Science topic

Trauma Surgery - Science topic

Explore the latest questions and answers in Trauma Surgery, and find Trauma Surgery experts.
Questions related to Trauma Surgery
  • asked a question related to Trauma Surgery
Question
152 answers
Accidents involving motorcycles are responsible for over 50% of open fractures of the tibia and can be associated with other lesions and the victims, in the vast majority, are youth and young adult (Brazil epidemiological data). What preventive measures could be taken to reduce this type of accident?
Relevant answer
Answer
Dear Dr. Nelson Elias ,
I suggest you to have a look at the following, interesting reference:
- Motorcycle Safety
My best regards, Amir Beketov.
  • asked a question related to Trauma Surgery
Question
10 answers
In our practice, an estimated bullet trajectory is almost always used as a guide to intro-abdominal injuries during management of abdominal gunshot patients. While it seems logical to expect that the bullet would have damaged all structures that came in its path, what are the global practices of using an estimated trajectory when in the present era there are increasing trends of selective non operative management of gunshot patients based on objective clinical and diagnostic findings?
Relevant answer
Answer
= I treated a 7 yr old boy whose injury resulted from a .30 Cal deformed solid point which ricocheted from a granite wall. It penetrated his khaki trouser, scrotal skin and dartos muscle and located itself in the right testicular sac.
= Another case of a .22 Cal. solid point bullet ricochet on lagoon water fired from 500 yards on a 9 yr old. It penetrated her dress, anterior midline abdominal wall and was found sitting on top of her omentum,
= Another case was a .22 Cal ricocheted solid point bullet through the right flank of a 17 year old to lodge in his liver, right lobe. He developed and died of gas gangrene.
= Dr. Ordog, do you have studies on injuries of spent, ricocheted bullets?
  • asked a question related to Trauma Surgery
Question
7 answers
20/f with loss of vision for 4 year in left eye. Cataractouts lens and 360 degree posterior synaechie. No h/o ocular trauma and surgery. Ultrasound so this high echoiec calcified mass without central halo in front of optic disc. What it could be? How should we proceed?
Relevant answer
Answer
a diagnostic cataractous lens extraction without iol is a possibility intially....then do an ido on table. but do rule out neovascularisation of the anterior segment before any procedure.
  • asked a question related to Trauma Surgery
Question
3 answers
If i am doing a prospective randomised study on fracture pt and i have selected 90 patients and i have to divide them into 3 groups. But the patients will be recruited as they will come to the clinci over a period of time. How will i ensure randomisation and equal number of 30 in 3 groups?
fracture pt will be divided into 3 groups
Relevant answer
Answer
I would recommend “block randomization“ as the easiest way with blocks of 6 or 9 people if you don’t have to consider confounders. If you want one or more variables to be equally distributed in three group, ” stratified randomization“ is a better option if baseline characteristics of all subjects are available before allocation. Please see the reference linked below. It contains links to useful online software for randomination.
  • asked a question related to Trauma Surgery
Question
3 answers
Inflammatory mediators promote insulin resistance, suggesting perhaps that critical care patients may exhibit hyperinsulinemia. However, I have great difficulty finding an article referring to serum insulin levels (there is an overabundance of publications on hyperglycaemia and insulin resistance but not insulin).
I would very much appreciate it if anyone can refer me to a manuscript making reference on insulin levels in any severe inflammatory setting (burns, sepsis, trauma, and surgery… any context where a strong inflammatory response is solicited).
Note: hyperglycaemia is often treated with intensive insulin therapy –it would be super if the study refer to untreated patients.
Relevant answer
Answer
Hi Ian, many thanks!
Honestly, I was absolutely smitten as why I could not find any reference to serum insulin levels. However, that there is in fact not many publications on this topic is even stranger though...
In any case, articles definitely seem relevant. Will most certainly have a closer look -thanks!
