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ORTHOPEDICS AND TRAUMATOLOGY (150 journals)                     

Showing 1 - 152 of 152 Journals sorted alphabetically
Acta Orthopaedica     Open Access   (Followers: 32)
Advances in Orthopedics     Open Access   (Followers: 9)
American Journal of Orthodontics and Dentofacial Orthopedics     Hybrid Journal   (Followers: 9)
American Journal of Orthopedics     Partially Free   (Followers: 3)
Archives of Orthopaedic and Trauma Surgery     Hybrid Journal   (Followers: 9)
Archives of Osteoporosis     Hybrid Journal   (Followers: 1)
Arthritis und Rheuma     Hybrid Journal  
Arthroplasty Today     Open Access   (Followers: 1)
Australasian Musculoskeletal Medicine     Full-text available via subscription   (Followers: 5)
BMC Musculoskeletal Disorders     Open Access   (Followers: 29)
Bone & Joint 360     Full-text available via subscription   (Followers: 18)
Bone Research     Hybrid Journal   (Followers: 2)
Burns & Trauma     Open Access   (Followers: 11)
Cartilage     Hybrid Journal   (Followers: 5)
Case Reports in Orthopedic Research     Open Access  
Case Reports in Orthopedics     Open Access   (Followers: 6)
Chinese Journal of Traumatology     Open Access  
Cleft Palate-Craniofacial Journal     Hybrid Journal   (Followers: 8)
Clinical Medicine Insights : Arthritis and Musculoskeletal Disorders     Open Access   (Followers: 3)
Clinical Orthopaedics and Related Research     Hybrid Journal   (Followers: 78)
Clinical Trials in Orthopedic Disorders     Open Access   (Followers: 1)
Concussion     Open Access  
Craniomaxillofacial Trauma and Reconstruction     Hybrid Journal   (Followers: 1)
Current Orthopaedic Practice     Hybrid Journal   (Followers: 14)
Current Reviews in Musculoskeletal Medicine     Open Access   (Followers: 13)
Der Orthopäde     Hybrid Journal   (Followers: 6)
Die Wirbelsäule     Hybrid Journal  
Duke Orthopedic Journal     Open Access   (Followers: 5)
East African Orthopaedic Journal     Full-text available via subscription  
EFORT Open Reviews     Open Access   (Followers: 1)
Egyptian Orthopaedic Journal     Open Access   (Followers: 1)
EMC - Técnicas Quirúrgicas - Ortopedia y Traumatología     Full-text available via subscription  
EMC - Tecniche Chirurgiche - Chirurgia Ortopedica     Full-text available via subscription  
Ergonomics     Hybrid Journal   (Followers: 22)
European Journal of Orthopaedic Surgery & Traumatology     Hybrid Journal   (Followers: 9)
European Journal of Podiatry / Revista Europea de Podología     Open Access   (Followers: 1)
European Spine Journal     Hybrid Journal   (Followers: 24)
Foot & Ankle International     Hybrid Journal   (Followers: 10)
Foot & Ankle Orthopaedics     Open Access   (Followers: 3)
Gait & Posture     Hybrid Journal   (Followers: 17)
Geriatric Orthopaedic Surgery Rehabilitation     Open Access   (Followers: 5)
Global Spine Journal     Open Access   (Followers: 12)
Hip International     Hybrid Journal  
Indian Journal of Orthopaedics     Open Access   (Followers: 8)
Informationen aus Orthodontie & Kieferorthopädie     Hybrid Journal  
Injury     Hybrid Journal   (Followers: 20)
International Journal of Orthopaedic and Trauma Nursing     Hybrid Journal   (Followers: 11)
International Journal of Orthopaedic Surgery     Open Access   (Followers: 5)
International Journal of Orthopaedics     Open Access   (Followers: 2)
International Journal of Research in Orthopaedics     Open Access  
International Musculoskeletal Medicine     Hybrid Journal   (Followers: 7)
International Orthopaedics     Hybrid Journal   (Followers: 18)
JAAOS : Global Research & Reviews     Open Access   (Followers: 1)
JBJS Journal of Orthopaedics for Physician Assistants     Hybrid Journal  
JBJS Reviews     Full-text available via subscription   (Followers: 11)
JOR Spine     Open Access   (Followers: 3)
Journal de Traumatologie du Sport     Full-text available via subscription   (Followers: 2)
Journal für Mineralstoffwechsel & Muskuloskelettale Erkrankungen     Hybrid Journal  
Journal of Bone and Joint Diseases     Open Access   (Followers: 4)
Journal of Bone and Joint Infection     Open Access   (Followers: 1)
Journal of Brachial Plexus and Peripheral Nerve Injury     Open Access   (Followers: 4)
Journal of Cachexia, Sarcopenia and Muscle     Open Access   (Followers: 2)
Journal of Children's Orthopaedics     Open Access   (Followers: 10)
Journal of Clinical Orthopaedics and Trauma     Hybrid Journal   (Followers: 5)
Journal of Experimental Orthopaedics     Open Access   (Followers: 8)
Journal of Hand Surgery (European Volume)     Hybrid Journal   (Followers: 44)
Journal of Head Trauma Rehabilitation     Hybrid Journal   (Followers: 17)
Journal of Musculoskeletal Research     Hybrid Journal   (Followers: 9)
Journal of Orofacial Orthopedics / Fortschritte der Kieferorthopädie     Hybrid Journal  
Journal of Orthodontic Science     Open Access   (Followers: 2)
Journal of Orthopaedic & Sports Physical Therapy     Full-text available via subscription   (Followers: 69)
Journal of Orthopaedic Association of South Indian States     Open Access   (Followers: 5)
Journal of Orthopaedic Diseases and Traumatology     Open Access   (Followers: 5)
Journal of Orthopaedic Reports     Full-text available via subscription   (Followers: 12)
Journal of Orthopaedic Research     Hybrid Journal   (Followers: 29)
Journal of Orthopaedic Science     Hybrid Journal   (Followers: 4)
Journal of Orthopaedic Surgery     Open Access   (Followers: 1)
Journal of Orthopaedic Surgery and Research     Open Access   (Followers: 8)
Journal of Orthopaedic Translation     Open Access  
Journal of Orthopaedic Trauma     Hybrid Journal   (Followers: 15)
Journal of Orthopaedics     Full-text available via subscription   (Followers: 3)
Journal of Orthopaedics and Allied Sciences     Open Access   (Followers: 9)
Journal of Orthopaedics and Spine     Open Access   (Followers: 3)
Journal of Orthopaedics and Traumatology     Open Access   (Followers: 16)
Journal of Orthopaedics, Trauma and Rehabilitation     Open Access   (Followers: 6)
Journal of Orthopedics & Rheumatology     Open Access  
Journal of Orthopedics, Traumatology and Rehabilitation     Open Access   (Followers: 6)
Journal of Pediatric Orthopaedics     Hybrid Journal   (Followers: 15)
Journal of Prosthetics and Orthotics     Hybrid Journal   (Followers: 14)
Journal of Scleroderma and Related Disorders     Hybrid Journal  
Journal of the American Academy of Orthopaedic Surgeons     Hybrid Journal   (Followers: 12)
Journal of the American Podiatric Medical Association     Full-text available via subscription   (Followers: 8)
Journal of Traumatic Stress     Hybrid Journal   (Followers: 25)
Knee Surgery, Sports Traumatology, Arthroscopy     Hybrid Journal   (Followers: 27)
Multiple Sclerosis and Related Disorders     Hybrid Journal   (Followers: 8)
Musculoskeletal Care     Hybrid Journal   (Followers: 19)
Musculoskeletal Science and Practice     Hybrid Journal   (Followers: 3)
Nigerian Journal of Orthopaedics and Trauma     Open Access  
North American Spine Society Journal (NASSJ)     Open Access   (Followers: 3)
OA Orthopaedics     Open Access   (Followers: 7)
Obere Extremität     Hybrid Journal   (Followers: 1)
Open Journal of Orthopedics     Open Access   (Followers: 3)
Open Journal of Orthopedics and Rheumatology     Open Access  
Open Journal of Trauma     Open Access  
Open Orthopaedics Journal     Open Access  
Operative Orthopädie und Traumatologie     Hybrid Journal  
Operative Techniques in Orthopaedics     Full-text available via subscription   (Followers: 6)
Orthopädie & Rheuma     Full-text available via subscription  
Orthopädie und Unfallchirurgie up2date     Hybrid Journal  
Orthopaedic Journal of Sports Medicine     Open Access   (Followers: 14)
Orthopaedic Nursing     Hybrid Journal   (Followers: 11)
Orthopaedic Proceedings     Partially Free  
Orthopaedic Surgery     Open Access   (Followers: 1)
Orthopaedics & Traumatology: Surgery & Research     Full-text available via subscription   (Followers: 6)
Orthopaedics and Trauma     Full-text available via subscription   (Followers: 28)
Orthopedic Clinics of North America     Full-text available via subscription   (Followers: 5)
Orthopedic Research and Reviews     Open Access   (Followers: 6)
Orthopedic Reviews     Open Access   (Followers: 7)
Orthopedics     Full-text available via subscription   (Followers: 6)
Orthoplastic Surgery     Open Access  
Osteoarthritis and Cartilage     Full-text available via subscription   (Followers: 20)
Osteoarthritis and Cartilage Open     Open Access  
Osteologie     Hybrid Journal  
Osteoporosis and Sarcopenia     Open Access  
OTA International     Open Access  
Paediatric Orthopaedics and Related Sciences     Open Access   (Followers: 3)
Pain Management in General Practice     Full-text available via subscription   (Followers: 12)
Prosthetics and Orthotics International     Hybrid Journal   (Followers: 8)
Revista Brasileira de Ortopedia     Hybrid Journal  
Revista Chilena de Ortopedia y Traumatología / Chilean Journal of Orthopaedics and Traumatology     Open Access  
Revista Colombiana de Ortopedia y Traumatología     Full-text available via subscription  
Revista Cubana de Ortopedia y Traumatologí­a     Open Access  
Revista de la Asociación Argentina de Ortopedia y Traumatología     Open Access  
Revista Española de Cirugía Ortopédica y Traumatología     Full-text available via subscription   (Followers: 1)
Revista Portuguesa de Ortopedia e Traumatologia     Open Access  
Revue de Chirurgie Orthopédique et Traumatologique     Full-text available via subscription   (Followers: 3)
Romanian Journal of Orthopaedic Surgery and Traumatology     Open Access  
SA Orthopaedic Journal     Open Access   (Followers: 2)
SICOT-J     Open Access   (Followers: 1)
Spine     Hybrid Journal   (Followers: 73)
Spine Journal     Hybrid Journal   (Followers: 26)
Sport-Orthopädie - Sport-Traumatologie - Sports Orthopaedics and Traumatology     Full-text available via subscription   (Followers: 3)
Strategies in Trauma and Limb Reconstruction     Open Access   (Followers: 1)
Techniques in Orthopaedics     Hybrid Journal   (Followers: 6)
Therapeutic Advances in Musculoskeletal Disease     Hybrid Journal   (Followers: 5)
Trauma     Hybrid Journal   (Followers: 5)
Trauma (Travma)     Open Access  
Trauma und Berufskrankheit     Hybrid Journal  
Traumatology     Full-text available via subscription   (Followers: 1)
Traumatology and Orthopedics of Russia     Open Access  
Zeitschrift für Orthopädie und Unfallchirurgie     Hybrid Journal   (Followers: 2)
Ортопедия, травматология и протезирование     Open Access  

