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The use of virtual surgical planning and navigation in the treatment of orbital trauma.

Alan Scott HERFORD ; Meagan MILLER ; Floriana LAURITANO ; Gabriele CERVINO ; Fabrizio SIGNORINO ; Carlo MAIORANA

Chinese Journal of Traumatology.2017;20(1):9-13. doi:10.1016/j.cjtee.2016.11.002

Virtual surgical planning (VSP) has recently been introduced in craniomaxillofacial surgery with the goal of improving efficiency and precision for complex surgical operations. Among many indications, VSP can also be applied for the treatment of congenital and acquired craniofacial defects, including orbital fractures. VSP permits the surgeon to visualize the complex anatomy of craniofacial region, showing the relationship between bone and neurovascular structures. It can be used to design and print using three-dimensional (3D) printing technology and customized surgical models. Additionally, intraoperative navigation may be useful as an aid in performing the surgery. Navigation is useful for both the surgical dissection as well as to confirm the placement of the implant. Navigation has been found to be especially useful for orbit and sinus surgery. The present paper reports a case describing the use of VSP and computerized navigation for the reconstruction of a large orbital floor defect with a custom implant.
Adult ; Female ; Humans ; Ketones ; Orbit ; diagnostic imaging ; injuries ; surgery ; Polyethylene Glycols ; Printing, Three-Dimensional ; Reconstructive Surgical Procedures ; methods ; Surgery, Computer-Assisted ; methods ; Tomography, X-Ray Computed

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Imaging of unilateral adrenal hemorrhages in patients after blunt abdominal trauma: Report of two cases.

Asli Tanrivermis SAYIT ; Emrah SAYIT ; Hediye Pinar GUNBEY ; Kerim ASLAN

Chinese Journal of Traumatology.2017;20(1):52-55. doi:10.1016/j.cjtee.2016.05.002

Adrenal hemorrhage following blunt abdominal trauma is extremely rare. Most of the lesions are unilateral and right sided. Although often asymptomatic, life-threatening adrenal insufficiency may develop in the bilateral adrenal gland hemorrhage. Isolated adrenal injuries are very rare. They are often associated with other organ injuries. The mortality rates of patients range from 7% to 32%. In this report, we present the computed tomography and magnetic resonance imaging findings of unilateral adrenal hemorrhages in two patients with a history of fall from a height.
Abdominal Injuries ; diagnostic imaging ; Adrenal Gland Diseases ; diagnostic imaging ; Adult ; Hemorrhage ; diagnostic imaging ; Humans ; Magnetic Resonance Imaging ; Male ; Tomography, X-Ray Computed ; Wounds, Nonpenetrating ; diagnostic imaging

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Investigation on occupant injury severity in rear-end crashes involving trucks as the front vehicle in Beijing area, China.

Quan YUAN ; Meng LU ; Athanasios THEOFILATOS ; Yi-Bing LI

Chinese Journal of Traumatology.2017;20(1):20-26. doi:10.1016/j.cjtee.2016.10.002

PURPOSERear-end crashes attribute to a large portion of total crashes in China, which lead to many casualties and property damage, especially when involving commercial vehicles. This paper aims to investigate the critical factors for occupant injury severity in the specific rear-end crash type involving trucks as the front vehicle (FV).

METHODSThis paper investigated crashes occurred from 2011 to 2013 in Beijing area, China and selected 100 qualified cases i.e., rear-end crashes involving trucks as the FV. The crash data were supplemented with interviews from police officers and vehicle inspection. A binary logistic regression model was used to build the relationship between occupant injury severity and corresponding affecting factors. Moreover, a multinomial logistic model was used to predict the likelihood of fatal or severe injury or no injury in a rear-end crash.

RESULTSThe results provided insights on the characteristics of driver, vehicle and environment, and the corresponding influences on the likelihood of a rear-end crash. The binary logistic model showed that drivers' age, weight difference between vehicles, visibility condition and lane number of road significantly increased the likelihood for severe injury of rear-end crash. The multinomial logistic model and the average direct pseudo-elasticity of variables showed that night time, weekdays, drivers from other provinces and passenger vehicles as rear vehicles significantly increased the likelihood of rear drivers being fatal.

