Fracturas vertebrales múltiples / Multiple vertebral fractures

Introducción: Las fracturas vertebrales múltiples son el resultado de traumatismos de alta energía. Se clasifican en contiguas cuando hay fractura de dos o más cuerpos vertebrales en forma adyacente y no contiguas cuando hay lesiones de varios niveles separadas por, al menos, una vértebra sin lesión. Objetivos: Evaluar la clínica y la cinemática de las fracturas vertebrales múltiples, establecer su distribución, evaluar la asociación con lesiones extravertebrales y detallar las complicaciones. Materiales y métodos: Estudio multicéntrico, prospectivo y observacional de pacientes con fracturas vertebrales múltiples. Resultados: 66 pacientes (26 mujeres y 40 hombres; promedio de edad 39 años) con 196 lesiones vertebrales, 55 no tenían déficit neurológico. Cinemática: 32 accidentes automovilísticos, 27 caídas de altura, 5 traumas directos y 2 traumas deportivos. Topografía: dos C0-C3, cuatro C3-C7, ocho C7-T1, 61 T1-T10, 91 T10-L2, 28 L2-L5 y una sacro. Combinación: 21 toracolumbar-toracolumbar y 8 torácica-torácica. Treinta y dos fracturas eran contiguas; 19, no contiguas y 15 tenían un patrón mixto. Veintiséis pacientes pre-sentaron 47 lesiones extravertebrales (20 politraumatismos), 12 traumas torácicos. Treinta y seis pacientes recibieron tratamiento conservador y 30 fueron operados. Conclusiones: La presencia de fracturas vertebrales múltiples es frecuente y son consecuencia de accidentes automovilísticos, la mayoría de los pacientes no tiene compromiso neurológico. El sector más afectado fue entre T2 y L5, la combinación más frecuente fue toracolumbar-toracolumbar, seguida de torácica-torácica. Las lesiones extravertebrales más frecuentes fueron traumatismos de cráneo y de tórax. Nivel de Evidencia: IV

Background: Multiple vertebral fractures (MVF) are the result of high-energy trauma. These can be contiguous (CMVF) when there is a fracture of two or more vertebral bodies in an adjacent way and non-contiguous (NCMVF) when there are lesions of various levels separated by at least one vertebra without injury. Objective: To evaluate clinical features and kinematics, establish distribution, evaluate association with extra-vertebral injuries, detail complications. materials and methods: A multicenter, prospective, and observational study. Patients with MVF. Results: Sixty-six patients presented 196 vertebral lesions, without neurological deficit in 55; 26 were women and 40 were men, with an average age of 39 years old. Kinematics: 32 car accidents, 27 falls from height, 5 direct traumas and 2 sports traumas. Topography: 2 C0-C3, 4 C3-C7, 8 C7TT1, 61 T1-T10, 91 T10-L2, 28 L2-L5 and 1 sacrum. Combination: 21 thoracolumbar-thoracolumbar and 8 thoracic-thoracic. There were 32 contiguous injuries, 19 non-contiguous injuries, and 15 mixed-pattern injuries. Twenty-six patients presented 47 extra-verterbral injuries (20 multiple trauma, 12 thoracic trauma). 36 patients received non-surgical treatment and 30 patients underwent surgery. Conclusion: The presence of MVF in spinal cord trauma is frequent, most do not show neurological involvement and are consequences of motor vehicle accidents. The most affected sector was between T2 to L5, the most frequent combination was thoracolumbar-thoracolumbar, followed by thoracic-thoracic; the most frequent were extra-vertebral injuries, mainly head and chest trauma. Complications: one patient had increased kyphosis; one, surgical site infection; and one patient died. Level of Evidence: IV

Cuidados de enfermagem ao paciente politraumatizado: revisão integrativa / Nursing care for polyramed care: integrative review / Polytraumatized patient nursing care: revisión integrativa

OBJETIVO: Descrever os cuidados de enfermagem ao paciente politraumatizado grave. MÉTODO: Revisão integrativa com buscas nas bases de dados CINAHL, MEDLINE/BIREME, IBECS, BDENF e LILACS, utilizando os MeSH (Medical Subject Headings) obtidos através da estratégia PVO e operador booleano em duas estratégias distintas: estratégia 01 "nursing care AND multiple trauma" e estratégia 02 "nursing care AND patient AND multiple trauma". RESULTADOS: Após buscas e aplicação dos critérios de elegibilidade restaram uma totalidade de 09 artigos. Nesse sentido, observou-se que os cuidados de enfermagem ao paciente politraumatizado estão ligados ao âmbito do manejo adequado com a estrutura corporal, com ênfase na técnica de imobilização; aos cuidados à restauração e manutenção da pele; à administração medicamentosa e controle da dor; e, ao monitoramento de sistemas fisiológicos. CONCLUSÃO: O cuidado de enfermagem é um instrumento complexo que abrange o ser em sua totalidade, onde na assistência ao politraumatizado várias intervenções são necessárias para que haja progressão no estado de saúde deste individuo, demonstrando a importância desta profissão em virtude das inúmeras atividades desempenhadas.(AU)