           

Similar Journals
Journal Cover
Trauma
Journal Prestige (SJR): 0.157
Number of Followers: 5  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 1460-4086 - ISSN (Online) 1477-0350
Published by Sage Publications Homepage  [1174 journals]
  • Removing a fishing hook from inside the nasal alar: The push through and
           cut off method

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      Authors: Seyed Mojtaba Mirzadeh
      Abstract: Trauma, Ahead of Print.
      IntroductionFishing can be problematic for the novice fisherman when the fishing hook sinks into the fisherman’s body. The hook can often not be removed easily because of its specific structure.Case reportA 12-year-old boy had a fishing hook sunk into his nose after it was thrown towards his face; it inserted into the septum and right lower lateral cartilage of the nose due to inexperience in handling it by the victim.DiscussionThe hook was extracted through the ‘push through and cut off’ method with no damage caused to the lower lateral cartilage, septum and the nasal skin. Deep insertion of the hook in the sensitive areas such cartilage of the nose can cause an irreversible complication if erroneously manipulated.ConclusionThis is the first report of technique of removed fishing hook with extra teeth from the nasal cartilage. Surgeon knowledge about the hook type and techniques of hook removal can help successful removal from the body without irreversible complication.
      Citation: Trauma
      PubDate: 2022-08-08T12:41:53Z
      DOI: 10.1177/14604086211019525
       
  • Impact of Modified Geriatric Trauma Activation Criteria on patient
           outcomes at a level 1 trauma center

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      Authors: Reginald Alouidor, Margaret Siu, Sandy Roh, Aixa M. Perez Coulter, Tovy H. Kamine, Kristina Z. Kramer, Eleanor S. Winston, Gabriel Ryb, Adin T. Putnam, Edward Kelly
      Abstract: Trauma, Ahead of Print.
      BackgroundThe American College of Surgeons Trauma Quality Improvement Program recommends a lower threshold for trauma activation on geriatric patients. We implemented the Modified Geriatric Trauma Activation Criteria (MGTAC) and assessed the clinical impact on geriatric trauma patients.MethodsGeriatric trauma patients aged 65 years and over presenting between 1/1/2014 and 12/31/2020 were identified through the Trauma Registry. MGTAC were implemented on 3/1/2017, where patients aged 65 and above were rendered as Highest Level activations when presenting with no prior work-up. Those presenting from 1/1/2014 to 2/28/2017 were grouped as Standard Activation Criteria (SAC), and those presenting between 3/1/2017 and 12/31/2020 were grouped as MGTAC. Patient demographics, mechanism of injury, level of activation, operative intervention, intensive care unit (ICU) admission, length of stay, survival, and undertriage rates were reviewed. Chi square, ANOVA, and unpaired t-test were used for analysis to compare SAC and MGTAC patient outcomes.Results2582 patients were identified: 1293 (50.1%) in SAC and 1289 (49.9%) in MGTAC. Highest Level trauma activations for SAC vs. MGTAC were 9.3% vs. 30.4%, p < .01. Between SAC and MGTAC, ICU admission was 24.1% vs. 16.5%, p
      Citation: Trauma
      PubDate: 2022-06-27T04:31:29Z
      DOI: 10.1177/14604086221110972
       
  • Psychological and psychosocial aspects of major trauma care in the United
           Kingdom: A scoping review of primary research

