Diagnosis and management of colonic injuries following blunt trauma

AIM: To retrospectively evaluate the preoperative diagnostic approaches and management of colonic injuries following blunt abdominal trauma. METHODS: A total of 82 patients with colonic injuries caused by blunt trauma between January 1992 and December 2005 were enrolled. Data were collected on clinical presentation, investigations, diagnostic methods, associated injuries, and operative management. Colonic injury-related mortality and abdominal complications were analyzed. RESULTS: Colonic injuries were caused mainly by motor vehicle accidents. Of the 82 patients, 58 (70.3%) had other associated injuries. Laparotomy was performed within 6 h after injury in 69 cases (84.1%), laparoscopy in 3 because of haemodynamic instability. The most commonly injured site was located in the transverse colon. The mean colon injury scale score was 2.8. The degree of faecal contamination was classified as mild in 18 (22.0%), moderate in 42 (51.2%), severe in 14 (17.1%), and unknown in 8 (9.8%) cases. Sixty-seven patients (81.7%) were treated with primary repair or resection and anastomosis. Faecal stream diversion was performed in 15 cases (18.3%). The overall mortality rate was 6.1%. The incidence of colonic injury- related abdominal complications was 20.7%. The only independent predictor of complications was the degree of peritoneal faecal contamination (P = 0.02). CONCLUSION: Colonic injuries following blunt trauma are especially important because of the severity and complexity of associated injuries. A thorough physical examination and a combination of tests can be used to evaluate the indications for laparotomy. One stage management at the time of initial exploration is mostoften used for colonic injuries.

Computed tomography for pancreatic injuries in pediatric blunt abdominal trauma

AIM:To evaluate the efficacy of computed tomography scan in diagnosing and grading the pattern of pancreatic injuries in children. METHODS:We conducted a retrospective study to review medical files of children admitted with blunt pancreatic injuries to the Maternity and Children Hospital Al-Madina Al-Munawwarah, Kingdom of Saudi Arabia. The demographic details and mechanisms of injury were recorded. From the database of the Picture Archiving and Communication System of the radiology department, multidetector computed tomography (MDCT) images of the pancreatic injuries, severity, type of injuries and grading of pancreatic injuries were established. RESULTS:Seven patients were recruited in this study over a period of 5 years; 5 males and 2 females with a mean age of 7 years (age range 5-12 years). Fall from height was the most frequent mechanism of injury, reported in 5 (71%), followed by road traffic accident (1 patient, 14%) and cycle handlebar (1 patient, 14%) injuries. According to the American Association for the Surgery of Trauma grading system, 1 (14%) patient sustained Grade Ⅰ, 1 (14%) Grade Ⅱ, 3 (42%) GradeⅢ and 2 (28%) patients were found to have Grade Ⅴ pancreatic injuries. This indicated a higher incidence of severe pancreatic injuries; 5 (71.4%) patients were reported to have Grade Ⅲ and higher on the injury scale. Three (42%) patients had associated abdominal organ injuries. CONCLUSION: Pediatric pancreatic injuries due to blunt abdominal trauma are rare. The majority of the patients sustained extensive pancreatic injuries. MDCT findings are helpful and reliable in diagnosing and grad- ing the pancreatic injuries.

