Traumatic Separation Research Articles

PROBLEMATIC ISSUES OF LIMB AMPUTATION IN WOUNDED WITH COMBAT TRAUMA

Among the wounded with limb injuries admitted to the Military Medical Center of the Western region during the year of Russia’s full-scale war in Ukraine, 29% had a mine-blast injury, 47% had shrapnel wounds, 8% had gunshot bullet wounds, 1.5% – thermal injuries, and14.5% – traumatic injuries. Upper limbs were injured in 22%, lower – in 32%, 15% had two limbs injured, and 31% had combined combat trauma. In all hospitalized with multi-fragment fractures, limbs were fixed with external fixation devices. 2% of patients had vascular damage. All wounded had unhealed wounds with a soft tissue defect. The average age of patients was 30 years. There were no comorbid diseases in the wounded, and concomitant diseases that did not affect the course of injury were found in 10%. Amputations of limbs were performed in 6.5%. Traumatic separation of a limb segment or its destruction with crushed bone and non-viable soft tissues, nerve damage with significant defect, soft tissue and bone defect, as well as thermal ischemia of the limb for more than 6 hours with necrosis of its soft tissues, were indications for primary limb amputation in 3% of wounded and injured, which were in the nature of primary debridement. Progressive wound infection with the development of the septic condition of the wounded despite intensive treatment, total ischemic necrosis, and recrudescent arrosive bleeding from great vessels required a secondary limb amputation in 1.5%. In 1.5% of the wounded, staged operations were performed as re-amputations. Re-amputation had to be performed in 0.6% of patients with an inappropriate limb stump level, which complicated prosthetics. To reduce the number of amputations for secondary indications, a timely diagnosis is needed of compartment syndrome and rational treatment of soft tissue wounds and gunshot fractures with surgical and medical prevention of the infectious process.

Functional Outcome Of Bristow-Latarjet Procedure In Post-Traumatic Recurrent Anterior Shoulder Instability.

Due to its lack of bony support, the shoulder joint has the broadest range of motion out of all the joints in the body. Instead, one of the joints that dislocate most frequently is the shoulder joint. Multiple pathologic abnormalities, including the traumatic separation of the anterior-inferior capsule-labral complex from the glenoid rim, are caused by repeated anterior glenohumeral dislocation. The objective of the study is to ascertain the Bristow-LATARJET procedure's efficacy in situations of recurrent post-traumatic anterior shoulder instability. From 31 January 2020 to 31 July 2020, a descriptive case series was undertaken in the orthopaedic surgery department of the Lahore General Hospital. For this study, 71 patients who met the inclusion and exclusion criteria were recruited, and all interventions were conducted while the patients were lying in a beach chair while under general anaesthesia. The Delto-pectoral incision surgical technique was applied. For 12 weeks, all patients underwent clinical follow-up, and the results were documented. There were 50(70.4%) males and 21(29.6%) females in this study & the mean age of the patients were 34.64±10.73. There were 37(52.1%) patients among them the outcome of treatment (Rowe Scale at 12th week) was excellent, among 21(29.6%) it was good, among 8(11.3%) it was fair and among 5 (7.0%) it was poor. There was a significant association between the outcome of treatment (Rowe scale at 12th week) and age groups (p-value: 0.000). The Bristow-LATARJET procedure is deemed to be a very productive, safe, and problem-free procedure for curing post-traumatic reoccurring traumatic anterior shoulder instability.

Morel-Lavallée Lesion: A Case Report

Morel-Lavallée lesion is a result of the traumatic separation of the superficial tissue from the adjacent fascia creating a potential space that may be filled with fluid. Although it is not a rare lesion, the oftenly misdiagnosed nature of the disease necessitates its radiological features to be reviewed in detail. Not only the classical location of the lesion but also the characteristic imaging findings should direct the diagnosis by preventing any morbidity stemming from misdiagnosis.