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      Authors: Philippa Olive, Lucy Hives, Neil Wilson, Amy Ashton, Marie Claire O’Brien, Gemma Mercer, Raeesa Jassat, Catherine Harris
      Abstract: Trauma, Ahead of Print.
      IntroductionMore people are surviving major trauma, often with life changing injuries. Alongside physical injury, many survivors of major trauma experience psychological and psychosocial impacts. Presently, there is little guidance at the UK national level for psychological and psychosocial aspects of major trauma care. Set in the context of the regional model of major trauma care implemented in the UK in 2012, the purpose of this review was to identify and bring together primary research about psychological and psychosocial aspects of major trauma care in the UK to produce an overview of the field to date, identify knowledge gaps and set research priorities.MethodsA scoping review was undertaken. Seven electronic databases (MEDLINE, Cochrane Library, CINAHL, Embase, PsycINFO, SocINDEX with Full Text and PROSPERO) were searched alongside a targeted grey literature search. Data from included studies were extracted using a predefined extraction form and underwent bibliometric analysis. Included studies were then grouped by type of research, summarised, and synthesised to produce a descriptive summary and overview of the field.ResultsThe searches identified 5,975 articles. Following screening, 43 primary research studies were included in the scoping review. The scoping review, along with previous research, illustrates that psychological and psychosocial impacts are to be expected following major trauma. However, it also found that these aspects of care are commonly underserved and that there are inherent inequities across major trauma care pathways in the UK.ConclusionThough the scoping review identified a growing body of research investigating psychological and psychosocial aspects of major trauma care pathways in the UK, significant gaps in the evidence base remain. Research is needed to establish clinically effective psychological and psychosocial assessment tools, corresponding interventions, and patient-centred outcome measures so that survivors of major trauma (and family members or carers) receive the most appropriate care and intervention.
      Citation: Trauma
      PubDate: 2022-06-18T06:01:16Z
      DOI: 10.1177/14604086221104934
       
  • Erector spinae plane versus paravertebral catheter techniques for rib
           fracture analgesia: A pilot matched cohort study

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      Authors: Nathan Murray, Justin Swierczek, Brooke Riley, Andrew Mitchell, Catherine Abi-fares, Willem Basson, Chris Anstey, Leigh White
      Abstract: Trauma, Ahead of Print.
      BackgroundNumerous regional techniques are available to provide analgesia and reduce complications related to rib fractures. There is a paucity of evidence comparing the efficacy of these techniques. This pilot study aims to assess the efficacy of erector spinae plane block (ESPB) versus paravertebral block (PVB) catheters for rib fracture analgesia.MethodsPatients who received either an ESPB or PVB catheter for rib fracture analgesia over the study period (April 2017 to September 2020) were eligible for inclusion. Patients were matched based on demographics and injury characteristics. Outcomes of interest included pre and post catheter-insertion numerical pain scores at rest and with movement, and time to rescue analgesia following catheter insertion.ResultsThirty-four matched patients were included in this study. Pain scores at rest and with movement were significantly reduced in both groups. There were no statistically significant differences in post-block pain scores or time to rescue analgesia between the two groups. Fifteen (88.2%) of those in both groups had a documented subjective improvement in pain, inspiratory effort or cough strength.ConclusionThis pilot study is the first to show that the recently described ESPB technique provides non-inferior analgesia compared to PVB for the management of rib fractures. Both techniques were effective in reducing pain scores and had similar times to rescue analgesia. This study supports claim that the ESPB is an effective alternative to traditional regional techniques in the management of rib fractures.
      Citation: Trauma
      PubDate: 2022-06-13T12:52:25Z
      DOI: 10.1177/14604086221106849
       
  • Post-traumatic Lemierres Syndrome: A rare presentation secondary to
           mandibular fracture

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      Authors: Saul Kaplan, Ruan Grobler, Sean Chetty
      Abstract: Trauma, Ahead of Print.
      Lemierre’s Syndrome is a rare phenomenon with a low prevalence and is characteristically seen in patients with an oropharyngeal infection that is complicated by thrombophlebitis of the internal jugular vein and secondary septic emboli. We present the case of a 16 year old previously well male who was diagnosed with a rare case of Lemierre’s syndrome secondary to a mandibular fracture. Blood tests and radiological imaging confirmed the diagnosis, with CT scan of the patients head and neck revealing a right mandibular fracture with abscess formation, bilateral parapharyngeal abscesses, bilateral internal jugular vein thromboses, left sigmoid sinus thrombosis, cavernous sinus thrombosis, post septal orbital cellulitis with enhancing infraorbital collections and a subdural empyema overlying the left tentorium cerebelli. The treatment is usually non-operative with antibiotics and in some instances surgical drainage. In this case a combination of surgical drainage for source control and antibiotics were used. Unfortunately, despite an initial improvement in the patient’s clinical status the patient died. This is the first case of Lemierre’s syndrome secondary to blunt facial trauma reported in the scientific literature. This case highlights the importance of clinicians having a high degree of suspicion of Lemierre’s syndrome when a patient presents with typical clinical features following facial trauma.
      Citation: Trauma
      PubDate: 2022-06-13T12:37:38Z
      DOI: 10.1177/14604086221106854
       
  • Isolated duodenal perforation in children: Importance of high index of
           suspicion following blunt trauma abdomen

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      Authors: Sajad A Wani, Kumar A Rashid
      Abstract: Trauma, Ahead of Print.
      IntroductionIsolated duodenal perforation (IDP) is rare and only isolated cases are reported in the literature. Due to its rarity and subtle presentation, the diagnosis of IDP is often delayed. Delay in the diagnosis and surgical intervention result in increased morbidity and mortality. The aim of this article is to highlight the importance of a high index of suspicion of IDP following blunt abdominal trauma and safety of primary repair without diversion in such cases.Material and methodsChildren with isolated duodenal injuries following blunt abdominal trauma were included; mode of trauma, clinical presentation, diagnosis, operative intervention and outcome were studied.ResultsNine patients with isolated duodenal perforations were identified and operated on. Most had minimal clinical findings on arrival and were haemodynamically stable. Abdominal radiography and ultrasonography were unremarkable. However, pain remained persistent and worsening of vomiting was seen over time. Contrast-enhanced computed tomography (CECT) of the abdomen with oral and intravenous contrast was done to identify the injuries. Primary repair of perforation was performed in all cases. The most common cause was road traffic accident. There were three Grade 2 injuries, five Grade 3 and one Grade 4 injuries. Eight patients healed well with uneventful recovery – one patient died from sepsis after presenting 24 h after injury with frank peritonitis.ConclusionIsolated duodenal perforation presents without specific signs and symptoms and a high index of suspicion is necessary for early diagnosis. Contrast-enhanced computed tomography of the abdomen with oral contrast should be ordered early if symptoms persist or worsened over time.
      Citation: Trauma
      PubDate: 2022-05-26T03:29:05Z
      DOI: 10.1177/14604086221103055
       
  • Major traumatic injury sustained during use of a virtual reality (VR)
           headset

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      Authors: Megan Joy Jones-Dellaportas, James Alexander Keitley, Richard Donald Bullough, Blair Graham
      Abstract: Trauma, Ahead of Print.
      We report the first documented case of significant, potentially life-changing trauma sustained during use of virtual reality (VR). A male in his fifties fell from standing whilst immersed in a VR game and sustained injuries including bilateral occipital condyle fractures, spinal cord contusion resulting in central cord syndrome, right vertebral artery occlusion, and left hypoglossal nerve palsy. His injuries were managed conservatively with a lengthy recovery period. The patient made a good recovery with full resolution of his symptoms and has returned to full-time employment. This case discusses how these injuries are commonly related and considers the implications of VR on a person’s balance and whether the headset may make neck extension injuries more likely.
      Citation: Trauma
      PubDate: 2022-05-26T03:13:27Z
      DOI: 10.1177/14604086221100139
       