Gastric blunt traumatic injuries: A computed tomography grading classification

AIM To produce a radiological grading of gastric traumatic injuries. METHODS In our study, we retrospectively analyzed 32 cases of blunt gastric traumatic injuries and compared computed tomography(CT) data with patients' surgical or medical development. In all cases, a basal phase was acquired, and an intravenous contrast material was administered via an antecubital venous catheter with acquisition in the venous phase(70-90 s). In addition, a further set of delayed scans was performed 4-5 min after the first scanning session, without supplementary intravenous contrast material, to identify or better define areas of active bleeding. All CT examinations were retrospectively reviewed by two radiologists, with more than 5 years of experience in emergency radiology, to detect signs of gastric injuries and/or associated abdominal lesions according to literature data. Specific CT findings for gastric rupture include luminal content extravasation and discontinuity of the gastric wall, while CT findings suggestive of injury consisted of free peritoneal fluid, extraluminal air, pneumatosis, and thickening and hematoma of gastric wall.RESULTS We found 32 gastric traumatic injuries. In 22 patients(68.8%), the diagnosis was based on the surgical findings; in the other 10 patients(31.2%), the diagnosis was based on the clinical and CT radiological data. We observed discontinuity of the gastric wall and luminal content extravasation in 1 patient(3.1%); in 10 patients(31.2%), there was extra-luminal air in the peritoneum. In 28 patients(87.5%), there was peritoneal fluid, which was blood in 14 patients(hematoma in 11 patients and contrast material extravasation from active bleeding in 3 patients). In 15 patients(46.9%), there was gastric wall thickening. In 3 patients, it was possible to identify a prevalent involvement of the external layer of the gastric wall, whereas, in 2 patients, the inner side of the gastric wall presented with major involvement. In 3 patients(9.4%), pneumatosis of the gastric wall was detected. In 19(59.4%) patients, the stomach was full. The fundus was the most frequently damaged part of the stomach because it was involved in 17 patients(53.1%). Based on the observed data, we identified four grades of gastric lesions.CONCLUSION A radiologic score is helpful for guiding the diagnosis and management(surgical or conservative) of gastric blunt traumatic injuries and stratify patients according to short-term outcomes.

Management and outcome of bronchial trauma due to blunt versus penetrating injuries

BACKGROUND The number of patients with bronchial trauma(BT)who survived to hospital admission has increased with the improvement of prehospital care;early diagnosis and treatment should be considered,especially among blunt trauma patients,whose diagnosis is frequently delayed.AIM To describe the early recognition and surgical management considerations of blunt and penetrating BTs,and to elaborate the differences between them.METHODS All patients with BTs during the past 15 years were reviewed,and data were retrospectively analyzed regarding the mechanism of injury,diagnostic and therapeutic procedures,and outcomes.According to the injury mechanisms,the patients were divided into two groups:Blunt BT(BBT)group and penetrating BT(PBT)group.The injury severity,treatment procedures,and prognoses of the two groups were compared.RESULTS A total of 73 patients with BT were admitted during the study period.The proportion of BTs among the entire cohort with chest trauma was 2.4%(73/3018),and all 73 underwent thoracotomy.Polytrauma patients accounted for 81.6% in the BBT group and 22.9%in the PBT group,and the mean Injury Severity Score was 38.22±8.13 and 21.33±6.12,respectively.Preoperative three-dimensional spiral computed tomography(CT)and/or fiberoptic bronchoscopy(FB)were performed in 92.1% of cases in the BBT group(n=38)and 34.3% in the PBT group(n=35).In the BBT group,a delay in diagnosis for over 48 h occurred in 55.3% of patients.In the PBT group,31 patients underwent emergency thoracotomy due to massive hemothorax,and BT was confirmed during the operation.Among them,22 underwent pulmo-tractotomy for hemostasis,avoiding partial pneumonectomy.In this series,the overall mortality rate was 6.9%(5/73),and it was 7.9%(3/38)and 5.7%(2/35)in the BBT group and PBT group,respectively(P>0.05).All 68 survivors were followed for 6 to 42(23±6.4)mo,and CT,FB,and pulmonary function examinations were performed as planned.All patients exhibited normal lung function and healthy conditions except three who required reoperations.CONCLUSION The difference between blunt and penetrating BTs is obvious.In BBT,patients generally have no vessel injury,and the diagnosis is easily missed,leading to delayed treatment.The main cause of death is ventilation disturbance due to tension pneumothorax early and refractory atelectasis with pneumonia late.However,in PBT,most patients require emergency thoracotomy because of simultaneous vessel trauma and massive hemothorax,and delays in diagnosis are infrequent.The leading cause of death is hemorrhagic shock.

