Журнал травм и лечения

The impact of trauma work upon practitioners is well documented. Experiences of vicarious trauma, compassion fatigue are explored throughout the trauma literature. However, less understood are the emotional benefits of such work and the restorative nature of working in trauma settings.

Background: Tibia stress fractures are microscopic fractures of the tibia that are often the result of repetitive microtrauma as commonly seen in military recruits and intense athletics. Tibia stress fractures are more commonly unilateral and are usually in the diaphyseal portion of the tibia. We describe a case of bilateral medial proximal tibia occult fractures along the epiphyseal scar following blunt trauma.

Case description: A 41-year-old bipolar male presented to the clinic one-week following a pedestrian versus motor vehicle accident. He subsequently developed low back pain and bilateral knee pain. The diagnosis of bilateral proximal tibia fractures was made using repeat plain X-ray films two-weeks after initial presentation. Operative treatment with bilateral medial tibia internal fixation was elected and the patient was discharged full weight-bearing.

Literature review: There have been two case reports which explored the treatment options for bilateral proximal tibia fractures. Neither case elected to treat with internal fixation.

Clinical relevance: Because the incidence of bilateral tibia stress fractures is low and operative treatment with bilateral internal fixation has not been reported, our case examines the viability of operatively treating bilateral tibia stress fractures with internal fixation. Our case demonstrates the successful treatment of bilateral medial proximal tibia occult fractures with internal fixation.

Background: The useful surgical hemostasis agent using in patients with grade 4 of the liver laceration is a challenging problem. This study assessed a topical hemostatic agent (Surgicel) using a partial hepatic laceration hemorrhage model. This experimental study compared the hemostatic effects of Surgicel and conventional gauze packing in hepatic parenchymal bleedings.

Methods: Twenty male Wistar albino rats (weight 250 ± 50 g) were randomly divided into two groups. Within each treatment group, surgicel or gauze packing (GP) (n=10/group) was applied to the liver laceration site that was created in the large lobe of the liver.

Results: There was statistically significant difference between two groups regarding the changes of before and after operation of HCO3 (P=0.019). Across two groups, rats receiving surgicel lost less blood and formed clots more frequently than GP (p<0.001).

Conclusion: Surgicel may be useful to treat hemorrhage from Liver lacerations in trauma patients.

Medical simulations often lack the fidelity necessary to train higher-level procedures such as surgery. To work around these gaps, organizations with a training mission like the Department of Defense (DoD) often resort to biologic tissues from cadavers and animals.

Ehlers-Danlos Syndrome (EDS) type IV is a connective tissue disorder with autosomal dominant inheritance. It can be potentially life-threatening due to increased risk of arterial rupture. The diagnosis is based on clinical findings including thin, translucent skin; bleeding propensity, rupture of vessels, and viscera. Isolated peripheral vascular injury may be the first presenting complaint, leading to eventual diagnosis in patients who often experience minimal trauma. We present a case of a brachial artery rupture requiring surgical reconstruction, eventually leading to the diagnosis of EDS type IV after a non-contact, low-energy injury to the arm of an adolescent.

Introduction: Traumatic bowing is a commonly missed diagnosis on which only little information is available, inadequate treatment can cause permanent function loss.

Method: A systematic review would determine what the effect is of treatment of traumatic bowing of the lower arm in children on the functional outcome. A search on Embase, Medline, Web of Science, Scopus, Cochrane, Pubmed publisher, CINAHL and Google scholar, last accessed at the 15th of May 2016. Intervention of interest was treatment; with reduction, reduction and cast or cast only. The primary outcome measure was (I) function; pro and supination, (II) posttraumatic function, (III) posttreatment function and (IV) residual bowing.

Results: Five articles were included. Treatment by reduction only showed a normal function, 4 weeks to 8 weeks of cast and reduction followed by cast, both resulted in 0 degrees to 20 degrees residual of pronation loss.

Discussion: The treatment was overall well tolerated, had a direct effect and lead to faster restore of function. It is unclear to what amount of bowing can be accepted without any loss of function. But in view of the few complications and good results for reduction, the overall opinion is to reduce all significant bowing fractures of the lower arm in children with limited function.

Aneurysmal subarachnoid hemorrhage (SAH), a potentially catastrophic stroke, which occurs at a relatively younger age (median 55 years), afflicts over 30,000 patients a year in the USA. It accounts for 3% to 5% of all strokes and 4.4% of deaths from stroke belong to this group of patients. It carries high rate of morbidity (25%) and case fatality (35%) in most series.

Introduction: Resuscitative endovascular balloon occlusion of the aorta has been used in various clinical settings to elevate blood pressure in the setting of shock, even if the evidence base is weak with no clear indications.

Case presentation: We report a case of traumatic hemorrhagic shock in which this technique was used in an unusual manner, treating obvious arterial abdominal bleeding associated with suspected pelvic arterial bleeding, in a Trauma Center where hybrid angiographic-surgical suite is not available. A 35-year-old man was involved in a traffic accident within 2 trucks. He was transported to the Major Trauma Center of an Integrated Trauma System where emergent laparotomy confirmed massive hepatic rupture and a bleeding control was obtained by large abdominal packing. Trauma team decided to considerate Resuscitative Endovascular Balloon Occlusion of the Aorta, positioning a deflated balloon in zone III to eventually manage a pelvic arterial hemorrhage, while performing Bogota Bag. Suddenly a new abdominal arterial bleeding was noted through Bogota Bag. Because Pringle maneuver was considered too difficult in this case because of liver hilum injury, the balloon was moved cranially with the aim to reach zone I. Introducer sheath displacement occurred at this time, and the balloon was then only partially inflated in zone II, usually considered too dangerous, and immediately the target systolic blood pressure of 90 mmHg was obtained. Transfer the patient into interventional radiology suite was then feasible and embolization of active bleeding by right hepatic artery and superior mesenteric artery branch, missed during first laparotomy, were performed. Balloon was definitely deflated after 50 minutes. The patient was discharged by the hospital 113 days later, fully recovered with long lasting motor rehabilitation program.

Discussion: Partial zone II Resuscitative Endovascular Balloon Occlusion of the Aorta in this particular case allowed overcoming procedural mistakes without major complications and with good clinical outcome.

Conclusion: Judicious manage of REBOA inflation time and amount, together with multidisciplinary contemporary damage control strategy with clear and effective team leading, is the key to effectively resuscitate multiple trauma shocked patients.