients (52.7%, n = 2,838), Hispanic/Latino patients (53.0%, n = 2,635), and patients of other races (54.8%, n = 681). Across all years of the study period, Black patients had a greater risk-adjusted mortality rate than White patients and Hispanic/Latino patients. ConclusionSignificant racial disparities in mortality after firearm assault continue to persist. Early death within the emergency department appears to be a significant driver of these persistent disparities.

Surgical Management of Penetrating Carotid Artery Injury: Preoperative Level of Consciousness Does Matter.

The optimal surgical management of penetrating carotid artery injuries (PCAI) remains controversial. This study aimed to examine the association between operative techniques for PCAI and the incidence of stroke. This retrospective cohort study used the American College of Surgeons Trauma Quality Improvement Program (2016-2021) database. We included patients (≥16 years old) with severe penetrating injuries to the common or internal carotid arteries (CCA/ICA) who underwent one of the following operative procedures: primary suture repair, ligation, and arterial reconstruction with a graft. Multivariate logistic regression analysis with cluster-adjusted robust standard errors was performed to estimate the adjusted odds ratio (AOR) for postoperative stroke stratified by the initial Glasgow Coma Scale (GCS). A total of 429 patients were included (329 underwent primary suture repair, 82 underwent ligation, and 81 underwent arterial reconstruction with a graft). The median age was 31 years (interquartile range [IQR]: 24-43) and median GCS on arrival was 11 (IQR: 3-15). On multivariate analysis after adjusting for potential confounders, ligation of CCA/ICA was significantly associated with increased odds of stroke in patients with initial GCS ≥9 (AOR: 4.40, 95% confidence interval [CI]: 1.16-16.58, p=0.029), whereas there was no significant association in patients with GCS <9 (AOR: 0.77, 95% CI: 0.28-2.11, p=0.37). No significant association was identified between arterial reconstruction with a graft and stroke, irrespective of the initial GCS. The study findings suggest that the preoperative level of consciousness may help in planning operative strategies for PCAI. In patients with an initial GCS ≥ 9, definitive repair of the CCA/ICA, including arterial reconstruction with a graft, should be pursued instead of ligation.

Open Trauma to the Larynx by a Stab Wound: A Case Report

&amp;lt;i&amp;gt;Introduction&amp;lt;/i&amp;gt;: Open laryngeal trauma is rare. Only early and appropriate diagnosis and treatment can preserve or restore the respiratory and phonatory functions of the larynx and prevent the appearance of disabling functional sequelae. &amp;lt;i&amp;gt;Material and method&amp;lt;/i&amp;gt;: This was a 50-year-old patient with a history of psychiatric illness, admitted for treatment of a penetrating wound to the neck following an attempted self-lysis with a bladed weapon (knife). On examination, we objectified a conscious patient with a makeshift bandage soiled with blood at the neck. A respiratory murmur was also perceived. Given this picture, the patient was immediately taken in a lying position to the operating room for surgical management. The postoperative course was marked on D13 by a decannulation process and a complete decanution on D15 postoperatively. We proceeded to remove the nasogastric tube on D21. A cure without respiratory or vocal sequelae was obtained on D28 postoperatively. &amp;lt;i&amp;gt;Conclusion&amp;lt;/i&amp;gt;: Open trauma is a diagnostic and therapeutic emergency. If unrecognized or poorly managed, it can be life-threatening in the immediate term or cause serious long-term after-effects.

