Injury
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Myocardial injury is a cause of mortality in paediatric trauma, but it is often difficult to diagnose. The objectives of this pilot study were to (1) determine the prevalence of elevated cardiac troponin I (TnI) in paediatric trauma patients and (2) to determine whether elevated TnI correlates with clinically significant myocardial injury, defined as abnormalities on echocardiogram (ECHO) and/or electrocardiograms (ECG). To this end, we investigated a convenient sample size of 59 paediatric trauma patients with an Injury Severity Score (ISS)>12. ⋯ Patients with elevated TnI were more likely to be intubated (p=0.04), to have higher Injury Severity Scores (p=0.02), required more resuscitation fluid (p=0.001), and to have thoracic injuries (p<0.001). Our data indicates that the prevalence of elevated TnI in paediatric trauma patients is 27%; and whilst elevated TnI reflects overall trauma severity, it is frequently elevated without a clinically significance myocardial injury. Hence, large scale studies are required to determine if an elevated threshold TnI value can be identified to accurately diagnose severe myocardial injury in paediatric trauma.
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Trauma is a major cause of paediatric morbidity and mortality, yet knowledge of fluid resuscitation is limited. Our objectives were to determine current practises in resuscitation volume (RV) administered to paediatric non-haemorrhagic (NH) blunt trauma patients and to identify fluid related complications. ⋯ The range of median RV administered to paediatric NH blunt trauma patients with ISS ≥ 12 was 22-26 ml/kg/24h. The RV administered was excessive based on high urine outputs and the presence of fluid-related complications. Further evaluation of RV triggers and endpoints used by paediatric traumatologists is required.
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Comparative Study
Dynamisation and early weight-bearing in tibial reamed intramedullary nailing: its safety and effect on fracture union.
To compare the safety and effect on tibial diaphyseal fracture bone union of two intramedullary nailing techniques: (1) dynamic locking with early, full weight bearing, and (2) static locking with delayed weight bearing until bone union. ⋯ Dynamic nailing assembly in intramedullary nailing in closed or type I open tibial diaphyseal fractures with limited comminution (types A and B according to the AO classification) is safe when used for these fracture types. A dynamic mode of nailing should be encouraged in these fracture patterns.
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The posterior dislocation remains one unresolved complication of the posterior approach to the hip joint. In this study, a variation of the posterior hip approach - a partial osteotomy of the greater trochanter - was performed in order to investigate whether it provides better stability to the operated hip joint and reduces the risk of dislocation. We carried out a partial intertrochanteric osteotomy, initially in a cadaveric model and then in 68 patients (30 acute neck of femur fractures and 38 patients with hip osteoarthritis) requiring a total hip replacement. ⋯ After the osteosynthesis of the osteotomised fragment, hip dislocation points were increased more than 15% in the flexion and 10% in the internal rotation plane of movement. At one year follow up, no dislocation was observed in the clinical component of the study. This technique was found reliable in providing a stable hip joint.
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Road traffic injuries (RTIs), disabilities and deaths are recognised as a major public health problem worldwide. This study aimed to quantify the magnitude and the trends of RTI-related fatal and non-fatal injuries in Kuwait for the period 2000-2009. Data on road traffic crashes and related events (i.e., fatal and non-fatal minor and severe injuries) were obtained from police records, and the population data were sought from Ministry of Interior, Kuwait. ⋯ The overall declining trends in minor and severe RTI rates (both population based and registered vehicles based) were statistically significant (p(trend)<0.001). Despite declined minor and severe RTI rates, the RTI-related crude and age-adjusted mortality rates during the past decade continued to be high for a high-income country. Targeted interventions may help reduce the burden of minor and severe RTIs and related deaths in Kuwait and other countries in the region.