Epidemiology of work-related hand and wrist injuries in a referral center: A descriptive study

BACKGROUND Occupational hand and wrist injuries(OHWIs)account for 25%of work-related accidents in low-and middle-income countries.In Colombia,more than 500000 occupational accidents occurred in 2021,and although the rate declined to less than 5%in 2020 and 2021,at least one in four accidents involved a hand or wrist injury.AIM To describe the OHWIs in workers seen at the emergency room at a second-level hospital in Colombia.METHODS An observational study was performed using data from workers who experienced OHWIs and attended a second-level hospital,between June,2020 and May,2021.The overall frequency of OHWIs,as well as their distribution by sociodemo-graphic,clinical,and occupational variables,are described.Furthermore,association patterns between sex,anatomical area(fingers,hand,wrist),and type of job were analyzed by correspondence analysis(CA).RESULTS There were 2.101 workers treated for occupational accidents,423(20.3%)were cases of OHWIs,which mainly affected men(93.9%)with a median age of 31 years and who worked mainly in mining(75.9%).OHWIs were more common in the right upper extremity(55.3%)and comprised different types of injuries,such as contusion(42.1%),laceration(27.9%),fracture(18.7%),and crush injury(15.6%).They primarily affected the phalanges(95.2%),especially those of the first finger(25.7%).The CAs showed associations between the injured anatomical area and the worker’s job that differed in men and women(explained variance>90%).CONCLUSION One out of five workers who suffered occupational accidents in Cundinamarca,Columbia had an OHWI,affecting mainly males employed in mining.This occupational profile is likely to lead to prolonged rehabilitation,and permanent functional limitations.Our results might be useful for adjusting preventive measures in cluster risk groups.

Chest X-rays in detecting injuries caused by blunt trauma

BACKGROUND:The appropriate sequence of different imagings and indications of thoracic computed tomography(TCT)in evaluating chest trauma have not yet been clarified at present.The current study was undertaken to determine the value of chest X-ray(CXR)in detecting chest injuries in patients with blunt trauma.METHODS:A total of 447 patients with blunt thoracic trauma who had been admitted to the emergency department(ED)in the period of 2009–2013 were retrospectively reviewed.The patients met inclusion criteria(age>8 years,blunt injury to the chest,hemodynamically stable,and neurologically intact)and underwent both TCT and upright CXR in the ED.Radiological imagings were re-interpreted after they were collected from the hospital database by two skilled radiologists.RESULTS:Of the 447 patients,309(69.1%)were male.The mean age of the 447 patients was 39.5±19.2(range 9 and 87 years).158(35.3%)patients were injured in motor vehicle accidents(MVA).CXR showed the highest sensitivity in detecting clavicle fractures[95%CI 78.3(63.6–89)]but the lowest in pneuomediastinum[95%CI 11.8(1.5–36.4)].The specificity of CXR was close to 100%in detecting a wide array of entities.CONCLUSION:CXR remains to be the first choice in hemodynamically unstable patients with blunt chest trauma.Moreover,stable patients with normal CXR are candidates who should undergo TCT if significant injury has not been ruled out.

Radiological findings of February 2023 twin earthquakes-related spine injuries

BACKGROUND The February 6,2023,twin earthquakes in Türkiye caused significant structural damage and a high number of injuries,particularly affecting the spine,which underscores the importance of understanding the distribution and nature of vertebral injuries in disaster victims.AIM To investigate the distribution of radiological findings of vertebral injuries in patients referred to a major tertiary center during the February 6,2023 twin earthquakes in Türkiye.METHODS With the approval of the institutional ethics committee,1216 examinations of 238 patients transferred from the region to a tertiary major hospital after the twin earthquakes of February 6,2023,were retrospectively analyzed for spine injuries.RESULTS Spine computed tomography(CT)scans were performed in 192 of 238 patients with a suspected spinal injury,42 of whom also had an magnetic resonance imaging(MRI).In 86 of 192 patients(44.79%;M:F=33:53)a spinal fracture was detected on CT and in 33 of 42 patients(78.57%;M:F=20:13)a spinal injury was found on MRI.Of the 86 patients in whom vertebral injury was detected,fractures were detected in the Denis-B group in 33,Denis-C in 4,Denis-D in 20 and Denis-E in 11 patients.Among the vertebral bodies:40"compression fractures",17"burst fractures",5"translational dislocation fractures",5"flexion-distraction fractures"and 58"prolonged forced fetal posture fractures"were detected.In addition,isolated transverse or spinous process fractures were found in eighteen vertebrae.CONCLUSION Our study highlights the prevalence and diverse spectrum of spinal injuries following the February 6,2023 twin earthquakes in Turkey underscoring the urgent need for effective management strategies in similar disaster scenarios,and emphasizing the"prolonged forced fetal posture"damage we encountered in earthquake victims who remained under the collapse for a long time.