OBJECTIVE: To describe nursing care for severe polytrauma patients. METHOD: Integrative review with searches in the following databases: CINAHL, MEDLINE/BIREME, IBECS, BDENF and LILACS, using MeSH (Medical Subject Headings) obtained through the PVO strategy and Boolean operator in two different strategies: strategy 01 "nursing care AND multiple trauma "and strategy 02" nursing care AND patient AND multiple trauma". RESULTS: After searching and applying the eligibility criteria, a total of 09 articles remained. In this sense, it was observed that nursing care for polytrauma patients is linked to the scope of adequate management with body structure, with an emphasis on the immobilization technique; care for the restoration and maintenance of the skin; medication administration and pain control; and, the monitoring of physiological systems. CONCLUSION: Nursing care is a complex instrument that encompasses the being in its entirety, where in assistance to multiple trauma patients, several interventions are necessary for there to be progression in the health status of this individual, demonstrating the importance of this profession due to the numerous activities performed.(AU)

OBJETIVO: Describir la atención de enfermería a pacientes politraumatizados graves. METODO: Revisión integrativa con búsquedas en las bases de datos CINAHL, MEDLINE/BIREME, IBECS, BDENF y LILACS, utilizando el MeSH (Medical Subject Headings) obtenido a través de la estrategia PVO y operador booleano en dos estrategias distintas: estrategia 01 "cuidado de enfermería y trauma múltiple" y estrategia 02 "cuidado de enfermería y y y trauma múltiple del paciente". RESULTADOS: Después de buscar y aplicar los criterios de elegibilidad, se mantuvieron un total de 09 artículos. En este sentido, se observó que la atención de enfermería para pacientes politraumatizados está vinculada al ámbito de un manejo adecuado con estructura corporal, con énfasis en la técnica de inmovilización; cuidado de la restauración y mantenimiento de la piel; administración de drogas y control del dolor; y, el monitoreo de los sistemas fisiológicos. CONCLUSION: La atención de enfermería es un instrumento complejo que abarca el ser en su totalidad, donde en el cuidado de la politraumatizada son necesarias varias intervenciones para que haya progresión en el estado de salud de este individuo, demostrando la importancia de esta profesión debido a las numerosas actividades realizadas.(AU)

Síndrome de osteoporosis-pseudoglioma: a propósito de un caso pediátrico de osteoporosis primaria / Osteoporosis-pseudoglioma Syndrome: a pediatric case of primary osteoporosis

La osteoporosis es un trastorno para tener en cuenta en niños con patologías crónicas graves o con algunas enfermedades genéticas que predisponen al incremento de la fragilidad ósea. La osteoporosis primaria es una entidad con etiologías emergentes y puede ocurrir en forma sindrómica. La asociación con pliegues retinianos congénitos debe orientar al diagnóstico de osteoporosis-pseudoglioma (OMIM 259770), síndrome poco frecuente (prevalencia de 1/2000000), que se origina por la pérdida de función de la proteína LRP5 (low-density lipoprotein receptor-related protein 5) y compromete la vía de señalización de Wnt/ß-catenina. Se presenta el caso de un niño con pliegues retinianos congénitos, ceguera progresiva y múltiples fracturas cuyo estudio clínico, bioquímico y genético confirmó el diagnóstico de osteoporosis primaria debido a una nueva variante inactivante en el gen LRP5 en homocigosis

Osteoporosis should be considered in children with severe chronic diseases or in association with some genetic diseases that bear an increased risk of bone fragility. Primary osteoporosis is an entity in which emerging aetiologies are being recognized. Its association with congenital retinal folds should guide the diagnosis to the Osteoporosis-Pseudoglioma syndrome (OMIM 259770), a rare disease (prevalence of 1/2000000), caused by the loss of function of the protein LRP5 (low-density lipoprotein receptor-related protein 5) resulting in the alteration of the Wnt/ß-catenin signalling pathway. We report the case of a child with congenital retinal folds, progressive loss of vision and multiple fractures whose clinical, biochemical and genetic studies confirmed the diagnosis of primary osteoporosis due to a novel homozygous inactivating variant in LRP5

Continuous serratus anterior plane block provides analgesia in multiple rib fractures: a case report / O bloqueio contínuo do plano serrátil anterior fornece analgesia em fraturas múltiplas de costelas: relato de caso

Abstract Thoracic trauma with rib fractures is a challenging condition due to the severe associated pain. Uncontrolled pain impairs breathing and an adequate pain control is necessary to provide comfort and to avoid further complications. Serratus Anterior Plane block is a procedure safe and easy to accomplish. The authors describe a case of thoracic trauma with rib fractures and respiratory compromise. Pain control was only achieved after performing a Serratus Anterior Plane block. The technique was done as described in the medical literature with placement of a catheter. Pain relief was achieved with a low concentration infusion of local anesthetic.