  • asked a question related to Trauma Surgery
Question
14 answers
A 35 year old female presented to the outpatient ENT clinic in AL-Hussein teaching hospital/Samawah city with painless swelling over the posterior aspect of the right auricle 2 years ago, the swelling is gradually increasing in size. There is no history of previous trauma or surgery.
   The mass is non tender, oval in shape, measured 5ₓ 3 cm. in dimeters, freely mobile, fluctuant and the skin overlying it is warm on touch and there is an increased in its vascularity. There is no scar and no changes over the skin surrounding the swelling. The swelling is neither pulsatile nor compressible.
   The mass was excised under general anaesthesia and sent for histopathological examination and we are waiting for the result of the pathological evaluation. Grossly the mass is an oval in shape, 5ₓ 3 cm in dimeters, when excise part of it, its cavity  contains a blood with a thick wall but the cavity contains no hair.
What is the differential diagnosis of this swelling?
Thank you in advance for your valuable response.
Best regards
Raid
Relevant answer
Answer
It is an infected schwannoma. No recurrence is expected.
  • asked a question related to Trauma Surgery
Question
5 answers
Ultrasound has been used for different functions, what is its role in the diagnosis, evaluation and evolution of intra-abdominal hypertension?
Relevant answer
Answer
I have not seen such report yet. however, several parameters may be helpful such as distension of inferior vena cava, need exclusion of volume depletion.  
  • asked a question related to Trauma Surgery
Question
10 answers
What are the current indications for the use of Diagnostic Peritoneal Lavage (DPL) in abdominal trauma patients?
ATLS 
Relevant answer
Answer
In the last twenty years in our emergency  hospital  we have performed only less than five DLP, I think. This extremely low number is explained because we have routinely performing FAST in the emergency department to all patients admitted with blunt  or open abdominal trauma. In some cases, when the diagnosis was uncertain we performed abdominal puncture under US guidance. Hemodinamic stable patients, in the last years, were referred to the CT scan for a thoroughly abdominal exam.
  • asked a question related to Trauma Surgery
Question
13 answers
We had a 23 years old who had a gunshot injury in the right 3rd space 2 hours ago. A right chest tube was inserted and it drained 250 cc blood with complete lung expansion. ECG and cardiac enzymes were normal. Echo was performed which showed a mild hemopericardium with no tamponade. CT Chest showed a right sided lung contusion with mild pericardial collection and the bullet in the subcaribal region. He was monitored in ICU on IV fluids, Tramal 50 mg TID and perfalgan 1gm QID. Patient was fully conscious initially and remained same for 8 hours then started to be agitated. He was ventilated electively due to CO2 retension 9 hours after trauma because of respiratory acidosis. F UP ECHO showed mild rim of pericardial effusion with no tamponade. F UP CT showed the same CT findings presented earlier. Patient was kept ventilated for 3 days on no inotropes. Suddenly he became severely agiatated again on ventilator with good blood gases. He arrested for 40 minutes despite good CPR. An urgent subxiphoid drainage window was performed and drained only 50cc. ECG regained again for 2-3 minutes then arrested again and he was declared dead. Where was the problem? What we missed in the management? What are the possible causes of death?
Relevant answer
Answer
Sorry do you mean subcarinal? 
Could this patient have had embolism and the culprit being cerebral rather than cardiopulmonary? The fact of good blood gases and no tamponade suggests this.
it would be interesting what the autopsy would reveal.
  • asked a question related to Trauma Surgery
Question
3 answers
Mid aged man presents with 1.5m steel rod penetrating through the skull up to the genitals and beyond attracting all major specialities in one surgical table~ Neuro-Stomatology- ENT-Thoracic-Cardio-General-Uro-Ortho-
Relevant answer
Answer
Did the patient arrive alive to the trauma bay? If yes, I would apply the ATLS premise that you treat first what would kill faster.
it doesn't look like his major vessels were affected. He will likely have neurological sequela since it looks like his frontal lobe was damaged.
