This is an RSS newsfeed from BioMed Central It is intended to be used with an RSS reader. For more information about RSS newsfeeds from BioMed Central, visit http://www.biomedcentral.com/info/about/rss/ http://www.traumamanagement.org The latest articles from Journal of Trauma Management & Outcomes (ISSN 1752-2897) published by BioMed Central Background: Airway clearance is frequently needed by patients suffering from blunt chest wall trauma. High Frequency Chest Wall Oscillation (HFCWO) has been shown to be effective in helping to clear secretions from the lungs of patients with cystic fibrosis, bronchiectasis, asthma, primary ciliary dyskinesia, emphysema, COPD, and many others. Chest wall trauma patients are at increased risk for development of pulmonary complications related to airway clearance. These patients frequently have chest tubes, drains, catheters, etc. which could become dislodged during HFCWO. This prospective observational study was conducted to determine if HFCWO treatment, as provided by The VestTM Airway Clearance System (Hill-Rom, Saint Paul, MN), was safe and well tolerated by these patients. Methods: Twenty-five blunt thoracic trauma patients were entered into the study. These patients were consented. Each patient was prescribed 2, 15 minute HFCWO treatments per day using The Vest(R) Airway Clearance System (Hill-Rom, Inc., St Paul, MN). The Vest(R) system was set to a frequency of 10-12 Hz and a pressure of 2-3 (arbitrary unit). Physiological parameters were measured before, during, and after treatment. Patients were free to refuse or terminate a treatment early for any reason. Results: No chest tubes, lines, drains or catheters were dislodged as a result of treatment. One patient with flail chest had a chest tube placed after one treatment due to increasing serous effusion. No treatments were missed and continued without further incident. Post treatment survey showed 76% experienced mild or no pain and more productive cough. Thirty days after discharge there were no deaths or hospital re-admissions. Conclusions: This study suggests that HFCWO treatment is safe for trauma patients with lung and chest wall injuries. These findings support further work to demonstrate the airway clearance benefits of HFCWO treatment. http://www.traumamanagement.org/content/2/1/8 Casandra A Anderson, Cassandra A Palmer, Arthur L Ney, Brian Becker, Steven D Schaffel and Robert R Quickel Journal of Trauma Management & Outcomes 2008, 2:8 2008-10-06 doi:10.1186/1752-2897-2-8 Journal of Trauma Management & Outcomes 1752-2897 2 8 2008-10-06 Background: 55 BHU bicentric bipolar hemiarthroplasties were reviewed after a mean follow up of 4 years (range 1-5 years). Patients with displaced subcapital fractures were selected for operation on the basis of good mobility before the fracture. Object of the study was to see the efficacy of BHU bipolar prostheses and functional outcome. Results: There were no incidences of dislocation. Modified Harris hip scoring system scoring system was used which included sitting crosslegged and squatting in view of the sociocultural needs of the patients of Indian subcontinent. Modified Harris hip scoring system 89% had a good or excellent result and 94% had no or only occasional pain. Majority of the patients returned to their prefracture activity. Conclusion: Thus at follow up of 4 year the BHU bicentric bipolar prosthesis has been shown to be a good option for intracapsular fractures of neck femur with encouraging results. http://www.traumamanagement.org/content/2/1/7 Anil K Rai, Rakesh Agarwal, Saurabh Singh and Ratnav Ratan Journal of Trauma Management & Outcomes 2008, 2:7 2008-09-25 doi:10.1186/1752-2897-2-7 Journal of Trauma Management & Outcomes 1752-2897 2 7 2008-09-25 Background: Infected non-union of long bones is a problem in the developing countries. Persistent infection, deformity, shortening, bone loss, joint stiffness and disability complicate the non-union. Secondary procedures are often required for correction of bone defects and deformity. Ilizarov method addresses all the above problems simultaneously and offers a panacea for infected non-unions. The stability of the fixation and provision for bone transport allows bridging of bone defects, limb lengthening, early weight bearing ambulation and joint mobilisation.Aim of the studyTo know the suitability of this procedure in recalcitrant infected tibial non-unions in the Indian population and the influence of socio-economic factors in the functional outcome.Method of studyThis was a 3-year prospective study in 22 consecutive patients with an average follow up of 13 months following fracture union. The results were analysed using the ASAMI scoring system. Results: Of 22 patients in the study, 13 patients who underwent external bone transport, had an average bone gap of 4 cms [2–11 cms] with an average duration of fixation of 9.3 months [6.5–13 months]. There were 4 excellent, 3 good, 4 fair and 2 poor bony results and 1 excellent, 3 good, 6 fair and 2 poor results. 