Resumo O trauma torácico com fraturas de costelas é uma condição desafiadora devido à dor intensa associada. O não controle da dor prejudica a respiração enquanto, o seu controle adequado é necessário para proporcionar conforto e evitar maiores complicações. O bloqueio do plano serrátil anterior é um procedimento seguro e fácil de fazer. Descrevemos um caso de trauma torácico com fraturas de costelas e comprometimento respiratório. O controle da dor só foi obtido após o bloqueio do plano serrátil anterior. A técnica foi aplicada conforme descrito na literatura médica, com a colocação de um cateter. O alívio da dor foi obtido com uma infusão de anestésico local em baixa concentração.

Continuous erector spinae plane block for postoperative analgesia of multiple rib fracture surgery: case report / Bloqueio do plano do eretor da espinha para analgesia pós-operatória de cirurgia de fratura de múltiplas costelas: relato de caso

Abstract Introduction: The erector spinae plane block is a newly described and effective interfascial plane block for thoracic and abdominal surgery. This case report describes a patient with multiple rib fractures undergoing ultrasound-guided continuous erector spinae plane block for analgesia. Case report: A 37-year-old male patient was taken for surgical fixation of multiple rib fractures. At the end of the surgery, using ultrasound-guided longitudinal parasagittal orientation 3 cm to the lateral aspect of the T5 spinous process and an in-plane technique, 20 mL 0.25% bupivacaine was administered between the erector spinae muscle and the transverse process, and a catheter was then inserted in the same plane. Before the end of surgery, 1 g paracetamol and 50 mg dexketoprofen were administered. Postoperative analgesia was applied with patient controlled analgesia method using 0.25% bupivacaine via the catheter. The patient's Visual Analogue Scale score at rest in the first 24 h was 0. The patient was monitored for 3 days with Visual Analogue Scale < 4, and the catheter was removed on postoperative day 4. No opioid requirement other than paracetamol and dexketoprofen occurred during this time. No postoperative complications were recorded. Discussion: The erector spinae plane block is an alternative to paravertebral, intercostal, epidural or other regional techniques. It may be a suitable technique in anesthesia and algology practice due to providing analgesia in the postoperative period with a catheter in the erector spinae plane.

Resumo Introdução: O bloqueio do plano do eretor da espinha é um bloqueio do plano interfacial recentemente descrito e eficaz para cirurgia torácica e abdominal. Neste relato descrevemos o caso de um paciente com fratura de múltiplas costelas, submetido ao bloqueio contínuo do plano do eretor da espinha guiado por ultrassom para analgesia. Relato de caso: Paciente do sexo masculino, 37 anos, encaminhado para fixação cirúrgica de fratura de múltiplas costelas. Ao final da cirurgia, usando a orientação parassagital longitudinal guiada por ultrassom 3 cm em relação à face lateral do processo espinhoso T5 e a técnica no plano, 20 ml de bupivacaína a 0,25% foram administrados entre o músculo eretor da espinha e o processo transverso, e um cateter foi então inserido no mesmo plano. Antes do final da cirurgia, 1 g de paracetamol e 50 mg de dexcetoprofeno foram administrados. A analgesia pós-operatória foi aplicada com o método de analgesia controlada pelo paciente, com bupivacaína a 0,25% via cateter. Na Escala Visual Analógica, o escore do paciente em repouso nas primeiras 24 h foi zero. O paciente foi monitorado por três dias com a Escala Visual Analógica < 4, e o cateter foi removido no quarto dia de pós-operatório. Exceto por paracetamol e dexcetoprofeno, não houve necessidade de outro agente opioide durante esse tempo. Não houve registro de complicação pós-operatória. Discussão: O bloqueio do plano do eretor da espinha é uma alternativa às técnicas paravertebrais, intercostais, epidurais ou outras técnicas regionais. Pode ser uma técnica adequada na prática de anestesia e algologia devido ao fornecimento de analgesia no período pós-operatório mediante um cateter no plano do eretor da espinha.

Profil épidémiologique et lésionnel des polyfractures de membres au Centre Hospitalier Universitaire Départemental de L'Ouémé-Plateau (CHUDOP) de Porto-Novo

OBJECTIF : Déterminer le profil épidémiologique et lésionnel des patients polyfracturés admis dans le service de chirurgie générale du CHUDOP. MATERIEL ET METHODE : Etude mixte, rétrospective de deux ans allant du 1er janvier 2014 au 31 décembre 2015 puis prospective de six mois du 1er janvier au 30 juin 2016. RESULTATS : Nous avons colligé 50 dossiers exploitables sur une période d'étude de 30 mois. L'âge moyen de nos patients était de 38,4 ans et le sex ratio de 5,25. L'étiologie principale retrouvée était les accidents de la voie publique à 76%. Les lésions osseuses sont majoritairement homolatérales gauches et le segment jambier le plus atteint avec 31 fractures du tibia enregistrées. CONCLUSION : la célérité des moyens de déplacement de nos jours est responsable de la recrudescence des accidents de la voie publique génératrices de lésions multiples chez un même traumatisé

