Journal of Trauma & Treatment

Bilateral complex traumatic cleft of the earlobes in a 54 year old lady. Aetiology was from wearing of heavy ear rings. Duration was for 10 years and had progressively worsened till the situation seen in the pre-operative photographs occurred.

Temporal bone fractures following blunt force trauma can result in significant morbidity including complete hearing loss. We present the case of a 15 year-old male who suffered traumatic bilateral transverse temporal bone fractures through both cochleae, resulting in profound bilateral hearing loss. Having met criteria for cochlear implantation, he was successfully managed with expedited, simultaneous bilateral cochlear implantation preceded immediately by evoked auditory brainstem response testing. The auditory brainstem response demonstrated weak wave V activity with high-level stimulation, and placement of the cochlear implants albeit it challenging secondary to early ossification of the cochlea, was successfully performed 5 weeks post-trauma. This case underscores the importance or early diagnosis and expedited implantation following otic capsule fractures to optimize chances for meaningful hearing rehabilitation prior to ossification of inner ear structures.

Introduction: Trauma is a very important social and economic problem. It has become a worldwide public health problem, due to its high rates of morbidity and mortality and it is frequently associated to functional impairment. The main purpose of this study is to analyze the epidemiological profile of patients treated in the orthopedic ward of the Metropolitano Hospital situated in Ananindeua.

Materials and Methods: Descriptive and analytical study. A standardized data collection form was used for epidemiological data abstraction from the medical record of all injured patients in the orthopedic ward of the Metropolitano Hospital from August to December of 2012.

Results: The majority of injured patients were male adults. Road traffic injuries, involving motorcycles were the most common mechanism of injury, representing 30.8% of the patients. As to the female gender, the most common mechanism of injury were falls, representing 69.8% of the patients. The lower limbs were the most common location of injuries which required surgery, representing 52.3% of all accidents. Age group affected by trauma injuries (adults) is productive economically, which shows that these trauma injuries are responsible for a large portion of employees on leave and temporary or permanent loss of productive capacity.

Conclusion: Male young adults were shown as the main trauma affected patients. On the other hand, the most common females affected were elderly women, representing 33.3% of the patients, which have falls as the main mechanism of injury. It is also important to point out the importance of the joint performance of health professionals and other public sectors to stimulate preventive campaigns.

Traumatic penile amputation is a rare clinical situation. We report a case of self-inflicted penile amputation in a patient with psychosis and discuss the surgical management. Acute management largely entails stabilization in preparation for surgery, where options include replantation of the amputated penis versus closure of the remaining stump, depending on the viability of the penis. Although replantation is the best option, it is often not possible and thus closure of the wound is acceptable

Spinal cord (SC) injury is a neurological emergency that results in complications increasing in number and severity according to the level of the injury. Systemic response after SC injury may alter hematological and biochemical parameters. The present study was designed to investigate the effect of the lesion depending on its level and severity in order to provide a prognosis during its acute (24 hours post injury) and subacute (15 days post injury) phases. We hypothesized that hematologic and biochemical parameters will depend directly on the site, severity and phase of the lesion. Rats were subjected to T1 (high) or T11 (low) severe or moderate SC injury. Rats that were anesthetized but did not receive surgical procedure were used as controls. Blood samples were obtained 24 hours and 15 days post injury for acute and subacute analysis respectively. Results show that in both acute and subacute phases, the level of injury is not related to hematological alterations, in contrast, severity interferes with the normal blood cell count, hematocrit and hemoglobin concentrations. Regarding biochemical values, neither level, nor severity of injury are related to changes. It is worth mentioning that on the subacute phase almost all of the altered variables, that appeared during the acute stage of injury, tend to return to their normal values. The variation on both hematological and biochemical parameters may also be caused by hemorrhage, liver damage and inflammatory responses due to secondary mechanisms inflicted by SC injury. These findings help to understand the pathophysiology observed after injury and provide data that contribute to improve the initial management and the design of future therapies after SC injury.

Andersson lesion is a destructive vertebral or discovertebral lesion that occurs as a late noninflamatory episode in ankylosing spondylitis. The lesion was first reported by in 1937. Since then many cases have been reported.

Trauma to the supraorbital ridge is common and long-term sequalae of injury to the supraorbital and supratrochlea nerves is under-appreciated. Blunt trauma from motor vehicle accidents, sports injury, cosmetic surgery, and craniofacial surgery all represent potential sources of injury to these nerves, which are at risk as they traverse a path from intra-orbital to subcutaneous through a bony notch/foramen at the supraorbital ridge. Pain related to these nerves causes migraine headaches, dysesthesias in the forehead, and disability related to medication for chronic pain. A series of 5 patients are presented who represent post-traumatic pain related to these two nerves. Treatment strategies are reviewed. A new operative approach is described in which the proximal end of the supraorbital and the supratrochlear nerves are left within the orbit. Long-term follow-up documents no complications with regard to extraocular muscles and range of motion of the orbit, and significant relief of pain.

Background: Implementing an electronic health record (EHR) system is an expensive and large-scale project. Few studies have examined the impact of inpatient EHRs on documentation, coding levels, and professional fee reimbursement. Trauma and Emergency Surgery services are ideal for studying this question given their high percentage of inpatient evaluation and management (E & M) work. This study elucidates effects of an EHR on coding practices for the inpatient Trauma and Emergency Surgery Service at an academic level I Trauma Center. We hypothesize that EHR implementation leads to higher coding levels and increased professional fee revenue.

Methods: De-identified data was extracted from the University Health System Consortium and Association of American Medical Colleges Faculty Practice Solution Center database. Our medical center transitioned from written physician notes to the EHR in May 2009. The database was queried for notes written by the Trauma and Emergency Surgery service in calendar years 2008 and 2011 to compare years before and after EHR implementation. The CPT codes of interest were for E & M Initial Hospital Care (99221, -2, and -3) and Subsequent Hospital Care (99231, -2, and -3). Coding levels were linked to standard Medicare Relative Value Units. Professional coders were used throughout and coding guidelines were unchanged over the study period. Results: Coding levels for Initial Hospital Care notes increased immediately and markedly. Revenue from these codes increased by 28.1% while Subsequent Hospital Care codes increased less dramatically by 1.7%.

Conclusions: The increase in higher E & M coding levels due to HER implementation was financially significant, immediate, and durable. The increase in total Initial Hospital Care notes resulted from improved coder note recognition and higher note quality. Revenue increased measurably.

Although the inferomedial and inferior midline approaches are commonly used for intra-articular injection or aspiration of the knee joint, they may not be ideal for optimal needle placement. With these approaches, the fat pad may be contacted, which may lead to the injection of medication in the incorrect region, cause severe pain during the injection procedure, or present a false sign of low yield of fluid aspiration. Therefore, the objective of this study was to compare various approaches for knee injection and aspiration to identify the optimal one for needle placement. In this retrospective study, the ultrasound images of bilateral knee joints in 33 consecutive patients with knee pain were studied. This patient population was divided into two groups: Group A with knee effusions (n=10) and Group B without knee effusions (n=23). The results showed that among 90% of patients in Group A and 100% of patients in Group B, the superolateral view allowed visualization of the greatest amount of intra-articular knee fluid and the least amount of fat pad. In conclusion, the ultrasound-guided superolateral approach appears to be an optimal approach for knee intra-articular injection or aspiration compared to the conventional inferomedial and inferior midline approaches.