Heel flap injuries in spoke wheel accidents.

AIM: To compare and discuss motorcycle and bicycle spoke heel flap injuries and also to discuss the pathomechanics and treatment modalities of spoke wheel injuries. METHODS: The study comprises 42 heel flap injuries patients who were selected from amongst 216 cases of lower extremity trauma. The injuries were graded into three classes: I-III, depending upon the severity and extent of the injury. The management was based on this classification. Posterior heel injuries were covered with various flaps depending upon the defect size, its exact location, associated injuries, extent of zone of trauma, and complexity of the defect. RESULTS: Eighty percent of the injuries were confined to the right side because of the existence of the chain guard on the left side of the two-wheeler. Inadequate footwear was a contributory factor. 57% of the cases were caused by motorcycle. The healing time was prolonged in motorcycle spoke injuries. No fracture was noted. Severity of injury in motorcycle was due to high momentum and rigidity of spokes. CONCLUSION: Since the first report of bicycle spoke injuries, presented a half century ago, prevention has not improved. Protective footwear should be made compulsory. Changes should also be made in the design of the rear wheel of motorcycle.

Nutrition in burns: need for an aggressive dynamic approach.

INTRODUCTION: Extensive burns elicit a pronounced metabolic response causing physiological derangements leading to the hyper-metabolic state. The hyper-metabolic response is accompanied by severe catabolism and a loss of lean body mass and also by a progressive decline of host defenses that impairs the immunological response. AIMS: A study was conducted in our hospital to assess various aspects of nutritional management of burns considering the ground realities of general hospital. The main aim of the study was to assess the use of early naso-gastric tube insertion, charting out daily calorie intake and to appropriately decrease the deficit with use of low cost feeds taking in to consideration the local dietary habits. MATERIALS AND METHODS: A total 138 cases were studied prospectively during April 2003 to March 2005, which were compared with 206 controls taken retrospectively from April 2000 to March 2003. The cases and controls were compared regarding the mortality rate, average days of stay and number of procedure done after dividing them in to various categories (%Burns) using the Z-test and student t-test. DISCUSSION AND CONCLUSION: The use of early naso-gastric tube insertion, charting out daily calorie intake and using low cost feeds consistent with local dietary habits lead to a significant decrease in average number of days and the number of procedures in 20-39% TBSA burns; and caused the significant decrease in mortality, average number of days and the number of procedure in 40-59%TBSA burns.