Clinical Features and Treatment Outcomes of Acute Multiple Thoracic and Lumbar Spinal Fractures: A Comparison of Continuous and Noncontinuous Fractures

OBJECTIVE: The treatment of multiple thoracolumbar spine fractures according to fracture continuity has rarely been reported. Herein we evaluate the clinical features and outcomes of multiple thoracolumbar fractures depending on continuous or noncontinuous status.METHODS: From January 2010 to January 2016, 48 patients with acute thoracic and lumbar multiple fractures who underwent posterior fusion surgery were evaluated. Patients were divided into two groups (group A : continuous; group B : noncontinuous). We investigated the causes of the injuries, the locations of the injuries, the range of fusion levels, and the functional outcomes based on the patients’ general characteristics.RESULTS: A total of 48 patients were enrolled (group A : 25 patients; group B : 23 patients). Both groups had similar pre-surgical clinical and radiologic features. The fusion level included three segments (group A : 4; group B : 5) or four segments (group A : 19; group B : 5). Group B required more instrumented segments than did group A. Group A scored 23.5 and group B scored 33.4 on the Korean Oswestry Disability Index (KODI) at the time of last follow-up. In both groups, longer fusion was associated with worse KODI score.CONCLUSION: In this study, due to the assumption of similar initial clinical and radiologic features in both group, the mechanism of multiple fractures is presumed to be the same between continuous and noncontinuous fractures. The noncontinuous fracture group had worse KODI scores in long-term follow-up, thought to be due to long fusion level. Therefore, we recommend minimizing the number of segments that are fused in multiple thoracolumbar and lumbar fractures when decompression is not necessary.

Clinical Features and Treatment Outcomes of Acute Multiple Thoracic and Lumbar Spinal Fractures: A Comparison of Continuous and Noncontinuous Fractures

OBJECTIVE: The treatment of multiple thoracolumbar spine fractures according to fracture continuity has rarely been reported. Herein we evaluate the clinical features and outcomes of multiple thoracolumbar fractures depending on continuous or noncontinuous status. METHODS: From January 2010 to January 2016, 48 patients with acute thoracic and lumbar multiple fractures who underwent posterior fusion surgery were evaluated. Patients were divided into two groups (group A : continuous; group B : noncontinuous). We investigated the causes of the injuries, the locations of the injuries, the range of fusion levels, and the functional outcomes based on the patients’ general characteristics. RESULTS: A total of 48 patients were enrolled (group A : 25 patients; group B : 23 patients). Both groups had similar pre-surgical clinical and radiologic features. The fusion level included three segments (group A : 4; group B : 5) or four segments (group A : 19; group B : 5). Group B required more instrumented segments than did group A. Group A scored 23.5 and group B scored 33.4 on the Korean Oswestry Disability Index (KODI) at the time of last follow-up. In both groups, longer fusion was associated with worse KODI score. CONCLUSION: In this study, due to the assumption of similar initial clinical and radiologic features in both group, the mechanism of multiple fractures is presumed to be the same between continuous and noncontinuous fractures. The noncontinuous fracture group had worse KODI scores in long-term follow-up, thought to be due to long fusion level. Therefore, we recommend minimizing the number of segments that are fused in multiple thoracolumbar and lumbar fractures when decompression is not necessary.

Approach for naso-orbito-ethmoidal fracture

The purpose of this study is to discuss several approaches to addressing naso-orbito-ethmoidal (NOE) fracture. Orbital fracture, especially infraorbital fracture, can be treated through the transconjunctival approach easily. However, in more severe cases, for example, fracture extending to the medial orbital wall or zygomatico-frontal suture line, only transconjunctival incision is insufficient to secure good surgical field. And, it also has risk of tearing the conjunctiva, which could injure the lacrimal duct. Also, in most complex types of facial fracture such as NOE fracture or panfacial fracture, destruction of the structure often occurs, for example, trap-door deformity; a fracture of orbital floor where the inferiorly displaced blowout facture recoils to its original position, or vertical folding deformity; fractured fragments are displaced under the other fragments, causing multiple-packed layers of bone.

