Journal of Trauma & Treatment

Background: Trauma patients are at considerable risk for developing a Deep Vein Thrombosis [DVT] and subsequently experiencing a Pulmonary Embolism [PE], a process known as Venous Thromboembolism [VTE], which is a life-threatening complication that continues to be a major medical challenge.

Objective: To determine if a trauma patient who sustains a serious chest trauma as defined by the Abbreviated Injury Scale of 3 or more should be considered a high risk candidate for PE.

Method: This is a twelve-year retrospective study done at St. Mary’s Medical Center, a level II trauma center in West Palm Beach, FL, reviewing all trauma charts and autopsy reports of those patients who were diagnosed with PE, regardless of their mechanism of injury or initial diagnosis.

Results: A total of 18,451 patients were admitted to the trauma service during this time and 30 patients [0.16%] were diagnosed with a PE during their hospital stay or on autopsy. Among the 30 patients with a diagnosis of PE, 15 patients [50%] sustained chest trauma including diaphragmatic injuries, rib fractures, pneumothorax, and/or pulmonary contusion, and seven of those patients did not have a documented DVT. Among the 30 patients with PE, 18 [60%] did not have a detectable DVT.

Conclusion: This study supports the current literature that although DVTs are the most common cause of PE, severe chest trauma should be considered a significant contributing factor due to thrombi forming within the pulmonary vasculature.

The purpose of this study is to evaluate the causes, numbers, demographics and outcomes of all trauma and elective patients admitted under orthopaedic care but needed intensive care input during their inpatient stay. A retrospective case note study looking at all trauma patients admitted between January 2009 and August 2010 from a University Teaching Hospital that needed ITU admission during their inpatient stay. ITU records were cross matched with an orthopaedic trauma database to create a list of patients. 43 trauma patients were admitted to ITU from orthopaedic care during this 19 month period. These patients were then split into three categories 1) Trauma patients (one fracture) 2) Poly trauma patients (<2 fractures) 3) Transfers (Inter-hospital transfers). Within the “trauma” patients’ category, 25% of patients were admitted due to post-operative complications following hip hemi-arthroplasties, 17% due to wound debridement and soft tissue infection and 14% attributed to post-oprative complications following IMHS fixation. 30% of patients needed ITU input due to sepsis, 19% due to acute renal failure and 17% to respiratory failure.11 patients were categorised as “poly-trauma” patients. 55% of patients sustained a RTA whilst the rest were split between “fall from height” and “crush” injuries. 34% of these patients needed ventillatory support and inotropes. The mortality rate was highest and the length of stay in ITU was longer in the “trauma” cohort, 21% and 4 days respectively.Largest proportion of ITU admissions were due to post operative complications following hip surgery especially hemi-arthroplasties. However, a surprising group that emerged was the number of patients admitted to ITU who had metal work and soft tissue infections. This has highlighted the need for pre-operative optimisation and post-operative vigilance in patients with orthopaedic infections and hip fractures.

Introduction: It is known that in Pyloric Stenosis, Macrocephaly, and convictions for “Shaken Baby Syndrome”(SBS) the infant is twice as likely to be male as female. It has previously been hypothesised that the injuries assumed to prove SBS actually result from transient venous hypertension occurring during violent vomiting caused by pyloric stenosis. Macrocephaly also can be explained in terms of venous hypertension. By 1912 the pylorus had been recognized as a three part organ (antrum, canal, sphincter) independent of the stomach, but capable of cooperative action. Much of this has now been forgotten and the pylorus is considered to be merely the distal part of the stomach. Understanding of the early development and function of the pylorus is essential to understanding the development of stenosis and hence assymetrical gender distribution. Mechanics: At birth the human pylorus is proportionately longer and thinner than in the adult. In the first few months of life, before weaning, it has to grow thicker and more compact to be powerful enough to reduce food lumps to paste before passing food onwards into the duodenum. Testosterone stimulates contractile protein production, but not cell length, in the smooth muscle cells surrounding the pylorus. In males muscle will may grow too bulky for the current circumference and expand inwards, producing stenosis. Conclusion: The 2:1 male gender bias in pyloric stenosis, and hence conviction rate for SBS, arises naturally from this Transient

Objective: To study Matrix Metalloproteinase-3 (MMP-3) and Osteopontin (OPN) levels and correlations of MMP- 3 and OPN with Bone Metabolic Markers and Bone Mineral Density (BMD) in postmenopausal Chinese women.

Methods: MMP-3, OPN Osteoprotegrin (OPG), Osteoprotegrin Ligand (OPGL) of 120 postmenopausal Chinese female volunteers was measured using ELISA. BMD were measured using dual energy X-ray absorptiometry. According to the criteria of WHO, women were divided into 3 groups, such as normal, oteopenia and osteoporosis group.

Results: OPN concentrations were significantly higher in osteoporosis (56 ± 20) ng/ml than normal (26 ± 11) ng/ml (P<0.05). But MMP-3 concentrations were little higher in osteoporosis (153 ± 121) ng/ml than normal (125 ± 101) ng/ml. In osteoporosis, notable negative correlations between OPN, ratio of OPN/MMP-3 and BMD, sOPGL were found (P<0.05) as well as positive relations between OPN, ratio of OPN/MMP-3 and sOPG (P<0.05), and positive relation of MMP-3 and BMD of Ward’s triangle was existed (P<0.05), in osteopenia negative relations of MMP-3 and BMD as well as ratio of OPN/MMP-3 were detected (P<0.05).

Conclusion: There are significant correlations between serum OPN, ratios of OPN and MMP-3 and bone biomarkers of sOPG, sOPGL, OPN and OPN/MMP-3 may increase with high bone-metabolism. The increases of OPN and ratio of OPN/MMP-3 appear possibly as a concomitant event in high bone turnover state, such as postmenopausal osteoporosis.

Background: Given the decline of kidney function with advanced age, we evaluated the association between admission CT with IV contrast and acute kidney injury (AKI) in trauma patients older than 70 years.

Methods: A retrospective study was performed at an urban, academic Level I trauma center from January 1, 2006 to December 31, 2010. Trauma patients older than 70 years with available serum creatinine at admission and 48 to 72 hours post admission were included in the analysis. Patients who underwent an admission CT scan with IV contrast were compared to those who underwent admission CT without IV contrast. Mean creatinine levels and rate of AKI were compared. Stepwise logistic regression was performed to determine if IV contrast was an independent predictor of AKI.

Results: A total of 453 elderly patients met inclusion criteria with a mean age of 82.2 years and overall mortality of 13%. Patients who received IV contrast were younger (80.7 vs. 83.1 years, p<0.01), although had similar demographics and baseline characteristics. The rate of AKI in patients who received IV contrast was similar to the rate of those who did not (21.1% vs. 22.6%, p=0.73). Additionally, IV contrast with admission CT was not an independent predictor of developing AKI (AOR 1.2; CI 0.72-1.98; p=0.50).

Conclusion: Although a high ratio of elderly patients, approximately 1 in 5, was likely to develop AKI after trauma, this study demonstrates admission CT with IV contrast is not associated with AKI in trauma patients older than 70 years.