Partial Occlusion, Less AKI: an AORTA Registry Analysis of pREBOA-PRO

Abstract Background Non-compressible torso hemorrhage remains a leading cause of potentially preventable deaths. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) has emerged as an adjunct temporizing hemorrhage control. The complete occlusion strategy with the ER-REBOA catheter can cause distal ischemia when used for longer than 30 minutes. To specifically address this limitation, the pREBOA-PRO catheter was developed. The objective of the current study is to investigate the impact of longer, partial occlusion times provided by pREBOA-PRO on acute kidney injury and mortality. Methods This is a retrospective analysis of the Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery (AORTA) registry as of August 2023. Patients in the pREBOA-PRO group (n = 110) receiving partial occlusion in Zone 1 were contrasted to patients in the ER-REBOA group (n = 752) treated with complete occlusion in Zone 1. Between-group comparisons included demographics, clinical presentation, aortic occlusion (AO) strategy, clinical complications, and mortality. Results Demographics, clinical presentation, and mortality were indistinguishable between groups, except for age which was higher in the ER-REBOA group (44 vs. 38, p &lt; 0.002). The partial AO strategy was employed more often in the pREBOA-PRO group (87% vs 33%, p &lt; 0.05) and for longer periods (59 min vs. 50 min, p &lt; 0.003). In contrast, AKI occurred less frequently in the pREBOA-PRO group (19% vs. 33%, p &lt; 0.05). Conclusions The more frequently partial and longer occlusion times in Zone 1 with the use of pREBOA-PRO resulted in lower AKI incidence suggesting that this newer device is a safer extended bridge to hemorrhage control.

A clinical study on the effect of axillary approach in the treatment of Ideberg type II scapular glenoid fractures

BackgroundDue to its deep position and complex surrounding anatomy, the scapular glenoid fracture was relatively difficult to deal with especially in cases of severe fracture displacement. Improper treatment may lead to failure of internal fixation and poor fracture reduction, severely affecting the function of the shoulder joint. Inferior scapular glenoid fracture was Ideberg type II fracture, and posterior approach was commonly used to deal with inferior scapular glenoid fracture. However, there are shortcomings of above surgical approach for inferior scapular glenoid fracture, such as insufficient exposure of the operative field, significant trauma, and limited screw fixation direction. This study adopts the axillary approach for surgery, which has certain advantages.MethodsThe clinical data of 13 patients with Ideberg type II scapular glenoid fractures treated from December 2018 to January 2024 were retrospectively analyzed. There were 8 males and 5 females, with an age range of 19 to 58 years and an average age of 38 years. The causes of injury were falls from heights in 7 cases and car accidents in 6 cases. There were 5 cases on the left side and 8 cases on the right side. The time from injury to surgery was 2 to 11 days, with an average of 5.5 days. All cases underwent open reduction and internal fixation through the axillary approach. Postoperative X-ray and CT three-dimensional reconstruction were performed on the next day to evaluate the fracture reduction and the position of internal fixation. During the follow-up period, follow-up examinations were performed every two months in the first half of the year and every three months in the second half. CT scans were performed during the examinations to assess the glenohumeral joint congruence, fracture healing, and position of internal fixation. The shoulder joint function was evaluated at 6 months postoperatively according to the Constant-Murley value score.ResultsThe patients all achieved primary wound healing after surgery, without any complications such as infection or nerve injury. Re-examination on the second day after operation, all fractures obtained excellent reduction, and the internal fixation was in excellent position, and no screw was found to enter the joint cavity. All patients in this group were followed up for 6 to 25 months, with an average follow-up time of 11.7 months. All fractures were bony unioned, and the healing time ranged from 4 to 6 months, with an average healing time of 4.8 months. At 6-month follow-up, according to the Constant-Murley score, 11 cases were excellent and 2 case was good.ConclusionOpen reduction and internal fixation through the axillary approach is an feasible and safe surgical method for the treatment in scapular Ideberg type II glenoid fractures with less stripping of soft tissue, minimal surgical trauma, and the incision is concealed and beautiful. It can provide a strong internal fixation for fractures, so patients can perform functional exercise early after operation, and the clinical results is satisfactory.