1 patient was lost for follow up at final functional analysis. 9 patients who underwent internal bone transport had an average bone gap of 5.4 cms [1.5–9 cms] with an average duration of fixation of 8.5 months [4–11 months]. There were 3 good 4 fair and 2 poor bony results and 1 good, 3 fair, and 2 poor functional results. Good to excellent results were witnessed in well-motivated patients with adequate social and financial support. Patients with fair to poor results preferred amputation to limb salvage despite the fact that they retained their limbs. Conclusion: Treatment of infected non-unions of Tibia with Ilizarov ring fixation is effective but for optimal results the treatment needs to be individualised by the treating surgeon with due consideration of the socio-economic factors. http://www.traumamanagement.org/content/2/1/6 Thayur R Madhusudhan, Balasundaram Ramesh, KS Manjunath, Harshad M Shah, Dabir C Sundaresh and N Krishnappa Journal of Trauma Management & Outcomes 2008, 2:6 2008-07-23 doi:10.1186/1752-2897-2-6 Journal of Trauma Management & Outcomes 1752-2897 2 6 2008-07-23 This study was conducted on patients of head injury admitted through Accident & Emergency Department of Sher-i-Kashmir Institute of Medical Sciences during the year 2004 to determine the number of head injury patients, nature of head injuries, condition at presentation, treatment given in hospital and the outcome of intervention. Traumatic brain injury (TBI) deaths were also studied retrospectively for a period of eight years (1996 to 2003).The traumatic brain injury deaths showed a steady increase in number from year 1996 to 2003 except for 1999 that showed decline in TBI deaths. TBI deaths were highest in age group of 21–30 years (18.8%), followed by 11–20 years age group (17.8%) and 31–40 years (14.3%). The TBI death was more common in males. Maximum number of traumatic brain injury deaths was from rural areas as compared to urban areas.To minimize the morbidity and mortality resulting from head injury there is a need for better maintenance of roads, improvement of road visibility and lighting, proper mechanical maintenance of automobile and other vehicles, rigid enforcement of traffic rules, compulsory wearing of crash helmets by motor cyclist and scooterists and shoulder belt in cars and imparting compulsory road safety education to school children from primary education level. Moreover, appropriate medical care facilities (including trauma centres) need to be established at district level, sub-divisional and block levels to provide prompt and quality care to head injury patients http://www.traumamanagement.org/content/2/1/5 GH Yattoo and Amin Tabish Journal of Trauma Management & Outcomes 2008, 2:5 2008-06-21 doi:10.1186/1752-2897-2-5 Journal of Trauma Management & Outcomes 1752-2897 2 5 2008-06-21 Background: Many surgeons tend to believe that MRI is an accurate, non invasive diagnostic method, enough to lead to decisions for conservative treatment and save a patient from unnecessary arthroscopy. We conducted a retrospective study to investigate the accuracy of the MRI of the knee for the detection of injuries of the meniscus, cruciate ligaments and articular cartilage, in comparison with the preoperative clinical examination and intraoperative findings. Between May 2005 and February 2006 102 patients after clinical examination were diagnosed with meniscal or cruciate injury and underwent definitive treatment with arthroscopy. 46 of these patients fulfilled the inclusion criteria. The accuracy, sensitivity, specificity, negative and positive predictive values of the MRI findings were correlated with the lesions identified during arthroscopy. The diagnostic performance of the initial clinical examination was also calculated for the meniscal and cruciate ligament injuries. Results: The accuracy for tears of the medial, lateral meniscus, anterior and posterior cruciate ligaments and articular cartilage was 81%, 77%, 86%, 98% and 60% respectively. The specificity was 69%, 88%, 89%, 98% and 73% respectively. The positive predictive value was 83%, 81%, 90%, 75% and 53% respectively. Finally, the clinical examination had significant lower reliability in the detection of these injuries. Conclusion: MRI is very helpful in diagnosing meniscal and cruciate ligament injuries. But in a countable percentage reports with false results and in chondral defects its importance is still vague. The arthroscopy still remains