Please let us know how it went.
Best regards,
Alice Gallo
  • asked a question related to Trauma Surgery
Question
12 answers
If i encounter a case of gunshot with a foreign body in the chest  and the patient is stale after chest tube drainage shall i remove the bullet?
Relevant answer
Answer
This problem was studied extensively during and after WWII.  Still, if there is no specific complication, e.g., hemoptysis, bronchial obstruction, infection, it may be left alone and simply observed over the years.  Certainly, I would not operate shortly after the chest tubes were removed, assuming none of the above complications.
  • asked a question related to Trauma Surgery
Question
4 answers
Any specific treatments to avoid other than stressing the plantarflexors until 6 weeks?  Everything I have read has said to focus on ROM to patient tolerance and to WB in a boot until the 6 week mark.  I am currently following the protocol for the Strayer method listed in this attachment.  Any input would be helpful, thanks.
Relevant answer
Answer
What you are describing Is safe, as the goal is to protect the surgical wounds aand repairs. The mobilisation of the ankle is correctly started about 15-21 days after surgery. removal of protective boot can be done about 6 weeks post op.
  • asked a question related to Trauma Surgery
Question
10 answers
ATLS(R)'s providor manual states its at the junction of medial and middle thirds of clavicle so does medscape.
whereas the just in time video for the same program states its the junction of lateral 1/3 and medial 2/3 of clavicle.
Does anyone knows any new guidelines ?
Relevant answer
Answer
Dear Komet Thongkhao,
Please use ultrasound guide insertion from the outset for avoiding "failed blind puntures" ... it is easy to learn and handle 
If you see an obstruction/obliteration (following former punctions , infection, thrombosis,..) of the subclavian vein ... you will smile - doing no "blind puncture" - and you will switch to ultrasound guide insertion of internal jugular vein or the opposite side.
We see and expect increasing difficulties because of chemotherapies, port catheter systems, i.e.. 
  • asked a question related to Trauma Surgery
Question
1 answer
The continued mechanical stress caused by the chronic presence of a relatively high fill volume is at least a cause of interstitial remodeling and therefore contributes to the burden of inflammation.
In each exchange, the tissues bordering the peritoneal cavity are exposed to a mechanical stress of 2 kg. Do the mass to calculate the mechanical stress over the peritoneum in one year! 
Relevant answer
Answer
We are working on it
  • asked a question related to Trauma Surgery
Question
17 answers
Male patient, 46y motorcycle accident. Cardiac arrest at the scene for 5 min. Whole body CT with thoracic trauma only. Flail chest from 2nd to 7th left ribs(CT attached). Eco: normal. 5th day after trauma still in the ventilator. Fever from a probable pulmonar infection. Had an air leak until day 3, now there is no air leak. Would you perform an titanium plate (I'd use the MatrixRib system) fixation procedure in this case? Can we put those plates in patients with systemic infection?
Relevant answer
Answer
I would prefer to avoid the prosthetic material in already infected patient.
  • asked a question related to Trauma Surgery
Question
5 answers
We recently have evaluated a 60 years old male who was victim of 
Relevant answer
Answer
You are most welcome, Sir
  • asked a question related to Trauma Surgery
Question
9 answers
If you prefer operative treatment, do you use plating, external fixation or primary arthrodesis? Is there an indication for non-operative care?
Relevant answer
Answer
'Span - scan - plan' summarises the treatment of a severe pilon fracture.
Span
Soft tissues settle much better in a temporary ankle spanning external fixator than in a plaster cast, and this helps maintain length.  This is combined with the initial wound debridement if the patient has an open fracture.  I try to encourage all my colleagues to get a patient into a fixator within 24 hours of the injury.  Access to theatres in the evening in our hospital is very poor - almost always this is done on the trauma list the next day.  It makes it much easier to watch the soft tissues once the leg is 'safe' in a fixator, and it means that the CT scan is performed on a fracture that is provisionally reduced.