Osteosíntesis interna en fracturas múltiples / Internal osteosynthesis in multiple fractures

Los accidentes automovilísticos, como traumas de alta energía, producen múltiples lesiones. Es objetivo de este trabajo describir la conducta seguida y la evolución de una paciente de 21 años de edad que, cuando viajaba de acompañante en una bicicleta con motor, fue impactada por un automóvil y proyectada a más de 20 m de distancia. Llegó al Hospital Militar Central "Dr. Carlos J. Finlay" en estado de shock hipovolémico agudo y con grandes deformidades en ambos miembros inferiores. Se constataron 13 fracturas; se trató el shock hipovolémico y fue operada de urgencia. Se le realizó la osteosíntesis interna con láminas AO auto compresivas. Posterior al tratamiento quirúrgico, tuvo varias complicaciones que fueron tratadas de forma oportuna y adecuada. La paciente evolucionó satisfactoriamente, con solo una discrepancia de longitud de 2 cm del miembro inferior derecho en relación con el izquierdo(AU)

ABSTRACT Automobile accidents, such as high-energy trauma, produce multiple injuries. The purpose of this paper is to describe the behavior and evolution of a 21-year-old patient who, when traveling as a passenger on a motorized bicycle, was hit by a car and projected more than 20 m away. He arrived at Dr. Carlos J. Finlay Central Military Hospital in an acute state of hypovolemic shock, with large deformities in both lower limbs. There were 13 fractures; hypovolemic shock was treated and he was operated on urgently. Internal osteosynthesis was performed with self-compressive AO sheets. After surgical treatment, he had several complications that were treated in a timely and properly. The patient evolved satisfactorily, with only a discrepancy of length of 2 cm of the right lower limb in relation to the left(AU)

RÉSUMÉ Les accidents de la circulation, impliquant des traumatismes à haute énergie, provoquent des lésions multiples. Le but de ce travail est de décrire le procédé suivi et l'évolution d'une patiente âgée de 21 ans ayant été heurtée par une voiture et projetée à une distance de plus de 20 mètres, quand elle voyageait à bicyclette à moteur comme accompagnatrice. Elle est arrivée à l'hôpital militaire «Dr. Carlos J. Finlay¼ en état de choc hypovolémique aigu et souffrant de grands traumatismes au niveau des membres inférieurs. Treize fractures ont été constatées; la patiente a été prise en charge pour le choc hypovolémique et opérée en urgence. Le geste chirurgical a consisté à une ostéosynthèse interne par plaques auto-compressives AO. Après l'intervention, les complications survenues ont été convenablement corrigées. L'évolution de la patiente a été satisfaisante, sauf une disparité de 2 cm de longueur du membre inférieur droit par rapport au gauche(AU)

Multiple vertebral fractures at the "dr. manuel dufoo" spine clinic / Fraturas vertebrais múltiplas na clínica de coluna "dr. manuel dufoo" / Fracturas vertebrales múltiples en la clínica de columna "dr. manuel dufoo"

ABSTRACT Objective: To establish the frequency of presentation of multiple vertebral fractures and evaluate the relationship between the postsurgical condition and the initial neurological lesion, as well as to report the associated injuries in this group of patients. Methods: We conducted a review of patients with spinal trauma and a diagnosis of multiple vertebral fractures who were admitted to the "Dr. Manuel Dufoo Olvera" Spine Clinic of the Secretary of Health of Mexico City from January 1,2014 to June 30, 2017. The multiple fractures were classified as either contiguous or non-contiguous, according to the number of vertebral bodies and levels affected. The statistical analysis was conducted using formulas of descriptive statistics and the information was then tabulated and graphed to assess the relationship between the anatomical classification and the degree of neurological injury. Results: We observed 530 patients, of whom 47 met the criteria. Thirty-one (65.95%) of the cases corresponded to contiguous fractures and 16 cases (34.05%) to non-contiguous fractures. Fourteen patients (29.78%) with neurological integrity were classified as ASIA D, 20 patients (42.58%) with complete lesion as ASIA A, 7 seven patients (14.89%) as ASIA B, and 6 patients (12.76%) with partial injury as ASIA C. Conclusions: The correlation between the classification of vertebral injuries and the presence of neurological lesion did not show significant differences between contiguous and non-contiguous fractures. Level of Evidence II; Retrospective.

RESUMO Objetivos: Estabelecer a frequência de apresentação de múltiplas fraturas vertebrais e avaliar a relação de sua condição pós-cirúrgica e a lesão neurológica inicial, bem como relatar as lesões associadas neste grupo de pacientes. Métodos: Uma revisão dos casos com traumatismo espinhal e diagnóstico de fratura vertebral múltipla, que entraram no Spine Clinic " Dr Manuel Dufoo Olvera " Secretário da Cidade do México saúde da coluna vertebral, durante o período de 1 de janeiro de 2014 a 30 de Junho de 2017. A classificação divide fraturas múltiplas como contíguas e não contíguas, seguido pelo número de pessoas afetadas e os corpos de nível. A análise estatística foi realizada utilizando fórmulas statística descritivas, então tabuladas e as informações representadas graficamente. Para avaliar a relação entre a classificação anatômica e do grau de lesão neurológica. Resultados: 530 Pacientes foram observados, dos quais 47 apresentaram os critérios necessários. 31 pacientes (65,95%) do estudo foram classificados com fraturas adjacentes contíguas e 16 casos (34,05%) como não contíguas. 14 doentes (29,78%) foram classificados com integridade neurológica ÁSIA D, 20 doentes (42,58%) apresentaram lesão completa ÁSIA A, sete doentes (14,89%) na ASIA B e seis doentes. (12,76%) com lesão incompleta ÁSIA C. Conclusão: A correlação entre a classificação das lesões da coluna vertebral e a presença de lesão neurológica não mostraram diferenças significativas entre fraturas adjacentes e não adjacentes. Nível de Evidência II; Restrospectivo.