CONCLUSIONAll the abovementioned significant factors should be improved, such as the conditions of lighting and the layout of lanes on roads. Two of the most common driver factors are drivers' age and drivers' original residence. Young drivers and outsiders have a higher injury severity. Therefore it is imperative to enhance the safety education and management on the young drivers who steer heavy duty truck from other cities to Beijing on weekdays.

Accidents, Traffic ; Adolescent ; Adult ; Age Factors ; Aged ; Automobile Driving ; China ; epidemiology ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Motor Vehicles ; Trauma Severity Indices ; Wounds and Injuries ; epidemiology

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Clinical analysis of thoracoscopic surgery combined with intraoperative autologous blood transfusion in the treatment of traumatic hemothorax.

Hu-Sai MA ; Ju-Hua MA ; Feng-Lai XUE ; Xiang-Ning FU ; Ni ZHANG

Chinese Journal of Traumatology.2016;19(6):371-372.

From January 2013 to January 2015, 19 patients of traumatic hemothorax with hemorrhagic shock were treated in our department by thoracoscopic surgery combined with autologous blood transfusion. This study retrospectively analyzed the therapeutic effect and shared our experience. The average amount of blood transfused back was 662.41 ml ± 269.15 ml. None of the patients developed transfusion reaction and were all discharged uneventfully. Thoracoscopic surgery combined with autologous blood trans- fusion is effective in the rescue of patients with progressive hemothorax and hemorrhagic shock. When corresponding indications are well managed, treatment for these patients is quicker, safer, and more effective.
Blood Transfusion, Autologous ; Female ; Hemothorax ; surgery ; Humans ; Male ; Retrospective Studies ; Thoracic Injuries ; surgery ; Thoracoscopy ; methods

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Gastroduodenal artery aneurysm - A rare complication of traumatic pancreatic injury.

Annu BABU ; Amulya RATTAN ; Maneesh SINGHAL ; Amit GUPTA ; Subodh KUMAR

Chinese Journal of Traumatology.2016;19(6):368-370.

Aneurysm of gastroduodenal artery (GDA) is rare. Most reported cases are due to pancreatitis and atherosclerosis; however, those following pancreatic trauma have not been reported. We encoun- tered GDA aneurysm in a patient of blunt abdominal trauma, who had pancreatic contusion and retroduodenal air on contrast enhanced computed tomography of abdomen. Emergency laparotomy for suspected duodenal injury revealed duodenal wall and pancreatic head contusion, mild hemo- peritoneum and no evidence of duodenal perforation. In the postoperative period, the patient developed upper gastrointestinal hemorrhage on day 5. Repeat imaging revealed GDA aneurysm, which was managed successfully by angioembolization. This case highlights, one, delayed presen- tation of GDA aneurysm after blunt pancreatic trauma and two, its successful management using endovascular technique.
Abdominal Injuries ; complications ; Adult ; Aneurysm ; etiology ; Duodenum ; blood supply ; Embolization, Therapeutic ; Humans ; Male ; Pancreas ; injuries ; Stomach ; blood supply ; Wounds, Nonpenetrating ; complications

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Percutaneous poking reduction and fixation versus open reduction and fixation in the treatment of displaced calcaneal fractures for Chinese patients: A systematic review and meta-analysis.

Xiao-Jian WANG ; Yun-Xing SU ; Lu LI ; Zhi-Hua ZHANG ; Xiao-Chun WEI ; Lei WEI

Chinese Journal of Traumatology.2016;19(6):362-367.

PURPOSETo compare the efficacy of percutaneous poking reduction and fixationwith open reduction and fixation in the treatment of displaced calcaneal fractures.

METHODSReports of studies using case-controlled trials (CCT) to compare the percutaneous poking reduction and fixation with the open reduction and fixation in the management of calcaneal fractures were retrieved from the Cochrane Library, PubMed Database, CNKI, Chinese Biomedical Database, Wanfang Data (from January of 2005 to August of 2015). Methodological quality of the trials was critically assessed, and relevant data were extracted. Statistical software Revman 5.0 was used for data-analysis.