A Rare Secondary Dysmenorrhea Resulted from Separation of Corpus Uteri from Cervix: A Case Report and Literature Review

Secondary dysmenorrhea is a pain associated with disease such as endometriosis, pelvic inflammatory disease, leiomyomas, and interstitial cystitis. Treatment of secondary dysmenorrhea always focuses on the causative pelvic pathology or medical condition. Here, we found a rare case with secondary dysmenorrhea that resulted from traumatic separation of the uterine corpus from the cervix. In this case, the patient experienced a childhood blunt trauma of the pelvic crush and was successfully diagnosed by magnetic resonance imaging and 3-dimensional ultrasonography. Moreover, laparoscopic anastomosis could be a minimally invasive way to resolve this problem.

The ICD-11 and DSM-5-TR prolonged grief criteria: Validation of the Traumatic Grief Inventory-Self Report Plus using exploratory factor analysis and item response theory.

More recently, the prolonged grief disorder (PGD) has been recognized as a mental health disorder following bereavement, which is distinct from depression and PTSD. However, the number and proposed symptom items vary across the ICD-11 and the DSM-5-TR criteria for PG. The Traumatic Grief Inventory-Self Report Plus (TGI-SR+), which is an updated version of the TGI-SR, is currently the only robust instrument that assesses PG according to the ICD-11 and DSM-5-TR criteria. For research and clinical use among French-speaking countries, the forward-backward procedure was applied to translate the TGI-SR+ into French language. Exploratory factor analysis and parallel analysis converged towards a two-dimensional structure for the TGI-SR+, representing adaptation difficulties and traumatic separation distress. However, items mapping onto ICD-11 and DSM-5-TR criteria for PG represented a one-dimensional structure. Findings based on item response theory method provided strong evidence for discriminative characteristics of the items. The internal reliability was excellent for the TGI-SR+ (McDonald's ω = 0.97) and ICD-11 and DSM-5-TR criteria for PGD (McDonald's ω = 0.95). We also demonstrated a very high temporal stability for the TGI-SR+ total score (ICC = .91, p < 0.0001) and ICD-11 PGD and DSM-5-TR PGD (ICC = 0.90, and ICC = 0.88, ps < 0.0001, respectively). The concurrent validity of the instrument was also demonstrated, such that the TGI-SR+ total score and all combinations were positively and significantly associated with the levels of depression, anxiety and post-traumatic stress symptoms. However, the effect sizes were moderate. We conclude that for research and clinical use among French bereaved populations, the TGI-SR+ is a sound tool with very good psychometric properties.

Miniature Pediatric Dental Office Model

Background: Dental fear and anxiety remains the most common emotions experienced by the child who visit the pediatric dentist. The success of pedodontics is determined by the odontologist's capability to gain the confidence and maintain the cooperation of the child. Objective/Aim: The aim of the study was to assess the behavior and anxiety levels of school-going children in a dental setting using a Miniature Pediatric Dental Office Model during the first dental visit of the child. Study Design: This cross-sectional research was carried out in a dental institute in the department of pediatrics and preventive dentistry. The study protocol was explained to the parents of 3–9-year-old children. Demographics were elicited from the parents and their correlation with the placement of the doll in the pediatric dental office model and a modified Frankl's behavior rating scale was used to assess the child's behavior. Results: Of 84 participants, 47 children were under the age of 6 years and 37 children were ≥6 years of age. In the doll placement test, the majority (36.9%) of the children preferred pattern 2 (the child is on the chair, the dentist is inside the operatory, the mother is inside the operatory, and the father is outside the operatory) in the doll placement test, and the least (8.3%) preferred pattern 1 (the child is on the chair, the dentist is inside the operatory, the father is inside the operatory, the mother is outside the operatory). Thirty-four percent children up to the age of 6 years exhibited a mix of negative-positive behavior, and 43.2% of children aged 6 years showed a positive behavior according to the modified Frankl's rating scale. Conclusion: The doll placement test using a miniature pediatric office aided us in determining the child's anxiety level during their first dental visit. To achieve emotional support and avoid the impact of traumatic separation, especially in younger children, our study showed that mothers should be present in the dental office to remove behavior-related problems.

Evaluation of Patients with Acromioclavicular Joint Separation Treated Using the Clavicular Hook Plate.

