Journal of Trauma & Treatment

Background: This study examines the clinical assessment and management of patients sustaining blunt abdominal trauma (BAT) with unexplained intra-abdominal free fluid. Methods: All adult patients (age 18 years) presenting with BAT to our trauma center over a 7-year period were reviewed. Those with abdominal computed tomography (CT) demonstrating intra-peritoneal free fluid but neither solid organ injury nor pneumoperitoneum were studied further. Demographic data, radiologic interpretation, operative findings, clinical management and outcome were analyzed. Results: 115 patients met the inclusion criteria. Except 9 patients for non-operative management, 91 patients (86%) underwent therapeutic laparotomy, in whom 83 patients (78%) benefited from surgical intervention and 15 patients (14%) underwent non-therapeutic laparotomy, in whom 8 patients (8/15=53%) had retroperitoneal hematoma with associated pelvic fractures. Mesenteric tear, urinary bladder rupture, and bowel injury constituted 81% (93/115) of the studied patients. Both bowel injury and mesenteric tear had a significantly higher rate of bowel wall thickening, mesenteric hematoma and streaky sign on CT scan. Urinary bladder rupture was associated with a significantly longer hospital stay, higher injury severity score (ISS), a higher rate of associated pelvic fracture (47%) and gross hematuria (97%). Conclusions: Laparotomy might be suggested for BAT patients with free fluid collection without solid organ injury and pneumoperitoneum on CT scan because most of these patients benefited from the surgical intervention (78%), especially when there are combined with clinical presentation of gross hematuria or CT images of bowel wall thickening or mesenteric lesion.

Hemothorax is defined as a bleeding into pleural cavity. Hemothorax is a frequent manifestation of blunt chest trauma. Some authors suggested a hematocrit value more than 50% for differentiation of a hemothorax from a sanguineous pleural effusion. Hemothorax is also often associated with penetrating chest injury or chest wall blunt trauma with skeletal injury. Much less common, it may be related to pleural diseases, induced iatrogenic or develop spontaneously. In the vast majority of blunt and penetrating trauma cases, hemothoraces can be managed by relatively simple means in the course of care.

Introduction: Boerhaave syndrome (BS) is a spontaneous perforation of the esophagus which depends on increased intra-esophageal pressure, while the upper sphincter is closed during excessive vomiting. Case: A 75-year-old man was referred to hospital with sudden chest pain after vomiting. A computed chest tomography demonstrated mediastinal emphysema, thickening of the wall at the esophago-gastric junction level, and left pleural effusion. An upper gastrointestinal endoscopy showed an esophageal stenosis at mid thoracic portion and a perforation detected just 1 cm above of the lower gastro-esophageal sphincter. The patient underwent left posterolateral thoracotomy in the 12th hour of event. Stenotic segment is dilated and the mucosal perforation was repaired. Conclusion: BS is a serious disease with high morbidity and mortality rates. While BS usually occurs in a normal esophagus; in our case, BS was due to esophageal benign stenosis instead of upper sphincter esophageal sphincter closure. Benign stenosis may facilitate perforation as seen in our patient due to increased intraluminal pressure following vomiting.

Background: A three-decade long conflict between the government military and Tamil rebels in Sri Lanka ended in 2009 with the defeat of the rebels. The civilians were the most affected in the war with reports of scant respect for human rights on both sides of the warring factions. Objective: To conduct a cross-sectional study to assess the prevalence of psychiatric morbidity among married females in two villages in Northern Sri Lanka that was affected significantly in the last phase of the war. Method: All married females in two resettled villages in the Mannar District were interviewed by trained data collectors using the translated K-10 and PSSR-17 questionnaires to estimate the prevalence of post-traumatic stress disorder (PTSD) and depressive disorder. All families in these villages were from internally displaced camps where they had been living for more than a year after having been displaced from their homes and having experienced direct war trauma for weeks. Data was collected from 135 married females between March to May 2011 with ethical approval for the study. Result: Criteria for diagnosis of severe PTSD were met in 57% of all participants and all participants had at least mild symptoms of PTSD. The screening tool for depression showed 63% to have significant depressive symptoms. Both depressive and severe PTSD features were present in 24%. Nearly 73% of participants were having either depression or severe PTSD. Conclusion: Psychiatric morbidity was high in the post-conflict period, in a highly vulnerable population of married females.

Traumatic brain injury (TBI) is a significant source of morbidity and mortality in the adult population. The management of traumatic brain injury depends on its severity. It must be recognized that almost all forms of treatment for TBI are geared towards the minimization of secondary injury, as it is assumed that primary injury is irreversible. The discussion here represents much of what is known up-to-date concerning TBI management, but its treatment continues to evolve once new mechanisms of injury are discovered and those that we know of now are refined. The treating staffs are encouraged to keep up with the current state of the literature to stay informed.

