Implementation of a new Single-Pass Whole-Body Computed Tomography Protocol: Is it safe, effective and efficient in patients with severe trauma? / Implementación de un nuevo protocolo de Tomografía Computarizada Corporal Total de un solo pase: ¿Es seguro, efectivo y eficiente en pacientes con trauma severo?

Abstract Purpose: The objective of this study was to evaluate the implementation of a new single-pass whole-body computed tomography Protocol in the management of patients with severe trauma. Methods: This was a descriptive evaluation of polytrauma patients who underwent whole-body computed tomography. Patients were divided into three groups: 1. Blunt trauma hemodynamically stable 2. Blunt trauma hemodynamically unstable and 3. Penetrating trauma. Demographics, whole-body computed tomography parameters and outcome variables were evaluated. Results: Were included 263 patients. Median injury severity score was 22 (IQR: 16-22). Time between arrival to the emergency department and completing the whole-body computed tomography was under 30 minutes in most patients [Group 1: 28 minutes (IQR: 14-55), Group 2: 29 minutes (IQR: 16-57), and Group 3: 31 minutes (IQR: 13-50; p= 0.96)]. 172 patients (65.4%) underwent non-operative management. The calculated and the real survival rates did not vary among the groups either [Group 1: TRISS 86.4% vs. real survival rate 85% (p= 0.69); Group 2: TRISS 69% vs. real survival rate 74% (p= 0.25); Group 3: TRISS 93% vs. real survival rate 87% (p= 0.07)]. Conclusion: This new single-pass whole-body computed tomography protocol was safe, effective and efficient to decide whether the patient with severe trauma requires a surgical intervention independently of the mechanism of injury or the hemodynamic stability of the patient. Its use could also potentially reduce the rate of unnecessary surgical interventions of patients with severe trauma including those with penetrating trauma.

Resumen Introducción: El objetivo de este estudio fue evaluar la implementación de un nuevo protocolo de tomografía computarizada corporal total para el manejo de pacientes con trauma severo. Métodos: Este estudio es una evaluación descriptiva de pacientes que recibieron tomografía computarizada corporal total. Los pacientes fueron divididos en 3 grupos: 1. Trauma cerrado hemodinámicamente estables, 2. Trauma cerrado hemodinámicamente inestables y 3. Trauma penetrante. Se evaluaron las características demográficas, parámetros relacionados con la técnica y los desenlaces de los pacientes. Resultados: Se incluyeron 263 pacientes. La mediana del puntaje de severidad de la lesión fue 22 (RIQ: 16-22). El tiempo entre el ingreso a urgencias y completar la tomografía corporal total fue menor a 30 minutos en la mayoría de pacientes [Grupo 1: 28 minutos (RIQ: 14-55), Grupo 2: 29 minutos (RIQ: 16-57), y Grupo 3: 31 minutos (RIQ: 13-50; p= 0.96). 172 pacientes (65.4%) recibieron manejo no operatorio. Las tasas de supervivencia calculadas y reales no difirieron entre ninguno de los grupos [Grupo 1: TRISS 86.4% vs. Tasa real de supervivencia 85% (p= 0.69); Grupo 2: TRISS 69% vs. Tasa real de supervivencia 74% (p= 0.25); Grupo 3: TRISS 93% vs. Tasa real de supervivencia 87% (p= 0.07)]. Conclusión: Este nuevo protocolo de tomografía corporal total de un solo pase fue seguro, efectivo y eficiente para definir si los pacientes con trauma severo requieren o no una intervención quirúrgica. Su uso podría reducir la tasa de intervenciones quirúrgicas innecesarias en estos pacientes incluyendo los que se presentan con trauma penetrante.

Surgical Management of Ipsilateral Fracture of the Femur and Tibia in Adults (the Floating Knee): Postoperative Clinical, Radiological, and Functional Outcomes

BACKGROUND: This study evaluated the outcomes of surgical management of ipsilateral femoral and tibial fractures in adults. METHODS: Fifteen patients (13 men, 2 women; mean age, 34.8 years; range, 18 to 65 years) were enrolled in this study. The fractures types were classified according to the classification by Fraser et al. as follows: type I (5), type IIa (3), IIb (4), IIc (3). Femur fractures were treated using locked intramedullary nails, plate-screws, or dynamic condylar screws, and tibia fractures were treated with an external fixator (in open fractures), or plate-screws, and locked intramedullary nailing. The mean follow-up duration was 2.2 years (range, 1.3 to 4 years). RESULTS: The extent of bony union according to the Karlstrom criteria was as follows: excellent, 8; good, 4; acceptable, 2; poor, 1. CONCLUSIONS: The associated injuries and type of fracture (open, intra-articular, comminution) are prognostic factors in a floating knee. The best management of the associated injuries for good final outcome involves intramedullary nailing of both the fractures and postoperative rehabilitation.

Accurate determination of wound depth with ultrasound and its forensic significance / 法医学杂志

Accurate determination of the wound depth has long been a difficult task in forensic medicine due to lack of technology. Nowadays, the depth of the wound can be accurately determined by using high frequency 2-D ultrasound and Color Doppler Flow Imaging (CDFI). Two typical cases with ultrasonic images were reported to show the importance of ultrasound technology in forensic medicine. The new technology provides scientific evidence of the injury assessment.

Method selection from medical imaging examinations in evaluation of pelvic injury in forensic medicine / 法医学杂志

OBJECTIVE@#To table a proposal for select using the medical imaging methods to evaluate pelvic injury in forensic field, by studying the structure of pelvis and radiological methods in common use.@*METHODS@#A study of several cases of pelvic injury was done, in which biomechanics and classification of pelvic injury were analyzed, moreover imaging methods were compared with each other, such as fluoroscopy, X-ray photography, computerized tomography (CT) and so on.@*RESULTS@#Four cases of pelvic injury are all multiple injuries, confirmed by X-ray photography and CT examination approvingly.@*CONCLUSIONS@#Authors advocate that pelvic injury mechanism and biomechanics should be considered accordingly, multiple injuries should be attracted notice, so as to select suitable imaging methods to evaluate pelvic injury exactly.

An unusual case of a retained metallic arrowhead in the orbit and sphenoidal sinus.

A case of retained metallic arrowhead in orbit and sphenoidal sinus through an unusual route is reported. The eyeball was removed because of a possible risk of sympathetic ophthalmia.

Plastic deformation of forearm.

The unusual occurrence of plastic deformation in an adult is described.

Isolated Fractures of the Greater Trochanter Report of 6 Cases

Isolated fractures of the greater trochanter are unusual injuries. Because of their relative rarity and the unsettled controversy regarding their etiology and pathogenesis, several methods of treatment have been advocated. Furthermore, the reports on this particular type of injury are not plentiful and the average textook coverage afforded to this entiry is limited. These fractures are seen as two distinctly different types which occur in different age groups. The first type are epiphyseal separations which are found in the adolescent population, ususlly from seven to seventeen years of age. In this type, the mechanism of injury is muscle contraction that results in avulsion of the entire trochanteric apophysis and it can be displaced up to 6 cm. The second type is a comminuted fracture of the greater trochanter seen in adults. In this type, the mechanism of injury is usually a direct blow to the greater trochanter that results in a comminuted fracture, and only a part of the greater trochanter is generally involved.