Scan
CT scan determines the surgical approach for articular reduction, and surgical planning - 1 incision / 2 incisions.  For me, the most important CT image is the axial cut just above the ankle joint.  Often there is an anteromedial or anterolateral fracture line that can be opened to give access to central depression fragments.
Plan
There is no one correct way to fix a pilon fracture because the decision depends on multiple factors, including the patient, their soft tissues, the amount of metaphyseal comminution, the length of proximal fracture extension, associated injuries.....etc.
In general, my preference is usually not to fix the fibula.  If there is a lot of comminution of the distal tibial metaphysis, it means that you are left with a big hole to fill - whereas if the tibia and fibula both heal a little short, but congruent with each other, that is probably better.
Where the soft tissues are in good condition by about 10 days post injury, I will fix the fracture with lag screws and several small buttress plates (2.7 or 3.5mm 1/3 tubular), or occasionally precontoured distal tibia plates, anterior or medial, depending on fracture configuration.  If the fracture is relatively simple, a MIPO technique might be possible, but not at the expense of doing a good fixation!
Sometimes a circular frame is a better choice, for example if the soft tissues are poor, fracture was open, patient is high risk (diabetic, peripheral vascular disease), or there is a lot of metaphyseal comminution.
Practice varies a lot across the UK - some cities plate almost all pilon fractures, others put almost all in a circular frame.  It's always a source of lively debate at round table trauma meetings!
  • asked a question related to Trauma Surgery
Question
12 answers
It was a mid shaft open clavicle fracture associated with scapular neck fracture occurred after attack with an ax or similar tool. The patient also had a serious head injury. At 3 a.m., I intramedullary placed a 20cm long Schantz pin. Fortunately, the main neuro-vascular structures and lung were intact.
There are only few articles related to this topic.
Relevant answer
Answer
Fortunately, Dr Tanchev, the patient is doing well. He has survived collision with a train, not an ax attack, as we taught initially. He was sent as nameless person, without any valid information from emergency personnel. As I said, it was an emergency at 3 a.m. and I had to perform a DCO. Few days after thorough diagnostics and police report, I have got a full picture of this case. There was a suspicion of possible scapulothoracic dissociation, which I confirmed afterwords. It seems that it is the first case (who survived) of an open scapulothoracic dissociation (STD) associated with floating shoulder and brachial plexus injury. Besides, he has suffered a cranio-facial and thoracic injuries. The wound over clavicle has healed with no signs of infection. The Schantz pin is doing fine. Although no evident signs of brachial plexus injury were found during wound exploration, the Erb`s palsy in its clinical expression was found after he became conscious. ЕMG will confirm the real extent and the level of brachial plexus injury. I postponed to inform followers of this particular case earlier, since I was busy with collecting data and with my schedule.
Kind regards
  • asked a question related to Trauma Surgery
Question
34 answers
Recently a paper published by Seamon raised the question of performing ED Thoracotomies in Traumatic Cardiac arrest cases. Do you think it is worth it in non-penetrating trauma cases?
Relevant answer
Answer
I believe there is merit in performing EDRT for blunt trauma if vital signs were lost within 5 minutes of arrival, and particularly if ED ultrasound is available and there is any sign of cardiac activity. Clearly the presence of pericardial effusion, cardiac activity and no pulse (tamponade physiology) would merit immediate needle pericardiocentesis if not full-out EDRT. Hope this helps...
  • asked a question related to Trauma Surgery
Question
267 answers
Recently an American Society of Anesthesia launched a guideline where the use of ultrasound to place a central line is mandatory.
Relevant answer
Answer
Every doctor must know how to place a central line using anatomic landmarks but if available, central venous canalization must be done guided by ultrasound to avoid complications. I work in pediatric anaesthesia and I think that in this field it has to be absolutely mandatory.