the gold standard for definitive diagnosis. http://www.traumamanagement.org/content/2/1/4 Vassilios S Nikolaou, Efstathios Chronopoulos, Christianna Savvidou, Spyros Plessas, Peter Giannoudis, Nicolas Efstathopoulos and Georgios Papachristou Journal of Trauma Management & Outcomes 2008, 2:4 2008-06-02 doi:10.1186/1752-2897-2-4 Journal of Trauma Management & Outcomes 1752-2897 2 4 2008-06-02 Background: Large-scale traumatic events may burden any affected public health system with consequential charges. One major post-disaster, expense factor emerges form early psychological interventions and subsequent, posttraumatic mental health care. Due to the constant increase in mental health care costs, also post-disaster public mental health requires best possible, cost-effective care systems. Screening and monitoring the affected population might be one such area to optimize the charges. Methods: This paper analyzes the potential cost-effectiveness of monitoring a psychologically traumatized population and to motivate individuals at risk to seek early treatment. As basis for our model served Grossman's health production function, which was modified according to fundamental concepts of cost-benefit analyzes, to match the basic conditions of online monitoring strategies. We then introduce some fundamental concepts of cost-benefit analysis. Results: When performing cost-benefit analyses, policy makers have to consider both direct costs (caused by treatment) and indirect costs (due to non-productivity). Considering both costs sources we find that the use of Internet-based psychometric screening instruments may reduce the duration of future treatment, psychological burden and treatment costs. Conclusion: The identification of individuals at risk for PTSD following a disaster may help organizations prevent both the human and the economic costs of this disease. Consequently future research on mental health issues should put more emphasis on the importance of monitoring to detect early PTSD and focus the most effective resources within early treatment and morbidity prevention. http://www.traumamanagement.org/content/2/1/3 Francesco de Gara, William T Gallo, Jonathan I Bisson, Jerome Endrass and Stefan Vetter Journal of Trauma Management & Outcomes 2008, 2:3 2008-04-15 doi:10.1186/1752-2897-2-3 Journal of Trauma Management & Outcomes 1752-2897 2 3 2008-04-15 Background: Management of orthopaedic injuries in polytrauma cases continues to challenge the orthopaedic traumatologist. Mass disasters compound this challenge further due to delayed referral. Recently there has been increasing evidence showing that damage control surgery has advantages that are absent in the early total care modality. We studied the damage control modality in the management of polytrauma cases with orthopaedic injuries who had been referred to our hospital after more than 24 hours of sustaining their injuries in an earthquake. This study was conducted on 51 cases after reviewing their records and complete management one year after the trauma. Results: At one year, out of the 62 fractures, 3 were still under treatment, while the others had united. As per the radiological and functional scoring there were 20 excellent, 29 good, 5 fair and 5 poor results. In spite of the delayed referral there was no mortality. Conclusion: In situations of delayed referral in areas where composite trauma centers do not exist the damage control modality provides an acceptable method of treatment in the management of polytrauma cases. http://www.traumamanagement.org/content/2/1/2 Shabir Ahmed Dhar, Masood Iqbal Bhat, Ajaz Mustafa, Mohammed Ramzan Mir, Mohammed Farooq Butt, Manzoor Ahmed Halwai, Amin Tabish, Murtaza Asif Ali and Arshiya Hamid Journal of Trauma Management & Outcomes 2008, 2:2 2008-01-29 doi:10.1186/1752-2897-2-2 Journal of Trauma Management & Outcomes 1752-2897 2 2 2008-01-29 Background: The Iraq war has vividly brought the problem of traumatic brain injury to the foreground. The costs of death and morbidity in lost wages, lost taxes, and rehabilitative costs, let alone the emotional costs, are enormous. Military personnel with traumatic brain injury and acute respiratory distress syndrome may represent a substantial problem. Each of these entities, in and of itself, may cause a massive inflammatory response. Both presenting in one patient can precipitate an overwhelming physiological scenario. Inhaled nitric oxide has recently been demonstrated to have anti-inflammatory effects beyond the pulmonary system, in addition to its ability to improve arterial oxygenation. Furthermore, it is virtually without side effects, and can easily be applied to combat casualties or to civilian casualties.Presentation of hypothesisUse of