  • Injuries associated with hypotension after trauma: Is it always
           haemorrhage'

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      Authors: Michael Eichinger, Martin A Schreiber, Elaine Cole, Christopher Aylwin
      Abstract: Trauma, Ahead of Print.
      IntroductionRestricted fluid replacement strategy is one part of damage control resuscitation for patients with trauma haemorrhage. However, not all patients presenting with physiological symptoms suggestive of haemorrhage are bleeding. This descriptive study aims to compare demographics and injuries in adult and older trauma patients presenting to the Emergency Department with hypotension versus normotension.MethodsThis was a retrospective, descriptive data analysis from a UK trauma registry. The records from one major trauma centre were analysed between 2014–2019, and every hypotensive (systolic blood pressure
      Citation: Trauma
      PubDate: 2022-05-24T03:11:50Z
      DOI: 10.1177/14604086221099422
       
  • Routine repeat imaging of blunt splenic injuries identifies complications
           prior to clinical change

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      Authors: Lindsey L Perea, Kelsey L Fletcher, Madison E Morgan, Banan W Otaibi, Joshua P Hazelton
      Abstract: Trauma, Ahead of Print.
      BackgroundThere are no definitive recommendations guiding repeat imaging, or its timing, in patients with blunt splenic injury managed non-operatively. This study examines delayed complications and interventions in patients with blunt splenic injuries who undergo repeat imaging. Imaging was prompted either by a clinical change (CC) or non-clinical change (NCC) including institutional recommendations and individual physician practice patterns.MethodsA 3-year, retrospective, dual-institution study was conducted of adult patients with blunt splenic injuries. Patients who underwent repeat imaging were grouped based on the reason for scan: CC or NCC. The incidence of delayed complications and interventions was examined.ResultsOf 235 patients, 105 (45%) underwent repeat imaging [CC n = 67 (64%), NCC n = 38 (36%)]. Median time to repeat imaging was shorter in the NCC group [CC = 96 (IQR 48–192) hours, NCC = 48 (IQR 36–68) hours, p = .0005]. Delayed complications were found in 28 (42%) CC patients versus 18 (47%) NCC patients (p = .683). Interventions for complications were performed in 6 (21%) CC versus 10 (56%) NCC (p = .027).DiscussionNearly half of patients reimaged because of NCC were found to have complications, with more than half undergoing intervention. Complications were identified and treated earlier in the NCC group than the CC group. This suggests patients with blunt splenic injuries should undergo routine repeat imaging to allow for prompt identification and treatment of delayed complications.
      Citation: Trauma
      PubDate: 2022-05-24T02:10:36Z
      DOI: 10.1177/14604086221103060
       
  • Risk factors and outcomes associated with ventilator associated pneumonia
           amongst intubated trauma patients admitted to the general intensive care
           unit of a major trauma centre

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      Authors: Claire Hirst, Matthew Needham
      Abstract: Trauma, Ahead of Print.
      BackgroundDespite the use of care bundles, ventilator associated pneumonia (VAP) remains a frequently occurring health care-associated infection, increasing costs, length of stay (LOS) and mortality. The incidence is higher amongst trauma patients, although due to variable definitions and study populations risk factors for developing VAP are disputed, with few reports from the UK.MethodsThis 6-year review of intubated trauma patients admitted to the general Intensive Care Unit (ICU) of a UK major trauma centre, collected data on suspected risk factors for VAP, as well as demographic information, outcomes and microbiology. Ninety-nine patients who developed VAP within the first 7 days of admission were compared with 191 patient who did not, with multivariable logistic regression used to control for confounding variables.ResultsUnivariable analysis suggested that injury severity score (ISS) (34 v 29), head injury (66.7% v 50.8%), polytrauma (79.8% v 68.1%) and ventilator days (10 v 5) were associated with increased risk of VAP, but after adjustment only ventilator days remained significant (OR 1.04, 95% CI 1.01–1.06). Antibiotics within 24 h of admission were associated with reduced odds of developing VAP, whether this was for pulmonary prophylaxis (OR 0.43, 95% CI 0.22–0.83, p = 0.013) or non-pulmonary reasons (OR 0.27, 95% CI 0.15–0.51, p < 0.001).ConclusionsOnly increasing ventilator days was associated with increased odds of developing VAP. The use of early antimicrobials was associated strongly with a reduction in the odds of developing VAP; this could be explained by unmeasured confounding or a prophylactic effect against aspiration.
      Citation: Trauma
      PubDate: 2022-05-21T01:29:23Z
      DOI: 10.1177/14604086221094651
       
  • Predictive factors for community integration among Nepalese persons after
           traumatic brain injury

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      Authors: Sumana Lama, Jintana Damkliang, Luppana Kitrungrote
      Abstract: Trauma, Ahead of Print.
      BackgroundVarious factors affect the community integration (CI) of persons experiencing traumatic brain injury (TBI). To ensure positive outcomes in terms of life at home, social activities, and productive work among persons suffering TBI, it is necessary to understand the factors that facilitate or impede CI.PurposeTo compare CI by looking at demographic and clinical characteristics and determine significant predictors of CI among TBI Nepalese persons.Methods120 participants were selected using a stratified random sampling technique. A questionnaire was used to identify the participants’ demographic and clinical characteristics, and the Community Integration Questionnaire was used to measure CI. Univariate and multivariate analyses were performed for demographic and clinical factors associated with community integration.ResultsUsing univariate analysis, male, employed, living with family, and independence in performing activities of daily living had significantly higher CI scores than female (t = −4.18, p
      Citation: Trauma
      PubDate: 2022-05-04T09:16:09Z
      DOI: 10.1177/14604086221088104
       
  • Formalised major trauma induction for anaesthesia trainees

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      Authors: Amar Singh Jessel, Matthew Wyse, Andrew Kelly, Laura Conway, Laura May
      Abstract: Trauma, Ahead of Print.

      Citation: Trauma
      PubDate: 2022-04-25T10:07:24Z
      DOI: 10.1177/14604086221088149
       
  • Ventilating the blast lung: Exploring ventilation strategies in primary
           blast lung injury

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      Authors: Jaden Tollman, Zubair Ahmed
      Abstract: Trauma, Ahead of Print.
      IntroductionPrimary blast lung injury (PBLI) is the most common and fatal of all primary blast injuries. The majority of those with PBLI will require early intubation and mechanical ventilation, and thus, ventilation strategy forms a crucial part of any management plan.Methods: A comprehensive, but not systematic, PubMed and Google Scholar database search identified articles that contribute to our current understanding of ventilation strategies in PBLI for a narrative educational review.ResultsA PBLI ventilation strategy must strive to minimise all four of ventilator-associated lung injury (VALI), volutrauma, barotrauma and biotrauma. The three main ventilation strategies available are conventional low tidal volume (LTV) ventilation, airway pressure release ventilation (APRV) and high frequency oscillatory ventilation (HFOV). Conventional LTV ventilation together with a variable positive end-expiratory pressure (PEEP) and permissive hypercapnia has demonstrated reduced inflammation and mortality with a greater number of ventilator-free days. APRV has the potential to reduce dynamic strain, PaO2/FiO2 ratios, levels of applied mechanical power and extravascular lung water while encouraging spontaneous breathing. HFOV is able to effectively avoid VALI while curbing inflammation and histological lung injury, though not necessarily mortality.Conclusions: Presently, PBLI should largely be managed with conventional LTV ventilation alongside a variable PEEP and permissive hypercapnia with APRV and HFOV reserved as rescue strategies for where conventional LTV ventilation fails. Clinicians should additionally consider supplementing their strategy with adjunctive therapies such as prone positioning, inhaled nitric oxide and extracorporeal membrane oxygenation that may further reduce mortality and combat severe respiratory and/or cardiac failure.
      Citation: Trauma
      PubDate: 2022-04-02T10:02:55Z
      DOI: 10.1177/14604086221080020
       