Upper extremity vascular injuries:Etiology,management and outcome

BACKGROUND Vascular injuries of the upper extremities are considered relatively rare injuries affecting mostly the young population.They often are complex injuries accompanied by other musculoskeletal trauma or trauma in other anatomic locations.Their management is challenging since they can lead to disabilities with major socioeconomic effects.AIM To analyze data about the mechanism of injury,the management algorithm and functional outcomes of vascular injuries of the upper extremity.METHODS One hundred and fifteen patients(96 males and 19 females)with arterial injuries of the upper extremity treated in a tertiary trauma center from January 2003 to December 2022 was conducted.Mean patients’age was 33.7 years and the mean follow up time was 7.4 years.Patients with Mangled Extremity Severity Score≥7 and Injury Severity Score≥20,previous upper limb surgery or major trauma and any neuromuscular or psychiatric disease were excluded,from the study.RESULTS A penetrating trauma was the most common cause of injury.The radial artery was the artery injured in most of the cases(37.4%)followed by the ulnar(29.5%),the brachial(12.1%)and the axillary(6%).A simultaneous injury of both of the forearm’s arteries was in 15.6%of the cases.In 93%of the cases there were other concomitant musculoskeletal injuries of the extremity.Tendon lacerations were the most common,followed by nerve injuries.The postoperative functional scores(full Disabilities of the Arm,Shoulder,and Hand and VAS)had very satisfactory values.CONCLUSION Although vascular injuries of the upper extremity are rare,they may occur in the context of major combined musculoskeletal trauma.Although a multidisciplinary approach is essential to optimize outcome,the ability of trained hand surgeons to repair all injuries in combined vascular and musculoskeletal upper extremity trauma,excluding isolated vascular injuries,ensures shorter operative times and better functional outcomes.

Predicting full-thickness necrosis in adult acute corrosive ingestion injuries in a sub-Saharan African setting

BACKGROUND Corrosive ingestion remains an important global pathology with high morbidity and mortality.Data on the acute management of adult corrosive injuries from sub-Saharan Africa is scarce,with international investigative algorithms,relying heavily on computed tomography(CT),having limited availability in this setting.AIM To investigate the corrosive injury spectrum in a low-resource setting and the applicability of parameters for predicting full-thickness(FT)necrosis and mortality.METHODS A retrospective analysis of a prospective corrosive injury registry(March 1,2017–October 31,2023)was performed to include all adult patients with acute corrosive ingestion managed at a single,academic referral centre in Cape Town,South Africa.Patient demographics,corrosive ingestion details,initial investigations,management,and short-term outcomes were described using descriptive statistics while multivariate analysis with receiver operator characteristic area under the curve graphs(ROC AUC)were used to identify factors predictive of FT necrosis and 30-day mortality.RESULTS One-hundred patients were included,with a mean age of 32 years(SD:11.2 years)and a male predominance(65.0%).The majority(73.0%)were intentional suicide attempts.Endoscopy on admission was the most frequent initial investigation performed(95 patients),while only 17 were assessed with CT.Seventeen patients had full thickness necrosis at surgery,of which eleven underwent emergency resection and six were palliated.Thirty-day morbidity and mortality were 27.0%and 14.0%,respectively.Patients with full thickness necrosis and those with an established perforation had a 30-day mortality of 58.8%and 91.0%,respectively.Full thickness necrosis was associated with a cumulative 2-year survival of only 17.6%.Multivariate analyses with ROC AUC showed admission endoscopy findings,CT findings,and blood gas findings(pH,base excess,lactate),to all have significant predictive value for full thickness necrosis,with endoscopy proving to have the best predictive value(AUC 0.850).CT and endoscopy findings were the only factors predictive of early mortality,with CT performing better than endoscopy(AUC 0.798 vs 0.759).CONCLUSION Intentional corrosive injuries result in devastating morbidity and mortality.Locally,early endoscopy remains the mainstay of severity assessment,but referral for CT imaging should be considered especially when blood gas findings are abnormal.