RESUMEN Objetivo: Establecer la frecuencia de presentación de las fracturas vertebrales múltiples y evaluar la relación de su condición postquirúrgica y la lesión neurológica inicial, así como relatar las lesiones asociadas en este grupo de pacientes. Métodos: Se realiza una revisión de los casos con traumatismo raquimedular y diagnóstico de fractura vertebral múltiple que ingresaron a la Clínica de Columna "Dr. Manuel Dufoo Olvera" de la Secretaría de Salud de Ciudad de México del 1° de enero de 2014 al 30 de junio del 2017. La clasificación divide las fracturas múltiples como contiguas y no contiguas, acorde al número de cuerpos afectados y el nivel.. El análisis estadístico se realizó utilizando fórmulas de estadística descriptiva, para después tabular y graficar la información, para evaluar la relación entre la clasificación anatómica y el grado de lesión neurológica. Resultados: Fueron observados 530 pacientes, de los cuales 47 presentaron los criterios necesarios. Treinta y un pacientes (65,95%) del estudio fueron clasificados con fracturas contiguas y 16 casos (34,05%) con no contiguas. Catorce pacientes (29,78%) fueron clasificados con integridad neurológica ASIA D, 20 pacientes (42,58%) presentaron lesión completa ASIA A, siete pacientes (14,89%) en ASIA B y seis pacientes (12,76%) con lesión incompleta ASIA C. Conclusiones: La correlación entre la clasificación de lesión de columna vertebral y la presencia de lesión neurológica no mostró diferencias significativas entre fracturas contiguas y no contiguas. Nivel de Evidencia II; Retrospectivo.

A retrospective study of mandibular fractures in children

OBJECTIVES: The incidence and patterns of mandibular fractures vary by country and population age. This retrospective study evaluated the etiologies and patterns of mandibular fractures in children. MATERIALS AND METHODS: The clinical records of 89 children (45 males and 44 females) aged 0 to 12 years who presented with mandibular fractures from July 2012 to June 2016 were retrospectively reviewed. The sex, patient age, site of fracture, etiology of trauma, and monthly variations of the fractures were recorded. Descriptive statistics, the z-test and chi-square test were used for statistical analysis and the P-value was set at < 0.05. RESULTS: Eighty-nine children (male-to-female ratio 1.02:1) sustained 131 mandibular fractures. Within the study sample, the 6 to 9 year age group most frequently experienced fractures (47.3%). Falls and road traffic accidents (RTA) were the two most common etiological factors that accounted for 44.9% and 24.7% of cases. The condylar fracture was the most common anatomical location (38.9%) followed by the angle (20.6%), parasymphysis (18.3%), body (15.3%), and symphysis (5.3%). A single fracture (51.7%) was more common than multiple fractures (48.3%). The month-wise distribution of mandibular fractures was fairly constant. CONCLUSION: The condylar region was the most common anatomic site for fractures; in addition, a fall and RTA were the major etiological factors for mandibular fractures. A single fracture was observed in 51.7% of patients while multiple fracture lines accounted for 48.3% of cases.

Usefulness of indirect open reduction via a transconjunctival approach for the treatment of nasal bone fracture associated with orbital blowout fracture

BACKGROUND: Nasal fracture and orbital blowout fracture often occur concurrently in cases of midface blunt trauma. Generally, these multiple fractures treatment is surgery, and typically, the nasal bone and orbit are operated on separately. However, we have found that utilizing a transconjunctival approach in patients with concurrent nasal bone fracture and orbital blowout fracture is a useful method. METHODS: The participants in the present study included 33 patients who visited the Plastic Surgery outpatient department between March 2014 and March 2017 and underwent surgery for nasal fracture and orbital blowout fracture. We assessed patients’ and doctors’ satisfaction with surgical outcomes after indirect open reduction via a transconjunctival approach for the treatment of nasal bone fracture with associated orbital blowout fracture. RESULTS: According to the satisfaction scores, both patients and doctors were satisfied with transconjunctival approach. CONCLUSION: We presented here that our method enables simultaneous operation of nasal fracture accompanied by orbital blowout fracture, rather than treating the two fractures separately, and it allows precise reduction of the nasal fracture by direct visualization of the fracture site without any additional incisions or difficult surgical techniques. Also, by preventing the use of excessive force during reduction, this method can minimize damage to the nasal mucosa, thereby reducing the incidence of nasal bleeding.