  • Experiences of living and coping with spinal cord disability due to road
           traffic injuries: A phenomenological study

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      Authors: Mina Hashemiparast, Hajieh Sheydaei, Vijay Kumar Chattu, Maryam Gharacheh
      Abstract: Trauma, Ahead of Print.
      IntroductionGlobally, people living with spinal cord disability experience more limitations in an individual and social life. In many cases, this leads to complex psychological and social problems that may also affect the adaptation to the conditions. The aim of the study was to explore the experience of living and coping with disability in people with spinal cord disability due to road traffic accidents in Iran’s cultural context.MethodsThis is a qualitative study with a phenomenological approach on 10 Iranian people with spinal cord disability due to road traffic injuries. Data collection and analysis were performed from September to March 2019. Data were collected through individual, face-to-face in-depth interviews, and the experience of living with disability and adaptation strategies were explored. Van Manen’s methodical activities were used to guide the study’s process.Results“Victim of destiny” was the main theme extracted from three themes and nine sub-themes. The disabled people viewed life as a prison that destiny had ordained for them and trapped them in the fences of isolation, anger, regret, anxiety, sorrow, pity, and futility such that they require assistance from others as dependent individuals. The participants’ coping strategies to adjust to their difficulties were religious recourse, satisfaction with God’s expediency, and change of life values.ConclusionsSpinal cord disability imposed irreversible restrictions on the participants’ lives. Providing social support, empowering disabled people to overcome their limitations, and adopting religious recourse can help them to recover their mental health and better cope with their conditions.
      Citation: Trauma
      PubDate: 2022-04-01T07:19:59Z
      DOI: 10.1177/14604086221076274
       
  • Characterization of platelet concentrations and evaluation of risk factors
           for thrombocytopenia following traumatic injury

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      Authors: Julie E Farrar, Kushal Naik, Edward T Van Matre, Katelyn G Martin, Louis J Magnotti, G Christopher Wood, Joseph M Swanson
      Abstract: Trauma, Ahead of Print.
      IntroductionThrombocytopenia is common in critically ill trauma patients and can lead to potentially broad differentials, including major bleeding, hemodilution, extracorporeal circuit losses, heparin-induced thrombocytopenia, and more. Understanding the normal time course of platelet decline and recovery may delineate thrombocytopenia(HIT) secondary to traumatic injury versus other inciting factors.MethodsThis retrospective study included trauma patients admitted over a 1-year period. The primary aim was characterizing the effect of trauma on platelet concentration and thrombocytopenia incidence in the first 30 days following injury. Thrombocytopenia was defined as platelet concentration
      Citation: Trauma
      PubDate: 2022-04-01T07:17:43Z
      DOI: 10.1177/14604086221076280
       
  • Elevated body mass index is associated with tibial plateau fracture
           complexity and post-operative complications

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      Authors: Kathy M McGurk, Sophia A Traven, Austin McCadden, Christopher T LeBrun, Kristoff R Reid, Langdon A Hartsock, Harris S Slone
      Abstract: Trauma, Ahead of Print.
      IntroductionAs the average body mass index (BMI) is increasing at an alarming rate, dichotomous literature exists regarding whether BMI is protective or disadvantageous for fracture risk. Therefore, the purpose of this study was to evaluate the relationship between BMI, fracture complexity, and post-operative complications for tibial plateau fractures.MethodsA retrospective analysis of the National Surgical Quality Improvement Program’s database for the years 2005–2018 was completed. Only patients undergoing primary surgical fixation of an isolated tibial plateau fracture were included. Patients were then stratified into unicondylar and bicondylar fracture patterns by CPT code. Multivariate logistic regression analyses were used to assess risk factors for fracture severity, post-operative complications, and staged fixation.ResultsOf the 3454 patients identified for inclusion, we found that patients with higher BMIs were more likely to sustain a bicondylar fracture compared with patients with lower BMIs. For each additional BMI point, the risk of sustaining a bicondylar fracture increased by 1.0%. Additionally, there was a 3.8% increased risk of surgical complications for every increased BMI point. Specifically, the risk of a deep infection increased by 6.1%, wound dehiscence by 8.5%, and venous thromboembolism by 4.2%.ConclusionThis data demonstrates that an elevated BMI is associated with increased tibial plateau fracture complexity and post-operative complications. These results may be used to help surgeons and hospitals identify at-risk patients to help guide perioperative management in an effort to help mitigate such complications as much as possible.
      Citation: Trauma
      PubDate: 2022-03-30T08:34:17Z
      DOI: 10.1177/14604086211063083
       
  • Peer support facilitates post-traumatic growth in first responders: A
           literature review

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      Authors: Nicole Donovan
      Abstract: Trauma, Ahead of Print.
      IntroductionFirst responders are routinely exposed to traumatic workplace incidents that can result in post-traumatic stress disorder (PTSD). First responder organizations utilize different types of peer led programs to support first responders following a critical incident including the Critical Incident Stress Management Program (CISM) and stand-alone peer support programs. Little research has been done to determine the benefits or limitations of stand-alone peer support programs on the mental health of first responders. The aim of this project was to understand what characteristics of peer support facilitate post-traumatic growth (PTG) in first responders.MethodsA literature search was completed using the City University of Seattle library database, ResearchGate and Google Scholar. The studies used in this review were found on EBCSOhost, ProQuest, PubMed and Wiley Online. This review includes literature published since 2006 that references post-traumatic growth in first responders, and/or their preferences for support, their coping styles and organizational impacts on growth. Thematic analysis was conducted to identify the themes and patterns in the final 10 research papers.ResultsThis literature review identified five themes of formal and informal peer interactions that support PTG in first responders. (1) Peer support assists first responders with the processing of traumatic events and (2) managing organizational stressors. (3) Peer support alone may not lead to PTG and requires the use of adaptive coping behaviours. (4) First responders who actively engage with peer support experience increased well-being and (5) relational safety with peers encourages disclosure that leads to post-traumatic growth.ConclusionFormal and informal peer support contribute to post-traumatic growth (PTG) in first responders. Further research needs to be done to differentiate between the effects of trained peer support and support from colleagues.
      Citation: Trauma
      PubDate: 2022-03-29T01:36:53Z
      DOI: 10.1177/14604086221079441
       
  • A survey-based review of psychology provision in major trauma centres
           (MTCs) in England