Crosstalk among mitophagy,pyroptosis,ferroptosis,and necroptosis in central nervous system injuries

Central nervous system injuries have a high rate of resulting in disability and mortality;however,at present,effective treatments are lacking.Programmed cell death,which is a genetically determined fo rm of active and ordered cell death with many types,has recently attra cted increasing attention due to its functions in determining the fate of cell survival.A growing number of studies have suggested that programmed cell death is involved in central nervous system injuries and plays an important role in the progression of brain damage.In this review,we provide an ove rview of the role of programmed cell death in central nervous system injuries,including the pathways involved in mitophagy,pyroptosis,ferroptosis,and necroptosis,and the underlying mechanisms by which mitophagy regulates pyroptosis,ferroptosis,and necro ptosis.We also discuss the new direction of therapeutic strategies to rgeting mitophagy for the treatment of central nervous system injuries,with the aim to determine the connection between programmed cell death and central nervous system injuries and to identify new therapies to modulate programmed cell death following central nervous system injury.In conclusion,based on these properties and effects,interventions targeting programmed cell death could be developed as potential therapeutic agents for central nervous system injury patients.

Use of induced pluripotent stem cell-derived brain cells,organoids,assembloids,and blood-brain barrier models in understanding alcohol and anesthetic-induced brain injuries:an emerging perspective

Neurological disorders,including developmental disorders,Alzheimer’s disease(AD),and psychiatric conditions,have significant social and economic impacts globally.Despite extensive research into the underlying mechanisms of these disorders,effective treatments remain elusive,partly due to the complexity of the brain,the limited availability of human brain tissue,and the blood-brain barrier(BBB)’s impermeability to certain drugs.This perspective article discusses the potential of human induced pluripotent stem cell(iPSC)-based models of brain cells,organoids,assembloids,and BBB to advance our understanding of the etiology,progression,and mechanisms of brain injuries induced by alcohol consumption and general anesthesia.These models could also be used to develop protective and therapeutic approaches.

Bicycle-related traumatic injuries: a retrospective study during COVID-19 pandemic

BACKGROUND:This study aimed to review bicycle-related injuries during the COVID-19 pandemic to assist with reinforcement or implementation of new policies for injury prevention.METHODS:This is a retrospective descriptive analysis of injuries sustained during cycling for patients 18 years old and above who presented to Singapore General Hospital from January to June 2021.Medical records were reviewed and consolidated.Descriptive analyses were used to summarize patient characteristics,and differences in characteristics subgrouped by triage acuity and discharge status were analyzed.RESULTS:The study included 272 patients with a mean age of 43 years and a male predominance(71.7%).Most presented without referrals(88.2%)and were not conveyed by ambulances(70.6%).Based on acuity category,there were 24(8.8%)Priority 1(P1)patients with 7 trauma activations,174(64.0%)and 74(27.2%)P2 and P3 patients respectively.The most common injuries were fractures(34.2%),followed by superficial abrasion/contusion(29.4%)and laceration/wound(19.1%).Thirteen(4.8%)patients experienced head injury and 85 patients(31.3%)were documented to be wearing a helmet.The majority occurred on the roads as traffic accidents(32.7%).Forty-two patients(15.4%)were admitted with a mean length of stay of 4.1 d and 17(6.3%)undergone surgical procedures.Out of 214(78.7%)discharged patients,no re-attendances or mortality were observed.In the subgroup analysis,higher acuity patients were generally older,with higher proportions of head injuries leading to admission.CONCLUSION:Our study highlights significant morbidities in bicycle-related injuries.There is also a high proportion of fractures in the young healthy male population.Injury prevention is paramount and we propose emphasizing helmet use and road user safety.