Introduction: Open fracture is a loss of bone continuity that puts the bone in contact with the external environment through the wound. Open tibia shaft fractures are one of the most devastating orthopedic injuries. The aim of this current study is to analyze the results of the management of these series of recent open fractures of the leg. Patients and methods: This was a retrospective study over a period of 18 months involving 27 cases of open fractures of the leg treated with intramedullary unreamed nailing. Type I and II of Gustillo Anderson open fractures were included in this study, and were treated at the hospital during the period of the study by this nailing technique. The cases included 20 males (74.8%) and 7 females (20.2%), and the average age was 31 years (17-60 years). Results: The average duration of hospitalization was 16 days (12-30 days). On leaving the hospital, patients received the combination oxacillin-Lincocine oral antibiotics. The average time for bone consolidation was 115 days (90-140 days). Some complications were reported: 2 cases of secondary drifting of suture occurred postoperatively among 2 type II fractures. Local care and a secondary suture using U points led to wound healing without removal of the nail. A case of late infection occurred without impact on consolidation. Conclusion: Treatment of open fracture of the leg remains controversial. But increasingly, the idea of an early internal fixation by intramedullary unreamed nailing is gaining ground.

Traumatic brain injury (TBI) leads to a broad spectrum of neurological deficits, including cognitive impairments that are irreversible and significantly influence quality of life even after recovery from physical disabilities. Clinically, there is no standardized procedure for treating secondary TBI, as each case is symptomatic. Src family kinase (SFK) inhibitors, a relatively new treatment regarding TBI, have so far been neuroprotective against secondary damage in non-human models. Immediately after TBI, there is increased expression of NR2A and NR2B. SFKs regulate NR2 subunits of NMDARs through tyrosine phosphorylation. Synthetic inhibitors of SFKs may help reduce the cognitive dysfunction seen after TBI by binding to SFKs and inhibiting the tyrosine phosphorylation of NMDARs, thereby preventing excitotoxicity within neurons that leads to cell death.

Introduction: Osteosynthesis has well defined principles. When the surgeon does not follow these principles, implant failure is likely to happen. The purpose of this study was to study this issue in our service and to search for underlining factors. Methodology: It was a descriptive study done from September 2009 to September 2012, in the orthopaedics and traumatology service of the Laquintinie hospital of Douala in Cameroon. Were enrolled, all patients operated or referred in the service and presenting an implant failure (folding, breakage, migration, disassembly bone fixation loosening). Results: We had 58 cases (after 330 Osteosynthesis that is 17.58%), 45 men and 13 women. Sex ratio: 3.46. Mean age 25 years. The initial condition was: a close fracture in 29 (50%) of cases, an open fracture in 21 (36.21)%, a pseudarthrosis in 4 (6.90%), an osteomyelitis in 3 (5.17%), and a limb deformation in 1 (1.72%). Plating was the most involved procedure: 36 (62.07%) of failed implants were stainless steel plates; and 21(56.33%) of these were broken. In 13 (22.41%) of cases, there was a fall preceding implant failure. In 8 cases (14%), the physiotherapy was inappropriately done by a traditional healer. Conclusion: Implant failure is a real problem in our environment. Factors include- surgeon failure, implant failure and patient related failure. Good indications, surgical technique and appropriate physiotherapy can reduce implant failure in our milieu. We did not carry out mechanical studies on failed implants.

Trauma is the leading cause of mortality among Americans 1-44 years old and is responsible for 193,000 deaths annually. One third of these patients die from exsanguination. Current practice guidelines emphasizing nonoperative management (NOM) of most hemodynamically stable blunt trauma patients and advances in endovascular equipment and techniques have led to an established role for adjunctive endovascular therapy in the arrest of traumatic hemorrhage.

The Shaken Baby Hypothesis assumes the brain can slide in the skull, but trabeculae (thin strips of collagen reinforced tissue that link across the subarachnoid space) appear to prevent this. They are so thin that they are undetectable by ultrasound or MRI imaging systems. Pediatricians in the 1970s were unaware of their existence. The Shaken Baby Syndrome hypothesis ignores them. The purpose of this study was to investigate whether omitting the trabecular structures from the SBS hypothesis would have made any difference to the legal validity of cases based on it. When the Shaken Baby Syndrome concept was created in the 1970s it was believed that there was a layer of fluid between the Dura and Arachnoid Maters (a “Subdural Space”) which allowed the brain cortex to slide. Electron microscopy has since shown that the Subdural Space does not exist. Electron microscopy has shown a “Cob-Web” of tissue (Trabeculae) linking the Arachnoid and Pia Maters. There is no subarachnoid space in the “Shaken Baby” model so no subarachnoid trabeculae are considered. Collagen fibres within these subarachnoid trabeculae are continuous with bundles of collagen in the inner aspect of the arachnoid and with collagen bundles in the subpial space, effectively “stitching” the pia and arachnoid membranes together. By implanting radio-opaque markers in cadaver heads and using high speed X-ray recorders vehicle accident researchers established that fresh brain is softly elastic. Under impact various regions move over different loci at different speeds. This trabecular stitching causes the cerebral cortex surface to follow skull movement closely. The cortex cannot slide, it reversibly deforms to take up movements. Therefore the bridging veins cannot be strained as was assumed in the 1970s and the Shaken Baby Syndrome hypothesis is invalid.