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      Authors: Alistair Teager, Benjamin Dawson, Louise Johnson, Abigail Methley, Jodie Mairs, Calum Murray
      Abstract: Trauma, Ahead of Print.
      IntroductionFollowing major trauma, individuals frequently experience psychological or neuropsychological consequences of their injuries. Clinical psychologists are well-placed to provide support for these individuals and the multidisciplinary teams that work with them. It is currently unclear as to the level of psychology provision in major trauma centres (MTCs), and the input they can provide. This study therefore aimed to identify psychology provision in major trauma centres in England to facilitate discussion and support service development.MethodElectronic surveys were distributed via a mailing list to psychologists in MTCs to gather data on the role and resource of psychology provision in major trauma centres in England. Data were analysed quantitatively and qualitatively.ResultsPsychologists from 21/40 MTCs in England responded. Significant gaps in psychology service provision were found across all services, including not being able to provide consistent input throughout the week and not being able to provide a combination of assessment, formulation and intervention, amongst others. Common barriers to providing psychology input included lack of integration into multidisciplinary teams and reduced knowledge of patient transfers, underpinned by staff resource. These issues also contributed to psychologists in MTCs limiting the types of referrals they accept.ConclusionsPsychology is presently under-resourced in MTCs in England, particularly in services for children. Recommendations for major trauma psychology roles and level of resource need to be provided in national service specifications in order improve service delivery and prioritise psychosocial outcomes of individuals with potentially life-changing injuries.
      Citation: Trauma
      PubDate: 2022-03-29T01:00:13Z
      DOI: 10.1177/14604086211063084
       
  • Pre-hospital trauma triage: Outcomes of interfacility transferred trauma
           patients meeting pre-hospital triage criteria

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      Authors: Winny Li, Garrick Mok, Brodie Nolan
      Abstract: Trauma, Ahead of Print.
      IntroductionIn Ontario, Canada, paramedics use the Field Trauma Triage Standard to identify patients at risk for severe injury. These triage criteria encompass physiologic, anatomic, mechanism of injury, and special considerations to identify patients that should be transported directly to a trauma center. Patients meeting any one of these criteria mandate direct transfer to a trauma center. This study evaluated whether severely injured trauma patients that underwent an interfacility transfer met these triage criteria. The secondary objective was to assess the impact of failed triage application on in-hospital mortality.MethodsThis is a retrospective cohort study of interfacility trauma transfers to an adult trauma center over a 3-year period that were either admitted to the intensive care unit, received an operation within 4 h of arrival, or died within 48 h of arrival. Data were abstracted from the hospital’s trauma registry and chart review of electronic medical records. Frequency of patients meeting pre-hospital triage criteria and which specific criteria were collected. Multivariable logistic regression was performed to assess the impact of missed pre-hospital triage on in-hospital mortality.ResultsThere were 1008 interfacility patients during the study period, of which 340 patients met inclusion criteria; 78.5% (n = 267) of interfacility transports had met at least one triage criteria. Most frequent criteria met were: Glasgow Coma Scale
      Citation: Trauma
      PubDate: 2022-03-24T06:06:05Z
      DOI: 10.1177/14604086211064447
       
  • Arthroscopic management of a cavitated calcaneum following gunshot injury

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      Authors: Samir A Sakka
      Abstract: Trauma, Ahead of Print.
      We report a 35 year old man who sustained a close range through and through gunshot injury to his calcaneum causing a comminuted cavitated fracture with contamination from his socks and shoe. He was successfully treated by a novel technique of intra-osseous arthroscopic removal of contamination debris, debridement and extensive arthroscopic washout. At a second stage, the fracture was bone grafted from his iliac crest with subsequent union of the fracture and reconstitution of the trabeculae, meaning he regained excellent hindfoot function. At 2 years follow-up there has been no sequelae from his injury and he remains pain and infection free.
      Citation: Trauma
      PubDate: 2022-03-23T09:53:17Z
      DOI: 10.1177/14604086211066376
       
  • Pediatric intracranial pressure surveillance and quantitative outcomes in
           kids: (PIPSQK) Study

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      Authors: Ryan Wan, Madison E Morgan, Lindsey L Perea
      Abstract: Trauma, Ahead of Print.
      ObjectivesIntracranial pressure (ICP) monitoring in pediatric traumatic brain injury (TBI) patients remains controversial. This study aimed to characterize the association between ICP monitoring and mortality for pediatric severe TBI, hypothesizing that ICP monitoring would not be associated with improved survival.MethodsPediatric patients (≤14 years) presenting to Pennsylvania trauma centers from 2003 to 2018 who met severe brain injury criteria (Glasgow Coma Score
      Citation: Trauma
      PubDate: 2022-03-22T07:33:19Z
      DOI: 10.1177/14604086211063101
       
  • Traumatic chorioretinitis sclopetaria with avulsed retinochoroidal tissue

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      Authors: Naresh Babu, Piyush Kohli, Karthikeyan Kasilingam, Kim Ramasamy
      Abstract: Trauma, Ahead of Print.

      Citation: Trauma
      PubDate: 2022-03-09T09:54:23Z
      DOI: 10.1177/14604086211056309
       
  • The characteristics, management and outcomes of high- and low-grade renal
           injuries in paediatric trauma patients at a major trauma centre

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      Authors: Ruth Bird, Thomas De Los Reyes, Suzanne Beno, Asad Siddiqui
      Abstract: Trauma, Ahead of Print.
      IntroductionChildren, given anatomical variations, are at increased risk of renal injury following trauma. The management of paediatric renal injuries has, similar to other solid organ injuries, largely shifted towards conservative management; however, hemodynamically unstable patients may still warrant surgical exploration or interventional techniques. The aim of this study is to describe the local incidence, demographics, morbidity and outcomes associated with high- and low-grade renal injury in a paediatric major trauma population.MethodThis was a 5-year retrospective review of trauma registry data and chart analysis of all paediatric renal injuries from major trauma at a North American level 1 paediatric trauma centre between January 2016–31 December 2020. Data was analysed using SPSS v27 with p < 0.05 considered significant.ResultsOf 1334 major trauma patients, 45 suffered a kidney injury (20 high-grade and 25 low-grade injuries), of which 93.3% underwent conservative management with no difference in outcomes between groups. 80% of patients had concurrent injuries (a quarter requiring surgery for these), with a trend towards higher rates of chest injuries in high-grade renal injury patients (p = 0.08). Bicycle injuries were statistically more likely to cause high-grade renal injury (p = 0.02). Angiography was utilized infrequently (3/45 patients, 6.6%), and no patients underwent embolization in our study population. Overall mortality (4.4%) and length of stay were unaffected by grade of injury.ConclusionPaediatric renal injury is an uncommon injury in major trauma patients (3.4%). Most cases can be managed conservatively regardless of the grade of injury. Renal injury patients are likely to have concurrent injuries, often requiring surgery. Further studies are needed to measure the success and utilization of interventional radiology techniques for management in children.
      Citation: Trauma
      PubDate: 2022-03-02T05:23:24Z
      DOI: 10.1177/14604086221076650
       
  • Comparison of modified rapid deployment hemostat dressing with standard
           haemostat as part of standardized perihepatic packing for major liver
           trauma in a level 1 trauma center