A Case of Fat Embolism Syndrome after Fracture of Tibia Fibula

Fat embolism syndrome is a fatal condition that affects several organs. It often occurs after trauma or orthopedic surgeries. Most are unnoticed, and treatment of it is primarily supportive, with early fracture repair as a preventative measure. This case report describes a patient who had a left tibia fibula fracture diagnosed using Gurd's criteria and verified by a CT pulmonary angiography and MRI, and was treated with supportive care. Bangladesh Crit Care J September 2024; 12 (2): 167-171

The radiological primary survey: A systematic approach and guide to reading torso computed tomography images in trauma for surgeons

Background Trauma is a disease where time is of the essence. In many lower middle-income countries, definitive management and planning for trauma patients are often delayed after working hours because of either a lack of technicians to perform computed tomography (CT) scans or a lack of radiologists to interpret them. These lacunae can be bridged if more and more surgeons become confident in interpreting trauma CT images. Method In this narrative review, written in a ‘how to do it’ manner, we describe a way of doing a structured and quick ‘radiological primary survey’ of the torso CT, which we believe will help quickly identify major injuries systematically, thereby avoiding delays in management and forming a care plan. The method has been developed by a team of trauma surgeons and radiologists and stems from the DRS ABCDE technique used in interpreting trauma chest X-rays. Result The DRS ABCDE extrapolated to the trauma torso CT includes the following steps- Details, WRAP (W-windowing, R-Region, A-Axis, P-Phase), S- the Scout film, Airway, Breathing, Circulation, Disability and Extras. Conclusion The review will enable resident trainees and trauma care professionals to interpret trauma CTs using a structured approach.

INVISIBLE STRUGGLES: EXPLORING CHALLENGES FACED BY WOMEN WITH AMPUTATION IN INDIA

Women in India, particularly those with amputation, face significant challenges, including but not limited to, unequal prosthetic access and satisfaction, societal discrimination, and the physical and emotional consequences of amputation. These challenges are further exacerbated by gender biases towards access to education and socioeconomic factors, which increases their vulnerability to unemployment and mental health issues. This article emphasizes the urgent need for affordable and customizable prosthetic options tailored to the unique needs of women with amputation, particularly those from low-income backgrounds who often face neglect. Thus, addressing these disparities would significantly enhance their overall well-being and independence. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/44002/33160 How To Cite: Alam J, Joshi A, Mir N, Chawla N, Sagar S. Invisible struggles: Exploring challenges faced by women with amputation in India. Canadian Prosthetics &amp; Orthotics Journal. 2024; Volume 7, Issue 1, No.5. https://doi.org/10.33137/cpoj.v7i1.44002 Corresponding Author: Professor Sushma Sagar,Division of Trauma Surgery and Critical Care, Jai Prakash Narayan Apex Trauma Centre, AIIMS, New Delhi, India.E-Mails: sagar.sushma@gmail.com; dr.sushma@aiims.gov.inORCID ID: https://orcid.org/0000-0002-4700-9868

An Evaluation of Intra-articular Pathologies Accompanying Tibial Plateau Fractures Postoperatively.

Tibial plateau fractures are one of the most complex and common intra-articular fractures encountered in trauma surgery. This study aimsto evaluate the MRI intra-articular findings of patients with tibial plateau fractures treated surgically and the functional and radiological changes after surgical treatment. A total of 91 patients admitted to our clinic between 2010 and 2019 and operated for tibial plateau fracture were identified from the hospital information system. Patients were excluded fromthe study if aged <18 years, if the radiographs and MRIs were not suitable for the measurements, or if they could not be contacted by telephone. The study was completed with 49 operated knees and 49 healthy knees of 49 patients. The patients were evaluated with respect to demographic characteristics, KneeSocietyKneeScore (KSKS), KneeSocietyFunction Score (KSFS), KneeInjuryandOsteoarthritisOutcomeScore (KOOS) functional and clinical scores, Rasmussen, Kellgren-Lawrence, and Whole-OrganMagneticResonanceImagingScore (WORMS) radiological scoring, and meniscus and ligament pathologies examined on the follow-up MR images. The patients comprised 39 males and 10 females with a mean age of 45.9±11.89 years, and a mean follow-up of 58.2±30.7 months. The fractures were seen to be 49% (n=24)in the lateral plateau, 6.1% (n=4) in the medial plateau, and 42.9% (n=21) were bicondylar fractures involving both plateaux. The KSKS knee score was satisfactory in 85.7% of the patients, the KSFS functional score in 89.7%, and the Rassmussen radiological score in 93.8%. In the KOOS subjective questionnaire, the mean points obtained were 430.7, and the mean total WORMS points were 34.2. According to the Kellgren-Lawrence grades, severe osteoarthritis (grade 3-4) developed in 18.3% (n=9) of the patients. Meniscus injuries that are overlooked at the time of the first injury or which may develop in the subsequent process were not found to seriously affect the functional outcomes of tibial plateau fractures. It can be considered that even if a ligament injury is seen to be accompanying the fracture at the time of the first trauma, the effect is not great in terms of prognosis, and the treatment can remain conservative, especially for collateral ligament injuries.