A Case of Orbital Apex Syndrome with Central Retinal Artery and Vein Occlusion Following Trauma

PURPOSE: To report a case of orbital apex syndrome (OAS) combined with central retinal artery occlusion (CRAO) and central retinal vein occlusion (CRVO) following blunt trauma. CASE SUMMARY: A 4-year-old female visited the hospital following a traffic accident. She was admitted because of multiple fractures of the skull and pneumocephalus. On day 5, she was referred to us with decreased visual acuity in her right eye. Her initial visual acuity was hand motions in the right eye and 0.8 in the left eye. The right eye showed a dilated pupil, ptosis, and total ophthalmoplegia, and the left eye showed limited abduction. A fundus examination revealed multiple retinal hemorrhages, tortuous veins, and an edematous white retina with a cherry-red spot in the right eye. Brain magnetic resonance imaging revealed an entrapped right optic nerve because of bony fragments in the orbital apex. The patient was diagnosed with OAS accompanied by CRAO and CRVO in the right eye, and with traumatic abducens nerve palsy in the left eye. After 6 months, the visual acuity was hand motions, and the fundus examination showed absorbed retinal hemorrhages, pale discs, and general retinal thinning of the right eye. Ptosis of the right eye and extraocular muscle movement of both eyes were improved. CONCLUSIONS: Combined CRAO and CRVO following trauma is very rare and is even more rarely associated with OAS. It is important for clinicians to be aware of the potential for central retinal vessel occlusions and OAS in cases of blunt ocular trauma.

Takotsubo Syndrome Resulting from Traumatic Multiple Rib Fractures

Takotsubo syndrome, also known as stress-induced cardiomyopathy, is a transient cardiac syndrome that mimics acute coronary syndrome. This condition should be suspected if the patient presents with chest pain after intense emotional stress, accompanied by an abnormal electrocardiogram, elevated levels of myocardial enzymes, and left ventricular apical akinesia on echocardiography. Coronary angiography should be performed for prompt differentiation from ischemic heart disease. A 77-year-old female presented with traumatic multiple fractures of the left sixth and seventh ribs resulting from a violent strike. Clinical findings of physical examination, laboratory tests, electrocardiogram, and coronary angiography provided the diagnosis of Takotsubo syndrome. We performed conservative management including pain control, and the patient was uneventfully discharged seven days after admission.

Perfil Epidemiológico dos Pacientes com Fraturas / Epidemiological Profile of Patients with Fracture

Introdução: Os acidentes motociclísticos estão entre as causas mais frequentes de traumatismos faciais. O fato de a motocicleta ser um veículo leve e de fácil condução e o descumprimento à legislação atual contribuem para o aumento da incidência e da gravidade dessas fraturas. Metodologia: Foram entrevistados 123 pacientes, momento em que foram colhidas as seguintes variáveis: Dependentes: Faixa etária, gênero, local de procedência, uso de capacete, se havia ingerido bebida alcoólica antes do acidente, se possuia habilitação para motocicleta, ossos faciais fraturados e lesões em outras áreas do corpo. As fraturas faciais bem como as fraturas em outras áreas do corpo foram diagnosticadas após exame clínico e imaginológico. Resultados: Houve uma predominância de indivíduos do gênero masculino (85,4%) e de pacientes provenientes de cidades do interior do estado do Ceará (61,8%). Fraturas múltiplas da face ocorreram em 49,6% dos pacientes pesquisados. A maioria dos pacientes não utilizavam capacetes ou não possuíam habilitação (75,6% e 73,2%, respectivamente.), e 38,2% haviam ingerido bebida alcoólica antes do acidente. Foi observado ainda que 20.3% dos pacientes apresentavam fraturas em outros ossos do corpo que não a face. Conclusão: Observa-se que os acidentes motociclísticos correspondem a uma grande parcela das fraturas faciais e que a maior parte desses acidentes estão associados ao descumprimento da legislação... (AU)

Introduction: motorcycle accidents are among the most common causes of facial trauma. The fact that the motorcycle be a light vehicle and within easy driving and breach the current legislation contribute to the increased incidence and severity of these fractures. Methodology: We interviewed 123 patients, at which the following variables were collected: Dependents: age range, gender, place of origin, helmet use, if had been drinking before the accident, it has qualified for motorcycle, fractured facial bones and lesions in other areas of the body. Facial fractures and fractures in other areas of the body were diagnosed after clinical examination and imaginologic. Results: There was a predominance of male (85.4%) and patients from cities in the state of Ceará (61.8%). Multiple facial fractures occurred in 49.6% of patients surveyed. Most patients did not use helmets or had no qualifications (75.6% and 73.2% respectively.) And 38.2% had been drinking before the accident. It was also observed that 20.3% of patients had fractures in other bones of the body other than the face. Conclusion: It is observed that motorcycle accidents account for a large portion of facial fractures and that most of these accidents are associated with the breach of the legislation... (AU)