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      Authors: Roberta Iadarola, Salomone Di Saverio, Valentina Chiarini, Sherman Kwan, Alice Gori, Carlo Coniglio, Gregorio Tugnoli
      Abstract: Trauma, Ahead of Print.
      IntroductionUncontrolled hemorrhage is a major cause of mortality in surgery and trauma. Damage control surgery (DCS) is essential in the management of these cases. The use of topical hemostatic agents has increased over the last two decades with the evolution of DCS and trauma-induced coagulopathy. The aim of this study was to compare the performance of standard perihepatic packing with the addition of either a MRDH (modified rapid deployment hemostat) or a non-MRDH hemostatic dressing.MethodsThis was a retrospective, comparative analysis of prospectively collected data held in the registry of a level I trauma center in Bologna, Italy, between 2005 and 2019. 33 patients with grade IV/V liver injuries who underwent a standardized perihepatic packing with hemostatic dressings were enrolled in the study.The study group included 21 patients treated with standard packing plus MRDH. The control group included 12 patients treated with standard packing plus a combination of fibrillar absorbable hemostat and human fibrin sealant.ResultsThe two groups were homogeneous in terms of age and American Association for the Surgery of Trauma (AAST) grade although the MRDH one seemed to have more severe injury: hemodynamic instability was present in 95% of MRDH patients vs. 83% in the control group. Also, Injury Severity Score (ISS) and New Injury Severity Score (NISS) were 41 vs 35.5 and 47 vs 39.1, respectively.The incidence of re-bleeding requiring repacking at the second-look laparotomy was 4.7% in MRDH patients vs. 16.7% in non-MRDH patients (p = .5, OR = 4).The overall complication rate was of 23% after the introduction of MRDH vs. 81% in the control group.ConclusionDespite the potential effectiveness of MRDH, this study does not seem to confirm a significant superiority of this hemostat over the standard.
      Citation: Trauma
      PubDate: 2022-02-24T02:50:54Z
      DOI: 10.1177/14604086211056310
       
  • Cortical step sign in spinal clearance on trauma computed tomography –
           Indicator of acute thoracolumbar compression fracture

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      Authors: Ramanan Rajakulasingam, Peter Nightingale, Naman Bhatt, Surabhi Choudhary
      Abstract: Trauma, Ahead of Print.
      IntroductionDifferentiating an acute from chronic compression fracture of the thoracolumbar (TL) spine can pose a dilemma for radiologists interpreting spinal imaging following trauma. Mild wedging of the vertebrae can be due to spondylosis or osteoporosis, whilst acute simple compression fractures may not always be associated with loss of body height. In this observational study, we hypothesize that the presence of a vertebral body cortical step is a reliable sign of an acute compression fracture on Computed Tomography (CT) scans.MethodsIn a retrospective review of thoracolumbar CT scans following trauma, two observers analysed for the presence of a cortical step at the anterior or posterior vertebral body cortex, fracture morphology and associated injuries. A ‘cortical step’ is defined as a break of hyperdense cortex on CT scans, intervening non-sclerosed trabecular bone, and sharp overlap of the underlying cortex. MRI of the spine was used as gold standard.Results187 consecutive CT scans over 2 years were assessed. Sensitivity, specificity and accuracy of cortical step sign were 100%, 90.2% and 97% in diagnosing an acute thoracolumbar compression fracture, respectively. The interobserver reliability was high (kappa = 0.97). False positive cortical step was seen in Kummel’s disease and large Schmorl’s nodule.ConclusionOur results demonstrate high sensitivity and specificity of ‘cortical step sign’ in diagnosing acute vertebral body compression fractures of TL spine on CT scans in patients with trauma. This sign can be useful to radiologists for safe clearance of the thoracolumbar spine following trauma, helping distinguish acute trauma from chronic causes of vertebral body height loss.
      Citation: Trauma
      PubDate: 2022-02-21T11:26:42Z
      DOI: 10.1177/14604086211056616
       
  • Rectal avulsion associated with complex open pelvic fracture following
           rollover injury

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      Authors: Jian Ping Jen, Sarah Addison, Steve Amerasekera
      Abstract: Trauma, Ahead of Print.
      BackgroundWe present a rare case of complete rectal avulsion from the external anal sphincter complex associated with unstable pelvic ring disruption, including spinopelvic dissociation, following rollover by tractor.PurposeIn the context of major pelvic trauma, evaluating for unstable bony, acute vascular, urethral and bladder injuries is essential. However, a detailed search for anorectal injury is also required by the reporting radiologist.Research Design: Case Study.Study Sample:1.Data Collection and/or AnalysisRetrospective analysis of computed tomography (CT).ResultsIn this case report we highlight specific pelvic floor anatomy on CT, with a focus on gross morphology and the presence of peri-rectal free gas as primary evidence for injury. Secondary radiological evidence which should trigger the search for anorectal injury includes bony posterior pelvic ring disruption (sacrum or coccyx fractures) or associated Morel-Lavallée lesions.ConclusionThe presence of radiological abnormality should prompt direct clinical inspection for corroboration. Early recognition is crucial for joint colorectal and orthopaedic management and the avoidance of delayed pelvic sepsis, which may become intractable.
      Citation: Trauma
      PubDate: 2022-02-11T01:57:02Z
      DOI: 10.1177/14604086211068618
       
  • Early initiation of thromboembolic prophylaxis in critically ill trauma
           patients with high-grade blunt liver and splenic lacerations is not
           associated with increased rates of failure of non-operative management

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      Authors: Kerry Moore, Cassie A Barton, Yuxuan Wang, Ran Ran, Albert Chi, Susan Rowell, Martin Schreiber
      Abstract: Trauma, Ahead of Print.
      BackgroundNon-operative management (NOM) is the current standard of care of hemodynamically stable patients with traumatic blunt solid abdominal organ injuries. Guidelines do not define the optimal timing of initiation of venous thromboembolism (VTE) prophylaxis in this population, and fear of failure of NOM may lead to delayed initiation of prophylaxis specifically in patients with high-grade injuries.MethodsThis was a single-center, retrospective study of patients with high-grade (AAST grades ≥3) blunt liver and splenic lacerations presenting to our level 1 trauma center between January 2010 and October 2017. Patients were divided into groups based on timing of low-molecular weight heparin (LMWH) initiation for VTE prophylaxis. The primary outcome was rate of failure of NOM, defined as the need for interventional radiology or surgical intervention for management of abdominal organ bleeding. Secondary outcomes included rates of VTE, lengths of ICU and hospital stay, and in-hospital mortality.ResultsA total of 207 patients with high-grade blunt liver and splenic injuries undergoing an initial attempt at NOM were identified. The distribution of grades 3, 4, and 5 liver and splenic injuries were similar across all groups. Overall, 55.5% of patients received LMWH during their index admission. Early administration of LMWH was not associated with a statistically significant increased risk of failure of NOM (p = 0.054). Rates of VTE and in-hospital mortality were similar.ConclusionsEarly initiation of VTE prophylaxis was not associated with an increased rate of failure of NOM in patients with high-grade blunt abdominal organ injuries in patients who survived 24 h post-admission and did not require massive transfusion; however, the study was likely underpowered to detect a difference among groups due to small sample size.
      Citation: Trauma
      PubDate: 2022-02-01T12:58:29Z
      DOI: 10.1177/14604086211046099
       
  • Dex® carbohydrate drinks in trauma patients fasting preoperatively – A
           patient satisfaction study