RESULTSFifteen articles were included in the meta-analysis. Comparison of the efficacy of percutaneous poking reduction and fixation with open reduction and fixation in the treatment of calcaneal fractures revealed statistical significance in the incidence of complications after operation [RR = 0.32, 95% CI (0.20, 0.5), p < 0.05]. However, there were neither statistical significance in the degrees of recovery for calcaneal Bohler angle [WMD = -1.65, 95% CI (-3.43, 0.14), p > 0.05] and calcaneal Gissane angle [WMD = -3.21, 95% CI (-6.75, 0.33), p > 0.05], nor statistical significance in the rate of good foot function after operation [RR= 0.95, 95% CI (0.90, 1.00), p > 0.05].

CONCLUSIONFor the treatment of calcaneal fractures, percutaneous poking reduction and fixation is su- perior to open reduction and fixation in terms of the incidence of postoperative complications. But both techniques can obtain satisfactory clinical function.

Calcaneus ; injuries ; surgery ; Fracture Fixation, Internal ; adverse effects ; methods ; Fractures, Bone ; surgery ; Humans ; Open Fracture Reduction ; adverse effects ; methods ; Postoperative Complications ; epidemiology ; Publication Bias

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A distal-lock electromagnetic targeting device for intramedullary nailing: Suggestions and clinical experience.

Guido ANTONINI ; Wilfried STUFLESSER ; Cornelio CRIPPA ; Georgios TOULOUPAKIS

Chinese Journal of Traumatology.2016;19(6):358-361.

PURPOSETo describe our clinical experience with a system named SureShot? Distal Targeting (Smith & Nephew, Memphis, USA) based on magnetic field presence and discuss our suggestions on this technique.

METHODSWe analysed prospectively 47 patients affected by humeral, tibial or femoral fractures, treated in our institution during a 3-year period of time (August 2010 to September 2013). We considered the following parameters: the time to set up, the time to position a single screw, the effectiveness of the system (drilling ad screwing), the irradiation exposure time during distal locking procedure and surgical complications.

RESULTSA total number of 96 screws were inserted. The mean preparation time of the device was 5.1 min ± 2 min (range 3-10 min). The mean time for single screw targeting was 5.8 min ± 2.3 min (range 4-18 min). No major complications occurred. Only a few locking procedures were needed to be practiced in order to obtain the required expertise with this targeting device.

CONCLUSIONAccording to our results, this device is reliable and valid whenever the correct technique is followed. It is also user friendly, exposes to lower radiation and needs less surgical time compared to relative data from the literature. However, the surgeon should always be aware of how to use the free hand technique in case of malfunctioning of the system.

Bone Screws ; Fracture Fixation, Intramedullary ; adverse effects ; instrumentation ; methods ; Humans ; Magnetic Fields ; Prospective Studies

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Fracture union in percutaneous Kirschner wire fixation in paediatric tibial shaft fractures.

Ramji Lal SAHU ; Rajni RANJAN

Chinese Journal of Traumatology.2016;19(6):353-357.

PURPOSETo evaluate the efficacy of intramedullary Kirschner wires for the treatment of unstable tibial shaft fractures in children.

METHODSThis prospective study was conducted at the Department of Orthopaedic Surgery in Maharishi Markandeshwar Medical College from June 2005 to June 2010. Sixty-six children having closed fracture of the tibial shaft with a mean age of 7.7 years (range, 2-14 years) were recruited from emergency and outpatient department. They were treated with percutaneous intramedullary Kirschner wires. The clinical results of our study were rated on the basis of the criteria of union, nonunion, delayed union or malunion. All children were followed for one year.

RESULTSChildren achieved union in a mean time of 8 weeks (range, 6-10 weeks). Postoperatively, three children (4.55%) had delayed union, one (1.52%) valgus deformity of lower leg, three (4.55%) post- operative knee pain and twelve (18.18%) skin irritation at pin site.Wires were removed after 8-22 weeks without any complications. No patient was lost to follow-up. The results were excellent in 95.45% and good in 4.55% children.