Is there a place for endoscopic management in postcholecystectomy iatrogenic bile duct injuries?

In this editorial we comment on the article by Emara et al published in the recent issue of the World Journal of Gastrointestinal Surgery.Previously,surgery was the primary treatment for bile duct injuries(BDI).The treatment of BDI has advanced due to technological breakthroughs and minimally invasive procedures.Endoscopic and percutaneous treatments have largely supplanted surgery as the primary treatment for most instances in recent years.Patient management,including the specific technique,is typically impacted by local knowledge and the kind and severity of the injury.Endoscopic therapy is a highly successful treatment for postoperative benign bile duct stenosis and offers superior long-term outcomes compared to surgical correction.Based on the damage features of BDI,therapeutic options include endoscopic duodenal papillary sphincterotomy,endoscopic nasobiliary drainage,and endoscopic biliary stent implantation.

Beyond the imaging evaluation of fractures of the lateral process of the talus:Let’s not forget concomitant injuries

Fractures of the lateral process of the talus(FLPT)are uncommon fractures that represent a clinical challenge.Traditional radiological classification systems rely predominantly on radiographic findings.However,due to the high rate of FLPT misdiagnosis and the limited accuracy in evaluating concomitant talar injuries through plain radiographs,novel imaging classification systems have been developed that aim to enhance the diagnosis of concomitant talar injuries,thereby optimizing patient management and reducing the incidence of long-term complications.

Pelvic fractures in blunt trauma patients:A comparative study

BACKGROUND Pelvic fractures(PF)with concomitant injuries are on the rise due to an increase of high-energy trauma.Increase of the elderly population with age related comorbidities further complicates the management.Abdominal organ injuries are kindred with PF due to the proximity to pelvic bones.Presence of contrast blush(CB)on computed tomography in patients with PF is considered a sign of active bleeding,however,its clinical significance and association with outcomes is debatable.AIM To analyze polytrauma patients with PF with a focus on the geriatric population,co-injuries and the value of contrast blush.METHODS This retrospective cohort study included 558 patients with PF admitted to level 1 trauma center(01/2017-01/2023).Analyzed variables included:Age,sex,mechanism of injury(MOI),injury severity score(ISS),Glasgow coma scale(GCS),abbreviated injury scale(AIS),co-injuries,transfusion requirements,pelvic angiography,embolization,laparotomy,orthopedic pelvic surgery,intensive care unit and hospital lengths of stay,discharge disposition and mortality.The study compared geriatric and non-geriatric patients,patients with and without CB and abdominal co-injuries.Propensity score matching was implemented in comparison groups.RESULTS PF comprised 4%of all trauma admissions.89 patients had CB.286(52%)patients had concomitant injuries including 93(17%)patients with abdominal co-injuries.Geriatric patients compared to non-geriatric had more falls as MOI,lower ISS and AIS pelvis,higher GCS,less abdominal co-injuries,similar CB and angio-embolization rates,less orthopedic pelvic surgeries,shorter lengths of stay and higher mortality.After propensity matching,orthopedic pelvic surgery rates remained lower(8%vs 19%,P<0.001),hospital length of stay shorter,and mortality higher(13%vs 4%,P<0.001)in geriatric patients.Out of 89 patients with CB,45(51%)were embolized.After propensity matching,patients with CB compared to without CB had more pelvic angiography(71%vs 12%,P<0.001),higher embolization rates(64%vs 22%,P=0.02)and comparable mortality.CONCLUSION Half of the patients with PF had concomitant co-injuries,including abdominal co-injuries in 17%.Similarly injured geriatric patients had higher mortality.Half of the patients with CB required an embolization.

