Журнал травм и лечения

Introduction: Femoral neck fractures are a common public health problem and femoral head osteonecrosis represents the ultimate complication of this disease.

Methods: We conducted a retrospective study of 102 Garden 1 femoral neck fractures managed by a conservative surgical treatment. We studied the occurrence of femoral head osteonecrosis and its risk factors.

Results: The mean age was 63 years. On radiographs, Pauwels type III fractures accounted for 50% of fractures and a posterior femoral head tilt more than 10° was found in 75% of cases. The average preoperative delay was 7.18 days, 43.75% of patients were operated between the 3rd and the 7th day. Full weight bearing delay was less than 3 months in 78.12% of cases. Osteonecrosis occurred in 31.4% of cases in an average delay of 11.37 months. Risk factors with a statistically significant correlation with the occurrence of osteonecrosis were a preoperative delay between the 3rd and 7th day (p=0.006), Pauwels type III fractures (p<0.001), a femoral head tilt >10° (p<0.001) and a full weight bearing delay <3 months (p=0.02).

Conclusions: Femoral head osteonecrosis is a serious complication in undisplaced femoral neck fractures. The understanding of its occurrence risk factors is the key in avoiding it.

Management of abdominal wall defects can occur after blast injury. Reconstruction requires a multidisciplinary approach management for speedy and satisfactory recovery. We present a case of blast injury which resulted in abdominal wall defect along with skin and soft tissue defect over penis. Abdominal wall was reconstructed by mesh application to strengthen the abdominal wall followed by a transposition flap to cover the mesh.

Anemia following traumatic brain injury (TBI) is frequently encountered. A number of studies have shown negative effects on outcome with hemoglobin levels below 9 g/dL but no consensus has been reached in regards to what level of hemoglobin warrants blood transfusion. Some neurosurgical texts recommend transfusion for hemoglobin <10 g/dL despite lack of clear guidelines. While transfusion should theoretically prevent secondary insults from hypoxia, it may also increase morbidity and mortality. We discuss the factors creating confusion in the literature and offer an outline of prospective trial to determine the impact of anemia and transfusion on patient with moderate-tosevere TBI.

Objective: The Pan-American Trauma Society (PTS) developed a Trauma and Emergency Ultrasound Course (USET) in response to the requirement for trauma ultrasound training for low-and middle-income countries. The objective of this study was to evaluate the efficiency of this course. Method: Pre- and post- course tests were used. And interval estimation of proportions was calculated at 95% CI. Theoretical and practical pre- and post-course knowledge were assessed with the Wilcoxon Signed Rank test at 0.05 level of statistical significance. Result: Between 2005 and 2007, 114 students, including general surgeons, emergency medicine physicians, anesthesiologists, critical care physicians, and residents of these specialties, were trained in seven countries (Uruguay, Peru, Mexico, Venezuela, Aruba, Colombia, and Ecuador). The difference on complete knowledge ranked scores before and after the course was statistically significant (p<0.001). After the course, almost all participants (97.4%) demonstrated complete knowledge in final evaluation. Conclusion: The USET course is an effective approach for trauma ultrasound training. Specific training programs for trauma care providers that work in low-and middle-income countries are necessary and could be performed with low cost training programs.

Unstable pelvic ring injuries require definite operative fixation. While the posterior ring can be fixed utilizing open approaches, percutaneous screw fixation has become the treatment of choice avoiding the complications of open approaches. As the pelvis is a complex three-dimensional (3D) shape with many neurovascular structures situated within it, a thorough knowledge and understanding of the anatomy and radiographic imaging is required to accomplish the task of percutaneous iliosacral screw placement, while avoiding potential complications. Recent advances in computer assisted surgery (CAS) has provided some powerful tools in overcoming the obstacles associated with this procedure. This review examines the evolution of image guided surgery used for iliosacral screw placement, the current available options, and future perspectives.

The latter generation of mankind is somehow evolved. The ordinary people under 50 years old are trying to live as professional sports guys. They all do various kinds of sports apart from their ordinary life. They all seek for a better body built and an active life. But most of them started active sports after 3rd decade. Improper physical background plus enthusiastic physical activity ends with various kinds of sports injuries. Our generation of orthopaedic surgeons starts to examine more and more sport related injuries in our daily practice. Acromioclavicular joint (ACJ) injuries are one of them. ACJ injuries rather frequent in athletes as well as the ordinary young, active people because of falls, sports injuries, and accidents. In this review, current treatment modalities for AC joint injuries in athletes and young active patients are given briefly. Those suggestions may also be beneficial for an ordinary person seeking for a faster recovery.

Objetive: The purpose of this systematic review was to examine the scientific evidence found to determinate the effectiveness of collagenase injection in the treatment of Dupuytren´s contracture. Materials and methods: It was done through a literature search in 3 databases: PubMed, Scopus and PEDro. It was located 102 studies but only 8 clinical trial were selected because they fulfilled the criteria of inclusion and exclusion. Every clinical trial was assessed with PEDro scale. Results: In the 8 studies had a significant improvement of contracture in the patients who had an injection collagenase. The improvement is similar to proximal interphalangeal joint to Metacarpophalangeal joints. Conclusions: Despite the lack of studies about the effectiveness of this new treatment method, based on the chosen for our study we can say that the technique of collagenase can be effective in reducing the contracture caused by Dupuytren's disease.