This study aimed to evaluate the outcomes of patients who underwent surgical treatment using the clavicular hook plate for diagnosed Rockwood Type 3 - Type 4 - Type 5 acromioclavicular joint separation. Patients who were operated with the diagnosis of acute traumatic acromioclavicular joint separation between the years 2017-2021 were evaluated retrospectively. Patients&apos; age, gender, mechanism of injury, time to surgery, follow-up duration, and complications were evaluated. Functional results were evalu-ated using pre-op and post-op VAS and the Constant-Murley Shoulder Score. A total of thirty patients admitted with the diagnosis of acromioclavicular joint separation were included. All patients underwent surgical treatment using the clavicular hook plate. Twenty (66.6%) patients were male and 10 (33.6%) were female. Seventeen of the patients were admitted due to sports injuries, 6 due to traffic accidents, and 7 due to workplace accidents. The patients were followed up for an average of 26.1 weeks. The Rockwood Classification was used for classification of injuries. Accordingly, 12, 13, and 5 of the patients had Type 3, Type 4, and Type 5 injury, respectively. While the mean pre-op VAS score was 7.4 (5-9), it was 1.8 (1-4) in the post-op period. The mean pre-op Constant-Murley score was 31.5 (22-42), compared to 85.1 (72-100) in the post-op period. The differences between the pre-op and post-op VAS and Constant-Murley Shoulder Scores were statistically significant. In this study, we achieved good functional results in the treatment of acromioclavicular joint separation by using a clavicular hook plate providing stable fixation and allowing early mobilization.

Trauma in Phillis Wheatley’s Juvenilia

Reading Wheatley’s writings as juvenilia and considering her poetry and letters in relation to one another can productively complicate the view that her poetry is devoid of traumatic affect. This approach illuminates her agency in grappling with how to represent her traumatic childhood experiences. To hear trauma in Wheatley’s poetry requires recognition of her agency in representing her traumatic childhood experiences and their effects on her memory, attachment, and affect. This essay argues that the poems Wheatley published while under age twenty-one provide insight into the challenge of representing the traumatic separation from her mother when her physical and psychic survival depended on her affective relationship with her mistress Susanna Wheatley. What we can hear in Wheatley’s poetry about her childhood in Africa and her upbringing in the Wheatley household must be teased out of the performance of obedience and gratitude expected of her as an enslaved child. ⁠

Developmental Trauma Disorder: A Legacy of Attachment Trauma in Victimized Children.

Developmental trauma disorder (DTD) and posttraumatic stress disorder (PTSD) have been found to have both shared and unique traumatic antecedents. The present study was an independent replication, with the DTD Structured Interview and the Traumatic Events Screening Instrument administered to 271 children in mental health treatment in six U.S. sites. On an unadjusted basis, DTD (27.3% prevalence, N = 74) and PTSD (40.2% prevalence, N = 109) both were associated with traumatic physical assault or abuse, family violence, emotional abuse, caregiver separation or impairment, and polyvictimization. After controlling for PTSD, DTD was associated emotional abuse, OR = 2.9, 95% CI [1.19, 6.95], and traumatic separation from a primary caregiver, OR = 2.2, 95% CI [1.04. 4.60], both of which also were associated with caregiver impairment, physical assault/abuse, and witnessing family/community violence. Three traumatic antecedents associated with PTSD were not associated with DTD: noninterpersonal trauma, sexual trauma, and traumatic loss. Children exposed to both traumatic victimization and attachment trauma (36.2%) or attachment trauma alone (32.5%) were more likely than children exposed only to victimization (17.5%) or those with no history of victimization or attachment trauma (8.1%) to meet the symptom criteria for DTD, χ²(3, N = 271) = 17.68, p < .001. Study findings replicate and extend prior DTD field trial study results, showing that, although PTSD and DTD share traumatic antecedents, DTD is uniquely associated with traumatic emotional abuse and caregiver separation. Further research is needed to examine how specific trauma types contribute to the risk, course, and severity of DTD.