Relationships between Quadriceps:Hamstring Strength Ratio and Lower Extremity Injuries in Netball Players

Background: Netball is a popular sport. Due to high impact and quick movement, there is an enormous load on the lower extremities which increases the risk for injury. Aim: The aim of this study was to investigate the relationship between the quadricep and hamstring strength and the prevalence of lower extremity injuries in netball players. Setting: Twenty-five female netball players (age: 20.8 ± 1.4 years) voluntarily participated. Methods: The Cybex Isokinetic dynamometer was used to determine concentric knee torques. Quadriceps:hamstring strength ratio was determined. Occurrence of lower extremity injuries was documented bi-weekly. Results: Medium effect sizes were noted for flexion torque:work for the left leg and for the quadriceps:hamstring ratio (≥60%) for the right leg. All the other measured variables have a small effect size. 18.75% of lower extremity injuries and ConQ:ConH of Conclusion: Injuries to the ankle and knee are especially common among netball players. Hamstring and quadriceps muscle asymmetry (>10%) were found to be a potential indicator of lower extremity injury. Contribution: This study highlights awareness on lower extremity injuries and the strength ratio between the quadriceps and hamstrings. This can aid coaches and netball players to lower the risk for injuries and thus improve individual- and team performance.

Review and update on the management of triangular fibrocartilage complex injuries in professional athletes

Triangular fibrocartilage complex injuries are common in amateur and professional sports.These injuries are mainly caused by acute or chronic repetitive axial loads on the wrist,particularly on the ulnar side and in association with rotations or radial/ulnar deviations.In order to treat professional athletes,a detailed specific knowledge of the pathology is needed.Moreover,the clinician should fully understand the specific and unique environment and needs of the athletes,their priorities and goals,the type of sport,the time of the season,and the position played.An early diagnosis and appropriate management with the quickest possible recovery time are the uppermost goals for both the athlete and the surgeon.A compromise between conservative vs surgical indications,athletes’needs and expectations,and financial implications should be achieved.Arthroscopic procedures should be timely planned when indicated as they could allow early diagnosis and treatment at the same time.Conservative measures are often used as first line treatment when possible.Peripheral lesions are treated by arthroscopic repair,whilst central lesions are treated by arthroscopic debridement.Further procedures(such as the Wafer procedure,ulnar osteotomies,etc.)have specific indications and great implications with regard to rehabilitation.

Otorhinolaryngological (ORL) and Cervicofacial Injuries Resulting from Road Accidents within the Otorhinolaryngology (ORL) Department of the Regional Hospital of Mamou

Introduction: Otorhinolaryngological (ORL) and cervicofacial traumas encompass injuries affecting the neck, face, and ORL region, resulting from external influence. The objective of this study was to conduct an epidemiological and clinical analysis of ORL and cervicofacial injuries observed in victims of road accidents treated at the Otorhinolaryngology (ORL) department of the Regional Hospital of Mamou. Materials and Methods: This prospective and descriptive study was conducted over a period of 12 months, from January 1st to December 31st, 2021, within the Otorhinolaryngology (ORL) department of the Regional Hospital of Mamou. It included patients hospitalized for ORL and/or cervicofacial traumas resulting from road accidents during the study period. Results: A total of 348 cases were included, representing 36.22% of all traumas related to road accidents (AVP) within the Regional Hospital of Mamou. The average age of the patients was 26.44 years, with a sex ratio of 3.83, favoring males. The dominant socio-professional category was students, encompassing 32.47% of cases. Road accidents were mainly associated with motorcycle use (31.32% motorcycle-to-motorcycle, 24.43% motorcycle skidding, 13.51% motorcycle-pedestrian). Facial region injuries were the most common, accounting for 69.03% of cases, followed by rhinological injuries (17.28%) and otological injuries (13.69%). Associated injuries were predominantly closed head traumas (52.55%) and lower limb fractures (20.41%). Imaging was underutilized. Regarding surgical interventions, reconstructive surgery was the most predominant, accounting for 52.51% of cases, with a management timeframe of 30 minutes to 12 hours for 99.72% of patients. Conclusion: Road traffic accidents remain a serious public health issue, primarily affecting young males. Emphasis should be placed on road safety measures to reduce the frequency of these accidents.