Delayed Death Due to Aortic Laceration after Chest Blunt Trauma: An Autopsy Case / 대한법의학회지

A traumatic aortic injury due to blunt chest trauma is well recognized. However, a delayed death due to an aortic laceration after blunt chest trauma is very rare. A 49-year-old man arrived at the emergency room after falling from a height of approximately 4 m. Upon radiological examination, multiple fractures to his left ribs with a hemopneumothorax on his left side were found. After undergoing a closed thoracostomy, he was admitted to the general ward due to his vital signs being stable. After 13 hours from his admission, he complained of chest discomfort with the sudden development of massive blood drainage through his chest tube. A cardiopulmonary resuscitation was performed, where the patient then died and an autopsy was performed 36 hours after his death. On internal examination, a small laceration of the descending aorta with irritation of the tunica adventitia was revealed. Given the findings of an additional histological examination and the aforementioned findings, the author thought that the fractured fragments of the posterior ribs had irritated the tunica adventitia of the adjacent descending aorta for some time after the chest trauma and that a perforation had finally occurred. The author here reports a case of a delayed death due to an aortic laceration after a blunt chest trauma with the patient's clinical information and full autopsy findings.

Whole Body Bone Scan for Detecting Missed Bone Injuries in Multiple Trauma Patients

PURPOSE: Patients with multiple traumas often experience multiple fractures that are missed or overlooked, despite the use of imaging, careful history taking, and physical examinations. This study aimed to evaluate the usefulness of whole body bone scan (WBBS) for detecting missed bone injuries in patients with multiple traumas. METHODS: We evaluated 30 patients with multiple traumas who underwent WBBS at single tertiary referral center between March 2008 and February 2016. We assessed the association of patient demographics with WBBS uptake as a binomial outcome variable. RESULTS: There were no significant differences in patient demographics by WBBS. The mean injury severity score did not differ by WBBS (18.1 in the WBBS-negative group vs. 18.4 in the WBBS-positive group), and duration from admission to the evaluation of the WBBS was similar (5.4 days in both groups). The most common uptake site in the WBBS was the ribs (n=7), followed by the tibia (n=3), skull (n=2), ankle (n=1), and sternum (n=1). None of the missed injuries required further treatment, such as manual reduction or surgery. CONCLUSION: WBBS was useful for detecting missed bone injuries in patients with multiple trauma.

Surgical Treatment of Metacarpal and Phalangeal Fracture with Rotational Malalignment

PURPOSE: Hand fractures can be treated conservatively in many cases, but rotation malalignment is one of the important indications for surgical treatment because of dysfunction. We performed open reduction and internal fixation in these malalignment fractures and report clinical and radiological results. METHODS: This study included 28 patients (18 male, 10 female) who had metacarpal and phalangeal fractures with rotational malalignment of finger on initial examination. Patients with combined injuries including open soft tissue damage or multiple fractures were excluded. Mean age was 36.1 years and average follow-up period was 14.6 months. Perioperative extent of rotation and correction during the follow-up, union on the radiographs, Range of motion, disability of the arm, shoulder and hand (DASH) score, and pinch power at the last follow-up were evaluated. RESULTS: Average corrected angulation of rotation was 11.9° and no patient showed scissoring appearance of fingers at the last follow-up. All patients showed solid bony union on the radiographs during the follow-up. The average of total active motion of the injured fingers were average 254°, average DASH score was 3.2 and average pinch power was 3.0 kg at the last follow-up. CONCLUSION: Clinical and radiologically satisfactory results were obtained in all patients. Care should be taken not to overlook the rotational misalignment after fracture of the hand, and surgical treatment should be considered to ensure correct reduction and fixation.

Concurrent Surgery of Craniectomy and Splenectomy as Initial Treatment in Severe Traumatic Head Injury: A Case Report / 대한신경손상학회지

It is not a common case for neurosurgery department and the other departments to perform joint operation at the same time. Patients with severe head injury are a condition in which vital signs are unstable due to severe brain swelling and increased intracranial pressure, and emergency surgery is required. A 44-year-old man visited the trauma center with a motorcycle accident. The Glasgow Coma Scale score at the time of emergency department was 3 points, and the pupil was fixed at 6 mm on both sides. His medical history was unknown. His vital signs including blood pressure (BP), heart rate, respiratory rate and oxygen saturation were stable. Associated injuries included multiple fractures of whole body. Brain computed tomography revealed subarachnoid hemorrhage, intraventricular hemorrhage and severe cerebral edema. During the preparation of the craniectomy, abdominal ultrasonography performed because of decreased BP resulted in a large amount of hemoperitoneum. The bi-coronal craniectomy and splenectomy were performed simultaneously for about 4 hours. After fifty days of treatment, he was discharged with Glasgow Outcome Scale-extended 4 points and is undergoing rehabilitation. In severe polytrauma patients, active concurrent surgery is a good method to save their lives.