Management of traumatic laryngotracheal separation: Case series and review.

Laryngotracheal separation injuries are a rare but serious condition, as survival from such injuries relies on proper airway management. As a result, recommendations for management have been based on small case reports and expert opinion. We reviewed our last 10 years of experience with managing laryngotracheal separation injuries and identified 6 cases for chart review. Awake tracheostomy or videolaryngobronchoscopy was used in each case to initially obtain the airway. Surgical repair was then performed immediately using nonabsorbable monofilament suture or a miniplate, and a low fenestrated tracheostomy was placed. All of our patients who followed up were decannulated, eating regular diets, and had satisfactory voice quality at 3 months postoperatively. Review of the literature revealed that, while management strategies have changed over time, treatment still varies widely depending on surgeon preference and the details of each injury. Outcomes from our series suggest that our described techniques and management strategies can be used with good outcomes. We believe that this is due to securing a safe airway, early surgical intervention with no unnecessary tissue dissection, effective reconstruction of the airway, and the fenestrated tracheostomy technique.

Population-attributable risk of adverse childhood experiences for high suicide risk, psychiatric admissions, and recurrent depression, in depressed outpatients

ABSTRACT Background: Population-attributable risk (PAR) may help estimate the potential contribution of adverse childhood experiences (ACEs) to serious clinical presentations of depression, characterized by suicidality, previous psychiatric admissions, and episode recurrence. Objective: To determine the PAR of ACEs for serious clinical presentations of depression (high suicide risk, previous psychiatric admissions, and recurrent depression) in outpatients with ICD-10 clinical depression. Method: Systematic chart review of 1,013 adults who were assessed and/or treated in a mental health clinic in Santiago, Chile for a major depressive episode. Data were collected on demographics and clinical characteristics of depression. Exposure to ACEs was determined with the Brief Physical and Sexual Abuse Questionnaire, assessing seven types of ACEs. Multivariable logistic regression analysis was used to assess the association between exposure to ACEs and suicidality, previous psychiatric admissions, and recurrence. Predicted probabilities were used for calculations of PAR. Results: Of the 1,001 study participants with complete data, 53.3% had recurrent depression, 13.5% had high suicide risk, and 5.0% had previous psychiatric admissions. Exposure to at least one ACE was recorded for 69.0% of the sample. Exposure to at least one ACE and specific types of ACEs (i.e. childhood sexual abuse and traumatic separation from caregiver) were associated with serious clinical presentations of depression. A dose-response relationship was observed between cumulative exposure to ACEs and the most serious clinical presentations of depression. ACEs were attributed to a significant proportion of disease: 61.6% of previous psychiatric admissions, 45.0% of high suicide risk, and 14.5% of recurrent depression. Conclusions: A substantial proportion of serious clinical presentations of depression among outpatients are associated with ACEs. Early detection of depressive episodes associated with ACEs, and tailored treatment for these patients, may potentially reduce the incidence of serious complications in this population.

Hemorrhagic Shock in a Patient with a Morel-Lavallée Lesion Combined with Active Arterial Bleeding without Fracture

A Morel-Lavallée lesion is a closed degloving injury caused by traumatic separation of the skin and subcutaneous tissue from the underlying fascia. However, since physicians tend to focus on treating the bone fracture, hemodynamic instability accompanying a Morel-Lavallée lesion can sometimes be overlooked. We report the case of a hemodynamically unstable 73-year-old man who had a Morel-Lavallée lesion of the thigh, but no femur fracture. Angiography showed active bleeding from the muscular branch of the right deep femoral artery, which was then successfully embolized. Keywords: Morel-Lavallee lesion; Hemodynamic instability; Embolization

37.2 TRAUMA-FOCUSED CBT FOR CHILDREN WITH PARENTAL SUBSTANCE ABUSE

Trauma-focused CBT (TF-CBT) is an evidence-based treatment with efficacy for improving child PTSD related to multiple and diverse traumas. Children whose parents have substance abuse are at increased risk for experiencing multiple traumas (eg, neglect, traumatic separation, traumatic parental death) and resultant PTSD. Challenges to treating these children include chaotic living circumstances, multiple changes in placement, and disruptions in providing services. This presentation describes a quality improvement (QI) project to evaluate TF-CBT for children with parental substance abuse.

