トラウマと治療のジャーナル

Introduction: Even as early as 1916 it was suggested that the nitric oxide is synthetized in the mammals. This nitric oxide, synthetized in the body, was responsible for vasodilation by the endothelium derived relaxing factors and also by the stimulation of the guanylyl cyclase. Inflammatory conditions increase the production of nitrates and nitrites which is seen in the response to endotoxin and is accompanied with nitrosamine formation. Nitric oxide, hence, has been thought to be the physiological messenger and is increases in the pathological processes. This present study was conducted to find the association between the urinary secretion of nitrates and the osteoarthritis. Design: A total of 200 patients coming to the hospital out of 100 were patients with osteoarthritis of the knee joint and 100 were randomly selected. All the patients were screened for the causes of secondary osteoarthritis. Urine sample from all the patients was obtained along with X-ray of bilateral knees was taken to assess the grade of osteoarthritis. The osteoarthritic patients were assigned Group A and the randomly chosen patients were assigned the Group B. Both groups were compared and the results were evaluated. Results: In group A there were 5 cases with urinary nitrate positive as compared to 4 cases with positive urinary nitrate in group B, which was not statistically significant (p > 0.05). Conclusion: The current study clearly shows that there is no association between the urinary nitrate levels and OA.

We present the case of an unusual atrophy pattern of the supraspinatus muscle subsequent to suprascapular nerve compression by a paralabral cyst located in the spinoglenoid notch. A 58-year-old right-handed manual female worker presented to a specialized shoulder consultation with severe progressive pain in her right shoulder. Clinical exam revealed isolated limitation in active abduction and a painful Jobe test. MR-arthrogram showed a 12 × 10 mm paralabral cyst consecutive to a superior labral anterior to posterior (SLAP) II lesion, associated with an isolated supraspinatus Thomazeau stage II atrophy and Goutallier stage II fatty infiltration. A rotator cuff tear was excluded. After a failed nonoperative management, the patient underwent arthroscopic cyst decompression, SLAP debridement and biceps tenodesis, and presented satisfactory pain relief at 12 months follow-up with a constant score of 76 points. A control MR-arthrogram showed no recurrence of the cyst with regression of atrophy to stage I. In addition to confirm the known association between SLAP lesions and paralabral cysts, and to support the debated reversibility of atrophy, this presented case reveals the existence of a new type of lesion induced by suprascapular nerve compression, consisting in isolated denervation of the supraspinatus muscle. This can be explained by an anatomic variation of the supraspinatus branch of the nerve which had an unusually distal origin, whereas typical compression patterns involve either supraspinatus and infraspinatus, or infraspinatus alone.

Humeral diaphysis non-union is extremely difficult complication for the patients and orthopedic surgeons as well. Number of methods of managing atrophic humeral nonunion have been suggested, and each has its drawbacks. In current literature, there are no articles regarding treatment of humeral non-union after failed Ilizarov (ring) fixation surgery. This article presents early results of two cases of surgically treated fibular (intramedullar) strut graft and long LCP (PHILOS) plate. It is shown that fibular strut auto-graft bridging non-union site in conjunction with locked plating could be high potency healing material in osteoporotic atrophic humeral non-union. This technique need future and long term follow up analysis with potential use in different long bone non-union sites.

Approximately 1-2% of tibial fractures are associated with traumatic dislocations of the proximal tibiofibular joint. The associated injury pattern is frequently the result of a severe high-energy injury. Establishing the diagnosis of a proximal tibiofibular dislocation is frequently complicated by the fairly subtle clinical and radiographic presentation of this injury. Computer tomography scans of the knee should be considered for proper evaluation. Surgical treatment should consist of proper fixation of the tibial fracture followed by open reduction and internal fixation of the dislocated proximal tibiofibular joint. Multiple fixation options exist including screw, K-wire, and suture fixation constructs.

Objective: To report a rare presentation of Flexion-distraction injuries.
Summary of background data: To the best of our knowledge, traumatic disc herniation following non translated flexion distraction injuries of the thoracolumbar spine has not been reported in the English literature.
Methods: Description of the clinic and radiological presentation of a 35-year-old male who sustained a flexion distraction injury of the thoracolumbar spine following an assault.
Results: The intraoperative findings confirmed the presence of a large herniated disc fragment displacing the thecal sac. This was removed, the canal was decompressed and a hybrid screw-laminar hook construct was used to stabilize the fractured level while preserving uninjured motion segments.
Conclusions: MRI provides useful information to help define the pathology and management strategies in patients with discordance between their clinical presentation and imaging. It helped define a rare presentation of disc herniation and alerted us to the need for a formal decompression in this case of a non-translated flexion-distraction injury.