Utilization of registers to create an evidence-based approach in catastrophes and civil defence

Medical data registers are a key instrument of medical care research and a valuable tool for medical quality assurance. The structured plausibility tested documentation of large case numbers on a longitudinally oriented time axis with different points in time of data acquisition enables statements to be made on numerous relevant outcomes, not only the mortality of patients. For incidents outside the daily routine care in trauma surgery, such as natural disasters, accidents with multiple casualties and nonmilitary treatment of the domestic population in defence situations, such registers can provide data-based recommendations for action. These data, mainly obtained from routine traumatological treatment, enable a targeted resource management in the abovenamed incidents, which are associated with mass casualties. Due to the utilization of registers from the military field or from international registers, the perspective is additionally extended with respect to treatment strategies and injury patterns. Whether data can also be generated in a suitable manner for the abovenamed registers in specific disaster situations and can provide a direct gain of knowledge from the incident, must be critically discussed. The maintenance of the register datasets is time-consuming and has been subjected to a more stringent regulation at least since May 2018, when the European Union General Data Protection Regulation (EU-GDPR) came into force. The future Register Act in Germany will hopefully achieve greater simplification in the documentation of routine data.

Harnessing magnetic forces: Discovery and development of biliary strictures treatment with compression anastomosis

Magnetic compression anastomosis (MCA) is emerging as a promising alternative that uses magnetic force to create an anastomosis bypassing the stenosis in biliary strictures (BSs) where techniques such as percutaneous transhepatic biliary drainage and endoscopic retrograde cholangiopancreatography with stent placement are inadequate in the presence of complete obstruction or severe stenosis. MCA offers potential benefits such as less operative trauma, shorter hospital stay and lower complication rates. By placing magnets proximal and distal to the stenosis, necrosis of fibrotic tissue occurs, creating a new anastomosis. Investigating the role of MCA in the treatment of BS is crucial because of its potential to revolutionize care, improve outcomes and reduce healthcare costs. It offers an alternative for patients who are not suitable for conventional surgery. A comprehensive review of the principles, techniques, outcomes and applications of MCA is essential to inform clinicians, researchers and policy makers and to guide future research and clinical practice to optimize patient care for BSs.

Splenic Trauma: Concepts and Technique for Interventional Management

AbstractThe spleen is the most commonly involved organ in abdominal trauma, especially in blunt mode of injury. High vascularity and a thin capsule predispose to rapid and fatal bleeding, which could be acute as well as delayed at onset. FAST is usually the first line of investigation required to see for fluid and screen patients suffering abdominal trauma. Triple-phase contrast-enhanced computed tomography of the abdomen further aids in diagnosing and grading splenic trauma as per the American Association for the Surgery of Trauma (AAST) guidelines. Hemodynamic stability and AAST grade are the main guiding parameters for management. Treatment options include surgical and nonsurgical (endovascular intervention) management. The recent concept of endovascular resuscitation and trauma management, which dwells on creating a hybrid suite, is coming up fast and will play a pivotal role in offering splenic preserving management in trauma cases. In this review article, authors have bought insights about managing splenic trauma as a multidisciplinary concept to achieve splenic preservation and maintain this vital organ's immunological functions.