CONCLUSIONThis technique is cost-effective, simple, quick to perform, safe and reliable and avoids pro- longed hospitalization with good results.

Adolescent ; Bone Wires ; Child ; Child, Preschool ; Female ; Fracture Fixation, Intramedullary ; adverse effects ; methods ; Fracture Healing ; Humans ; Male ; Prospective Studies ; Tibial Fractures ; surgery

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Indirect reduction technique using a distraction support in minimally invasive percutaneous plate osteosynthesis of tibial shaft fractures.

Wen-Wei DONG ; Zeng-Yuan SHI ; Zheng-Xin LIU ; Hai-Jiao MAO

Chinese Journal of Traumatology.2016;19(6):348-352.

PURPOSETo describe an indirect reduction technique during minimally invasive percutaneous plate osteosynthesis (MIPPO) of tibial shaft fractures with the use of a distraction support.

METHODSBetween March 2011 and October 2014, 52 patients with a mean age of 48 years (16-72 years) sustaining tibial shaft fractures were included. All the patients underwent MIPPO for the fractures using a distraction support prior to insertion of the plate. Fracture angular deformity was assessed by goni- ometer measurement on preoperative and postoperative images.

RESULTSPreoperative radiographs revealed a mean of 7.6°(1.2°-28°) angulation in coronal plane and a mean of 6.8°(0.5°-19°) angulation in sagittal plane. Postoperative anteroposterior and lateral radio- graphs showed a mean of 0.8°(0°-4.0°) and 0.6°(0°-3.6°) of varus/valgus and apex anterior/posterior angulation, respectively. No intraoperative or postoperative complications were noted.

CONCLUSIONSThis study suggests that the distraction support during MIPPO of tibial shaft fractures is an effective and safe method with no associated complications.

Adolescent ; Adult ; Aged ; Bone Plates ; Fracture Fixation, Internal ; adverse effects ; methods ; Humans ; Middle Aged ; Minimally Invasive Surgical Procedures ; methods ; Tibial Fractures ; surgery

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Complications in the management of closed high-energy proximal tibial plateau fractures.

Kavin KHATRI ; Vijay SHARMA ; Darsh GOYAL ; Kamran FAROOQUE

Chinese Journal of Traumatology.2016;19(6):342-347.

PURPOSETo report complications in the management of complex closed proximal tibial fractures.

METHODA retrospective study was conducted to analyze the infectious and noninfectious complications encountered in the management of high-energy Schatzker type V and VI tibial plateau fractures. All patients were treated at the level 1 trauma centre between January 2011 and March 2014. Sixty two patients were included in the study. The mean patient age was (43.16 ± 11.59) years with 60 males and 2 females. Infectious complications like superficial and deep infection, wound dehiscence, malalignment in the immediate postoperative period and in follow-up period were noted.

RESULTSThe overall complication rate was 30.65% (19 out of 62). Infectious complications were noted in 20.97% cases (13/62). In majority of the cases (8/13), superficial infection was seen which managed with regular dressing and antibiotic administration. The patients (5/13) who had developed deep-seated infection were subjected to repeated debridements, flap coverage, implant removal or amputation depending upon the host response. Thirteen patients had experienced noninfectious complications. Hardware related complications were noticed in six patients and four among them received a secondary procedure. Malalignment was observed in seven patients but only single patient underwent subsequent operative intervention.

CONCLUSIONProximal tibial plateau fractures especially Shatzker type V and VI are associated with extensive soft tissue damage even in closed injuries. The complications encountered in the management of these fractures can be minimized with appropriate patient selection and minimal soft tissue dissection.

Adult ; Fasciotomy ; Female ; Fracture Fixation ; adverse effects ; Fractures, Closed ; surgery ; Humans ; Male ; Middle Aged ; Postoperative Complications ; therapy ; Retrospective Studies ; Tibial Fractures ; surgery

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