Turkey is a fast changing country with a young population. True, it used to be defined as an agrarian state; but, it is getting urbanized at tremendous speed. This change brings the citadin in interaction with the peasant under many possible circumstances. The former usually has the upper hand in this relation and on occasion does not even conceal his contempt for the latter. But the latter sometimes carries off his own victory despite disproportionate disadvantages and absolute deprivation.

Bilateral shoulder Dislocations with ipsilateral hip dislocation is a very rare entity. To our knowledge not a single case has been reported with this type of injury. We report a case were the anterior dislocation trio occurred one after the other in an unusual mechanism of injury.

Introduction: The Proliferation of small arms in the West African sub-region and the activities of insurgent groups and rustlers have caused renewed interest in Gunshot injuries. We aim to document the trend and outcome of such injuries in our sub-region.
Methods: It was a prospective study of cases of gunshot injuries admitted at the University Teaching hospital over a period of 18 months. Parameters analysed included patients’ bio-data, region of the body affected, mechanism and source of projectile, clinical presentations and short term outcome. Statistical analysis was done with IBM SPSS 20. Level of significance was p<0.05.
Results: A total of 43 patients were seen with a mean age of 33.76 ± 10.59. There were 42(97.7%) males and 1(2.3%) female. The victims were mostly farmers (25%), professional drivers (13.6%), Students (11.4%). The body region affected were the lower extremity (36.4%), upper extremity (27.3%), Most of the cases were from armed robbery attack (77.3%) and Assaults (13.6%). Low velocity weapons like Dane guns were the common sources of projectile 95.3%. High velocity weapon like AK 47 was used in 4.7% of cases. Majority of victims were shot at closed range (86.4%) and 79.5% were stable on presentation. Intervention carried out included wound debridement (65.9%), external fixation (23%), and chest tube drainage (9.1%). The outcome was such that 68.2% survived without residual deficit while 31.8% survived with residual deficit.
Conclusion: Gunshot injuries were mainly from armed robbery attack using low velocity weapon with farmers being the most victims. Strict regulations in the acquisition and use of light firearms would reduce the incidence of armed robbery and gun related violence in our sub region.

Carotid artery injuries are not common in trauma patients although they are associated with a high morbidity and mortality. The practician needs to have a high level of suspicion in trauma patients with injuries of the neck and skull, and always taking into consideration the mechanism of injury. Prompt diagnosis and treatment are imperative for optimal results. This review aims to focus on main diagnostic and therapeutic strategies and produce useful conclusions on proper management.

In a recent investigation of bullying of LGBTQ youth, LGBTQ students who reported higher levels of sexual activity described increased peer victimization in comparison to heterosexual students. Such bullying may be likened to slut shaming, a set of behaviors in which women are humiliated and may experience loss of status for their supposed sexual behavior. Because of the limited empirical literature base documenting and assessing this behavior, this commentary represents an argument for the inclusion of slut shaming as a form of bullying used to victimize LGBTQ students and urges further research in this area.

In this report we present our experiences with knee arthrodesis nails as a secondary salvage procedure after severe knee injuries at a level-one trauma centre. Exemplary two cases of subtotal amputation are discussed. Both cases, of totally destroyed knee joints, were treated with a unilateral external fixator, shortening and secondary bifocal distraction osteogenesis. In one case nailing after lengthening (NAL) was performed and in the second case nailing had to be performed as fracture treatment 20 years after bony consolidation at the docking site.

Traumatic hip dislocation is rare in children, accounting for 2 to 5% of all traumatic dislocations. Bilateral hip dislocations are unusual. There is no consensus on the protocol after reduction. We report the case of a 14-yearold girl sustaining a bilateral posterior hip dislocation after a road traffic accident in a limited resource setting. The concentrically reduction was performed 22 hours after the admission. Post-reduction radiograph showed an intraarticular fragment in the left hip and CT scan prescribed has not been performed. The patient was kept on bilateral skin traction for 3 weeks. At the end of the period of traction, bilateral hip spica cast was applied for 3 weeks. At 4 years 11 months follow-up the hips were pain-free. CT scan showed osteoarthritis secondary to AVN of the femoral head on the right hip.