inhaled nitric oxide in patients with severe traumatic brain injury and acute respiratory distress syndrome will show a benefit through improved physiological parameters, a decrease in biochemical markers of inflammation and brain injury, thus leading to better outcomes.Testing of hypothesisA prospective, randomized, non-blinded clinical trial may be performed in which patients meeting the case definition could be entered into the study. The hypothesis may be confirmed by: (1) demonstrating an improvement in physiologic parameters, intracranial pressure, and brain oxygenation with inhaled nitric oxide use in severely head injured patients, and (2) demonstrating a decrease in biochemical serum markers in such patients; specifically, glial fibrillary acidic protein, inflammatory cytokines, and biomarkers of the hypothalamic-pituitary-adrenal axis, and (3) documentation of outcomes.Implications of hypothesisInhaled nitric oxide therapy in traumatic brain injury patients with acute respiratory distress syndrome could result in increased numbers of lives saved, decreased patient morbidity, decreased hospital costs, decreased insurance carrier and government rehabilitation costs, increased tax revenue secondary to occupational rehabilitation, and families could still have their loved ones among them. http://www.traumamanagement.org/content/2/1/1 Thomas J Papadimos Journal of Trauma Management & Outcomes 2008, 2:1 2008-01-14 doi:10.1186/1752-2897-2-1 Journal of Trauma Management & Outcomes 1752-2897 2 1 2008-01-14 Background: Unstable proximal femoral fractures and pathological lesions involving the trochanteric region in the elderly comprise an increasing workload for the trauma surgeon as the ageing population increases. This study aims to evaluate use of the Russell-Taylor reconstruction nail (RTRN) in this group with regard to mortality risk, complication rates and final outcome. Methods: Retrospective evaluation of 42 patients aged over 60 years who were treated by reconstruction nailing for proximal femoral fractures over a 4 year period. Results: Over two-thirds of patients were high anaesthetic risk (ASA > 3) with ischemic heart disease the most common co-morbidity. 4 patients died within 30 days of surgery and 4 patients required further surgery for implant related failure. Majority of patients failed to regain their pre-injury mobility status and fewer than half the patients returned to their original domestic residence. Conclusion: Favourable fixation of unstable complex femoral fractures in the elderly population can be achieved with the Russell-Taylor reconstruction nail. However, use of this device in this frail population was associated with a high implant complication and mortality rate that undoubtedly reflected the severity of the injury sustained, co-morbidity within the group and the stress of a major surgical procedure. http://www.traumamanagement.org/content/1/1/7 Ulfin Rethnam, James Cordell-Smith, Thirumoolanathan M Kumar and Amit Sinha Journal of Trauma Management & Outcomes 2007, 1:7 2007-12-10 doi:10.1186/1752-2897-1-7 Journal of Trauma Management & Outcomes 1752-2897 1 7 2007-12-10 Background: Specialisation in spinal services has lead to a low threshold for referral of cervical spine injuries from district general hospitals. We aim to assess the capability of a district general hospital in providing the halo vest device and the expertise available in applying the device for unstable cervical spine injuries prior to transfer to a referral centre. Methods: The study was a postal questionnaire survey of trauma consultants at district general hospitals without on-site spinal units in the United Kingdom. Seventy institutions were selected randomly from an electronic NHS directory. We posed seven questions on the local availability, expertise and training with halo vest application, and transferral policies in patients with spinal trauma. Results: The response rate was 51/70 (73%). Nineteen of the hospitals (37%) did not stock the halo vest device. Also, one third of the participants (18/51, 35%, 95% confidence interval 22 – 50%) were not confident in application of the halo vest device and resorted to transfer of patients to referral centres without halo immobilization. Conclusion: The lack of equipment and expertise to apply the halo vest device for unstable cervical spine injuries is highlighted in this study. Training of all trauma surgeons in the application of the halo device would overcome this deficiency. http://www.traumamanagement.org/content/1/1/6 Ulfin Rethnam, James Cordell-Smith and Amit Sinha Journal of Trauma Management & Outcomes 2007, 1:6 2007-11-30 doi:10.1186/1752-2897-1-6 Journal of Trauma Management & Outcomes 1752-2897 1 6 2007-11-30