Application of the damage control principles and the use of a local negative pressure system for the prevention of infectious complications in a patient with traumatic separation of the upper limb and massive damage to soft tissues

The article presents a clinical case of the successful treatment of a patient with traumatic separation of the upper limb and massive damage to the soft tissues of the upper shoulder and chest. The effectiveness of applying the damage control principles and the method of local negative pressure for the prevention of local and systemic infectious complications is emphasized.

Unseen Costs: The Direct and Indirect Impact of U.S. Immigration Policies on Child and Adolescent Health and Well-Being.

Shifts in migration and border control policies may increase the likelihood of trauma exposure related to child–parent separation and result in costs to the health system and society. In the present study, we estimated direct and indirect costs per child as well as overall cohort costs of border control policies on migrant children and adolescents who were separated from their parents, detained, and placed in the custody of the United States following the implementation of the 2018 Zero Tolerance Policy. Economic modeling techniques, including a Markov process and Monte Carlo simulation, based on data from the National Child Traumatic Stress Network's Core Data Set (N = 458 migrant youth) and published studies were used to estimate economic costs associated with three immigration policies: No Detention, Family Detention, and Zero Tolerance. Clinical evaluation data on mental health symptoms and disorders were used to estimate the initial health state and risks associated with additional trauma exposure for each scenario. The total direct and indirect costs per child were conservatively estimated at $33,008, $33,790, and $34,544 after 5 years for No Detention, Family Detention, and Zero Tolerance, respectively. From a health system perspective, annual estimated spending increases ranged from $1.5 million to $14.9 million for Family Detention and $2.8 million to $29.3 million for Zero Tolerance compared to baseline spending under the No Detention scenario. Border control policies that increase the likelihood of child and adolescent trauma exposure are not only morally troubling but may also create additional economic concerns in the form of direct health care costs and indirect societal costs.

Acromioclavicular joint separation treated with clavicular hook plate: a study of radiological and functional outcomes.

ACJ separation is a common shoulder injury. A variety of surgical techniques for high-grade ACJ separations have been described. A commonly used technique represents open reduction and fixation by a hook plate. Goal of the present study was to evaluate radiographic and functional outcome in patients with high-grade ACJ separations following surgical treatment with a hook plate before and after surgery as well as after hook plate removal. Patients undergoing surgery with a hook plate due to traumatic ACJ separation between 2012 and 2014 were included and examined during a follow-up control. Demographic and clinical data as well as radiographs pre- and postoperatively were evaluated. Additionally, range of motion, DASH Score and Constant-Murley Score (CMS) were analysed in a follow-up examination. Wilcoxon signed-rank test and Spearman's rank correlation were used for statistical analysis. 99 patients (88m/11w, 44y) were included in the present study. 69 (64m/5w, 49y) could be examined during long-term follow-up (38month). After hook plate removal, the CCD increased significantly (13.7 ± 0.9mm) compared to the hook plate in situ (9.9 ± 0.8mm, p = 0.000001). 68% of all patients achieved a full range of motion post-operatively. Main limitations of range of motion affected external rotation as well as ante-/retroversion. Mean DASH Score was 5.6 ± 1 points and CMS 90.0 ± 1.4 points. In contrast to a significant higher CCD after hook plate removal, nearly all patients achieved good to excellent functional results for DASH and CMS. This indicates that loss of reduction does not necessarily lead to poor functional outcome after ACJ separation surgery.

‘From Your Ever Anxious and Loving Father’: Faith, Fatherhood, and Masculinity in One Man’s Letters to His Son during the First World War

In the early months of 1916, Charles Robb a retired shipping clerk in the East End of London, England, wrote a series of letters to his 19-year-old son Arthur, an army private awaiting embarkation to the Western Front. Charles Robb was my great grandfather and Arthur Robb was my grandfather. The letters offer an intriguing glimpse of one man ‘doing’ fatherhood under conditions of traumatic separation and extreme anxiety. This paper presents an analysis of the letters from a psychosocial perspective, exploring the ways in which the writer exhorts his son to live up to the ideals of Christian manhood, while managing the anxiety of separation by presenting a reconstruction in language of the familiar world of home and church.