Follow-up strategy for early detection of delayed pseudoaneurysms in patients with blunt traumatic spleen injury: A single-center retrospective study

BACKGROUND The spleen is the most commonly injured solid organ in blunt abdominal trauma,and splenic pseudoaneurysm rupture is associated with a high risk of mortality.Nonoperative management has become the standard treatment for hemodynam-ically stable patients with splenic injuries.On the other hand,delayed splenic pseudoaneurysms can develop in any patient,and at present,there are no known risk factors that may reliably predict their occurrence.Furthermore,there is a lack of consensus regarding the most appropriate strategies for monitoring and mana-ging splenic injuries,especially lower-grade(I-III).AIM To determine the predictors of pseudo-aneurysm formation following splenic injury and develop follow-up strategies for early detection of pseudoaneurysms.METHODS We retrospectively analyzed patients who visited the Level I Trauma Center bet-ween January 2013 and December 2022 and were diagnosed with spleen injuries after blunt abdominal trauma.RESULTS Using the American Association for the Surgery of Trauma spleen injury scale,the splenic injuries were categorized into the following order based on severity:Grade I(n=57,17.6%),grade II(n=114,35.3%),grade III(n=89,27.6%),grade IV(n=50,15.5%),and grade V(n=13,4.0%).Of a total of 323 patients,35 underwent splenectomy and 126 underwent angioembolization.19 underwent delayed angioembolization,and 5 under-went both initial and delayed angioem-bolization.In 14 patients who had undergone delayed angioembolization,no extravasation or pseudoaneurysm was observed on the initial computed tomography scan.There are no particular patient-related risk factors for the formation of a delayed splenic pseudoaneurysm,which can occur even in a grade I spleen injury or even 21 days after the injury.The mean detection time for a delayed pseudoaneurysm was 6.26±5.4(1-21,median:6,inter-quartile range:2-9)days.CONCLUSION We recommend regular follow-up computed tomography scans,including an arterial and portal venous phase,at least 1 week and 1 month after injury in any grade of blunt traumatic spleen injury for the timely detection of delayed pseudoaneurysms.

Ambulance Records as an Information Source to Document and Prevent Fall Injuries in Sweden

In Sweden, there has been only limited documentation for injuries requiring ambulance responses. The main objective of this study is, through the use of historic data, to assess the suitability of ambulance records to describe circumstances with fall injuries. Methods: The injury events data around patients were sourced from the ambulance data register. Descriptive statistics were used to describe injured patients based on age group, type of injury, place of injury, injury mechanism and consequence of an injury event. Two-group comparison was performed with Pearson’s chi-squared. Predictors of transport to hospital were identified using logistic regression analyses. Result: Ambulance provides unique data on all injury events, with direct implications for translational research, public policy and clinical practice (safety promotion). In 2002 ambulance attended 3964 injured people which represents 14% of ambulance attended workload in Värmland county, Sweden. The most common trauma location was the traffic area followed by residential area and nursing home. These three injury sites account for 2320 cases (61.6%). The most common cause of injury was falls (63.9%) followed by contact with another person (26.5%). Contact with another person is the most common site of injury in the traffic area (79.5%), and men aged 25-66 years are overrepresented. Conclusion: Logistic regression found that, age-group and place code were significant predictor for being attended by ambulance. Traffic, home and nursing homes were over-represented injury environments (61.6%) that require special attention. Most injury cases occur in the home and nursing homes among people over 67 years of age. Surprisingly, most of the injury events in the traffic environment are about hitting another person. Paramedics can provide rich and valuable data on injury events. Registration of such data is entirely possible and desirable, and can be used in preventive work.