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      Authors: Laura Marshall, Georgina Johnston, Katherine Martin, Mark Fitzgerald, Simon Hendel
      Abstract: Trauma, Ahead of Print.
      IntroductionDex® is an alkaline carbohydrate (CHO) drink used preoperatively in patients fasting for elective surgery. Its utilisation in patients awaiting emergency surgery is yet to be ascertained. We undertook a study assessing patient satisfaction relating to the introduction of Dex® in trauma patients in a Level 1 adult trauma centre.MethodsPatients fasting for surgery, and able to receive clear fluids in compliance with local guidelines, were eligible for inclusion. Patient satisfaction scores for predetermined variables were recorded via an interval observer scale prior to and following the introduction of Dex® to the trauma unit.ResultsPrior to the introduction of Dex® 14 satisfaction evaluations were completed. A further 13 evaluations were returned after Dex® was made available. Post-traumatic amnesia accounted for some patients being unable to complete the evaluation. Patients who completed the satisfaction evaluations after Dex® was introduced reported higher satisfaction in all but two variables (‘Headache’ and ‘Staff Annoyance’). ‘Hunger’ median scores were 7 (95% CI, 5–8) prior to the introduction of Dex® and 3 (95% CI, 2–6) after its’ introduction (p = .004). ‘Thirst’ median scores were 7.5 (95% CI, 6–10) and 4 (95% CI, 3–8) prior to and after Dex® introduction, respectively (p = .018).ConclusionNo adverse events or theatre timing related issues were associated with the use of Dex®. A larger randomised study of CHO drink supplementation in trauma patients fasting preoperatively is warranted to further evaluate these satisfaction endpoints as well as the other variables investigated in this study. Postoperative evaluation of these markers should also be considered.
      Citation: Trauma
      PubDate: 2022-02-01T05:13:41Z
      DOI: 10.1177/14604086221074196
       
  • Complication rates in operatively managed ankle fracture/dislocations: The
           effect of pre-reduction imaging and compliance with British orthopaedic
           association standards for trauma 12 guidance

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      Authors: Dominic O'Dowd, Alex Ward, Kar Phoon, Feargus Pitcher, Lucy Amos, Jennifer Butler, Paul Brewer, Mark Davies, Carolyn Chadwick, Howard Davies, Chris Blundell
      Abstract: Trauma, Ahead of Print.
      IntroductionThe British Orthopaedic Association Standards for Trauma (BOAST 12) guidelines for the management of ankle fractures aims to optimize recovery and reduce complications. Within the emergency department (ED), they advised urgent reduction of clinically deformed ankles, with radiographs prior only if this would not cause an unacceptable delay. The primary aim of this study was to assess the effect of time to acceptable reduction on the risk of complications and time to definitive reduction.MethodsThis was a retrospective observational study of patients presenting with ankle fracture dislocations between 2013 and 2017. Patients were divided into two groups with and without radiographs prior to reduction of their injury.ResultsA total of 242 patients were identified. The time taken from arrival to achieving an acceptable reduction was significantly longer in patients who received pre-reduction radiographs versus patients who did not (184.5 min vs 82, p < .00). The key finding of this follow-up study was that the overall risk of complications and soft tissue complications was not associated with an increased time to reduction (p = .62). Time to definitive operative management was similar between the two sub-groups (immediate reduction 1 day vs 2, p = .72).ConclusionThis study has shown that the use of pre-reduction radiographs in the management of ankle fracture dislocations significantly increases the time to reduction. However, this is not associated with an increased risk of complications or a longer time to definitive management. Further research is needed into the prognostic effect of prolonged ankle dislocation on soft tissues and long-term functional outcome.
      Citation: Trauma
      PubDate: 2022-01-31T12:43:37Z
      DOI: 10.1177/14604086211062486
       
  • Trauma clinic follow-up: Predictors of nonattendance and patient-reported
           reasons for no show

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      Authors: Hannes Prescher, Pranav Haravu, Amanda K Silva, Russell R Reid, Frederick Wang
      Abstract: Trauma, Ahead of Print.
      IntroductionThe objectives of this study were to identify factors associated with nonattendance to follow-up in patients seen for traumatic hand and facial injuries at an urban Level 1 trauma center and to elucidate patient-reported reasons for nonattendance.MethodsA retrospective chart review was performed for all patients seen for hand and facial trauma at our institution over a 2-year period. Demographic data, including race, insurance status, and incomes based on zip code data, were collected for all patients. Injury patterns, interventions, and patient disposition were analyzed. A binomial multivariate logistic regression was conducted to identify predictors of nonattendance to follow-up. All patients who were lost to follow-up over the last 12-month period were contacted via phone to identify reasons for nonattendance to determine whether they had followed up with another provider and to analyze long-term injury sequelae.ResultsAfter exclusion criteria were applied, there were 889 patients included in the analysis, with 31% of patients lost to follow-up. Factors significantly associated with follow-up nonattendance included patients who sustained injuries from gunshot wounds or assault, had no insurance or were out of network, and who received no acute intervention for their injuries. Forearm, wrist, and fingers fractures; facial fractures and lacerations; performing a procedure in the ED or operating room; and commercial insurance were all independent predictors of clinic attendance. The most common reasons for nonattendance cited by patients were “did not feel the need” (28%), lack of transportation (20%), and scheduling conflicts (19%).ConclusionsClinic follow-up for patients sustaining hand and facial trauma at a Level 1 trauma center is impacted by the socioeconomic factors that make this patient population particularly vulnerable to injury.
      Citation: Trauma
      PubDate: 2022-01-21T02:29:34Z
      DOI: 10.1177/14604086211052795
       
  • Hybrid extracorporeal membrane oxygenation (ECMO) cannulation following
           traumatic pneumonectomy: A case report

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      Authors: Jay I Conhaim, Nick C Levinsky, Paige L Barger, Heather L Palomino
      Abstract: Trauma, Ahead of Print.
      A 28-year-old man presented in extremis after a motorcycle crash. Following traumatic pneumonectomy, he developed right heart failure and was placed on veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) only to transition to veno-arteriovenous (VAV) ECMO due to persistent hypoxemia. Resulting flow limitation caused distal ischemia of his left leg, requiring thrombectomy and fasciotomy. Potential loss of limb necessitated transitioning to veno-venous (VV) ECMO from which he was successfully decannulated thereafter. ECMO can bridge recovery following the most dire injuries, and hybrid strategies can ameliorate post-operative complications; however, ECMO itself carries significant risks that must be weighed against intended benefit.
      Citation: Trauma
      PubDate: 2022-01-06T06:02:29Z
      DOI: 10.1177/14604086211055288
       
  • Aortic stenosis: An important cause of collapse to be considered in a
           polytrauma patient

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      Authors: Rajinder Singh, Bhajneek Grewal, Wajid Raza, Siddeshwar Patil
      First page: 262
      Abstract: Trauma, Ahead of Print.
      Undiagnosed and underlying medical co-morbidities are known to have a role in the causation of or contribution to injuries sustained in cases of polytrauma. Syncope provoked by valvular heart disease is one such example. Thorough clinical assessment is needed to ensure such diagnoses are detected and treated, whilst ensuring a patient’s ongoing rehabilitation needs are met. Here, the authors report a case of polytrauma, most likely secondary to severe aortic stenosis, causing syncope which was diagnosed at a later stage due to ongoing symptomatology. Delay in picking up such diagnoses can contribute to mortality in these patients or affect morbidity by having a detrimental impact on a patient’s functional recovery.
      Citation: Trauma
      PubDate: 2022-02-22T09:15:07Z
      DOI: 10.1177/14604086211046128
       
  • An exception to every rule; high velocity impact not always required for
           bilateral 1st rib fractures

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      Authors: Kudzayi H Kutywayo, Joyce Thekkudan, Nathan Tyson, Mohammed F Chowdhry
      First page: 267
      Abstract: Trauma, Ahead of Print.
      IntroductionFirst rib fractures are commonly reported in high velocity trauma. The neuromuscular sequelae that can ensue, not the physical disruption of the rib, necessitate thorough evaluation for such injuries.MethodsWe describe a case of a patient who sustained bilateral rib fractures following low-energy trauma.
      Citation: Trauma
      PubDate: 2022-01-10T03:41:14Z
      DOI: 10.1177/14604086211045363
       
 
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