Book Review: Traumatic divorce and separation: The impact of domestic violence and substance abuse in custody and divorce

Book Review: Traumatic divorce and separation: The impact of domestic violence and substance abuse in custody and divorce

Trauma-Focused Cognitive Behavioral Therapy for Childhood Traumatic Separation.

In light of the current U.S. family separation crisis, there is growing attention to Childhood Traumatic Separation, defined here as a significant traumatic stress reaction to a familial separation that the child experiences as traumatic. When living in a family setting, Childhood Traumatic Separation may interfere with the child's relationships with the current caregiver(s). Effective treatments for Childhood Traumatic Grief can be modified to address Childhood Traumatic Separation. This article describes current applications of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) for Childhood Traumatic Separation. Using two composite clinical cases, TF-CBT applications for Childhood Traumatic Separation are described. These include: (1) implementing the safety component first; (2) tailoring coping skills to address the uncertainty of Childhood Traumatic Separation; (3) integrating past traumas into trauma narration and processing of the traumatic familial separation; (4) providing Childhood Traumatic Separation-focused components to address challenges of committing to new relationships while retaining connections to the separated parent; and (5) addressing role changes. These modifications have been implemented for many youth with Childhood Traumatic Separation and have anecdotally resulted in positive outcomes. Research is needed to document their effectiveness. The above practical strategies can be incorporated into TF-CBT to effectively treat children with Traumatic Separation. Practical strategies include starting with safety strategies; tailoring skills components to address the ongoing uncertainty of traumatic separation; integrating past traumas into trauma narration and processing of traumatic separation; providing traumatic separation-focused components to balance the challenges of committing to new relationships with retaining connections to the separation parent; and addressing role changes. Through these strategies therapists can successfully apply TF-CBT for Childhood Traumatic Separation.

The life of the legendary professor G.A. Albrecht: at the origins of prosthetics orthotics (to the 140&lt;sup&gt;th&lt;/sup&gt; anniversary of the birth and the 85&lt;sup&gt;th&lt;/sup&gt; anniversary of the death)

The article noted that on 20 November 1907, awarded by the conference of the Academy degree of doctor of medicine, after public defence of a thesis on the theme: pathology and treatment of lateral curvature of the knee. One after another began to appear in print: the question of fluoroscopy and radiography gunshot injury, traumatic separation of the lower epiphysis of the radius, Apitizers as a method for the treatment of genu valgum, Pathology and treatment of hallux valgus, the technique of treatment of coxitis tuberculosae, Isolated fracture of the trochleae humeri with a bloody reduction method, the technique of treatment of pseudoarthrosis autoplastic way. German Alexandrovich considered the prosthesis as a special area of medicine and technology that have important national economic significance. The primary means of training was surgery. In addition, in medical institutions was to be made, fitting, final fitting of prosthetic devices and training in their use patients. Also provides a broad familiarization of surgeons with the essential requirements of the prosthesis. It was also noted that in 1928, the opening of the Institute for medical and orthopedic hospital with 30 beds in addition to the hostel with 50 places, intended for the waiting of prostheses. In this way organized a uniform system of preparation for prosthetics, supply of prostheses and learning to use them in a special institution, which has for this purpose the necessary medical and technical personnel and equipment. German Alexandrovich was a highly qualified physician, research worker and teacher is not unusual for the time, however, harmonically the current profile. After 10 years in the clinic of Professor G. I. Turner, he acquired a comprehensive knowledge of orthopedics, which formed the basis for his later activities. Having a brilliant operative technique, Albrecht has developed its own methods of arthrodesis of the ankle and knee joints, modification kinaesthesia operations on stumps of the upper arm and forearm, as well as highly desirable variation of talangsari the first metacarpal and the splitting of the stump of the forearm by Krukenberg.